Intraperitoneal mesh plasty

ABSTRACT

Incisional hernia is a common surgical condition with a reported incidence of 2-11% following laparotomy. Various modalities of repair have been advocated but the overall results still remain disappointing. To evaluate in incisional hernias the efficacy and safety of intraperitoneal mesh repair with conventional Polypropylene mesh. In CMH Muzaffarabad, CMH Sialkot and PAC Hospital Kamra. From January 2000 to January 2007. 90 cases of incisional hernia with a minimal defect size of 4 inches were included; there was no limitation to age and sex. Patients with comorbid conditions like Diabetes Mellitus, Hypertension, Bronchial Asthma, and lschemic Heart Disease etc were also included if there was no other contraindications for surgery. Observations were made with regard to duration and ease of the operation, wound complications, hospital stay, recurrence and delayed complications. In our series of 90 patients, females [92.22%, n=83] outnumbered males [7.77%, n=7] and the highest incidence was in the 4[th] decade of life in females and the 3[rd] decade of life in males. Gynecological operations accounted for 61.44% [n=51] of the index operations. 77.7% [n=70] of patients had a BMI >30. Comorbid conditions were present in 36.66% [n=33] of patients. The polypropylene mesh placed intraperitoneal varied from 15x7.5 cm to 30x20 cm. The mean operating time was 60 +/- 20 minutes; operating time was extended when the procedure was accompanied by Dermolipectomy 80 +/- 10 minutes. 85.55% patients [n=77] attended our follow-up, ranging from 12 months to five years. Method of follow-up in outpatients department [OPD]/Clinics 71.11% [n=64], by telephonic conversation 12.22% [n=11]. 14.44% [n=13] were lost in follow up. All patients in follow up had serial abdominal sonograms at 3, 6, 9 and 12 months postoperatively respectively to evaluate bowel motility, adhesion formation and any locally associated complication. No recurrence was noted in the follow-up group. Historically intraperitoneal mesh placement of conventional polypropylene has been avoided as it was associated with significant postoperative complications. Based on our analysis, we believe that intraperitoneal mesh repair is still an effective option for incisional hernias, especially in difficult cases and with patients having comorbid conditions. The associated high incidence of complications associated with intraperitoneal mesh placement in the literature were not seen in our experience