Outcomes of the open mesh repair of large incisional hernias using an intraperitoneal composite mesh: our experience with 100 cases

Abstract

Incisional hernia repair sometimes requires intraperitoneal implantation of a mesh. This becomes necessary when the hernia opening is large, in particular, in patients with a low abdominal wall surface/wall defect surface (AWS/WDS) ratio, in large boundary incisional hernias where the proximity to bone structures or cartilage often complicates retromuscular mesh implantation and in multi-recurrent incisional hernias that are sometimes characterised by an actual loss of abdominal wall tissue. The authors report on the results of a series of 100 incisional hernias treated between 1999 and 2006 using the open technique to implant an intraperitoneal mesh (Parietex Composite). Mean follow-up time was 42 months (range 12-96 months). The mean wall defect surface was 95 cm(2) (range 60-210 cm(2)). Twelve percent of patients suffered minor complications: 5 seromas (5%), 3 haematomas (3%) and 4 parietal suppurations (4%). No mesh had to be removed. The recurrence rate was 6%. At 6 months after surgery, no patient lamented pain or discomfort due to foreign body sensation. None of these patients presented intestinal occlusion or enterocutaneous fistulae. In conclusion, it is our opinion that the mesh should be implanted in direct contact with the viscera only where absolutely necessary, i.e., when it cannot be implanted in the retromuscular area without creating excessive parietal tension. Our experience with PC mesh, over the short-to-medium term, was positive. Naturally, further studies are required to evaluate long-term biocompatibility.

Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience

“…The high hernia recurrence rate observed in larger defects W C 10 cm reflects the significant risk factor of the ''hernia width defect'' irrespective of the technique, open or laparoscopy [13,14,27,43,44]. After mastering the procedure in these large cases, we started using the combined hybrid technique of effective closure with the laparoscopic IPOM reinforcement by additional TFS and overlap of [5 cm on all surfaces before closure, depending on abdominal surface, which has also been validated by other authors [4, 9-11, 37, 44-46].…”

“…Only 12 cases with large defect [15 cm needed a component separation technique. In all the hybrid procedures, we favored laparoscopic IPOM reinforcement under direct vision, to control the correct closure, for a better uniform mesh fixation, a complete overlap, and to avoid wrinkling of the mesh [13,15,57].…”

“…Indeed, the recurrence rate after LIVHR with wider mesh coverage ranges between 2.9 and 17.7 %, while it is mainly 12 % and reaches up to 32 % in exceptions in open repair with mesh [1,[4][5][6][7][8][9][10][11][12][13].…”

“…Objective: The aim of this retrospective study is to demonstrate the long-term efficiency of the minimal invasive augmentation technique, over a long follow-up period, in the mixed ventral and incisional hernias, while adopting the tailoring technique of proper patients' selection and choice of procedure, according to defect size, other characteristics and observations on mesh-related outcomes [8][9][10][11][12][13][14][15].…”

Compound Repair of Intraperitoneal Onlay Mesh Associated With the Sublay Technique for Giant Lower Ventral Hernia

“…25 We speculate that the use of too much polypropylene mesh (polypropylene mesh was used in the Rives-Stoppa technique and polypropylene ingredient of the composite mesh in the intraperitoneal onlay mesh repair) was the reason for this incidence, based on the finding that seroma formation has a strong association with polypropylene mesh size, as reported by Morris and Hughes. 26 Sterile aspiration is recommended when the seroma volume is 920 mL by B ultrasound evaluation to avoid secondary infection.…”