Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia

Abstract

Objective: The objective of this study was to determine the best treatment of incisional hernia, taking into account recurrence, complications, discomfort, cosmetic result, and patient satisfaction. Background: Long-term results of incisional hernia repair are lacking. Retrospective studies and the midterm results of this study indicate that mesh repair is superior to suture repair. However, many surgeons are still performing suture repair. Methods: Between 1992 and 1998, a multicenter trial was performed, in which 181 eligible patients with a primary or first-time recurrent midline incisional hernia were randomly assigned to suture or mesh repair. In 2003, follow-up was updated. Results: Median follow-up was 75 months for suture repair and 81 months for mesh repair patients. The 10-year cumulative rate of recurrence was 63% for suture repair and 32% for mesh repair (P Ͻ 0.001). Abdominal aneurysm (P ϭ 0.01) and wound infection (P ϭ 0.02) were identified as independent risk factors for recurrence. In patients with small incisional hernias, the recurrence rates were 67% after suture repair and 17% after mesh repair (P ϭ 0.003). One hundred twenty-six patients completed long-term follow-up (median follow-up 98 months). In the mesh repair group, 17% suffered a complication, compared with 8% in the suture repair group (P ϭ 0.17). Abdominal pain was more frequent in suture repair patients (P ϭ 0.01), but there was no difference in scar pain, cosmetic result, and patient satisfaction. Conclusions: Mesh repair results in a lower recurrence rate and less abdominal pain and does not result in more complications than suture repair. Suture repair of incisional hernia should be abandoned. (Ann Surg 2004;240: 578 -585)

Polypropylene Meshes to Prevent Abdominal Herniation. Can Stable Coatings Prevent Adhesions in the Long Term?

“…Incisional hernias are a major surgical complication occurring in at least 10-20% of all abdominal operations and need to be repaired in about one third of these patients. 6,17 Large trials have shown that hernia repair should be performed by mesh placement and no longer by primary resuturing of the hernia because of unacceptably high recurrence rates. 7,19 Mesh repair, however, is not free from complications, with significant factors being technical failure such as insufficient fixation of the mesh to the abdominal wall and complications which are a result of the mesh biomaterial itself.…”

“…16,22 The best method to repair these hernias is to implant a synthetic mesh that bridges the abdominal wall defect in a tension-free manner. [6][7][8]20 Such meshes are implanted in an open procedure or, with increasing frequency, laparoscopically. Despite important clinical successes, it is obvious that the ''ideal'' mesh is still not available.…”

Colonization by human fibroblasts of polypropylene prosthesis in a composite form for hernia repair

“…In an effort to reduce recurrence rates, synthetic meshes are employed, and their introduction was a milestone in hernia repair [3]. The ideal mesh should have no adhesion potential, excellent tissue integration, minimal shrinkage, and should be easy to use.…”

Development of incisional herniation after midline laparotomy

“…From earlier studies it is known that the rate of incisional hernia increases during longer follow‐up18. In a comparison of suture repair with mesh repair of incisional hernia, delayed incisional hernia recurrence was shown after 10 years of follow‐up19. Experimental evidence, however, is supportive of the small‐bites technique.…”