title: Incisional hernia: challenge of re-operations after mesh repair.
abstract: OBJECTIVE
  The widespread use of meshes for the repair of incisional hernia is currently followed by an increasing number of re-operations. The incidence of incisional hernia recurrence after mesh repair varies between 3 and 32%. The problem of mesh failure and options for another surgical intervention seem rather unattended.
  
  
  METHODS
  We present our experience of 77 re-operations after previous mesh repair that were performed between 1995 and 2004 out of a total of 1,070 operations for incisional hernia. The retrospective analysis focused on recurrence in relation to location, material of the previous mesh repair and the surgical procedure to resolve the problem.
  
  
  RESULTS
  The locations of the preceding meshes were epifascial as onlays (n=23), retromuscular as sublays (n=46), within the defect as inlays (n=6) or intraperitoneally (n=2). The direction of the incision was vertical medial (n=41) or horizontal crossing the linea semilunaris (n=36). Recurrences after median incisional hernia mesh repair mainly occurred at the cranial border of the mesh subxiphoidal. Except for two patients, all recurrences manifested at the margin of the enclosed mesh.
  
  
  CONCLUSIONS
  Re-operation after previous mesh repair is a surgical challenge. The type of revision procedure has to consider the position and material of the previous mesh. In our clinic recurrences, heavyweight polypropylene meshes were mostly treated with mesh exchange and lightweight polypropylene meshes could be treated by extension with a second mesh. In contrast to suture techniques, deficient mesh repairs are more evidently related to technical problems.
authors.affiliation: Surgical Department of the Rhenish Westfalian Technical University, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany. jconze@ukaachen.de
authors.forename: Joachim
authors.initials: J
authors.lastname: Conze
authors.forename: Carsten J
authors.initials: CJ
authors.lastname: Krones
authors.forename: Volker
authors.initials: V
authors.lastname: Schumpelick
authors.forename: Uwe
authors.initials: U
authors.lastname: Klinge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D046449:Hernia, Abdominal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013526:Surgical Mesh