Polyester (Parietex) mesh for total extraperitoneal laparoscopic inguinal hernia repair

Abstract

Polypropylene mesh is the most commonly used mesh for open and laparoscopic hernia repair in the United States. A variety of newly developed polyester mesh products have recently become available. This is the first U.S. multiinstitutional study evaluating the initial experience of polyester mesh use for total extraperitoneal (TEP) laparoscopic inguinal hernia repair. Between January 2000 and June 2001, 337 patients underwent 495 TEP laparoscopic inguinal hernia repairs using polyester mesh. There were 309 men and 28 women in the study, whose average age was 45 years (range, 17-80 years). The average operative time for all cases was 54.3 min (range, 18-157 min). There were no conversions to open repair and no mortality. Complications included 12 seromas/hematomas (six aspirated), chronic pain in three patients, urinary retention in two patients, and one incidence each of the following: epididimitis, prostatitis, hydrocele, and port-site cellulitis. Additionally, one patient had carbon dioxide (CO2) in the Foley bag at the end of the surgery, but a normal cystogram showed no identified bladder injury. There has been one recurrence (0.2%), occurring 4 months after surgery, which was repaired using a transabdominal laparoscopic approach. The mean follow-up period was 11 months (range, 2-22 months). There have been no documented infections of the mesh, and no mesh has been removed. This study documents a favorable initial experience with polyester mesh for TEP laparoscopic inguinal hernia repair. There were no complications related to the mesh. There may be technical and long-term advantages with the use of polyester mesh for laparoscopic inguinal hernia repair. Longer follow-up evaluation and additional studies are warranted to evaluate these potential advantages.

A study of intragastric and intravesicular pressure changes during rest, coughing, weight lifting, retching, and vomiting

“…Thus, newer-generation mesh products have been developed with lower tensile strength (N/cm) and more compliance than previous mesh products [17,18]. Our study provides data regarding intra-abdominal pressure during various activities that the newer mesh products need to protect against.…”

Laparoscopic repair of postoperative perineal hernia

“…A multicentric study in Europe with this mesh yielded favorable results [19]. Ramshaw et al [24] reported the initial experience in the United States with the composite mesh and concluded that there are technical and long-term advantages to the use of this mesh for laparoscopic inguinal hernia repair.…”

Normal Intraabdominal Pressure in Healthy Adults

“…It has been suggested by several investigators that many of the current mesh materials used for hernia repair restrict normal abdominal wall mobility because they are actually much stronger and stiffer than needed for an adequate repair [21]. Second-and thirdgeneration prosthetic biomaterials have been developed, which are intentionally less dense (g/cm 2 ) with less tensile strength (N/cm) than standard, nonabsorbable mesh, and which are more compliant with abdominal wall motion and more resistant to contraction due to reduced inflammation and good tissue ingrowth [5,22]. These novel biomaterials may provide adequate strength and improved postoperative function; however, little information is available regarding long-term outcomes after implantation.…”