Sandwich Mesh Technique Shows Promise for Lumbar Incisional Hernia Repair: Case Series Reveals
Egypt: The sandwich mesh repair technique appears to be a feasible surgical option for lumbar incisional hernia repair, with satisfactory early outcomes and acceptable complication rates.
A small case series published in BMC Surgery by Yasser A. Orban and colleagues from Zagazig University, Egypt, have explored the outcomes of a “sandwich” mesh technique for the management of lumbar incisional hernias. The study adds to the ongoing search for an optimal surgical approach for these complex hernias, which often arise after prior flank or lumbar surgical procedures and remain technically challenging to repair.
In this prospective series, ten patients with lumbar incisional hernias underwent repair using a dual-layer mesh strategy combining preperitoneal and onlay mesh reinforcement. The cohort included six men and four women, with a mean age of 50.5 years. All patients presented with a visible abdominal bulge at the previous surgical site, and nearly half reported associated pain. The majority had a history of surgery for ureteric stones, while a smaller proportion had undergone nephrectomy. Comorbid conditions such as diabetes, hypertension, ischemic heart disease, and smoking were present in half of the patients, reflecting a clinically diverse group.
The surgical procedure involved placement of mesh in a “sandwich” configuration, intended to provide layered reinforcement of the abdominal wall and improve structural support.
Key Findings:
- The average operative time was approximately 76 minutes.
- The mean hospital stay was about four days, indicating no prolonged hospitalization.
- Overall postoperative outcomes were favorable.
- Complications were infrequent and generally manageable.
- Seroma formation was the most commonly reported postoperative complication.
- No major complications or severe morbidity were observed in the early postoperative period.
- Hernia recurrence was not reported during the available short-term follow-up.
- Long-term recurrence data were not available due to limited follow-up duration.
The authors noted that while early results are encouraging, the study is constrained by its small sample size and short duration of follow-up. These limitations prevent definitive conclusions regarding long-term durability and recurrence rates. They emphasized the need for larger, multicentre comparative trials to evaluate how the sandwich mesh approach performs against established techniques such as isolated onlay or preperitoneal mesh repair.
Overall, the findings suggest that the sandwich mesh technique may offer a practical and safe option for lumbar incisional hernia repair, with acceptable early outcomes and manageable complication rates. However, further evidence is required before it can be recommended as a standard surgical approach.
Reference:
Orban, Y.A., Baz, Y. & Hegab, Y.H. Sandwich mesh repair for the treatment of lumbar incisional hernia: a case series. BMC Surg 26, 333 (2026). https://doi.org/10.1186/s12893-026-03679-5
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