Abstract
Incisional hernia repair sometimes requires intraperitoneal implantation of a mesh. This becomes necessary when the hernia opening is large, in particular, in patients with a low abdominal wall surface/wall defect surface (AWS/WDS) ratio, in large boundary incisional hernias where the proximity to bone structures or cartilage often complicates retromuscular mesh implantation and in multi-recurrent incisional hernias that are sometimes characterised by an actual loss of abdominal wall tissue. The authors report on the results of a series of 100 incisional hernias treated between 1999 and 2006 using the open technique to implant an intraperitoneal mesh (Parietex Composite). Mean follow-up time was 42 months (range 12–96 months). The mean wall defect surface was 95 cm2 (range 60–210 cm2). Twelve percent of patients suffered minor complications: 5 seromas (5%), 3 haematomas (3%) and 4 parietal suppurations (4%). No mesh had to be removed. The recurrence rate was 6%. At 6 months after surgery, no patient lamented pain or discomfort due to foreign body sensation. None of these patients presented intestinal occlusion or enterocutaneous fistulae. In conclusion, it is our opinion that the mesh should be implanted in direct contact with the viscera only where absolutely necessary, i.e., when it cannot be implanted in the retromuscular area without creating excessive parietal tension. Our experience with PC mesh, over the short-to-medium term, was positive. Naturally, further studies are required to evaluate long-term biocompatibility.
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References
Ammaturo C, Bassi G (2005) The ratio between anterior abdominal wall surface/wall defect surface: a new parameter to classify abdominal incisional hernias. Hernia 9(4):316–321
Oussoultzoglou E, Baulieux J, De la Roche E, Peyregne V, Adham M, Berthoux N, Ducerf C (1999) Long-term results of 186 patients with large incisional abdominal wall hernia treated by intraperitoneal mesh. Ann Chir 53:33–40
Morin B, Bonnamy C, Maurel J, Samama G, Gignoux M (2001) Late intestinal fistula following implantation of parietal abdominal prostheses. Ann Chir 126:876–880
Kaufman Z, Engelberg M, Zager (1981) Fecal fistula: a late complication of Marlex mesh repair. Dis Colon Rectum 24:543–544
Bonnamy C, Samama G, Brefort JL, Le Roux Y, Langlois G (1999) Long-term results of the treatment of eventrations by intraperitoneal non-absorbable prosthesis (149 patients). Ann Chir 53(7):571–576
Ott V, Groebli Y, Schneider R (2005) Late intestinal fistula formation after incisional hernia using intraperitoneal mesh. Hernia 9(1):103–104
Seelig MH, Kasperk R, Tietze L, Schumpelick V (1995) Enterocutaneous fistula after Marlex net implantation A rare complication after incisional hernia repair. Chirurg 66(7):739–741
Duca S, Popa EL, Perneki S, Negreanu A, Cernei L (1988) Jejunocutaneous fistula following the use of a polyester net for treating eventration. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Chir 37(5):387–391
Losanoff JE, Richman BW, Jones JW (2002) Entero-colocutaneous fistula: a late consequence of polypropylene mesh abdominal wall repair: case report and review of the literature. Hernia 6(3):144–147
Basoglu M, Yildirgan MI, Yilmaz I, Balik A, Celebi F, Atamanalp SS, Polat KY, Oren D (2004) Late complications of incisional hernias following prosthetic mesh repair. Acta Chir Belg 104(4):425–428
Miller K, Junger W (1997) Ileocutaneous fistula formation following laparoscopic polypropylene mesh hernia repair. Surg Endosc 11(7):772–773
Chevrel JP, Rath AM (2000) Classification of incisional hernias of the abdominal wall. Hernia 4:7–11
Sigel F, Golub RM, Loiacono LA, Parsons RE, Kodama I, Machi J, Justin J, Sachdeva AK, Zaren HA (1991) Technique of ultrasonic detection and mapping of abdominal wall adhesions. Surg Endosc 5:161–165
Chevrel JP (1979) Traitement des grandes éventrations médianes par plastie en paletot et prothése. Nov Press Med 8:695–696
Rives J, Lerdennois B, Pire JC (1974) Physiopathologie des éventration. 75ème Congrès Français de Chirurgie. Masson, Paris
Rives J, Pire JC, Flament JB, Covers G (1977) Traitment des éventration. In: Techniques Chirurgicales. Encycl Med Chir, Paris, pp 40–65
Rives J, Pire JC, Flament JB, Palot JP, Body C (1985) Les traitment des grandes éventrations. Chirurgie 111:215–225
Becouarn G, Szmil E, Leroux C, Arnaud JP (1996) Surgical cure of postoperative eventrations with intraperitoneal implantation of dacron mesh. Apropos of 160 operated cases. J Chir 133(5):229–232
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):1260–1262
Balique JG, Alexandre JH, Arnaud JP, Benchetrit S, Bouillot JL, Fagniez PL, Flament JB, Gouillat C, Jarsaillon P, Lepére M, Magne E, Mantion G (2000) Intraperitoneal treatment of incisional and umbilical hernias: intermediate results of a multicenter prospective clinical trial using an innovative composite mesh. Hernia 4(Suppl):S10–S16
Vrijland WW, Jeekel J, Steyerberg EW, Den Hoed PT, Bonjer HJ (2000) Intraperitoneal polypropylene mesh repair of incisional hernia is not associated with enterocutaneous fistula. Br J Surg 87(3):348–352
Ammaturo C, Bassi UA, Rossi R, Santoro M, Iavazzo E, Di Carlo F, Bassi G (2003) Novità nella chirurgia dei grandi laparoceli. Le indicazioni al trattamento “open” dei laparoceli con protesi composite. Arch Atti SIC Ed Pozzi 1:63–70
Ammaturo C, Bassi G (2004) Surgical treatment of large incisional hernias with an intraperitoneal Parietex Composite mesh: our preliminary experience on 26 cases. Hernia 8(3):242–246
Goni Moreno I (1947) Chronic eventrations and large hernias. Preoperative treatment by progressive pneumoperitoneum. Original procedure. Surgery 22:945–953
Cobb WS, Kercher KW, Heniford BT (2005) Laparoscopic repair of incisional hernias. Surg Clin North Am 85(1):91–103
Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238(3):391–399; discussion 399–400
Iqbal CW, Pham TH, Joseph A, Mai J, Thompson GB, Sarr MG (2007) Long-term outcome of 254 complex incisional hernia repairs using the modified rives-Stoppa technique. World J Surg 31(12):2398–2404
Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13(5):545–554 Review
Rives J, Palot JP, Burde A, Corcione F (1986) Large laparoceles: experience in 250 cases. Minerva Chir 41(3–4):135–144
Carbajo MA, del Olmo JC, Blanco JI, de la Cuesta C, Martín F, Toledano M, Perna C, Vaquero C (2000) Laparoscopic treatment of ventral abdominal wall hernias: preliminary results in 100 patients. JSLS 4(2):141–145
Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124(4):816–821; discussion 821–822
Klinge U, Conze J, Limberg W, Brücker C, Ottinger AP, Schumpelick V (1996) Pathophysiology of the abdominal wall. Chirurg 67(3):229–233
Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240(4):578–583; discussion 583–585
LeBlanc KA, Whitaker JM (2002) ) Management of chronic postoperative pain following incisional hernia repair with Composix mesh: a report of two cases. Hernia 6(4):194–197
Schug-Pass C, Tamme C, Sommerer F, Tannapfel A, Lippert H, Köckerling F (2008) A lightweight, partially absorbable mesh (Ultrapro) for endoscopic hernia repair: experimental biocompatibility results obtained with a porcine model. Surg Endosc 22(4):1100–1106
Schmidbauer S, Ladurner R, Hallfeldt KK, Mussack T (2005) Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res 10(6):247–253
Bellón JM, Rodríguez M, García-Honduvilla N, Pascual G, Buján J (2007) Partially absorbable meshes for hernia repair offer advantages over nonabsorbable meshes. Am J Surg 194(1):68–74
Cobb WS, Burns JM, Peindl RD, Carbonell AM, Matthews BD, Kercher KW, Heniford BT (2006) Textile analysis of heavy weight, mid-weight, and light weight polypropylene mesh in a porcine ventral hernia model. J Surg Res 136(1):1–7
Langer C, Liersch T, Kley C, Flosman M, Süss M, Siemer A, Becker H (2003) Twenty-five years of experience in incisional hernia surgery A comparative retrospective study of 432 incisional hernia repairs. Chirurg 74(7):638–645
Heartsill L, Richards ML, Arfai N, Lee A, Bingener-Casey J, Schwesinger WH, Sirinek KR (2005) Open Rives-Stoppa ventral hernia repair made simple and successful but not for everyone. Hernia 9(2):162–166
Flament JB, Avisse C, Palot JP, Delattre JF (2000) Complications in incisional hernia repairs by the placement of retromuscolar prostheses. Hernia 4:S25–S29
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Ammaturo, C., Bassi, U.A. & Bassi, G. Outcomes of the open mesh repair of large incisional hernias using an intraperitoneal composite mesh: our experience with 100 cases. Updates Surg 62, 55–61 (2010). https://doi.org/10.1007/s13304-010-0002-2
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DOI: https://doi.org/10.1007/s13304-010-0002-2