INTRAPERITONEAL MESH PLASTY

Background: Incisional hernia is a common surgical condition with a reported incidence of 2-11% following laparotomy. Various Modalities of Repair have been advocated but the overall results still remain disappointing. Objective: To evaluate in incisional Hernias the efficacy and safety of Intraperitoneal mesh repair with conventional Polypropylene Mesh. Setting: In CMH Muzaffarabad, CMH Sialkot and PAC Hospital Kamra. Period: From January 2000 to January 2007. Materials & Methods: 90 cases of Incisional hernia with a minimal defect size of 4 inches were included; there was no limitation to age and sex. Patients with Co morbid conditions like Diabetes Mellitus, Hypertension, Bronchial Asthma, and Ischemic Heart Disease etc: were also included if there was no other contraindications for Surgery. Observations were made with regard to duration and ease of the operation, wound complications, hospital stay, recurrence and delayed complications. Results: In our series of 90 patients, Females (92.22%, n= 83) outnumbered males (7.77%, n=7) and the highest incidence was in the 4th decade of life in females and the 3rd decade of life in males. Gynecological operations accounted for 61.44% (n=51) of the index operations. 77.7% (n=70) ofpatients had a BMI >30. Co morbid Conditions were present in 36.66% (n=33) of patients. The polypropylene mesh placed Intra peritoneal varied from 15×7.5 cm to 30×20 cm. The mean operating time was 60±20 minutes; operating time was extended when the procedure was accompanied by Dermolipectomy 80±10 minutes. 85.55% patients (n=77) attended our follow-up, ranging from 12 months to five years.Method of follow-up in outpatients department (OPD)/Clinics: 71.11%(n=64), by telephonic conversation: 12.22%(n=11). 14.44% (n=13) were lost in follow up. All patients in followup had serial abdominal sonograms at 3, 6, 9 and 12 months postoperatively respectively to evaluate bowel motility, adhesion formation and any locally associated complication. No recurrence was noted in the follow-up group. Conclusions:Historically intraperitoneal Mesh placement of conventional polypropylene has been avoided as it was associated with significant postoperative complications. Based on our analysis, we believe that intraperitoneal mesh repair is still an effective option for Incisional hernias, especially in difficult cases and with patients having co morbid conditions. The associated high incidence of complications associated with intraperitoneal mesh placement in the literature were not seen in our experience.

Intraperitoneal Mesh Repair for Incisional Hernia

Seventy-three patients who had incisional hernia repair at two hospitals, a government and a private, from 2000 to 2005 were reviewed. Fifty-nine (80.8%) patients were females and 52 (71.2%) patients were Saudi. Five (6.8%) patients had minor complications. Twenty-four (32.9%) patients had polypropylene mesh while 49 (67.1%) patients had Vypro mesh, both types where fixed intraperitoneally using absorbable Vicryl 2/0 interrupted suture. No differences in complications, duration of surgery, or hospital stay between patients using either Vypro or PROLENE mesh. Intraperitoneal mesh placement of incisional hernia is safe on short and long-term follow-up. Vypro mesh compares favorably with PROLENEmesh. The authors encountered no enterocutaneous fistula and experienced only 2 (2.7%) recurrences over one year.