Mesh-reinforced ventral hernia repair: preference for 2 techniques

John J Gleysteen
Archives of Surgery 2009, 144 (8): 740-5

HYPOTHESIS: Long-term (5-year) recurrence rates are comparable between onlay vs retrorectus mesh-reinforced ventral hernia repairs.

DESIGN: Retrospective study of prospective data collection.

SETTING: University and Veterans Affairs hospitals.

PATIENTS: One hundred twenty-five patients treated between February 1988 and September 2001. Ninety-four patients were male. The mean patient age was 56 years (age range, 29-80 years). Fifty percent of patients were smokers, and 32.0% were obese; comorbidities were similar in the 2 cohorts studied.

INTERVENTIONS: Open surgical extraperitoneal prosthetic mesh reinforcement of the incisional closure among 75 patients (onlay repair [cohort OR]) or in the retrorectus position among 50 patients (retrorectus repair [cohort RR]).

MAIN OUTCOME MEASURES: Recurrent hernia, wound infection, and intestinal fistulas.

RESULTS: Nine patients in cohort OR and 2 patients in cohort RR (8.8%) had wound infections; no fistulas occurred. Complications were similar in the 2 cohorts. One mortality occurred. All hernias recurred at the cranial or caudal edge of the mesh. The median recurrence rates were 20.0% at 15 months in the OR cohort and 4.0% at 9 months in cohort RR (P < .02). Follow-up periods averaged 64 months. Three other patients in cohort OR developed subsequent hernia adjacent to their mesh reinforcement at 72, 73, and 86 months.

CONCLUSIONS: Extraperitoneal mesh reinforcement avoids intestinal complications and subsequent operations to remove mesh. Recurrence is more frequent after onlay mesh reinforcement and usually occurs at the cranial or caudal edge of the mesh within the first 2 years after hernia repair. Retrorectus repair is the preferred open surgical treatment of incisional hernia, but it has not been universally applicable. Hernias developing 6 to 7 years after surgery are not the result of failed earlier repairs.

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