Midline Incisional Hernia. Anatomical Repairs for the Treatment with Prothesis

77% of the incisional hernias are located in the midline of the anterior abdominal wall. As a reinforcement of this surgical intervention, the use of a prothesis has been proposed. It’s of main concern the proper knowledge of the anatomical landmarks to perform the colocation of a prothesis in an intermuscular region. The objective of this work is to describe the anatomical landmarks for the colocation of the prothesis in the “retro-rectal intravainal space” during the treatment of midline incisional hernias. A bibliographic and retrospective analysis of the patients treated by the Ponka technique was made, emphasizing on the description of the anatomical landmarks and the technical complications recorded along the period of January 2002 – January 2012. The anatomical and surgical findings are analyzed in this work. On the therapeutic point of view, 431 surgical interventions where effectuated by the use of the Ponka technique, 253 of this group where women with an average age of 41 years old. In 194 cases, transaction of aponeurosis of external oblique muscle was made. The medial edge of the aponeurosis of the rectal muscle was dissected and the posterior space of the muscle was also dissected. In all cases, the superior and inferior epigastric vessels where identified. The polypropylene mesh was located with stitches in a “U” pattern; reabsorbable string was used, in the anterior region of the lateral sector. The medial edge of the aponeurosis of the rectal muscle was sutured. The Ponka technique is an easy and reproductible technique, with a short learning curve. The dissection of the aponeurosis of the rectal muscle, the placement of the mesh and the posterior suture are easy surgical interventions. By this technique, the objectives established by Shell and other authors are accomplished in the treatment of midline medial incisional hernia.