Is Onlay Polypropylene Mesh Repair an Available Option for Incisional Hernia Repair? A Retrospective Cohort Study

2019 ◽  
Vol 85 (2) ◽  
pp. 183-187 ◽  
Author(s):  
Oscar Cano-Valderrama ◽  
JosÉ L. Porrero ◽  
Esther Quirós ◽  
Oscar Bonachia ◽  
MarÍA J. Castillo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Surgical Procedures ◽  
Polypropylene Mesh ◽  
Mesh Repair ◽  
Incisional Hernia Repair ◽  
Hernia Recurrence ◽  
Onlay Mesh

Lately, incisional hernia repair (IHR) with onlay polypropylene mesh has been replaced by other surgical procedures. The aim of this study was to compare the complication and recurrence rate after onlay mesh repair and other surgical procedures for IHR. A retrospective cohort study of patients who underwent IHR in a single center was conducted. The data were obtained from electronic medical records. Patients who had been lost during follow-up were contacted for a visit in the clinic. Univariate and multivariate analysis was performed with Stata 13.0 to analyze the factors associated with postoperative complications and hernia recurrence. Between June 2004 and December 2015, 1078 patients underwent IHR in a single center. Onlay mesh repair was performed in 125 patients (11.6%). Other surgical procedures included Rives procedure (29.3%), sublay mesh repair (38.6%), intrabdominal mesh repair (17.1%), and primary closure (3.4%). After a mean follow-up of 2.8 years, 73 (7%) patients developed a recurrence. A higher percentage of complications were seen after onlay mesh repair than after other surgical procedures (22.4% vs 13.1%, P = 0.005). Nevertheless, recurrence was less frequent after onlay mesh repair (4.2% vs 7.1%, P = 0.241). Logistic regression discarded an association between onlay mesh repair and hernia recurrence or postoperative complications. Incisional hernia repair with onlay polypropylene mesh repair was not associated with a higher incidence of postoperative complications or recurrence rate. So, this procedure should not be discarded in selected patients presenting with incisional hernia.

scholarly journals Surgical treatment of subcostal incisional hernia with polypropylene mesh - analysis of late results

2014 ◽  
Vol 41 (2) ◽  
pp. 82-86 ◽  
Author(s):  
Marco Antonio de Oliveira Peres ◽  
Herberti Rosique Aguiar ◽  
Nelson Adami Andreollo
Keyword(s):  
Surgical Treatment ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Polypropylene Mesh ◽  
Wound Dehiscence ◽  
Incisional Hernia Repair ◽  
Late Results ◽  
Late Complications ◽  
Technical Failure

OBJECTIVE: To evaluate the results of subcostal incisional hernia repair using polypropylene mesh, the technical aspects of musculo-aponeurotic reconstruction, routine fixation of supra-aponeurotic mesh and follow-up for five years.METHODS: We conducted a retrospective study that assessed 24 patients undergoing subcostal incisional hernia repair with use of polypropylene mesh; 15 patients (62.5%) were female; ages ranged from 33 to 82, and 79.1% had comorbidities.RESULTS: Early complications: three cases (12.5%) of wound infection, three cases (12.5%) of seroma, one case (4.1%) of hematoma; and one case (4.1%) of wound dehiscence. Late complications occurred in one case (4.1%) of hernia recurrence attributed to technical failure in the fixation of the mesh and in one case (4.1%) of chronic pain. There were no cases of exposure or rejection of the mesh.CONCLUSION: The subcostal incisional hernia, though not very relevant, requires adequate surgical treatment. Its surgical correction involves rebuilding the muscle-aponeurotic defect, supra-aponeurotic fixation of polypropylene mesh, with less complexity and lower rates of complications and recurrences.

Increased risk of postoperative complications with retromuscular mesh placement in emergency incisional hernia repair: A nationwide register-based cohort study

2020 ◽  
pp. 145749692096623
Author(s):  
N. Juul ◽  
N. A. Henriksen ◽  
K. K. Jensen
Keyword(s):  
Postoperative Complications ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Incisional Hernia Repair ◽  
Secondary Outcome ◽  
Emergency Setting ◽  
Mesh Placement ◽  
Increased Risk ◽  
Elective Repair ◽  
Onlay Mesh

Introduction: Incisional hernia is common after abdominal surgery. Watchful waiting carries the risk of incarceration and a need for emergency intervention. The aim of this study was to examine the risk of postoperative complications after emergency versus elective incisional hernia repair. Methods: Patients above 18 years of age undergoing open incisional hernia repair in Denmark in 2017–2018 were identified in the Danish Ventral Hernia Database. Patients were grouped according to elective or emergency hernia repair. The primary outcome was postoperative complications requiring operative intervention within 90 days, and the secondary outcome was postoperative length of stay. Results: We included 1050 patients, of whom 882 were admitted for elective and 168 for emergency operation. Patients undergoing emergency repair were older (64.7 years vs 59.2 years, p < 0.001), more often smokers (25.8% vs 13.6%, p = 0.003), and more often had a Charlson comorbidity score ⩾2 (26.8% vs 19.2%, p = 0.005) compared to patients undergoing elective repair. In a multivariate regression analysis, emergency compared to elective operation (OR = 2.71, 95% CI = 1.4–5.25, p = 0.003) and retromuscular compared to onlay mesh placement (OR = 2.14, 95% CI = 1.08–4.24, p = 0.013) were factors significantly associated with increased risk of postoperative complications. In a subgroup analysis including only emergency repairs, risk of complications after retromuscular mesh placement was even higher (OR = 10.12, 95% CI = 1.81–56.68, p = 0.008). Conclusion: Emergency incisional hernia repair was associated with increased risk of postoperative complications and this risk was accentuated with retromuscular mesh placement. The use of retromuscular mesh in the emergency setting should be avoided, and the abdominal wall could either be closed by sutures or additional onlay mesh.

scholarly journals Modified Peritoneal Flap Hernioplasty Versus Retromuscular Technique for Incisional Hernia Repair: a Retrospective Cohort Study

2019 ◽  
Vol 109 (4) ◽  
pp. 279-288 ◽  
Author(s):  
P. Petersson ◽  
A. Montgomery ◽  
U. Petersson
Keyword(s):  
Cohort Study ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Incisional Hernia Repair ◽  
Hernia Recurrence ◽  
Short Term ◽  
Peritoneal Flap ◽  
Incisional Hernia Recurrence

Background and Aims: We present an open retromuscular mesh technique for incisional hernia repair, the modified peritoneal flap hernioplasty, where the fascia is sutured to the mesh and the hernia sac utilized for anterior mesh coverage. The aim was to describe the modified peritoneal flap hernioplasty technique and to compare it to a retromuscular repair, without component separation, regarding short-term complications, patient satisfaction, abdominal wall complaints, and recurrent incisional hernia. Materials and Methods: Consecutive patients operated electively with modified peritoneal flap hernioplasty technique (December 2012–December 2015) or retromuscular technique (Jan 2011–Oct 2014) were included in a retrospective single-center cohort study. Outcomes were evaluated from the Swedish Ventral Hernia Registry, by chart review, physical examination, and an abdominal wall complaints questionnaire. Results: The modified peritoneal flap hernioplasty group ( n = 78) had larger hernias (mean width 10.4 vs 8.5 cm, p = 0.005), more advanced Centers for Disease Control classification ( p = 0.009), and more simultaneous gastrointestinal-tract surgery (23.1% vs 11.5%, p = 0.041) than the retromuscular group ( n = 96). No difference in short-term complications was seen. Incisional hernia recurrence was lower in the modified peritoneal flap hernioplasty group (1.4% vs 10.3%, p = 0.023), and patients were more satisfied (93.8% vs 81.7%, p = 0.032). Follow-up time was shorter in the modified peritoneal flap hernioplasty group (614 vs 1171 days, p < 0.001). Conclusion: This retrospective study showed similar rates of short-term complications, despite more complex hernias in the modified peritoneal flap hernioplasty group. Furthermore, a lower incisional hernia recurrence rate for the modified peritoneal flap hernioplasty technique compared with the retromuscular technique used in our department was found. If this holds true with equally long follow-up remains to be proven.

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

2005 ◽  
Vol 390 (5) ◽  
pp. 408-412 ◽  
Author(s):  
Stefan Sauerland ◽  
Claus-Georg Schmedt ◽  
Silke Lein ◽  
Bernhard J. Leibl ◽  
Reinhard Bittner
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Polypropylene Mesh ◽  
Incisional Hernia Repair

scholarly journals Mesh fixation to fascia during incisional hernia repair results in increased prevalence of pain at long-term follow up: a multicenter propensity score matched prospective observational study

2021 ◽  
Author(s):  
Andreas Kohler ◽  
Joël L. Lavanchy ◽  
Rahel Gasser ◽  
Roland Wyss ◽  
Lars Nowak ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Propensity Score ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Mesh Fixation ◽  
Incisional Hernia Repair ◽  
Hernia Recurrence ◽  
Long Term Follow Up

Abstract Background Patient-reported outcomes such as postoperative pain are critical for the evaluation of outcomes after incisional hernia repair. The aim of this study is to determine the long-term impact of mesh fixation on postoperative pain in patients operated by open and laparoscopic technique. Methods A multicenter prospective observational cohort study was conducted from September 2011 until March 2016 in nine hospitals across Switzerland. Patients undergoing elective incisional hernia repair were included in this study and stratified by either laparoscopic or open surgical technique. Propensity score matching was applied to balance the differences in baseline characteristics between the treatment groups. Clinical follow-up was conducted 3, 12 and 36 months postoperatively to detect hernia recurrence, postoperative pain and complications. Results Three-hundred-sixty-one patients were included into the study. No significant differences in hernia recurrence and pain at 3, 12 and 36 months postoperatively were observed when comparing the laparoscopic with the open treatment group. Mesh fixation by sutures to fascia versus other mesh fixation led to significantly more pain at 36 months postoperatively (32.8% vs 15.7%, p = 0.025). Conclusions At long-term follow-up, no difference in pain was identified between open and laparoscopic incisional hernia repair. Mesh fixation by sutures to fascia was identified to be associated with increased pain 36 months after surgery. Omitting mesh fixation by sutures to the fascia may reduce long-term postoperative pain after hernia repair.

scholarly journals Role of laparoscopy in incisional hernia and relative benefit of the laparoscopic incisional hernia repair to the open incisional hernia repair

2020 ◽  
Vol 7 (7) ◽  
pp. 2165
Author(s):  
Sudhir Singh Pal ◽  
Azad Kumar Mourya
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Mesh Repair ◽  
Laparoscopic Group ◽  
Incisional Hernia Repair ◽  
Visual Analogue Score ◽  
Laparoscopic Incisional Hernia Repair ◽  
Post Operative Pain ◽  
Open Mesh Repair

Background: Incisional hernia is a common complication of abdominal surgery. Historically the open repair with or without mesh was the mainstay of treatment. However, many recently published laparoscopic repair studies have challenged surgeons to re-evaluate which technique provides the best short and long term outcomes.Methods: The study was conducted on 50 patients admitted at GMC Bhopal with approval from college ethical committee.Results: In 50 cases 21 were male and 29 were female. 7 male (14%) and 15 female (30%) patients had undergone laproscopic mesh repair (LMR) and 14 male (28%) and 14 female (28%) patients had undergone open mesh repair (OMR). Total complication in OMR group is 10 (35%) and in LMR group is 2 (9.09%). Mean duration of hospital stay in LMR group was 6.6 days and in OMR group was 15.57 days. Post-operative patients of LMR group returned back to the work early (mean 12 days) compared to OMR group (mean 20.7 days). Mean post-operative day of movement in LMR group was 1 day and in OMR group was 2.03 days. Pain measured using visual analogue score on 3rd post-operative day showed decreased pain score in laparoscopic group (mean 2) compared to open group (mean 5.35).Conclusions: Laparoscopic incisional hernia repair provides lesser post-operative pain, lesser complications, shorter hospital stay and lesser economic impact as they returned to work early. Thus patients have less morbidity and improved quality of life. 

Outcomes for Incisional Hernia Repair in Patients Undergoing Concomitant Surgical Procedures

2012 ◽  
Vol 78 (2) ◽  
pp. 243-249 ◽  
Author(s):  
Laura K. Altom ◽  
Laura A. Graham ◽  
Stephen H. Gray ◽  
Christopher W. Snyder ◽  
Catherine C. Vick ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Surgical Procedures ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Incisional Hernia Repair ◽  
Cox Proportional Hazards ◽  
Mesh Placement ◽  
Clean Contaminated ◽  
Operative Notes

The safety and efficacy of performing concomitant surgical procedures with an incisional hernia repair (IHR) is not well understood. There are conflicting reports on the outcomes for permanent mesh implantation in the setting of clean-contaminated procedures. The purpose of this study was to review the effect of concomitant surgical procedures on IHR outcomes. This is a retrospective multisite cohort of patients undergoing elective IHR at 16 Veterans Affairs hospitals from 1998 to 2002. Concomitant procedure status, hernia characteristics, and operative details were determined using physician-abstracted operative notes. Hernia outcomes of recurrence and mesh explantation were determined from the medical chart. χ2 tests, Kaplan-Meier curves, and Cox regression were used to evaluate the effects of concomitant status on hernia outcomes. Of the 1495 elective IHRs, 75 (4.8%) were same site and 56 (3.8%) different site concomitant procedures. At median follow-up of 69.3 months (range 19.1–98.3), 33.6 per cent of patients had a recurrence, mesh explantation, or both. Permanent mesh placement was less likely among concomitant procedures as compared with nonconcomitant procedures ( P < 0.0001). Adjusted Cox proportional hazards models of hernia outcomes resulted in an increased hazard for recurrence among same site clean procedures (Hazard Ratio (HR) = 1.8, P = 0.03) and an increased hazard for mesh explantation among same site clean-contaminated procedures (HR = 8.4, P = 0.002). Concomitant same site procedures are significantly associated with adverse hernia outcomes as compared with isolated IHR or IHR with other site concomitant procedures. The high failure rate of hernia repairs among same site concomitant procedures should be taken into account during the surgical decision-making process.

scholarly journals A new three-step hybrid approach is a safe procedure for incisional hernia: early experiences with a single centre retrospective cohort

Hernia ◽  
2020 ◽  
Author(s):  
L. Matthijs van den Dop ◽  
Gijs H. J. de Smet ◽  
Michaël P. A. Bus ◽  
Johan F. Lange ◽  
Sascha M. P. Koch ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Incisional Hernia Repair ◽  
Hernia Recurrence ◽  
Perioperative Outcomes ◽  
Safe Procedure ◽  
Intraoperative Complication ◽  
Hybrid Repair

Abstract Purpose In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined: so-called ‘three-step incisional hybrid repair’. The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh. Objectives To evaluate first perioperative outcomes with this technique. Methods From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤ 10 cm underwent a elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed. Results Mean operation time was 100 min. Mean hernia size was 4.8 cm; 45 patients (64.3%) had a hernia of 1–5 cm, 25 patients (35.7%) of 6–10 cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3 days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5 weeks. Conclusion A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low.

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