The widely used Mayo procedure leads to unacceptable results for repair of incisional hernias and other techniques should be evaluated and used more often. Repair of an incisional hernia does not improve overall quality of life.

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We consider the PeriGuard Repair Patch® a viable alternative to synthetic materials for diaphragm replacement. Moreover, we advise carrying out cautious follow-up in patients undergoing extensive oncological resection to learn more about the biological behavior of the bovine PeriGuard Repair Patch® after diaphragmatic repair.

PURPOSE:Novel composite meshes routinely used in laparoscopic hernia repair reportedly lead to fewer and less dense visceral adhesions and may provide a viable alternative in thoracic surgery as well.METHODS:A total of 15 adult domestic pigs underwent full thickness chest wall resection and reconstruction with Parietene (polypropylene composite; PTE, n = 5), Parietex (polyester composite; PTX, n = 5) or Bard (purely polypropylene, n = 5) mesh. After an observation period of 90 days all animals were sacrificed, intrathoracic adhesions classified via thoracoscopy (VATS), meshes explanted and peak peal strength required for lung/mesh separation recorded.RESULTS:Adhesions assessed through VATS-exploration were strongest in the PTX-Group while PTE and BM showed comparable results. Tensiometric analyses of peak peal strength confirmed lower values in BM than for PTE and PTX. Both composite materials showed good overall bioincorporation with post-surgical perigraft-fibrosis being strongest in BM.CONCLUSION:We consider composite grafts a suitable alternative for chest wall reconstruction. They are characterized by good overall biointegration and limited perigraft-fibrosis, thus potentially facilitating redo-procedures, even though a hydrophilic coating per se does not appear to prevent intrathoracic adhesion formation.

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