Peer review report 2 on “Laparoscopic ventral hernia repair with composite mesh: Analysis of risk factors for recurrence in 185 patients with 5 years follow-up”

Background: Laparoscopic ventral hernia repair has revolutionized treatment of ventral hernia by offering shorter recovery time, decreased pain, reduced wound complications and lower recurrence rates as compared to conventional open hernia repair. But intra-abdominal mesh placement is associated with a high risk of complications including adhesions, bowel obstruction and fistula formation. Many different types of meshes with adhesion barriers have been developed to overcome these problems. This prospective observational study evaluated the outcomes of laparoscopic repair of ventral hernias in terms of Intra-abdominal adhesion formation with composite mesh using ultrasound.Methods: The study was conducted from August 2017 to February 2019. All patients underwent standard laparoscopic ventral hernias repair using composite mesh secured with tackers. Omentum was interposed between the mesh and underlying bowel. At a mean follow-up of one year, all patients were subjected to ultrasound examination using visceral slide technique to detect Intra-abdominal adhesions.Results: Our study included 50 patients with a mean age of 43 years (range 26-59 years) and mean body mass index of 29.07±2.35 kg/m2 (range, 24-33 kg/m2). Mean fascial defect size of hernia was 13.4±3.77 cm2 (range12-16 cm2). There were no mesh-related complications and recurrence during the follow-up period of 1 year.Conclusions: Laparoscopic ventral hernia repair using composite mesh seems to be a promising technique for treating ventral hernias. However, longer follow-up periods are needed to confirm effectiveness and safety of the composite mesh.

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Long term outcome and elasticity of a polyester mesh used for laparoscopic ventral hernia repair

Hernia ◽

10.1007/s10029-021-02486-6 ◽

2021 ◽

Author(s):

P. J. O’Dwyer ◽

C. Chew ◽

H. Qandeel

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Laparoscopic Repair ◽

Ventral Hernia Repair ◽

Laparoscopic Ventral Hernia Repair ◽

Ct Scans ◽

Unique Problem ◽

Polyester Mesh

Abstract Background Repair of a ventral hernia is increasingly being performed by a laparoscopic approach despite lack of good long term follow up data on outcomes. The aim of this study was to examine the long term performance of a polyester mesh and to assess its elastic properties in patients undergoing laparoscopic ventral hernia repair. Methods All patients being assessed for a ventral hernia repair between August 2011 and November 2013 were placed on a prospective database. Those undergoing laparoscopic repair with a polyester mesh were seen at clinic at one month and one year, while their electronic records were assessed at 34 months (range 24–48 months) and 104 months (range 92–116 months). In addition, CT scans of the abdomen and pelvis performed for any reason on these patients during the follow up period were reviewed by a consultant gastrointestinal radiologist. Mechanical failure testing of the mesh was also performed. Results Thirty-two of the 100 patients assessed for ventral hernia repair had a laparoscopic repair with a polyester mesh. Nineteen (59%) had CT scans performed during the follow-up period. No recurrence was recorded at 34 months, while three (9.4%) had a recurrence at 104 months. Two had central breakdown of the mesh at 81 and 90 months, while 1 presented acutely at 116 months after operation. Mesh had stretched across the defect by an average of 21% (range 5.7–40%) in nine patients. Mechanical testing showed that this mesh lost its elasticity at low forces ranging between 1.8 and 3.2 N/cm. Conclusion This study shows that late recurrence is a problem following laparoscopic ventral hernia repair with polyester mesh. The mesh loses it elasticity at a low force. This combined with degradation of mesh seems the most likely cause of failure. This is unlikely to be a unique problem of polyester mesh and further long-term studies are required to better assess this operative approach to ventral hernia repair.

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