Preventing Hernia Recurrence: Optimising Mesh Use in Incisional Hernia Repair

Incisional hernia is a common complication of abdominal surgery, affecting up to a quarter of patients undergoing laparotomy. This case report discusses a 72-year-old lady with a recurrent incisional hernia following an emergency Hartman’s procedure. The discussion covers the properties of synthetic vs biological meshes, the significance of the anatomical location of the mesh, fixation methods, laparoscopic surgery, short and long term complications. Key points: The ideal mesh is biocompatible, strong, resistant to infection, has minimal bioreactivity and non-immunogenic Pore size is important to the degree of mesh integration, infection risk and the development of chronic pain Synthetic mesh is useful in contaminated cases but adds a significant cost to the procedure Sublay mesh placement is associated with a reduced risk of recurrence Most recurrences occur at the edge of the mesh. Surgeons should ensure a 5cm overlap between the mesh and native tissues and consider dual fixation methods Laparoscopic hernia repair has been associated with a shorter post-op recovery, less pain and a short term reduced risk of recurrence, however there is a greater risk of bowel injury and development of adhesions Composite meshes can reduce the risk of adhesions with intraperitoneal mesh placement Chronic pain is associated with the use of tacks, heavy weight synthetic meshes and chronic infection Resorbable meshes have not been shown to reduce chronic pain The choice of mesh, method of repair and surgical approach should be individualised to the patient.

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Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair

Surgical Endoscopy ◽

10.1007/s00464-001-9202-7 ◽

2002 ◽

Vol 16 (12) ◽

pp. 1713-1716 ◽

Cited By ~ 85

Author(s):

M. Riet ◽

P.J. Steenwijk ◽

G.J. Kleinrensink ◽

E.W. Steyerberg ◽

H.J. Bonjer

Keyword(s):

Tensile Strength ◽

Incisional Hernia ◽

Hernia Repair ◽

Mesh Fixation ◽

Incisional Hernia Repair ◽

Laparoscopic Incisional Hernia Repair ◽

Fixation Methods

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Vacuum suction fixation versus staple fixation in TAPP laparoscopic hernia repair: introduction of a new technique for mesh fixation

Surgical Endoscopy ◽

10.1007/s00464-015-4168-z ◽

2015 ◽

Vol 30 (1) ◽

pp. 114-120 ◽

Cited By ~ 5

Author(s):

Guangyong Zhang ◽

Xiang Zhang ◽

Hanxiang Zhan ◽

Sanyuan Hu

Keyword(s):

Hernia Repair ◽

Laparoscopic Hernia Repair ◽

Mesh Fixation ◽

New Technique ◽

Vacuum Suction ◽

A New Technique ◽

Staple Fixation

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Preliminary Report of a Sutureless Onlay Technique for Incisional Hernia Repair Using Fibrin Glue Alone for Mesh Fixation

The American Surgeon ◽

10.1177/000313481307901121 ◽

2013 ◽

Vol 79 (11) ◽

pp. 1177-1180 ◽

Cited By ~ 16

Author(s):

Nathaniel Stoikes ◽

David Webb ◽

Ben Powell ◽

Guy Voeller

Keyword(s):

Hernia Repair ◽

Fibrin Glue ◽

Operative Time ◽

Mesh Fixation ◽

Prospective Trial ◽

Fascial Closure ◽

Mesh Placement ◽

Early Results ◽

Onlay Technique ◽

Primary Fascial Closure

The Rives repair for ventral/incisional (V/I) hernias involves sublay mesh placement requiring retrorectus dissection and transfascial stitches. Chevrel described a repair by onlaying mesh after a unique primary fascial closure. Although Chevrel fixated mesh to the anterior fascia with sutures, he used fibrin glue for fascial closure reinforcement. We describe an onlay technique with mesh fixated to the anterior fascia solely with fibrin glue without suture fixation. From January 2010 to January 2012, 50 patients underwent a V/I hernia onlay technique with fibrin glue mesh fixation. Records were reviewed for technical details, demographics, mesh characteristics, and postoperative outcomes. Primary fascial closure with interrupted permanent suture was done with or without myofascial advancement flaps. Onlay polypropylene mesh was placed providing 8 cm of overlap. Fibrin glue was applied over the prosthesis and subcutaneous drains were placed. Mean age was 62.4 years. Mean body mass index was 30.1 kg/m2. Average mesh size was 14.5 cm 3 19.1 cm. Mean operative time was 144.4 minutes (range, 38 to 316 minutes). Mean discharge was postoperative Day 2.9 (range, 0 to 15 days). Morbidity included eight seromas, one hematoma, and three wound infections. Seventeen patients required components separation. Mean follow-up was 19.5 months with no recurrences. This is the first series describing fibrin glue alone for mesh fixation for V/I hernia repair. It allows for immediate prosthesis fixation to the anterior fascia. Early results are promising. Potential advantages include less operative time, less technical difficulty, and less long-term pain. A prospective trial is needed to evaluate this approach.

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The impact of atraumatic fibrin sealant vs. staple mesh fixation in TAPP hernia repair on chronic pain and quality of life: results of a randomized controlled study

Surgical Endoscopy ◽

10.1007/s00464-011-1862-3 ◽

2011 ◽

Vol 26 (1) ◽

pp. 249-254 ◽

Cited By ~ 47

Author(s):

R. H. Fortelny ◽

A. H. Petter-Puchner ◽

C. May ◽

W. Jaksch ◽

T. Benesch ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Hernia Repair ◽

Fibrin Sealant ◽

Mesh Fixation ◽

Randomized Controlled Study ◽

Controlled Study ◽

Randomized Controlled ◽

The Impact

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Mesh fixation techniques in primary ventral or incisional hernia repair

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd011563 ◽

2015 ◽

Cited By ~ 2

Author(s):

Maren Walgenbach ◽

Tim Mathes ◽

Robert Siegel ◽

Michaela Eikermann

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Mesh Fixation ◽

Incisional Hernia Repair ◽

Fixation Techniques

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Outcomes for Incisional Hernia Repair in Patients Undergoing Concomitant Surgical Procedures

The American Surgeon ◽

10.1177/000313481207800246 ◽

2012 ◽

Vol 78 (2) ◽

pp. 243-249 ◽

Cited By ~ 3

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.

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Laparoscopic Spigelian Hernia Repair: The Scroll Technique

The American Surgeon ◽

10.1177/000313480807400203 ◽

2008 ◽

Vol 74 (2) ◽

pp. 108-112 ◽

Cited By ~ 2

Author(s):

Alan A. Saber ◽

Mohamed H. Elgamal ◽

Arun J. Rao ◽

Robert L. Osmer ◽

Ed A. Itawi

Keyword(s):

Hernia Repair ◽

Laparoscopic Repair ◽

Operative Time ◽

Simple Technique ◽

Mesh Fixation ◽

Case Series ◽

Spigelian Hernia ◽

Mesh Placement ◽

Vague Abdominal Pain

Spigelian hernia is a rare clinical entity. It has a subtle clinical presentation with vague abdominal pain that may warrant laparoscopy. Even though laparoscopic ventral hernia repair is increasingly popular, laparoscopic repair of spigelian hernia has not been adequately studied. Eight patients who underwent laparoscopic spigelian hernia repair are presented herein, along with a description of our simple technique for mesh placement. In addition, literature review of laparoscopic repair of spigelian hernia is also presented. Our case series included six females and two males; two patients presented acutely whereas the others presented with chronic pain. Laparoscopic repair was successfully performed in all of our patients with a mean operative time of 92.5 minutes. There were no postoperative complications or recurrence with a mean follow up of 36 months. Our scroll technique for laparoscopic repair is simple and feasible. It minimizes intra-corporeal mesh manipulation, facilitates mesh fixation to the anterior abdominal wall, and maintains a precise orientation of the mesh in relation to the defect.

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