The marked reduction in recurrence rates following reinforcement of the abdominal wall by meshes in incisional hernia has promoted their increasingly widespread use. The primary suture in technique failed more than half of the cases; therefore, the closure method needs to be changed and improved, particularly with regard to a possibly underlying defect in collagen metabolism. After more than 100 years of mesh development they are mainly placed in a sublay or onlay position, ePTFE, polyester and polypropylene are preferred. In any case the mesh has to overlap the defect sufficiently because of wound contraction. On the basis of our experience and reports in the literature, the advantages and disadvantages of various mesh techniques and mesh materials are discussed. However, because longterm studies are missing, the relevance of the cumulative risk for long-term complications such as mesh migration and fistula formation, the extent of patient complaints or the potential risk of a persistent foreign-body reaction cannot yet be ascertained. Nevertheless, because there are no surgical alternatives, meshes represent an improvement in hernia surgery that cannot be overestimated.
The influence of mesh material on the clinical outcome of hernia repair has often been neglected, although recent studies have clearly demonstrated the importance of mesh properties for integration in the abdominal wall. Of particular significance are the amount of mesh material and the pore size. In the following study, patients received different mesh types with distinct amounts of polypropylene and of various pore sizes for incisional hernia repair. We investigated whether the type of material influenced the clinical and functional outcomes. Between 1991 and 1999, 235 patients received polypropylene meshes in a sublay position for incisional hernia repair: 115 patients were implanted with a Marlex heavy-weight mesh (Mhw mesh), 37 patients with an Atrium heavy-weight mesh (Ahw mesh) and 83 with a Vypro low-weight mesh (Vlw mesh). The study protocol included ultrasound examination and 3D-stereography in all patients, with a total follow-up of 24 +/- 13 months (Mhw-mesh), 11 +/- 8 months (Ahw-mesh) and 8 +/- 7 months (Vlw-mesh). Our findings demonstrate that the side effects of mesh implantation, comprising paraesthesia and restriction of abdominal wall mobility, were significantly affected by the type of material implanted. Three-dimensional stereographic examinations were well in accordance with our clinical findings. Our data support the hypothesis that the use of low-weight large-pore meshes is advantageous for abdominal wall function.
The marked reduction in recurrence rates following reinforcement of the abdominal wall by meshes in incisional hernia has promoted their increasingly widespread use. The primary suture in technique failed more than half of the cases; therefore, the closure method needs to be changed and improved, particularly with regard to a possibly underlying defect in collagen metabolism. After more than 100 years of mesh development they are mainly placed in a sublay or onlay position, ePTFE, polyester and polypropylene are preferred. In any case the mesh has to overlap the defect sufficiently because of wound contraction. On the basis of our experience and reports in the literature, the advantages and disadvantages of various mesh techniques and mesh materials are discussed. However, because long-term studies are missing, the relevance of the cumulative risk for long-term complications such as mesh migration and fistula formation, the extent of patient complaints or the potential risk of a persistent foreign-body reaction cannot yet be ascertained. Nevertheless, because there are no surgical alternatives, meshes represent an improvement in hernia surgery that cannot be overestimated.
The recognized difficulties still cause a loss of time and in some cases complications, which can only partly be compensated by the surgeon's experience. This leads to reluctance in the application of laparoscopic cholecystectomy in more complicated stages of the disease. Two-dimensional view satisfies the surgeon's demands for a safe procedure.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.