title: Massive Incisional Hernia Repair with Parietex: Monocentric Analysis on 500 Cases Treated with a Laparoscopic Approach.
abstract: OBJECTIVE
  The aim of this retrospective study is to demonstrate the safety and feasibility of the laparoscopic technique for treatment of massive incisional hernias (MIHs) and to compare three different fixation devices.
  
  
  METHODS
  From January 1, 2001, to December 31, 2014, we collected retrospective data from patients with large incisional hernias (IHs). Laparoscopic IH repair is performed by applying a three-dimensional polyester knit structure mesh with a resorbable collagen barrier on peritoneal side (Parietex™ Composite Mesh; Covidien, New Haven, CT). Patients were divided into three groups according to the different fixation devices. The mean follow-up was 19 (12-156) months.
  
  
  RESULTS
  The mean defect size was 12.83 cm (10-26 cm) and the mean body mass index was 30.8 kg/m2(26-39 kg/m2). The EMS stapler™ was used on 260 patients, the Protack®on 210 patients, and the AbsorbaTack™ on 30 patients. The mean operative time was 69.9 minutes (38-130 minutes). Intraoperative morbidity rate was 1.6% (8 cases). Early reoperation rate was 0.2% (1 case). The mean length of hospital stay was 2.3 days (range 2-7 days). Seromas were observed in 20 patients (4.0%) and neuralgia in 10 patients (2.0%). Recurrence was observed in 12 patients (2.4%) with the majority in the absorbable tack group (10%). There were no conversions (0%) to open technique.
  
  
  CONCLUSIONS
  The laparoscopic approach seems to be safe and appropriate for treatment of MIH. The Parietex composite mesh we used guarantees excellent intraabdominal laparoscopic repair of abdominal wall defects. Absorbatack system seems to give less postoperative neuralgia, but it is related to a high recurrence rate. Protack system seems to give more postoperative neuralgia than the Endopath EMS. In our experience, the best fixation system is the latter.
authors.affiliation: Department of General and Oncologic Surgery, Centre of Laparoscopic and Bariatric Surgery, Istituti Ospedalieri Bergamaschi-Policlinico San Marco , Zingonia, Italy .
authors.forename: Francesco
authors.initials: F
authors.lastname: Caruso
authors.affiliation: Department of General and Oncologic Surgery, Centre of Laparoscopic and Bariatric Surgery, Istituti Ospedalieri Bergamaschi-Policlinico San Marco , Zingonia, Italy .
authors.forename: Francesca
authors.initials: F
authors.lastname: Ciccarese
authors.affiliation: Department of General and Oncologic Surgery, Centre of Laparoscopic and Bariatric Surgery, Istituti Ospedalieri Bergamaschi-Policlinico San Marco , Zingonia, Italy .
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cesana
authors.affiliation: Department of General and Oncologic Surgery, Centre of Laparoscopic and Bariatric Surgery, Istituti Ospedalieri Bergamaschi-Policlinico San Marco , Zingonia, Italy .
authors.forename: Matteo
authors.initials: M
authors.lastname: Uccelli
authors.affiliation: Department of General and Oncologic Surgery, Centre of Laparoscopic and Bariatric Surgery, Istituti Ospedalieri Bergamaschi-Policlinico San Marco , Zingonia, Italy .
authors.forename: Giorgio
authors.initials: G
authors.lastname: Castello
authors.affiliation: Department of General and Oncologic Surgery, Centre of Laparoscopic and Bariatric Surgery, Istituti Ospedalieri Bergamaschi-Policlinico San Marco , Zingonia, Italy .
authors.forename: Stefano
authors.initials: S
authors.lastname: Olmi
mesh_terms: D000328:Adult; D000368:Aged; D003094:Collagen; D005240:Feasibility Studies; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000453:epidemiology; D061646:Operative Time; D010537:Peritoneum; D011091:Polyesters; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D049291:Seroma / Q000453:epidemiology; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013528:Surgical Staplers
chemical_list: D011091:Polyesters; C588279:parietex; D003094:Collagen
keywords: Absorbatack; Endopath EMS; Parietex; Protack; laparoscopic incisional hernia repair; massive incisional hernia