title: Central failures of lightweight monofilament polyester mesh   causing hernia recurrence: a cautionary note.
abstract: BACKGROUND
  Uncoated, lightweight, macroporous,monofilament mesh has been shown to demonstrate improved bacterial clearance, better tissue integration,reduced foreign body response, and less chronic pain with equivalent durability for hernia repair. These findings led us to use a new lightweight monofilament polyester mesh (Parietex TCM, Covidien). Here, we report our experience with this mesh in open incisional hernia repair.
  
  
  METHODS
  Patients undergoing incisional hernia repair with Parietex TCM were retrospectively identified within our prospectively maintained database. Patient demographics,operative characteristics, and follow-up were reviewed. Outcome parameters included 90-day wound morbidity and hernia recurrence.
  
  
  RESULTS
  In 2011, 36 patients (mean age 56.8; mean BMI32.4 kg/m2) underwent open incisional hernia repair with retrorectus mesh placement by two surgeons (MJR, YWN) at Case Medical Center. Anterior and posterior fascial closure was achieved in all cases. Wound morbidity included seven surgical site occurrences: four superficial infections that resolved with antibiotics, one wound dehiscence requiring wet-to-dry packing, and two seromas that resolved without intervention. With a mean follow-up of 13 months, 8 (22%) recurrences have occurred. On reoperation, 7 (19%) of these patients had mechanical failure or fracturing of the mesh. No confounding variables were identified by univariate analysis of patient demographics,operative characteristics, or wound morbidity.
  
  
  CONCLUSIONS
  Lightweight monofilament polyester mesh (Parietex TCM) appears to have a high incidence of mechanical failure in the context of open incisional hernia repair. While this limitation may ultimately be revealed asa weakness of all lightweight mesh, surgeons should be aware that these failures have already been documented.
authors.forename: C C
authors.initials: CC
authors.lastname: Petro
authors.forename: E H
authors.initials: EH
authors.lastname: Nahabet
authors.forename: C N
authors.initials: CN
authors.lastname: Criss
authors.forename: S B
authors.initials: SB
authors.lastname: Orenstein
authors.forename: H A
authors.initials: HA
authors.lastname: von Recum
authors.forename: Y W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: M J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D000368:Aged; D001672:Biocompatible Materials; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*
chemical_list: D001672:Biocompatible Materials; D011091:Polyesters