Outcomes of the open mesh repair of large incisional hernias using an intraperitoneal composite mesh: our experience with 100 cases

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.