A comparison of suture repair with mesh repair for incisional hernia.
BACKGROUND
Incisional hernia is an important complication of abdominal surgery. Procedures for the repair of these hernias with sutures and with mesh have been reported, but there is no consensus about which type of procedure is best.


METHODS
Between March 1992 and February 1998, we performed a multicenter trial in which we randomly assigned to suture repair or mesh repair 200 patients who were scheduled to undergo repair of a primary hernia or a first recurrence of hernia at the site of a vertical midline incision of the abdomen of less than 6 cm in length or width. The patients were followed up by physical examination at 1, 6, 12, 18, 24, and 36 months. Recurrence rates and potential risk factors for recurrent incisional hernia were analyzed with the use of life-table methods.


RESULTS
Among the 154 patients with primary hernias and the 27 patients with first-time recurrent hernias who were eligible for the study, 56 had recurrences during the follow-up period. The three-year cumulative rates of recurrence among patients who had suture repair and those who had mesh repair were 43 percent and 24 percent, respectively, with repair of a primary hernia (P=0.02; difference, 19 percentage points; 95 percent confidence interval, 3 to 35 percentage points). The recurrence rates were 58 percent and 20 percent with repair of a first recurrence of hernia (P=0.10; difference, 38 percentage points; 95 percent confidence interval, -1 to 78 percentage points). The risk factors for recurrence were suture repair, infection, prostatism (in men), and previous surgery for abdominal aortic aneurysm. The size of the hernia did not affect the rate of recurrence.


CONCLUSIONS
Among patients with midline abdominal incisional hernias, mesh repair is superior to suture repair with regard to the recurrence of hernia, regardless of the size of the hernia.
Department of Plastic and Reconstructive Surgery, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
R W
RW
Luijendijk
W C
WC
Hop
M P
MP
van den Tol
D C
DC
de Lange
M M
MM
Braaksma
J N
JN
IJzermans
R U
RU
Boelhouwer
B C
BC
de Vries
M K
MK
Salu
J C
JC
Wereldsma
C M
CM
Bruijninckx
J
J
Jeekel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013526:Surgical Mesh / Q000009:adverse effects; D013537:Sutures / Q000009:adverse effects
D011126:Polypropylenes