Have Outcomes of Incisional Hernia Repair Improved With Time?

Flum, David R.; Horvath, Karen D.; Koepsell, Thomas D.

doi:10.1097/00000658-200301000-00018

Cited by 494 publications

(286 citation statements)

References 12 publications

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“…The use of mesh implants in hernia surgery has become increasingly widespread, due to good postoperative results and low rates of long-term recurrence [5,18]. Polypropylene has been established as the basic synthetic material for mesh; it is a versatile thermoplastic polymer that exhibits excellent chemical resistance, low density, high tensile strength and a relatively high melting point, especially in comparison to its counterpart, polyethylene.…”

Section: Discussionmentioning

confidence: 99%

Colonization by human fibroblasts of polypropylene prosthesis in a composite form for hernia repair

Canuto

Saracino

Oraldi

et al. 2012

Hernia

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Purpose: Abdominal wall hernia is one of the commonest surgical disorders world-wide and there is no single gold-standard operative technique to repair it. In an effort to improve techniques and technologies to reinforce hernia repair, synthetic meshes are employed. In this study a new prosthesis (named composite) formed of two polypropylene layers, one macroporous (named mesh) and one transparent (named film) was examined to evaluate its capability to enable cell proliferation without inducing cell death. Inflammatory processes were also examined.Methods: Human fibroblasts BJ were seeded on multiwells, on which composite or film had been placed. After 7, 14 and 21 days, cell growth and viability, deposition of collagen, and release of IL-6, IL-1β and TNF-α were evaluated.Results: The "in vitro" protocol showed the composite to be colonized by human fibroblasts on the polypropylene macroporous mesh side; no cell growth occurred on the film. The slowdown of cell growth observed between 14 and 21 days was accompanied by an increase of type I collagen deposition and marked fibroblast activity. Inflammatory cytokines initially increased, followed by their reduction beginning at 14 days.Conclusions: The new prosthesis comprising two polypropylene layers of differing morphologies can be colonized by fibroblasts on the side facing the abdominal wall, whereas no cell growth occurs on the side facing the viscera. The transient inflammation, observed at early experimental times, is probably important for the healing process.

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Section: Discussionmentioning

confidence: 99%

Colonization by human fibroblasts of polypropylene prosthesis in a composite form for hernia repair

Canuto

Saracino

Oraldi

et al. 2012

Hernia

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“…The 5-year rate of reoperation was 24% after the first reoperation, 35% after the second, and 39% after the third, and the 7-year rate after three reoperations approached 50%. 16 This data underscores the importance of minimizing the risk for subsequent reoperations by employing the best evidencebased approach to the first hernia repair.…”

Section: Introductionmentioning

confidence: 91%

“…15 This fact is illustrated by the results of a retrospective cohort study of a population-based hospital discharge database which showed that 12% of patients undergoing incisional hernia repair required at least one subsequent reoperation within 5 years. 16 In addition, the length of time between reoperations progressively shortens after each additional Keywords ► components separation ► biologic mesh ► ventral hernia…”

Section: Evolution Of Prosthetic Implantsmentioning

confidence: 99%

Abdominal Wall Reconstruction with Mesh and Components Separation

Heller

Chike-Obi

Xue

2012

Seminars in Plastic Surgery

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Incisional hernias in the abdominal wall are a by-product of multiple previous laparotomies. Unfortunately, the incidence of incisional hernias has risen, as we have progressed with new surgical techniques in the treatment of abdominal pathologies. Many methods have been attempted in the past to achieve a better and more durable repair, namely using components separation to bring the fascia into the midline, and reinforce incisional hernias with different mesh materials. The authors review the recent literature regarding the efficacy of these synthetic materials and biomaterials in incisional hernia repair, as well as share their experience in treating complex abdominal wall defects using components separation and biologic mesh.

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“…In 1997, in Germany, 85% of incisional hernias repairs was still performed without prosthetic mesh, 26 while in 1999, in Washington state, 35% of incisional hernias was repaired without mesh. 27 In the Netherlands in 2002, surgeons failed to use a mesh in 40% of incisional hernia repairs. 8 To determine what type of hernia repair should be performed, long-term results of incisional hernia repair are needed.…”

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

1,428

807

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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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Have Outcomes of Incisional Hernia Repair Improved With Time?

Abstract: Incisional hernia repair is associated with high cumulative rates of reoperative repairs. The expectation that important measures of adverse outcome have improved in recent eras is not supported by the results of this large population-based study.

Cited by 494 publications

References 12 publications

Colonization by human fibroblasts of polypropylene prosthesis in a composite form for hernia repair

Colonization by human fibroblasts of polypropylene prosthesis in a composite form for hernia repair

Abdominal Wall Reconstruction with Mesh and Components Separation

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

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