Top

Langenbeck's Archives of Surgery

Published in:

01-09-2005 | Original Article

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

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

Published in: Langenbeck's Archives of Surgery | Issue 5/2005

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.

Abrahamson J (2001) Recurrent herniation: etiology and mechanisms. In: Phillips EH (ed) Abdominal wall hernias: principles and management. Springer, Berlin Heidelberg New York, pp 156–165

Amid PK, Shulman AG, Lichtenstein IL (1994) Use of Marlex mesh in the repair of recurrent incisional hernia. Br J Surg 81:1827

Amid PK, Shulman AG, Lichtenstein IL, Hakakha M (1994) Biomaterials for abdominal wall hernia surgery and principles of their applications. Langenbecks Arch Chir 379:168–171

Burger JWA, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–585

Carbajo MA, Martín del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13:250–252

Carbajo MA, Martín del Olmo JC, Blanco JI, Toledano M, de la Cuesta C, Ferreras C, Vaquero C (2003) Laparoscopic approach to incisional hernia: lessons learned from 270 patients over 8 years. Surg Endosc 17:118–122

Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89:534–545

Chevrel JP (2001) Treatment of incisional hernias by an overlapping herniorrhaphy and onlay prosthetic implant. In: Phillips EH (ed) Abdominal wall hernias: principles and management. Springer, Berlin Heidelberg New York, pp 500–503

Holmberg L, Baum M (1995) Can results from clinical trials be generalized? Nature Med 1:734–736

10.

Kingsnorth A, LeBlanc KA (2003) Prosthetic biomaterials for hernioplasty. In: LeBlanc KA (ed) Management of abdominal hernias, 3rd edn. Arnold, London, pp 78–104

11.

Klinge U, Klosterhalfen B, Müller M, Schumpelick V (1999) Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg 165:665–673

12.

Klosterhalfen B, Klinge U, Schumpelick V (1998) Functional and morphological evaluation of different polypropylene-mesh modifications for abdominal wall repair. Biomaterials 19:2235–2246

13.

Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, Corcione F, Fingerhut A, Flament JB, Kux M, Matzinger A, Myrvold HE, Rath AM, Simmermacher RKJ (2001) Classification and surgical treatment of incisional hernia—results of an expert meeting. Langenbecks Arch Surg 386:65–73

14.

Korenkov M, Sauerland S, Arndt M, Bograd L, Neugebauer EAM, Troidl H (2002) Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia. Br J Surg 89:50–56

15.

Korenkov M, Sauerland S, Paul A, Neugebauer E (2002) Die deutsche Narbenhernienchirurgie im Umbruch. Ein Vergleich zweier Kliniksumfragen 1995 und 2001. Zentralbl Chir 127:700–705

16.

Langer C, Liersch T, Kley C, Flosman M, Süss M, Siemer A, Becker H (2003) 25 Jahre Erfahrung in der Narbenhernienchirurgie. Eine vergleichende, retrospektive Studie an 432 Narbenbruchoperationen. Chirurg 74:638–645

17.

Lehr SC, Schuricht AL (2001) A minimally invasive approach for treating postoperative seromas after incisional hernia repair. JSLS 5:267–271

18.

Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JNM, Boelhouwer RU, de Vries BC, Salu MKM, Wereldsma JCJ, Bruijninckx CMA, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398

19.

Luijendijk RW, Lemmen MH, Hop WCJ, Wereldsma JCJ (1997) Incisional hernia recurrence following “vest-over-pants” or vertical Mayo repair of primary hernias of the midline. World J Surg 21:62–66

20.

Mittermair RP, Klingler A, Wykypiel H, Gadenstätter M (2002) Vertical Mayo repair of midline incisional hernia: suggested guidelines for selection of patients. Eur J Surg 168:334–338

21.

Paul A, Korenkov M, Peters S, Köhler L, Fischer S, Troidl H (1998) Unacceptable results of the Mayo procedure for repair of abdominal incisional hernias. Eur J Surg 164:361–367

22.

Rosch R, Junge K, Knops M, Lynen P, Klinge U, Schumpelick V (2003) Analysis of collagen-interacting proteins in patients with incisional hernias. Langenbecks Arch Surg 387:427–432

23.

Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8:42–46

24.

Sauerland S, Miserez M, Grass G, Stützer H, Neugebauer E (2004) LapSis: a randomised controlled multicentre trial of laparoscopic versus open ventral hernia repair using a classical versus a collagen mesh (SurgiSIS Gold) [abstract]. Langenbecks Arch Surg 389:429

25.

Schumpelick V, Klinge U, Welty G, Klosterhalfen B (1999) Meshes in der Bauchwand. Chirurg 70:876–887

26.

Toscano F, Agizza S, Mastantuono A, Avallone V, Bracale F, Tesauro B (1988) Terapia chirurgica del grosso laparocele: protesi inerti versus plastica diretta. Minerva Chir 43:1221–1225

27.

White TJ, Santos MC, Thompson JS (1998) Factors affecting wound complications in repair of ventral hernias. Am Surg 64:276–280

Title: Primary incisional hernia repair with or without polypropylene mesh: a report on 384 patients with 5-year follow-up
Authors: Stefan Sauerland
Claus-Georg Schmedt
Silke Lein
Bernhard J. Leibl
Reinhard Bittner
Publication date: 01-09-2005
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 5/2005
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-005-0567-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background and aim

Patients and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background and aim

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2005

Survival after surgical treatment of cancer of the rectum

Detection and clinical implications of minimal residual disease in gastro-intestinal cancer

Laparoscopic cholecystectomy in acute cholecystitis: indication, technique, risk and outcome

Risk factors influencing the early outcome results after laparoscopic repair of perforated duodenal ulcer and their predictive value

A less invasive, selective, functional neck dissection for papillary thyroid carcinoma

Sentinel node metastasectomy in thin ≤1-mm melanoma