Adverse effects of intraperitoneal onlay mesh used for incisional hernia repair

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State: Public
Version: After imprimatur
Serval ID
serval:BIB_7202A1A4444B
Type
A Master's thesis.
Publication sub-type
Master (thesis) (master)
Collection
Publications
Institution
Title
Adverse effects of intraperitoneal onlay mesh used for incisional hernia repair
Author(s)
Augsburger A.
Director(s)
Vuilleumier H. A.
Codirector(s)
Aellen S.
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Accepted
Issued date
2011
Language
english
Number of pages
17
Abstract
Context: In the past 50 years, the use of prosthetic mesh in surgery has dramatically¦changed the management of primary, as well as incisional hernias. Currently, there¦are a large number of different mesh brands and no consensus on the best material,¦nor the best mesh implantation technique to use. The purpose of this study is to¦illustrate the adverse effects of intraperitoneal onlay mesh used for incisional¦hernia repair encountered in patients treated at CHUV for complications after¦incisional hernia repair.¦Materials & Methods: This work is an observational retrospective study. A PubMed¦search and a systematic review of literature were performed. Thereafter, the medical¦records of 22 patients who presented with pain, abdominal discomfort, ileus, fistula,¦abscess, seroma, mesh infection or recurrent incisional hernia after a laparoscopic or¦open repair with intra-abdominal mesh were reviewed.¦Results: Twenty-two persons were reoperated for complications after incisional¦hernia repair with a prosthetic mesh. Ten were male and twelve female, with a¦median age of 58,6 years (range 24-82). Mesh placement was performed by a¦laparoscopic approach in nine patients and by open approach in thirteen others.¦Eight different mesh brands were found (Ultrapro®, Mersilene®, Parietex Composite®,¦Proceed®, DynaMesh®, Gore® DualMesh®, Permacol®, Titanium Metals UK Ltd®).¦Mean time from implantation and reoperation for complication was 34.2 months¦(range 1-147). In our sample of 22 patients, 21 (96%) presented mesh adhesion and¦15 (68%) presented hernia recurrence. Others complications like mesh shrinkage,¦mesh migration, nerve entrapment, seroma, fistula and abscess were also evaluated.¦Conclusion: The majority of articles deal with complications induced by¦intraperitoneal prosthetic mesh, but the effectiveness of mesh has been studied¦mostly on experimental models. Actually and as shown in the present study,¦intraperitoneal mesh placement was associated with severe complications witch may¦potentially be life threatening. In our opinion, intraperitoneal mesh placement should¦only be reserved in exceptional situations, when the modified Rives-Stoppa could not¦be achieved and when tissues covering the mesh are insufficient.
Keywords
intraperitoneal mesh, incisional hernia repair, laparotomy incisional hernia repair, laparoscopic incisional hernia repair, adhesions
Create date
14/05/2012 16:18
Last modification date
20/08/2019 15:30
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