A Centripetal Approach to Incisional Hernia Repair: Reflections from a Personal Surgical Evolution
Rajnish Talwar
Department of Surgical Oncology & General Surgery, Fortis Hospital, Mohali, Punjab, 160062, India.
Akhil Garg
Department of Plastic & Reconstruction Surgery, Fortis Hospital, Mohali, Punjab, 160062, India.
Shantanu Saraswat
Department of General Surgery, Fortis Hospital, Mohali, Punjab, 160062, India.
Ajay Basude *
Department of General Surgery, Fortis Hospital, Mohali, Punjab, 160062, India.
*Author to whom correspondence should be addressed.
Abstract
This study presents a refined surgical technique for incisional hernia repair developed over three decades of experience. The “centripetal approach” involves a wide elliptical incision placed in healthy parietes, progressing inward to en-bloc remove attenuated tissues, followed by anatomical closure and mesh reinforcement. The approach minimizes dissection and bleeding while maximizing repair strength and postoperative outcomes. In cases where primary closure risks compartment syndrome, the sac is preserved and a dual mesh is overlaid to avoid direct visceral contact. This manuscript outlines patient characteristics, indications, dissection strategy, closure principles, and outcomes, supported by relevant literature.
Keywords: Incisional hernia, centripetal approach, mesh repair, en-bloc excision, primary closure, dual mesh, component separation avoidance