[Management of large abdominal wall hernias with foreign implant materials (Gore-Tex patch)].

OBJECTIVE: Incisional hernia repair with conventional techniques (simple closure, Mayo) is associated with high recurrence rates in the range of 30-50%. Surgical repair using different prosthetic biomaterials gains more and more acceptance. Therefore we wanted to evaluate our own results of hernia repair and analyze the results of a mesh hernioplasty using an expanded polytetrafluoroethylene patch (ePTFE).

PATIENTS AND METHODS: 1. During the study period (1984-1992) a total of 205 hernia repairs (148 primary repairs, 57 repairs for recurrent hernia) were done in 173 patients at our institution using the following techniques: Mayo technique n = 90, simple one layer suture n = 56, absorbable mesh n = 25, ePTFE n = 17, other mesh techniques n = 17. In a retrospective study 135 of these patients (78%) could be examined clinically. The average follow up time was 44 months (10-105). 2. Since 1988 we used the ePTFE patch (Gore-tex Soft Tissue Patch) in selected cases for incisional hernia repair. In a second retrospective analysis the course of 26 patients, who were operated between 1988 and 1994, is reported.

RESULTS: 1. Local wound complications occurred in 3-6% with conventional techniques and in 11-13% after different types of mesh repair (n.s.). Overall recurrence rates were 30% for primary hernia repair and 38% for recurrent hernia repair without statistically different rates for the various techniques. The presence of two or more patient dependent risk factors (obesity, obstructive lung disease etc.) (p < 0.05) and hernia diameter > 5 cm (p < 0.05) were identified as risk factors for hernia recurrency. 2. In the ePTFE group one patient (4%) developed a superficial wound complication, in another three patients (12%) the patch had to be removed due to deep wound infections. All three patients had revealed septic wound complications after previous surgery. The recurrence rates (17% for primary repair and 20% for repeated repair) were clearly lower compared to conventional techniques.

CONCLUSIONS: The use of prosthetic mesh should be considered for repair of large or recurrent incisional hernias, especially in high risk patients (obesity, obstructive lung disease). Beside the most often used polypropylene mesh, the ePTFE patch (Gore-tex-Soft-Tissue-Patch) represents a valuable alternative in selected cases with direct contact of the prosthesis to abdominal viscera. Any previous septic wound complication or a contaminated operating field (e.g. colostomy) seems to be a contraindication for its use.