title: The use of porcine small intestine submucosa implants might be associated with a high recurrence rate following laparoscopic herniorrhaphy.
abstract: OBJECTIVE
  The efficacy of porcine small intestine submucosa (SIS) implants in hernia repair has rarely been reported and remained elusive. We herein report our experience to further elucidate the efficacy of SIS mesh in herniorrhaphy.
  
  
  METHODS
  Between June 2008 and October 2009, a total of 82 patients with 125 inguinal hernias undergoing endoscopic total extraperitoneal (TEP) herniorrhaphy were included. Seventy patients (with 108 hernias) had traditional polypropylene and 12 patients (with 17 hernias) had SIS mesh repair. Postoperative complications and recurrence rates were compared between the two meshes.
  
  
  RESULTS
  The demographics between two groups were similar. All operations were performed smoothly with laparoscopy, and the postoperative courses were uneventful. After a median follow-up of 18 months, five (7%) in the polypropylene group and three (25%) in the SIS group had chronic pain (p = 0.09). Five of 17 (29.4%) hernia repairs in the SIS group had an ipsilateral recurrence, compared to no recurrence in the polypropylene group. In the five cases, the second laparoscopy revealed the SIS mesh had been totally degraded and there was no obvious fibrotic tissue in the previous mesh sites.
  
  
  CONCLUSIONS
  Our data suggest that the use of SIS mesh in endoscopic TEP herniorrhaphy might be associated with a high recurrence rate. The second look laparoscopy in these recurrent cases revealed slow and inadequate integration of host tissue. More evidence is still required to further evaluate the efficacy of SIS mesh in endoscopic TEP herniorrhaphy.
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chen-Hsun
authors.initials: CH
authors.lastname: Ho
authors.affiliation: Department of Neurology, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Pin-Wen
authors.initials: PW
authors.lastname: Liao
authors.affiliation: Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei, Taiwan; Department of Urology, College of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Stephen Shei-Dei
authors.initials: SS
authors.lastname: Yang
authors.affiliation: Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
authors.forename: Fu-Shan
authors.initials: FS
authors.lastname: Jaw
authors.affiliation: Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei, Taiwan; Department of Urology, College of Medicine, Tzu Chi University, Hualien, Taiwan. Electronic address: tsai1970523@yahoo.com.tw.
authors.forename: Yao-Chou
authors.initials: YC
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D016009:Chi-Square Distribution; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012189:Retrospective Studies; D013552:Swine; D014183:Transplantation, Heterologous / Q000009:adverse effects*
chemical_list: D011126:Polypropylenes
keywords: hernia; laparoscopic; small intestine submucosa; total extraperitoneal