Long-term complications associated with prosthetic repair of incisional hernias.
OBJECTIVE
To determine whether the type of prosthetic material and technique of placement influenced long-term complications after repair of incisional hernias.


METHODS
Retrospective cohort analytic study.


METHODS
University-affiliated hospital.


METHODS
Two hundred patients undergoing open repair of abdominal incisional hernias with prosthetic material between 1985 and 1994.


METHODS
Four types of prosthetic material were used and placed either as an onlay, underlay, sandwich, or finger interdigitation technique. The materials were monofilamented polypropylene mesh (Marlex, Davol Inc, Cranston, RI), double-filamented mesh (Prolene, Ethicon Inc, Somerville, NJ), expanded polytetrafluroethylene patch (Gore-Tex, WL Gore & Associates, Phoenix, Ariz) or multifilamented polyester mesh (Mersilene, Ethicon Inc).


METHODS
The incidence of recurrence and complications such as enterocutaneous fistula, bowel obstruction, and infection with each type of material and technique of repair were compared with univariate and multivariate analysis.


RESULTS
On univariate analysis, multifilamented polyester mesh had a significantly higher mean number of complications per patient (4.7 vs 1.4-2.3; P<.002), a higher incidence of fistula formation (16% vs 0%-2%; P<.001), a greater number of infections (16% vs 0%-6%; P<.05), and more recurrent hernias (34% vs 10%-14%; P<.05) than the other materials used. The additional mean length of stay to treat complications was also significantly longer (30 vs 3-7 days; P<.001) when polyester mesh was used. The deleterious effect of polyester mesh on long-term complications was confirmed on multiple logistic regression (P=.002). The technique of placement had no influence on outcome.


CONCLUSIONS
Polyester mesh should no longer be used for incisional hernia repair.
Leber
G E
GE
Department of Surgery, Baystate Medical Center Campus of Tufts University School of Medicine, Springfield, Mass 01199, USA.
Garb
J L
JL
Alexander
A I
AI
Reed
W P
WP
D017577:Cutaneous Fistula / Q000453:epidemiology; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007412:Intestinal Fistula / Q000453:epidemiology; D007415:Intestinal Obstruction / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates / Q000009:adverse effects; D011095:Polyethylenes / Q000009:adverse effects; D011126:Polypropylenes / Q000009:adverse effects; D011138:Polytetrafluoroethylene / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D019736:Prostheses and Implants / Q000009:adverse effects*; D019919:Prosthesis Implantation; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors
C016674:Plastipore; D011093:Polyethylene Terephthalates; D011095:Polyethylenes; D011126:Polypropylenes; C025539:Lavsan; D011138:Polytetrafluoroethylene