Does intraperitoneal mesh increase the risk of bowel obstruction? A nationwide French analysis

Are Surgeons Going to Be Left Holding the Bag? Incisional Hernia Repair and Intra-Peritoneal Non-Absorbable Mesh Implant Complications

“…The Italian Laparoscopic Ventral Hernia Guideline group meta-analysis showed that the laparoscopic technique was associated with increased accidental full-thickness enterotomies [9]. Further, a nation-wide population-based review from France concluded that laparoscopic IPOM placement significantly increased the risk of bowel obstruction compared to patients with a previous laparotomy but no intra-peritoneal mesh [18]. The most recent Midline Incisional hernia guidelines from the European Hernia Society also state that any mesh in the abdominal cavity exposed to the abdominal viscera should be used with caution due to the risk of long-term complications at any subsequent abdominal surgery," and to "keep the mesh out of the peritoneal cavity where possible to limit contact with the viscera" [8].…”

“…Minor complications include seromas, hematomas, recurrent pain, and superficial surgical site infections. Major complications include hernia recurrence, complications of subsequent surgery, adhesive bowel obstruction, mesh contraction, deep prosthetic infection (i.e., mesh infection), enterocutaneous fistulae [17,18,22], and protracted medicolegal proceedings (Table 2). Seromas frequently complicate hernia repairs when the surgical site must be dissected in order to create an anatomic space for mesh implantation.…”

“…Surgical mesh is a medical device that supports the repair of a hernia as it heals. The use of mesh decreases hernia recurrences and has thus become standard practice [9][10][11][12][13][14][15][16][17][18], and has even be considered prophylactically when closing an incision at the first laparotomy [19,20]. The vast majority of patients are greatly benefited by the use of mesh, and it would be hard, if not impossible, to practice hernia surgery currently without mesh except at specialized centers or in low resource settings.…”