Use of polypropylene mesh for incisional hernia repair

Incisional hernia is an important complication of abdominal surgery. Procedures for the repair of these hernias with sutures and with mesh have been reported, but there is no consensus about which type of procedure is best. We have performed a retrospective analysis on 1014 patients operated on in our unit between 1994 and 2003 for simple or recurrent incisional hernias. The polypropylene mesh has been used in a number of 107 patients. The mesh has been placed either intraperitoneal, extraperitoneal/subfascial or onlay. Median follow-up was 36 months. There were 1 enterocutaneous fistula and 5 wound sinus developed. The mesh had to be removed in 6 cases. All of these complication developed when the mesh has been placed either extraperitoneal/subfascial or onlay. We note 5 recurrent incisional hernias after a period of up to 24 months. The recurrence rates after open mesh repair are less then after primary closure. The intraperitoneal use of polypropylene mesh with omental coverage is a good procedure with less complications.     

补片修补巨大腹壁切口疝80例

目的：探讨巨大腹壁切口疝的补片治疗。方法回顾性分析2003年8月至2013年10月,新疆伊宁市人民医院收治的巨大腹壁切口疝患者80例的临床资料。结果术前提高腹壁顺应性、手术术式、手术操作、引流管的放置、抗生素预防应用、围手术期处理对预后构成影响因素。80例患者均痊愈出院,无严重并发症,复发3例。手术复发率为3．7％。结论应用补片修补腹壁巨大切口疝效果满意,术后恢复快,要重视围手术期处理。     

巨大切口疝的开放式无张力修补术

目的:总结无张力技术修补巨大切口疝的临床经验及其围手术期处理要点.方法:对我院2002年5月至2007年5月收治的38例巨大切口疝临床资料进行回顾性分析,其中30例应用肌后修补法(sublay法)修补,8例采用腹腔内补片修补法(underlay法)修补,所用补片材料为聚丙烯(68.0%)或复合补片(32%).随访1～5年,统计病人的并发症和复发率.结果:80%病人有术前合并症,包括肥胖(45%)、糖尿病(16.4%)、慢性阻塞性肺疾病(12.5%)和腹主动脉瘤(2.7%).无张力疝修补后2～3周病人均痊愈出院.随访结果,复发2例(5.3%),伤口感染3例(7.9%),血清肿5例(13.1%).结论:人工材料无张力修补术是治疗腹壁大切口疝的优良术式,手术创伤小、术后恢复快.对于疝环巨大或疝内容物多、突出时间长的特大切口疝病人应给予充分的术前准备.     

善愈聚丙烯补片在小切口疝的临床应用

目的探讨总结善愈聚丙烯补片在腹部小切口疝的临床应用经验。方法对我院2007年1月至2009年2月收治的26例腹壁小切口疝临床资料进行回顾性分析。结果本组患者均治愈,手术时间30—70min,患者术后疼痛轻,未使用止痛药,无切口感染,无术后慢性疼痛,平均手术费用4100元,随访3～25个月,无并发症,异物感不明显。结论善愈补片修补腹壁小切口疝是一种安全、可靠的手术方式。     

Intraperitoneal polypropylene mesh repair of incisional hernia is not associated with enterocutaneous fistula

BACKGROUND: Incisional hernia repair with prosthetic material is followed by fewer recurrences than primary repair. Polypropylene is the most commonly used prosthetic material but may cause entero- cutaneous fistulas. The aim of this study was to determine whether enterocutaneous fistulas developed after incisional hernia repair with polypropylene mesh and to evaluate clinical outcome after incisional hernia repair. METHODS: A retrospective analysis of the outcome of incisional hernia repair with polypropylene mesh between 1982 and 1998 was conducted. Follow-up data were obtained from medical records and questionnaires. RESULTS: Polypropylene incisional hernia repair was performed in 136 patients. Median follow-up was 34 months. No enterocutaneous fistulas developed. Wound infection occurred in 6 per cent. Wound sinus formation occurred in two patients. No mesh was removed because of infection and no persisting infection of the mesh occurred. CONCLUSION: Enterocutaneous fistula formation appears to be very rare after incisional hernia repair with polypropylene mesh, regardless of intraperitoneal placement, omental coverage or closing of the peritoneum.     

Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair

BACKGROUND: Polymer mesh has been used to repair incisional hernias with lower recurrence rates than suture repair. A new generation of mesh has been developed with reduced polypropylene mass and increased pore size. The aim of this study was to compare standard mesh with new lightweight mesh in patients undergoing incisional hernia repair. METHODS: Patients were randomized to receive lightweight composite mesh, or standard polyester or polypropylene mesh. Outcomes were evaluated at 21 days, 4, 12 and 24 months from patient responses to the Short Form 36 (SF-36) and daily activity questionnaires. Complications and recurrence rates were recorded. RESULTS: A total of 165 patients were included in an intention-to-treat analysis (83 lightweight mesh, 82 standard mesh). Postoperative complication rates were similar. The overall hernia recurrence rate was 17 per cent with the lightweight mesh versus 7 per cent with the standard mesh (P = 0.052). There were no differences in SF-36 physical function scores or daily activities between 21 days and 24 months after surgery. CONCLUSION: The use of the lightweight composite mesh for incisional hernia repair had similar outcomes to polypropylene or polyester mesh with the exception of a non-significant trend towards increased hernia recurrence. The latter may be related to technical factors with regard to the specific placement and fixation requirements of lightweight composite mesh.     

应用聚丙烯补片修补腹壁切口疝20例

腹壁切口疝是腹部手术后常见的并发症之一,传统的修补方法存在较高的复发率,可达30%～50%[1],其根本原因是在有张力下修补。上世纪90年代中期,以补片为基础的无张力修补技术逐渐成为修补腹壁切口疝的主要术式。2001年1月～2004年1月我院采用人工合成材料网状聚丙烯补片行切口疝     

Prosthetic repair of incisional hernia in kidney transplant patients. A technique with onlay polypropylene mesh

The employment of synthetic mesh for incisional hernia repair in kidney-transplanted patients is rarely reported in the present literature. Many authors believe that mesh employment in such conditions is not safe due to fear of mesh related complications. From 1965 through 1999, a total of 1685 kidney transplants were performed at our Kidney Transplant Unit and 19 patients developed eventrations in the kidney transplant incision, an incidence of 1.1%. From September 1996 eight of these patients had prosthetic repair of the abdominal wall with onlay polypropylene mesh. All patients were under immunosuppressive therapy with prednisone, ciclosporine and azathioprine. Mean age was 48.8 years, mean body mass index was 22.5 and mean number of previous abdominal operations was 2.5. A large polypropylene mesh (Marlex^® mesh) was fixed over the aponeurosis after primary closure of the aponeurotic borders, as an onlay graft. There was neither morbidity nor mortality associated to the surgical procedure. No recurrences or long-term complications associated with mesh employment were verified after a follow-up ranging from one year to three years. We concluded that prosthetic repair of incisional hernia in transplanted patients can be performed routinely.     

Sutureless mesh fibrin glue incisional hernia repair

Purpose  

The aim of this study is to evaluate the usefulness of sutureless incisional open hernia repair with mesh fixation only using a fibrin glue sealant.     

Simplified technique for incisional hernia repair with mesh prosthesis

This paper describes a simplified technique for the repair of incisional hernias. The previous scar is resected, and the peritoneal sac is carefully dissected until it is completely exposed. The sac is opened to liberate structures adherent to the sac or to the area immediately surrounding the defect. The peritoneum is closed and invaginated to form a sac bed underlying the entire extent of the defect, and the mesh is laid on this sac bed. The mesh is then fixed with "U" stitches, reinforcing these by inserting a second line from the edge of the defect to the mesh. Suture material used is polypropylene 1/0 or 2/0. This procedure has been carried out on 15 patients, and after 1 year of follow-up, there has been no recurrence of the hernia. Operating time was reduced, and the surgical technique was found to be easier. Placing a mesh prosthesis inside the hernia sac and fixing it to the abdominal wall with two lines of suturing simplifies the repair procedure, reduces operating time, and is effective in the repair of all incisional hernias. A study is required to compare this outcome with the different mesh repair techniques.     

老年腹壁切口疝的腹腔镜下修补术

目的 探讨腹腔镜下应用补片行老年腹壁切口疝修补术的方法、安全性及临床效果。方法 2004年11月至2006年6月对17例老年切口疝患者行腹腔镜下应用补片切口疝修补术。结果 16例腹腔镜下行腹腔粘连松解和补片固定,顺利完成切口疝修补手术,1例因肠管与腹壁粘连紧密而中转开腹修补术。手术时间65～132min,平均95min。术后恢复排便、排气时间平均为31h,术后住院5～7d。术后并发症：疼痛3个月以上者3例,浆液肿5例,穿刺口感染1例,均经保守治疗后好转,无手术死亡和肠瘘发生。随访7～26个月（平均13个月）,未见切口疝复发。结论 腹腔镜下行腹腔内粘连松解,采用缝合器和缝线贯穿腹壁固定补片修补老年腹壁切口疝安全、有效。     

Predictors of mesh explantation after incisional hernia repair

Background

Prosthetic mesh used for incisional hernia repair (IHR) reduces hernia recurrence. Mesh infection results in significant morbidity and challenges for subsequent abdominal wall reconstruction. The risk factors that lead to mesh explantation are not well known.

Methods

This is a multisite cohort study of patients undergoing IHR at 16 Veterans Affairs hospitals from 1998 to 2002.

Results

Of the 1,071 mesh repairs, 55 (5.1%) had subsequent mesh explantation at a median of 7.3 months (interquartile range 1.4–22.2) after IHR with permanent mesh prosthesis. Infection was the most common reason for explantation (69%). No differences were observed by the type of repair. Adjusting for covariates, same-site concomitant surgery (hazard ratio [HR] = 6.3) and postoperative surgical site infection (HR = 6.5) were associated with mesh explantation.

Conclusions

Patients undergoing IHR with concomitant intra-abdominal procedures have a greater than 6-fold increased hazard of subsequent mesh explantation. Permanent prosthetic mesh should be used with caution in this setting.     

应用合成补片修补腹壁切口疝的经验总结

目的:探讨腹壁切口疝病人的无张力手术治疗方法和疗效.方法:回顾性分析我院2000年7月至2008年6月间收治的215例应用合成补片修补腹壁切口疝病人的临床资料.结果:215例中101例采用IPOM方法,有1例复发,复发率0.99%;97例采用Stoppa方法,有3例复发,复发率3.09%;17例采用肌前修补法,有3例复发,复发率17.6%.在21例复发疝病人中,16例采用了IPOM方法,无再复发病例;5例采用了Stoppa方法,有1例再复发,复发率20%.结论:IPOM方法和Stoppa方法的手术适应症宽、复发率低.IPOM方法对于复发的切口疝病人有更好的治疗效果.术者的经验和方法的正确性对修补的成功均有重要意义.     

Intraluminal migration of mesh following incisional hernia repair

Incisional hernia is the most common long term complication of colon surgery. These hernias are often repaired with synthetic mesh. Mesh migration is an infrequent occurrence. There are reports of mesh migrating into the peritoneum and into viscous organs causing a variety of symptoms including recurrent hernia, infection, and obstruction. We present the case of transmural mesh migration from the abdominal wall into the small bowel presenting as small bowel obstruction.     

轻型聚丙烯补片在腹股沟疝无张力修补术中的应用

目的 通过应用轻型聚丙烯补片与标准型聚丙烯补片进行腹股沟疝无张力修补术的对比研究,来初步验证轻型聚丙烯补片的应用价值.方法 实验组使用轻型聚丙烯补片,对照组使用标准型聚丙烯补片,每组各30例患者.记录两组患者手术前后的临床参数及术后并发症的发生例数,对数据进行统计学分析.结果 实验组手术时间(36±10)min,术后最高体温(37.16±0.47)℃,术后住院日数(1.9±1.0)d;对照组手术时间(38±9)min,术后最高体温(37.4±0.6)℃,术后住院日数(2.0±0.9)d,两组差异无统计学意义(P＞0.05).两组术后CRP升高的例数和术前与术后24 h血白细胞计数、中性粒细胞分类计数及生化AST、ALT、BUN、Cr等相比,差异均无统计学意义(P＞0.05).术后随访12～16个月,实验组阴囊积液2例,慢性疼痛1例,未出现局部异物感;对照组阴囊积液3例,慢性疼痛3例,出现局部异物感6例.两组局部异物感的发生率差异有统计学意义(P＜0.05).结论 轻型聚丙烯补片在腹股沟疝无张力修补术中的应用是安全有效的,可减少术后局部异物感的发生.     

Repair of giant incisional hernias with polypropylene mesh: a retrospective study.

The aim of the present study was to evaluate the long term results of repair of ventral incisional hernias or of defects in the abdominal wall using polypropylene mesh. Eighty-eight patients were operated on from 1979-1996, inclusive. Abdominal protrusion was found in 78 patients. Fifty-one of these patients had previously had an incisional hernia repaired and the remaining 10 patients had an abdominal wall defect as a result of excision of a malignant tumour. The polypropylene mesh was placed extraperitoneally and sutured with two rows of interrupted stitches, using non-absorbable sutures. Recurrence of the hernia was found in 10 of the 67 patients with incisional hernia. Eight patients had a relaxation of the muscles of the abdominal wall. Perioperative complications consisted of infection (n = 4), embolism (n = 1), haematoma (n = 1), and pneumonia (n = 3, one fatal), and one fatal bowel perforation. Median follow up time was 5.7 years (range 0-17). It is therefore possible to obtain acceptable results after repair of larger incisional hernias even if they had been repaired before.     

Primary incisional hernia repair with or without polypropylene mesh: a report on 384 patients with 5-year follow-up

Background and aim Several studies have claimed that mesh repair of incisional hernia lowers recurrence rates when compared to suture repair. We investigated the relative effectiveness of mesh and suture repair in a large homogeneous cohort of patients with primary incisional hernia.Patients and methods In a retrospective single-centre cohort study, a total of 446 consecutive patients were identified, of whom 86% could be followed up. Mean length of follow-up was 5 years. In 79 patients (22%), we implanted a mesh, usually polypropylene (Prolene).Results Compared to suture repair, mesh repair prolonged operating time by over 30 min and caused seroma in 12.7% of the patients (p<0.001). Only 4 of the 79 patients with mesh repair developed recurrence, compared to 55 of the 305 patients with suture repair (5 vs 18%, p=0.02 by log-rank test). In multivariate Cox regression, recurrence rates were fourfold higher after suture than after mesh repair (p=0.02). Interestingly, old age was associated with a decreased susceptibility for recurrence (p=0.01).Conclusion Our data confirms the long-term effectiveness of mesh repair under routine conditions. Suture repair should be restricted to small hernias in patients free of known risk factors.