title: Protrusion of prosthetic meshes in repair of inguinal hernias.
abstract: BACKGROUND
  Although techniques with prosthetic meshes have improved results of inguinal hernia repair, the problem of recurrence remains. In addition to patient- and surgeon-related causes, protrusion of prosthetic mesh through the hernia defect can be considered as a factor of recurrence.
  
  
  METHODS
  To simulate inguinal hernia, porcine tissue with standardized defects (3, 4, and 5 cm) was used. Nine different meshes (9 cm diameter) were positioned on the defects. In a pressure chamber the depth of protrusion through the defect was assessed. Both sides of each mesh were measured. Protrusion at a pressure representing Valsalva pressure was used for statistical analysis.
  
  
  RESULTS
  Protrusion, including the incidence of collapse, increased with larger defect sizes. Significant protrusion differences were found between different meshes and occasionally between the 2 sides of the same mesh.
  
  
  CONCLUSIONS
  The differences between the effects of the various meshes emphasize the importance of material characteristics when developing new surgical techniques. The 3 meshes showing least protrusion are considered especially suitable when repairing large defects or when preferring a small mesh when repairing inguinal hernias with a preperitoneal sublay approach.
authors.affiliation: Lowlands Institute of Surgical and Applied Surgery, Department of Neurosciences, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Kes
authors.forename: Johan
authors.initials: J
authors.lastname: Lange
authors.forename: Jaap
authors.initials: J
authors.lastname: Bonjer
authors.forename: Rob
authors.initials: R
authors.lastname: Stoeckart
authors.forename: Paul
authors.initials: P
authors.lastname: Mulder
authors.forename: Chris
authors.initials: C
authors.lastname: Snijders
authors.forename: Gertjan
authors.initials: G
authors.lastname: Kleinrensink
mesh_terms: D000818:Animals; D004548:Elasticity; D017276:Friction; D006552:Hernia, Inguinal / Q000601:surgery*; D066298:In Vitro Techniques; D008422:Materials Testing; D011312:Pressure; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D013526:Surgical Mesh; D034421:Sus scrofa