Abstract
Background and aims
Polypropylene mesh repair of large incisional ventral hernias has become increasingly popular. Long-term effects of the mesh on pain and abdominal muscles are not known.
Patients/methods
Retromuscular pre-peritoneal polypropylene mesh was placed by open technique in 84 consecutive patients with large ventral hernias (mean defect size 130 cm2). We re-examined the patients after a mean follow-up time of 3 years to find out the frequency of recurrence and chronic pain. We measured the thickness of abdominal muscles of eight patients preoperatively, and postoperatively after 1 year, using magnetic resonance imaging (MRI).
Results
Recurrent hernias had appeared in four patients (5%) at follow-up. Nine patients (13%) needed occasional pain-relieving drugs, but only three (4%) suffered persistent, severe, pain from the mesh. Some limitation during leisure-time physical activities was found in 10% of patients. Only ten patients (12%) were re-operated on because of wound complications or recurrence. MRI study indicated that abdominal muscles were postoperatively well preserved. Although wound infections (6%) and seroma (9%) were frequent complications, there was no need for meshes to be removed in the follow-up.
Conclusion
Open ventral herniorrhaphy with mesh is safe, effective and inexpensive. Small, recurrent hernias were infrequent and easy to re-operated on. Severe pain from the mesh was not common. Postoperative MRI study indicated no obvious damage of abdominal muscles after mesh placement.
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References
Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89:534–545
Sukkar SM, Dumanian GA, Szczerba SM, Tellez MG (2001) Challenging abdominal wall defects. Am J Surg 181:115–121
Ramirez OM, Ruas E, Dellon L (1990) “Components separation” method for closure of abdominal wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526
Luijendijk RW, Hop WCJ, van den Tol MP (2000) A comparison of suture repair with mesh repair for incisional hernia. N Eng J Med 343:392–398
Mathes SJ, Steinwald PM, Foster RD, Hoffman WY, Anthony JP (2000) Complex abdominal wall reconstruction: a comparison of flap and mesh closure. Ann Surg 232:586–596
Rives J, Pire JC, Flament JB (1985) Treatment of large eventrations. New therapeutic indications apropos of 322 cases. Chirurgie 111:215–225
Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554
Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190:645–650
Ramshaw BJ, Esartia P, Schwab J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827–832
Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7
Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54
Martin-Duce A, Noquerales F, Villeta R, Hernandez P (2001) Modifications to Rives technique for midline incisional hernia repair. Hernia 5:70–72
Wantz GE (1991) Incisional hernioplasty with Mersilene. Surg Gynecol Obstet 172:129–137
Toms AP, Dixon AK, Murphy JM, Jamieson NV (1999) Illustrated review of new imaging techniques in the diagnosis of abdominal wall hernias. Br J Surg 86:1243–1249
Petersen S, Henke G, Freitag M, Faulhaber A, Ludwig K (2001) Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg 167:453–457
Temudom T, Siadati M, Sarr MG (1996) Repair of complex giant or recurrent ventral hernias by using tension-free intraparietal prosthetic mesh (Stoppa technique): lessons learned from our initial experience (fifty patients). Surgery 120:738–743
McLanahan D, King LT, Weems C, Novotney M, Gibson K (1997) Retrorectus prosthesis mesh repair of midline abdominal hernia. Am J Surg 173:445–449
Maas SM, Reilingh TSV, Goor H, de Jong D, Bleichrodt RP (2002) Endoscopically assisted “components separation technique” for the repair of complicated ventral hernias. Am Coll Surg 194:388–340
Paajanen H (2002) Do absorbable mesh sutures cause less chronic pain than nonabsorbable sutures after Lichtenstein inguinal herniorrhaphy? Hernia 6:26–28
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Paajanen, H., Hermunen, H. Long-term pain and recurrence after repair of ventral incisional hernias by open mesh: clinical and MRI study. Langenbecks Arch Surg 389, 366–370 (2004). https://doi.org/10.1007/s00423-003-0440-0
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DOI: https://doi.org/10.1007/s00423-003-0440-0