A Comparison of Suture Repair with Mesh Repair for Incisional Hernia

Rw, Luijendijk; Wc, Hop; Tol, van den; Lange, D; Mm, Braaksma; Jn, Ijzermans; Ru, Boelhouwer; Bc, De Vries; Mk, Salu; Jc, Wereldsma; Cm, Bruijninckx; Jeekel, J.

doi:10.1056/nejm200008103430603

Cited by 1,666 publications

(954 citation statements)

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“…Suture repair of incisional hernia results in recurrence rates of 12% to 54%, 10 -16 while mesh repair results in recurrence rates of 2% to 36%. [13][14][15][17][18][19][20][21][22][23] Because most studies only provide shortterm follow-up, these recurrence rates may even be underestimated. In addition to the high recurrence rates, incisional hernia repair may give rise to serious complications, such as enterocutaneous fistula and bowel obstruction, causing deterioration rather than improvement of the patient's situation.…”

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confidence: 99%

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Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia

Burger¹,

Luijendijk²,

Hop³

et al. 2004

Annals of Surgery

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Objective: The objective of this study was to determine the best treatment of incisional hernia, taking into account recurrence, complications, discomfort, cosmetic result, and patient satisfaction. Background: Long-term results of incisional hernia repair are lacking. Retrospective studies and the midterm results of this study indicate that mesh repair is superior to suture repair. However, many surgeons are still performing suture repair. Methods: Between 1992 and 1998, a multicenter trial was performed, in which 181 eligible patients with a primary or first-time recurrent midline incisional hernia were randomly assigned to suture or mesh repair. In 2003, follow-up was updated. Results: Median follow-up was 75 months for suture repair and 81 months for mesh repair patients. The 10-year cumulative rate of recurrence was 63% for suture repair and 32% for mesh repair (P Ͻ 0.001). Abdominal aneurysm (P ϭ 0.01) and wound infection (P ϭ 0.02) were identified as independent risk factors for recurrence. In patients with small incisional hernias, the recurrence rates were 67% after suture repair and 17% after mesh repair (P ϭ 0.003). One hundred twenty-six patients completed long-term follow-up (median follow-up 98 months). In the mesh repair group, 17% suffered a complication, compared with 8% in the suture repair group (P ϭ 0.17). Abdominal pain was more frequent in suture repair patients (P ϭ 0.01), but there was no difference in scar pain, cosmetic result, and patient satisfaction. Conclusions: Mesh repair results in a lower recurrence rate and less abdominal pain and does not result in more complications than suture repair. Suture repair of incisional hernia should be abandoned. (Ann Surg 2004;240: 578 -585)

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“…14 Unfortunately, there have not been randomized trials of incisional hernia repair since, and some authors have even suggested that there may still be a place for suture repair of incisional hernia. 15,24,25 Disconcerting data indicate that surgeons are still performing suture repair, in spite of clinical evidence.…”

mentioning

confidence: 99%

Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia

Burger¹,

Luijendijk²,

Hop³

et al. 2004

Annals of Surgery

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1,428

807

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“…This has resulted in the introduction of prosthetic meshes to correct fascial defects, and randomized clinical studies have indeed proven the superiority of prosthetic meshes in the repair of inguinal [7] and incisional [2,12] hernias, making their usage almost obligatory in these cases.…”

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Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients

Hansson

Hingh

Bleichrodt³

2007

Surg Endosc

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Background: Parastomal herniation is a common complication, and its operative treatment is notoriously difficult. Recently, the authors have described a laparoscopic technique for closure and reinforcement of the hernia with a hand-made ''funnel-shaped'' Gore-Tex Dual Mesh. Potentially this technique combines the advantages of a mesh repair with those of minimal invasive surgery. Methods: In 2002, a multicenter trial of this new technique was started in The Netherlands. To date, 55 consecutive patients (27 men; median age, 63 years) with a symptomatic primary (n = 45) or recurrent (n = 10) parastomal hernia have undergone elective surgery using this technique. The demographic, perioperative, and early follow-up data prospectively collected for these patients are presented in this report. Results: Of the 55 procedures, 47 (85.5%) could be completed laparoscopically (median operation time, 120 min). Conversion to laparotomy was indicated because of dense adhesions prohibiting safe dissection (n = 4) or bowel injury (n = 4). No in-hospital mortality occurred. Postoperative recovery was uneventful for 47 patients (85%), who had a median hospital stay of 4 days. Surgical and nonsurgical complications occurred, respectively, for four patients each (7.2%). Full-thickness enterotomy appeared to be the most troublesome complication. After 6 weeks, when all the patients were reexamined, one recurrence was noted. Conclusion: Maximal efforts should be undertaken to prevent perioperative full-thickness enterotomy. Because this was achieved for the vast majority of patients, it is concluded that laparoscopic parastomal hernia repair is feasible and safe. Although a longer follow-up period is needed for definitive conclusions to be drawn regarding the recurrence rate, early follow-up evaluation shows very promising results.

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“…Their repair with a synthetic non-absorbable mesh to reinforce the abdominal wall leads to a significant decrease of nearly 50% in the hernia recurrence rate [2-4]. …”

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confidence: 99%

Use of biological mesh versus standard wound care in infected incisional ventral hernias, the SIMBIOSE study: a study protocol for a randomized multicenter controlled trial

Mariette¹,

Briez²,

Deniès³

et al. 2013

Trials

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BackgroundIn infected incisional ventral hernias (IVHs), the use of a synthetic non-absorbable mesh is not recommended and biological meshes hold promise. However, the level of evidence for their safety and efficacy remains low.MethodsThe SIMBIOSE trial is a multicenter, phase III, randomized, controlled trial comparing the use of a biological mesh versus traditional wound care in patients with an IVH. The primary end point is 6-month infectious and/or wound morbidity. Secondary end points are wound infection and recurrent hernia rates, post-operative pain, quality of life, time to heal, reoperation need, impact of the cross-linked mesh structure, and a medico-economic evaluation. One hundred patients need to be included.ResultsThe main results expected with biological mesh use are a significant decrease of post-operative morbidity, hernia recurrence, time to heal, and costs with an improved quality of life.ConclusionsFor the first time, the impact of biological meshes in the treatment of IVHs will be evaluated in an academic, randomized, phase III trial to provide scientific evidence ( NCT01594450).Trial registrationClinicalTrial.gov, NCT01594450

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A Comparison of Suture Repair with Mesh Repair for Incisional Hernia

Abstract: Among patients with midline abdominal incisional hernias, mesh repair is superior to suture repair with regard to the recurrence of hernia, regardless of the size of the hernia.

Cited by 1,666 publications

References 25 publications

Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia

Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia

Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients

Use of biological mesh versus standard wound care in infected incisional ventral hernias, the SIMBIOSE study: a study protocol for a randomized multicenter controlled trial

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