D Berger1, M Bientzle. 1. Department of Surgery, Stadtklinik, Balgerstrasse 50, 76532 Baden-Baden, Germany. d.berger@klinikum-mittelbaden.de
Abstract
BACKGROUND: Today, the laparoscopic approach is a standard procedure for the repair of incisional hernias. However, the direct contact of visceral organs with mesh material is a major issue. PATIENTS AND METHODS: This prospective observational study presents the data of 344 patients treated for incisional and parastomal hernias with a new mesh made of polyvinylidene fluoride (PVDF; Dynamesh IPOM) between May 2004 and January 2008 with a minimum follow-up of 6 months. The median follow-up of 297 patients after incisional hernias totaled 24 months and 20 months for 47 patients with parastomal hernias. Incisional hernias were repaired using an IPOM technique. For parastomal hernias, a recently described sandwich technique was used with two meshes implanted in an intraperitoneal onlay position. RESULTS: The recurrence rate for incisional hernias was 2/297 = 0.6% and 1/47 = 2% for parastomal hernias. Three patients developed a secondary infection after surgical revision or puncture of a seroma. One patient had a bowel fistula through the mesh, with an abscess in the hernia sac. In all cases, the infection healed and the mesh could be preserved. No long-term mesh-related complications have been observed. CONCLUSION: The laparoscopic repair of incisional and parastomal hernias with meshes made of PVDF (Dynamesh IPOM) revealed low recurrence and, overall, low complication rates. Especially in cases of infection, the material proved to be resistant without clinical signs of persistent bacterial contamination. Mesh-related complications did not occur during the follow-up.
BACKGROUND: Today, the laparoscopic approach is a standard procedure for the repair of incisional hernias. However, the direct contact of visceral organs with mesh material is a major issue. PATIENTS AND METHODS: This prospective observational study presents the data of 344 patients treated for incisional and parastomal hernias with a new mesh made of polyvinylidene fluoride (PVDF; Dynamesh IPOM) between May 2004 and January 2008 with a minimum follow-up of 6 months. The median follow-up of 297 patients after incisional hernias totaled 24 months and 20 months for 47 patients with parastomal hernias. Incisional hernias were repaired using an IPOM technique. For parastomal hernias, a recently described sandwich technique was used with two meshes implanted in an intraperitoneal onlay position. RESULTS: The recurrence rate for incisional hernias was 2/297 = 0.6% and 1/47 = 2% for parastomal hernias. Three patients developed a secondary infection after surgical revision or puncture of a seroma. One patient had a bowel fistula through the mesh, with an abscess in the hernia sac. In all cases, the infection healed and the mesh could be preserved. No long-term mesh-related complications have been observed. CONCLUSION: The laparoscopic repair of incisional and parastomal hernias with meshes made of PVDF (Dynamesh IPOM) revealed low recurrence and, overall, low complication rates. Especially in cases of infection, the material proved to be resistant without clinical signs of persistent bacterial contamination. Mesh-related complications did not occur during the follow-up.
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