Assessment of a dual-facing mesh in prevention of adhesions following ventral hernia repair

ABSTRACT

The present prospective clinical study was conducted to assess the value of the dual-facing mesh in prevention of adhesion formation after ventral hernia repair. Forty patients admitted to the Ahmadi Hospital, Kuwait, during 2006-2007, with umbilical hernia or incisional hernia underwent laparoscopic hernioplasty with intra-peritoneal placement of a DualMesh. Data regarding patient demographics, operative details, postoperative pain score, hospital stay, and time to return to normal physical activity were all prospectively collected. Postoperative complications [specific to meshadhesions or non-specific] and recurrence were also recorded. All patients were regularly followed-up every two weeks for the first three months postoperatively, and at three-month intervals thereafter for a mean of 24 months [range 15-39 months]. There were 28 women [70%] and 12 men [30%] with a mean age of 51 years [range 33-72 years]. The mean body mass index [BMI] was 27.68 [range 22-35]. Hypertension, diabetes mellitus, and bronchial asthma were the most common co-morbidities. The mean diameter of hernial defect was 5.2 cm [range 2-12 cm]. There were 18 paraumbilical, 13 recurrent and nine incisional hernias. About one third of patients [n=13, 32.5%] had multiple hernia defects. The mean operative time was 105 +/- 42 minutes [range 75-185 minutes]. There were no mortalities, and no visceral or other intra-operative complications. Postoperative pain resolved gradually over time. The mean postopcrative hospital stay was 4.2 days [range 1-10 days]. Patients were able to resume their normal physical activities after a mean of 17 days [range 10-31 days]. There were no major post-operative complications and the overall complication rate was 15% [six patients] in the form of seroma [7.5%], prolonged suture site pain [2.5%], flank hematoma [2.5%], and trocar site wound infection [2.5%]. There was a single recurrence at seven months, yielding a two-year recurrence rate of 2.5%. From the data presented it may be concluded that laparoscopic repair of ventral hernia with intra-peritoncal placement of the DualMesh confers the advantages of minimal access surgery and appears to be technically feasible, safe and effective, with good clinical outcome of no intra-operative, or major postoperative complications, and a very low recurrence rate