Prosthetic mesh repair in incisional Hernia: how I do?

ABSTRACT

Prosthetic mesh repairs of 250 incisional hernia during a period of 10 years using polypropylene material [Marlex, Prolene] were retrospectively studied to outline the techniques used and the associated short and long-term complications. Two basic surgical techniques were identified. The first was a pure double-strength prosthetic repair used in cases with massive incisional hernia [10 cm or more] i.e. in 41 cases [16.4%]. Both underlay [intraperitioneal] and onlay [subcutaneous] mesh grafts were applied. The second technique was a combined tissue-prosthetic repair. The tissue repair was performed extraperitoneally without opening the sac using an interrupted non absorbable synthetic sutures. This technique was used in the majority of cases [76.4%], while in 7.2% of cases a similar tissue repair was performed but after opening the sac and dealing with the present adhesions because of recent attacks of bowel obstruction. In the last two groups of total 209 patients [83.61], tissue repairs were reinforced with an onlay graft. No perioperative mortality. The total complication rate was 26%. Complications related to mesh application were not serious and met with in 16%. Infection rate was 5.6%, while recurrence rate was 1.6%. Minor surgical reintervention was necessary in 3.6%. In conclusion surgeon should not hesitate to tailor his technique according to the present anatomical and biological factors in each case. Our results is not different from those reported from other centers with special interest. There is an urgent need to conduct a controlled randomized studies to evaluate each technique used in the prosthetic mesh repair of incisional hernia in general