Advertisement

Hernia

, Volume 15, Issue 6, pp 659–665 | Cite as

New mesh shape and improved implantation procedure to simplify and standardize open ventral hernia repair: a preliminary report

  • G. AmatoEmail author
  • G. Romano
  • T. Goetze
  • G. Salamone
  • A. Agrusa
  • G. Gulotta
  • V. Paolucci
Original Article

Abstract

Introduction

Issues in ventral hernia repair are represented by the need for mesh fixation and how to assure a sufficient mesh overlap of the defect. Aiming to resolve these problems, this study describes a modified technique for ventral and incisional hernia repair based upon a newly developed mesh with a special design. This new type of implant allows broader coverage of the abdominal wall and results in tension- and fixation-free repair.

Materials and methods

A unique geometrically shaped mesh consisting of a large central body and radiating arms was used to repair ventral or incisional hernia. The mesh was intended not to be point-fixated. The friction of the straps passing through the tissues was hypothesized to be adequate to maintain the mesh firmly fastened in the abdominal wall, ensuring a wide coverage far from the hernia border. The newly designed mesh was placed in the preperitoneal sublay in 22 patients with ventral or incisional hernia. All straps were passed laterally through the transverse and oblique muscles. In all patients, a defect overlap of at least 8–12 cm was achieved.

Results

In a midterm follow-up of 18–24 (mean 22) months, three seromas and one infection occurred, which were successfully managed without mesh removal. No hematoma, chronic pain, or recurrence has been reported to date.

Conclusions

The described arm system of the implant allowed for a much smaller incision and eliminated the complicated maneuvers associated with suturing the mesh. The fixation arms seemed to have ensured the mesh stayed orientated in all patients. A very wide lateral mesh placement was accomplished, assuring sufficient defect overlap when shrinkage occurs.

Keywords

Hernia Ventral Prostheses Implants Surgical fixation devices Friction Recurrence 

Supplementary material

Supplementary material 1 (MPG 95995 kb)

References

  1. 1.
    Junge K, Klinge U, Prescher A, Giboni P, Niewera M, Schumpelick V (2001) Elasticity of the abdominal wall and impact for reparation of incisional hernias using mesh implants. Hernia 5:113–118PubMedCrossRefGoogle Scholar
  2. 2.
    Klinge U, Conze J, Klosterhalfen B, Limberg W, Obolenski B, Ottinger AP, Schumpelick V (1996) Changes in abdominal wall mechanics after mesh implantation. Exp Changes Mesh Stab Langenbecks Arch Chir 381(6):323–332Google Scholar
  3. 3.
    Van der Linden FT, Van Vroonhoven TJ (1988) Long-term results after surgical correction of incisional hernia. Neth J Surg 40:127–129Google Scholar
  4. 4.
    Langer S, Christiansen J (1985) Long-term results after incisional hernia repair. Acta Chir Scand 151:217–219PubMedGoogle Scholar
  5. 5.
    Gecim IE, Kocak S, Ersoz S, Bumin C, Aribal D (1996) Recurrence after incisional hernia repair: results and risk factors. Surg Today 26:607–609PubMedCrossRefGoogle Scholar
  6. 6.
    McLanahan D, King LT, Weems C, Novotney M, Gibson K (1997) Retrorectus prosthetic mesh repair of midline abdominal hernia. Am J Surg 173: 445–449Google Scholar
  7. 7.
    Arnaud JP, Tuech JJ, Pessaux P, Hadchity Y (1999) Surgical treatment of postoperative incisional hernias by intraperitoneal insertion of dacron mesh and an aponeurotic graft: a report on 250 cases. Arch Surg 134(11):1260–1262PubMedCrossRefGoogle Scholar
  8. 8.
    Langer C., Neufang T., Kley C., Liersch T, Becker H (2001) Central mesh recurrence after incisional hernia repair with Marlex are the meshes strong enough? Hernia 5(3):164–7Google Scholar
  9. 9.
    Bauer JJ, Harris MT, Kreel I, Gelernt IM (1999) Twelve-year experience with expanded polytetrafluoroethylene in the repair of abdominal wall defects. Mt Sinai J Med 66:20–25PubMedGoogle Scholar
  10. 10.
    Amid PK, Shulman AG, Lichtenstein IL, Hakakha M (1994) Biomaterials for abdominal wall hernia surgery and principles of their applications. Langenbecks Arch Chir 379(3):168–171PubMedCrossRefGoogle Scholar
  11. 11.
    Welty G, Klinge U, Klosterhalfen B, Kasperk R, Schumpelick V (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5(3):142–147Google Scholar
  12. 12.
    Awad ZT, Puri V, LeBlanc K, Stoppa R, Fitzgibbons RJ Jr, Iqbal A, Filipi CJ (2005) Mechanisms of ventral vernia recurrence after mesh repair and a new proposed classification. J Am Coll Surg 201(1):132–140Google Scholar
  13. 13.
    Boccon-Gibod L, Hermieu JF, Toublanc M, Delmas V, Ravery V (2004) International Continence Society Congress Abstract Book, p 681Google Scholar
  14. 14.
    Boukerrou M, Rubod C, Dedet B, Boodhum R, Nayama M, Cosson M (2008) Tissue resistance of the tension-free procedure: what about healing? Int Urogynecol J Pelvic Floor Dysfunct 19(3):397–400PubMedCrossRefGoogle Scholar
  15. 15.
    Amato G, Romano G, Agrusa A, Cassata G, Salamone G, Gulotta G (2010) Prosthetic strap system for simplified ventral hernia repair. Its results in a porcine experimental model. Hernia 14:389–395PubMedCrossRefGoogle Scholar
  16. 16.
    LeBlanc KA (2003) Tack hernia: a new entity. JSLS 7:383–387PubMedGoogle Scholar
  17. 17.
    Fatton B, Amblard J, Debodinance P, Cosson M, Jacquetin B (2007) Transvaginal repair of genital prolapse:preliminary results of a new tension-free vaginal mesh (Prolift technique)-a case series multicentric study. Int Urogynecol J Pelvic Floor Dysfunct 18:743–752PubMedCrossRefGoogle Scholar
  18. 18.
    Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C (2008) For the Nordic Transvaginal Mesh Group. Short-term outcome after transvaginal mesh repair of pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 19(6):787–793PubMedCrossRefGoogle Scholar
  19. 19.
    Abdel-Fattah M, Ramsay I (2008) West of Scotland Study Group. Retrospective multicentre study of the new minimally invasive mesh repair devices for pelvic organ prolapse. BJOG 115(1):22–30Google Scholar
  20. 20.
    Malik B, Lambaudie E, Collinet P, Dubois P, Cosson M (2007) Mechanical resistance of syntetic meshes for incontinence or polapse surgery. Int Urogynecol J 18:183–187Google Scholar
  21. 21.
    Alcalay M, Livne M, Shidlovsky D, Hod E (2009) Pullout force of polypropylene mesh deployed by endofast reliant fastener—a comparative study in a sheep model. ICS Congress Abstract Book, p 543Google Scholar
  22. 22.
    Müller M, Klinge U, Conze J, Schumpelick V (1998) Abdominal wall compliance after Marlex mesh implantation for incisional hernia repair. Hernia 2:113–117CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • G. Amato
    • 1
    Email author
  • G. Romano
    • 1
  • T. Goetze
    • 2
  • G. Salamone
    • 1
  • A. Agrusa
    • 1
  • G. Gulotta
    • 1
  • V. Paolucci
    • 2
  1. 1.Department of General Surgery, Urgency, and Organ TransplantationUniversity of PalermoPalermoItaly
  2. 2.Department of General and Visceral SurgeryKetteler KrankenhausOffenbachGermany

Personalised recommendations