Primary incisional hernia repair with or without polypropylene mesh: a report on 384 patients with 5-year follow-up.
OBJECTIVE
Several studies have claimed that mesh repair of incisional hernia lowers recurrence rates when compared to suture repair. We investigated the relative effectiveness of mesh and suture repair in a large homogeneous cohort of patients with primary incisional hernia.


METHODS
In a retrospective single-centre cohort study, a total of 446 consecutive patients were identified, of whom 86% could be followed up. Mean length of follow-up was 5 years. In 79 patients (22%), we implanted a mesh, usually polypropylene (Prolene).


RESULTS
Compared to suture repair, mesh repair prolonged operating time by over 30 min and caused seroma in 12.7% of the patients (p<0.001). Only 4 of the 79 patients with mesh repair developed recurrence, compared to 55 of the 305 patients with suture repair (5 vs 18%, p=0.02 by log-rank test). In multivariate Cox regression, recurrence rates were fourfold higher after suture than after mesh repair (p=0.02). Interestingly, old age was associated with a decreased susceptibility for recurrence (p=0.01).


CONCLUSIONS
Our data confirms the long-term effectiveness of mesh repair under routine conditions. Suture repair should be restricted to small hernias in patients free of known risk factors.
Sauerland
Stefan
S
Klinik für Allgemein- und Visceralchirurgie, Marienhospital Stuttgart, Böheimstrasse 37, 70199, Stuttgart, Germany. S.Sauerland@uni-koeln.de
Schmedt
Claus-Georg
CG
Lein
Silke
S
Leibl
Bernhard J
BJ
Bittner
Reinhard
R
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes; D012008:Recurrence; D013526:Surgical Mesh; D013537:Sutures
D011126:Polypropylenes