Hernia recurrence after laparotomy: how to close an incised light-weight mesh?
A rising number of patients require relaparotomy after implantation of mesh materials for incisional hernia (IH) repair. No published recommendation concerning how to close the incision in a surgical mesh exists. We describe a central IH recurrence through a partly absorbable mesh positioned in the retromuscular plane 16 months after laparotomy due to a small bowel ileus. This recurrence was repaired using a heavy-weight, monofilament polypropylene mesh, again in the retromuscular position. Reducing the amount of nonabsorbable material in large pore hernia meshes leads to markedly reduced scar formation rather than the formation of a thick scar plate. Once cut and resutured, this scar may be too weak to withstand the mechanical strain, giving rise to a 'blow-out' IH recurrence, as demonstrated in our case. In these cases, re-enforcement with a nonabsorbable, small, porous polypropylene mesh in the retromuscular space is feasible and leads to the development of a mechanically stable scar.
Höer
Jörg
J
Department of General, Vascular and Visceral Surgery, Marien Hospital Düsseldorf, Rochusstrasse 2, 40479 Düsseldorf, Germany. j.hoeer@marien-hospital.de
Roesel
Christian
C
Schachtrupp
Alexander
A
Töns
Christian
C
D000368:Aged; D002921:Cicatrix / Q000209:etiology / Q000601:surgery; D003082:Colectomy / Q000009:adverse effects; D004867:Equipment Design; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000295:instrumentation*; D011126:Polypropylenes; D016062:Porosity; D012008:Recurrence; D012086:Reoperation; D013314:Stress, Mechanical; D013526:Surgical Mesh
D011126:Polypropylenes