The feasibility of adopting laparoscopic incisional hernia repair in general surgery practice: early outcomes in an unselected series of patients

A laparoscopic approach to incisional hernia repair has been shown to be safe and effective in selected patients. We report our early outcomes following laparoscopic ventral/incisional hernia repair (LVHR) in an unselected series of patients encountered in general surgery practice. All patients referred with incisional hernia were offered a laparoscopic repair using prosthetic mesh. Patients were not excluded from laparoscopic approach on the basis of age, previous surgery, defect size, intraperitoneal mesh, body mass index (BMI), comorbidities, or abdominal wall stomas. We followed 28 consecutive patients who underwent LVHR (17 primary, 11 recurrent hernias). Laparoscopic repair was completed in 27 patients with a mean operative time of 141.6 +/- 11.9 minutes. There were no intraoperative complications. The mean size of the abdominal wall defects was 153.4 +/- 27.5 cm and the mean mesh size was 349.2 +/- 59.1 cm. The mean hospital stay was 3.7 +/- 0.3 days. Nine patients developed large wound seromas; all spontaneously resolved. Our experience suggests that LVHR is feasible as a primary approach to most incisional hernias encountered in general surgery practice.     

Laparoscopic repair of large incisional hernias

Incisional hernias after abdominal operations are a significant cause of long-term morbidity and have been reported to occur in 3 to 20 per cent of laparotomy incisions. Traditional primary suture closure repair is plagued with up to a 50 per cent recurrence rate. With the introduction of prosthetic mesh repair recurrence decreased, but complications with mesh placement emerged ushering in the development of laparoscopic incisional herniorrhaphy. The records of patients who underwent laparoscopic incisional hernia repair between June 1, 1995 and September 1, 2001 were reviewed. Patient demographics, hernia defect size, recurrence, operative time, and procedure-related complications were evaluated. Fifty patients (22 male and 28 female, mean age 57 years with range of 24-83) were scheduled for laparoscopic incisional hernia repair between June 1, 1995 and September 1, 2001. The average patient was obese with a mean body mass index of 35.8 kg/m2 (range 16-57 kg/m2). Two patients (4%) had primary ventral hernias. Forty-eight patients (96%) had incisional hernias with 22 (46%) of these previously repaired with prosthetic mesh. Mean defect size was 206.1 cm2 (range 48-594 cm2). The average mesh size was 510.2 cm2 (range 224-1050 cm2). Gore-Tex DualMesh and Bard Composite Mesh were used in 84 and 16 per cent of the repairs, respectively. Mean operating time was 97 minutes. There were no deaths. Complications were seen in 12 per cent patients (six occurrences) and included two small bowel enterotomies, a symptomatic seroma requiring aspirate, a mesh reaction requiring a short course of intravenous antibiotics, and trocar site pain (two patients). There were no recurrences during a mean follow-up of 41 months (range 3-74 months). We conclude that laparoscopic incisional herniorrhaphy offers a safe and effective repair for large primary and recurrent ventral hernia with low morbidity.     

Repair of giant incisional abdominal wall hernias using open intraperitoneal mesh

Background Very large and complex incisional hernias, especially those involving loss of abdominal wall, present a particular challenge to the surgeon. Aims The open intraperitoneal technique was used prospectively for the repair of incisional hernias in a selected group of patients with large defects, often those with major loss of abdominal wall, overweight patients, and previous failures of incisional repair. Materials and methods Between 1 January 1999 and 31 December 2005, out of 275 patients operated on for incisional hernia repair, 61 of them, most of whom were obese with multiorificial recurrent or giant hernias and contraindicated for laparoscopy, were treated using an open intraperitoneal mesh technique. There were 50 females and 11 males, with a mean age of 61. The median ASA score of the group was 2.3, with a mean BMI of 34 kg/m² and a mean hernia surface of 182 cm². Sixty-four percent of the patients had undergone one or more previous incisional hernia repairs. Results Mean operating time was 130 min, with an average hospital stay of 13 days. None of the patients died. Postoperative complications occurred in 21% of the patients; most of which were minor, but two cases (3.3%) developed deep abscesses requiring surgery and removal of the mesh. A recurrence rate of 5% was found after a mean follow-up of 35 months (8–88). Conclusion Open intraperitoneal mesh repair appears to be a good option for the treatment of complex incisional hernia (at least 10 cm in diameter or multiorificial) in obese patients contraindicated for laparoscopy.     

Laparoscopic tension-free repair of anterior abdominal wall incisional and ventral hernias with an intraperitoneal Gore-Tex mesh: prospective study and review of the literature

BACKGROUND: Recurrence rates after repair of incisional and ventral hernias range from 18% to 52%. Prosthetic open repair has decreased this rate, but the wide fascial dissection it requires increases the complication rate. Laparoscopic repair is a safe and effective alternative. PATIENTS AND METHODS: A prospective study was performed including 86 patients (63 women and 23 men) with a mean age of 54 years (range 29-79 years) having incisional or ventral hernias who underwent laparoscopic repair in our institution between July 1994 and October 2001. The majority of the patients were obese with a mean body mass index of 31.7 kg/m2. The abdominal wall defect size ranged from 2 X 1 cm to 20 X 13 cm. In all cases, a Gore-Tex mesh (Dual Mesh, W.L. Gore & Associates, Flagstaff, AZ, USA) was used in sizes ranging from 10 X 15 cm to 20 X 30 cm. RESULTS: Nineteen repairs were performed for recurrent hernias (12 incisional and 7 ventral). The mean operative time was 110.3 minutes (range 50-240 minutes). There was one open conversion (1.2%), one intraoperative complication (1.2%), and no deaths. There were no wound or mesh infections. Immediate postoperative complications occurred in 9 patients (10.6%) and late complications occurred in 16 patients (18.8%). The average hospital stay was 4.8 days (range 2-19 days). During a mean follow-up of 37 months (range 6-73 months), there were 6 hernia recurrences (7%). CONCLUSION: Laparoscopic repair of incisional hernia and ventral hernia appears to be safe, especially with the use of Gore-Tex mesh, and is proving to be effective as it decreases pain, complications, hospital stay, and recurrences.     

Laparoscopic ePTFE mesh repair of incisional and ventral hernias

Incisional hernia is a relatively frequent complication of abdominal surgery. The use of mesh to repair incisional and ventral hernias results in lower recurrence rates compared with primary suture techniques. The laparoscopic approach may be associated with lower postoperative morbidity compared with open procedures. Long-term recurrence rates after laparoscopic ventral and incisional hernias are not well defined. A prospective study of the initial experience of a standardized technique of laparoscopic incisional and ventral hernia repair carried out in a tertiary referral hospital was undertaken between January 2003 and February 2007. Laparoscopic hernia repair was attempted in 71 patients and was successful in 68 (conversion rate 4%). The mean age of the patients identified was 63.1 years (39 men and 31 women). Multiple hernial defects were identified in 38 patients (56%), and the mean overall size of the fascial defects was 166 cm(2). The mean mesh size used was 403 cm(2). The mean operative time was 121 minutes. There were six (9%) major complications in this series, but there were no deaths. Hernia recurrence was noted in four patients (6%) at a mean follow up of 20 months. Our preliminary experience indicates that laparoscopic incisional and ventral hernia repair is technically feasible and has acceptable postoperative morbidity and low early recurrence rates.     

Laparoscopic repair of incisional and ventral hernia

The application of laparoscopic principles to ventral or incisional hernia repair has recently been shown to be a safe and effective alternative to open procedures. In this study we analyzed our recent experience with laparoscopic incisional-ventral hernia repair. The outcomes of 75 consecutive patients (January 2002 to July 2006) who underwent laparoscopic repair for incisional-ventral hernia were reviewed. Patient's demographics, hernia parameters, and intraoperative and postoperative data were collected. Of the 75 patients, 44 were females and 31 males. Mean age was 59.1 yrs (range 29-80 yrs). Mean BMI was 25.9 (range 19.4-36.7). Twenty-one patients had primary ventral hernias while 54 patients had an incisional hernia. Fifty-three patients had a single defect and 22 patients multiple defects. In 45 cases the incisional hernia was a primary hernia; in 4 cases it was a first recurrence; in 2 cases a 2nd recurrence; and in 3 cases a 3rd recurrence. The mean defect size was 52,7 cm2 (range 4-432). Laparoscopic hernia repair was successfully performed in 71 cases (94.7%). The mean mesh size was 211 cm2 (range 63-694). Mean operating time was 101 min (range 50-220 min). The mean hospital stay was 4.7 days. The postoperative morbidity rate was 14%. After a mean follow-up of 24.6 months (range 7-56) the recurrence rate was 7% (5/71). Laparoscopic repair of incisional-ventral hernias seems to be safe and effective. Medium-term outcomes were promising with a relatively low rate of conversion to open surgery, a low complication rate and a low risk of recurrence.     

Laparoscopic repair of ventral incisional hernia

Background : Laparoscopic repair of ventral incisional hernias was first reported in 1993. Since then, there have been sporadic case reports and small series published about this procedure, but it has not been widely adopted. Newer types of composite prosthetic mesh may reduce the potential problem of bowel adhesion. Methods : Thirty cases of laparoscopic ventral incisional hernia repairs (carried out by two surgeons or their senior registrars) have been retrospectively reviewed and reported in this article. The data were obtained from patient records and subsequent phone surveys. Results : Thirty patients between 29 and 82 years (mean: 58 years) underwent this procedure. There were 14 men and 16 women. The average weight of the patients was 81 kg. The hernias were up to 6 or 7 cm in diameter. Mesh was used in 28 cases (polypropylene in 25 cases, expanded polytetrafluoroethylene in two cases and composite mesh in one case). Most meshes were laid intraperitoneally and fixed into position with laparoscopic spiral tacks. Twenty‐nine cases were completed laparoscopically. One operation (3.3%) was converted to an open procedure because of severe bowel adherence to the hernia sac. The mean operating time was 52 min for laparoscopic ventral incisional hernia repairs only. All but two patients tolerated an oral diet within 24 h. The postoperative hospital stay ranged from 0 to 11 days, with 17 patients (57%) staying overnight and eight patients (27%) staying another day. Over 80% of the patients returned to house duties within a week. There was no mortality, and minor complications occurred in four patients (14%). One patient had a small bowel obstruction treated successfully by repeat laparoscopy with division of fibrinous adhesions to polypropylene mesh on day four. Follow up ranged from 1 to 69 months (mean: 12 months). One patient did not attend follow‐up appointments. There were three cases of hernia recurrence (10%). Conclusion : The results suggest that laparoscopic repair of ventral incisional hernias is a safe, effective and technically feasible operation for small‐ to medium‐sized hernias allowing shorter hospital stay, early recovery and resumption of normal activities. However, recurrence rates are comparable to open mesh hernioplasty especially for larger hernias.     

无张力修补术在腹壁疝中的应用

目的探讨腹壁疝的无张力补片修补方法,总结腹壁疝的治疗经验。方法回顾性分析我科2004年10月至2008年11月间收治的25例腹壁疝患者的临床资料。24例手术采用全麻或硬膜外麻醉下的腹膜外补片无张力修补术。1例应用巴德CK补片,置于腹腔内。结果本组患者中,男性9例,女性16例;年龄37～81岁,平均年龄（68±10）岁。其中白线疝1例,半月环疝1例,脐疝6例,切口疝17例。腹壁切口疝疝环直径1～18cm,平均（7±4）em。均采用无张力疝修补术,平均手术时间（116±42）min。平均住院时间（8±3）d。术后1例发生轻微疼痛不适;术后2例发生浆液肿,经穿刺治愈;1例发生上呼吸道感染;随访6～48个月,无复发。结论采用人工补片行腹壁疝无张力修补术是一种安全可靠的手术方式,采用腹膜外修补方式进行手术,避免了补片与腹腔内脏器的直接接触,并发症少,复发率低。     

Laparoscopic repair of suprapubic incisional hernias: suturing and intraperitoneal composite mesh onlay. A retrospective study

BACKGROUND: Suprapubic hernias are those defects located 4 cm from the pubic symphysis. Our aim is to highlight the laparoscopic repair of suprapubic incisional hernias. PATIENTS AND METHODS: We retrospectively reviewed 17 patients with suprapubic incisional hernias from 1999 to 2007. A modified technique of laparoscopic intraperitoneal composite mesh onlay was performed for these patients. RESULTS: There were 12 females and 5 males with a mean age of 55.9 years and a mean BMI of 30 kg/m(2). The mean hernia size was 87.5 cm(2), with an average mesh size of 234 cm(2). Mean follow-up was 9 months. Complications were seen in five patients, with an overall recurrence rate of 5.8%. DISCUSSION: Suprapubic hernias are difficult to manage because of the complexity of dissection and their anatomic proximity to bony, vascular and nerve structures. The lower end of the mesh should be fixed to the Cooper's ligament and the pubic bone. Laparoscopic repair of these uncommon hernias is safe, effective and provides all the benefits of minimally invasive surgery.     

Extraperitoneal prosthesis repair in the surgical treatment of inguinal hernias

The authors analyse the current state of the art of the prosthetic repair of incisional hernia and the problems involved in positioning the prosthesis, comparing their own experience with the most recent literature. From January 1994 to June 2001, 50 patients were operated on for incisional hernia (28 males and 22 females); 12% had recurrent or re-recurrent incisional hernias. Defects smaller than 3 cm were repaired with a polypropylene plug; a double-layer polypropylene mesh placed in a preperitoneal position was used for defects measuring from 3 to 5 cm; in defects greater than 5 cm a double-layer mesh was placed behind the muscle layer. Fifteen patients were operated on under local anaesthesia. Only 22% required postoperative analgesia. The mean hospital stay was 3.95 days. Only 3 recurrences (6%) were recorded. On the basis of our experience it seems appropriate to repair incisional hernias when of small size, preferably under local anaesthesia, avoiding opening the hernia sac, using an extraperitoneal approach with an overlap technique that employs polypropylene.     

Preliminary results of a two-layered prosthetic repair for recurrent inguinal and ventral hernias combining open and laparoscopic techniques

The use of prosthetic mesh has become the standard of care in the management of hernias because of its association with a low rate of recurrence. However, despite its use, recurrence rates of 1% have been reported in primary inguinal repair and rates as high as 15% with ventral hernia repair. When dealing with difficult recurrent hernias, the two-layer prosthetic repair technique is a good option. In the event of incarcerated or strangulated hernias, however; placement of prosthetic material is controversial due to the increased risk of infection. The same is true when hernia repairs are performed concurrently with potentially contaminated procedures such as cholecystectomy, appendectomy, or colectomy. The purpose of this study is to report our preliminary results on the treatment of recurrent hernias by combining laparoscopic and open techniques to construct a two-layered prosthetic repair using a four ply mesh of porcine small intestine submucosa (Surgisis®, Cook Surgical, Bloomington, IN, USA) in a potentially infected field and a combination of polypropylene and ePTFE (Gore-Tex®, W.L. Gore and Associates, Flagstaff, AZ, USA) in a clean field. From September 2002 to January 2004, nine patients (three males and six females) underwent laparoscopic and open placement of surgisis mesh in a two layered fashion for either recurrent incisional or inguinal hernias in a contaminated field. A total of eight recurrent hernia repairs were performed (five incisional, three inguinal) and one abdominal wall repair after resection of a metastatic tumor following open colectomy for colon carcinoma. Six procedures were performed in a potentially contaminated field (incarcerated or strangulated bowel within the hernia), two procedures were performed in a contaminated field because of infected polypropylene mesh, and one was in a clean field. Mean patient age was 56.4 years. The average operating time was 156.8 min. Operative findings included seven incarcerated hernias (four incisional and three inguinal), one strangulated inguinal hernia, and one ventral defect after resection of an abdominal wall metastasis for a previous colon cancer resection. In two of the cases, there was an abscess of a previously placed polypropylene mesh. All procedures were completed with two layers of mesh (eight cases with surgisis and one with combination of polypropylene/ePTFE). Median follow up was 10 months. Complications included two seromas, one urinary tract infection, two cases of atelectasis and one prolonged ileus. There were no wound infections. The average postoperative length of stay was 7.8 days. There have been no mesh-related complications or recurrent hernias in our early postoperative follow-up period. The use of a new prosthetic device in infected or potentially infected fields, and the two-layered approach shows promising results. This is encouraging and provides an alternative approach for the management of difficult, recurrent hernias.     

Sutureless onlay hernia repair: a review of 97 patients

Background

Repair of large ventral/incisional (V/I) hernias is a common problem. Outside of recurrence, other factors such as wound complications and mesh infection can create significant morbidity. Chevrel described the premuscular repair and later modified it by using glue over the midline closure. We previously described our onlay technique using fibrin glue alone in a small case series. The aim of this study is to review the largest case series of sutureless onlay V/I hernia repair whereby mesh is fixated with fibrin glue alone for complex ventral hernias, and how the technique has evolved.

Methods

All patients who underwent onlay V/I hernia repair over a 3-year period were reviewed. Patient demographics, operative details, complications, and follow-up were reviewed.

Results

In total, 97 patients were included. 54.6 % were female, with a mean age of 57.3 years. Mean BMI was 32.2. 23(23.7 %) patients had diabetes. 90 (92.8 %) of the operations were for incisional hernias, 3 (3.1 %) primary ventral hernias, 2 (2.1 %) flank hernias, and 2 (2 %) complex abdominal wall reconstruction. 88 (90.7 %) of the cases were performed on an elective basis. 77 (77.3 %) cases were classified as clean, 21 (21.6 %) clean-contaminated, and 1 (1.0 %) contaminated. The mean defect size was 150 cm². Mean follow-up was 386 days, and maximum was 3.1 years. There were 21 (21.6 %) seromas, 4 (4.1 %) wound infections, 7 (7.4 %) had skin necrosis, and 9 (9.3 %) required re-operation due to a complication. At 3 years, there have been no recurrences or mesh explants.

Conclusions

The sutureless onlay V/I hernia repair with fibrin glue fixation has proven to be durable with a comparable complication profile to other techniques. The most common sequela, seroma, is easily managed in the outpatient setting. This sutureless technique is an effective option for onlay hernia repair that may provide several advantages over traditional suture techniques.

     

Surgical treatment of large incisional hernias by an intraperitoneal Dacron mesh and an aponeurotic graft

BACKGROUND: The therapeutic problems of giant incisional hernias of the abdominal wall are difficult to resolve. The technique of repair must make up for the loss of abdominal wall substance and reestablish the interplay of the abdominal musculature. The use of prosthetic materials complies with these two imperatives. The aim of this prospective study was to evaluate the results of surgical treatment of postoperative incisional hernias by intraperitoneal insertion of Dacron (DuPont) mesh and an aponeurotic graft. STUDY DESIGN: We prospectively studied 350 consecutive patients who were operated on for giant postoperative incisional hernia. RESULTS: Postoperative mortality was 0.6%. Seven patients (2%) developed subcutaneous infections that did not affect the prostheses. Another seven patients (2%) developed deep-seated infections that necessitated removal of the mesh in five cases. Eleven patients (3.1%) had recurrence of incisional hernia. CONCLUSIONS: This prospective study shows that the intraperitoneal positioning of Dacron mesh and an aponeurotic graft can efficiently treat giant abdominal wall hernias.     

Laparoscopic ventral hernia repair using a two (5-mm) port technique.

OBJECTIVE: High recurrence rates have been documented after primary repair of incisional hernias. Laparoscopic ventral and incisional hernia repairs have been performed with very low rates of recurrence. We have modified the standard technique of laparoscopic repair in patients with small incisional and ventral hernias. The purpose of this study was to document the technique utilizing only two 5-mm ports and demonstrate that it is safe, effective, and feasible. METHODS: Three patients with small incisional or ventral hernias were examined. The standard laparoscopic ventral hernia repair technique was modified as follows: two 5-mm ports were inserted on opposite sides of the defect. The defects ranged from 2.5 cm to 4 cm in size. Expanded polytetrafluoroethylene mesh (DualMesh, WL Gore, Flagstaff, AZ) was used to cover the hernia defect, overlapping the defect margins circumferentially by 3 cm. The mesh diameter ranged from 8.5 cm to 10 cm. The mesh was inserted through a 5-mm skin incision site and affixed into position with transfascial sutures and spiral tacks. RESULTS: The operative time ranged from 53 minutes to 57 minutes. All patients were discharged home the day of surgery and reported minimal postoperative pain. Follow-up ranged from 6 months to 1 year; all patients were doing well without recurrence. CONCLUSION: Laparoscopic repair of ventral or incisional hernias can be performed using only two 5-mm ports. This technique can be done on an outpatient basis in a safe, timely fashion.     

Intra Peritoneal Polypropylene Mesh and Newer Meshes in Ventral Hernia Repair: What EBM Says?

Incisional hernias and other ventral hernias are common surgical problems. It is estimated that incisional hernia complicates about 2 % to 10 % of laparotomies. Ventral and incisional hernia repairs are among the common surgeries done by a general surgeon. It is proven beyond any doubt that suture repair of these hernias should not be done as recurrence rates are unacceptably high, some series reporting as high as 54 % on long-term follow-up. A prosthetic mesh should always be used in ventral hernia repair (VHR). Now, the polypropylene mesh (PPM) has become the prosthetic mesh of choice in the repair of hernias, including inguinal hernia. However, with the advent of laparoscopic repair where the mesh is placed intraperitoneally, concerns regarding safety of PPM are raised. Newer meshes are introduced, claiming lesser complication rate. Many types of newer meshes are available now. Newer meshes are invariably costlier than PPM by 15–20 times. Is this extra cost worth? We looked in to available literature for an answer.     

Long-term complications of laparoscopic ventral and incisional hernia repair

To date, there have been no long-term follow-up studies of the results of laparoscopic ventral and incisional hernia repair. We evaluated the long-term complications of these repairs over a mean follow-up period of 64 months. Between March 1993 and April 2000, we retrospectively evaluated 9 patients who underwent ventral or incisional hernia repair with prosthetic material and one patient who received laparoscopic primary closure of a hernia defect. The prosthetic material polypropylene was used in one patient and an expanded-polytetrafluoroethylene patch was used in the other 8. In one patient, the hernia was closed directly. In 7 patients, the prosthesis was fixed by stapling or tacking with no transfacial suture fixation and a 2-cm prosthesis overlap. In 2 later patients, we modified our technique by fixing the prosthesis by stapling or tacking with transfacial suture fixation and using prosthesis overlap of more than 3 cm. There were 2 episodes of hernia recurrence (20%), one of which required reoperation. Both occurred in patients in whom we used the unmodified repair technique. One of the patients in whom we used the unmodified technique developed a seroma which resolved spontaneously without antibiotic therapy. One patient in whom we used the modified technique developed infection (10%) requiring removal of the prosthetic material. The 2 episodes of hernia recurrence occurred 40 months after laparoscopic treatment, and the case of infection occurred 11 months after treatment. There were no episodes of recurrence in patients who received the unmodified surgery and had hernia defects less than 42 cm2. To perform safe and effective laparoscopic repair of ventral or incisional hernias, it is necessary to use a prosthetic overlap of more than 3 cm from the edge of the hernia gate and to use transfacial suture fixation with nonabsorbable sutures. In addition, patients who undergo laparoscopic ventral or incisional hernia repair should be observed for more than 5 years.     

Incisional hernia treatment with progressive pneumoperitoneum and retromuscular prosthetic hernioplasty

BACKGROUND AND AIM: Major incisional hernias of the abdominal wall often pose a serious surgical problem. The choice between simple suture repair and mesh repair remains uncertain. METHODS: Seventy-seven patients underwent surgery to repair large abdominal incisional hernias, i.e., with parietal defects of 10 cm or more, by retromuscular prosthetic hernioplasty between 1996 and 1999. All patients were treated preoperatively by progressive pneumoperitoneum and were followed up for 2-5 years (mean 38.3 months). RESULTS: Almost all patients tolerated the pneumoperitoneum; no postoperative death occurred. Six patients developed a subcutaneous infection but none of them required removal of the mesh. Two patients (2.6%) had recurrent incisional hernia. CONCLUSIONS: This study shows that pneumoperitoneum is useful in preparing patients for incisional hernioplasty. Retromuscular mesh repair represents an appropriate surgical procedure, particularly in view of its low rate of recurrence.     

Repair of large complex recurrent incisional hernias with retromuscular mesh and panniculectomy

BACKGROUND: Recurrent incisional hernia repair is associated with high recurrence and wound complication rates. METHODS: The clinical courses of patients who underwent recurrent incisional hernia repair via retromuscular mesh placement with concomitant panniculectomy at a university teaching hospital from 1999 to 2004 were reviewed retrospectively. Postoperative evaluation included a quality of life survey. RESULTS: Forty-seven patients (13 male, 34 female) with an average body mass index of 34.4 kg/m2, an average midline hernia defect of 31.4 cm, and at least 1 and on average 2.5 previous repair attempts underwent hernia repair. Wound infections occurred in 4 patients (8%) and seromas requiring aspiration occurred in 1 patient (2%). Four patients (8%) had re-recurrences of their hernias. All patients rated the postoperative appearance of their abdomen as at least satisfactory. CONCLUSIONS: Recurrent incisional hernia repair with a retromuscular mesh and panniculectomy has low recurrence and wound complication rates and excellent patient satisfaction.     

Factors that affect recurrence after incisional herniorrhaphy with prosthetic material.

OBJECTIVE: To evaluate the risk factors for recurrence after prosthetic incisional herniorrhaphy. DESIGN: Retrospective study. SETTING: Tertiary referral centre, Spain. PATIENTS: 246 patients who had incisional herniorrhaphy with a prosthetic material (polypropylene) between 1990 and 1997 INTERVENTIONS: A reinforcement mesh was inserted when the hernia was more than 5 cm. In incisional hernias less than 5 cm the reinforcement mesh was inserted when the repair was under tension or when tissues were noted to be weak during the operation. MAIN OUTCOME MEASURES: Age, sex, obesity, the presence of bronchial disease, previous repair of the incisional hernia, type of surgery, size and site of hernia and presence of local complications during the immediate postoperative period. RESULTS: Mean (SD) follow-up was 77 (6) months (minimum follow up two years). The hernia recurred in 43 cases (17%) (mean time of recurrence 10 (8) months). Age over 60 years, previous herniorrhaphy, size of hernia, and postoperative local complications were significant risk factors (p < 0.01) in both the univariate and multivariate analyses. CONCLUSIONS: Patients at the greater risk of recurrence are those aged over 60 years, with large, recurrent hernias and who develop local complications during the postoperative period.     

The Analysis of Infection after Polypropylene Mesh Repair of Abdominal Wall Hernia

Aim The aim of the study was to evaluate the frequency of superficial and prosthetic mesh infection following polypropylene mesh repair of different abdominal wall hernia in individual patients and to analyze the manifestation, clinical process and outcomes in patients with prosthetic mesh infection. Methods This was a retrospective analysis of 375 patients with 423 implanted meshes for groin, femoral, umbilical, incisional and epigastric hernias, with a mean follow-up of 15 months (range: 3–73 months). Results The total superficial infection rate was 1.65% percnt;, and the rate of mesh infection was 0.94% percnt;. There were no statistically significant differences in prosthetic mesh infection between monofilament and multifilament meshes as well as between the different repair groups of hernias. The deep incisional surgical site infection after previous operation was established as a significant risk factor for prosthetic mesh infection in incisional hernia repair (P < 0.0001). Five cases of prosthetic mesh infection were presented and analyzed. Conclusions There is no correlation between the superficial and prosthetic mesh infection. There may be difficulties in determining mesh infection and to choose the right tactic. The reconvalescence in all patients with mesh infection was achieved only after removal of the infected mesh. An erratum to this article is available at .