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

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Abstract

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.

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Acknowledgements

We acknowledge the help of Jason Simpson for proofreading the manuscript.

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Authors and Affiliations

  1. Klinik für Allgemein- und Visceralchirurgie, Marienhospital Stuttgart, Böheimstrasse 37, 70199, Stuttgart, Germany

    Stefan Sauerland, Claus-Georg Schmedt, Silke Lein, Bernhard J. Leibl & Reinhard Bittner

  2. Biochemische und Experimentelle Abteilung, Medizinische Fakultät der Universität zu Köln, Ostmerheimer Strasse 200, 51109, Cologne, Germany

    Stefan Sauerland

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  1. Stefan Sauerland
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  2. Claus-Georg Schmedt
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  3. Silke Lein
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  4. Bernhard J. Leibl
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  5. Reinhard Bittner
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Correspondence to Stefan Sauerland.

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Sauerland, S., Schmedt, CG., Lein, S. et al. Primary incisional hernia repair with or without polypropylene mesh: a report on 384 patients with 5-year follow-up. Langenbecks Arch Surg 390, 408–412 (2005). https://doi.org/10.1007/s00423-005-0567-2

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  • DOI: https://doi.org/10.1007/s00423-005-0567-2

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