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Long-term retromuscular and intraperitoneal mesh size changes within a randomized controlled trial on incisional hernia repair, including a review of the literature

Rogmark, P. LU ; Ekberg, O. LU and Montgomery, A. LU (2017) In Hernia p.1-10
Abstract

Abstract: Purpose Ingrowth of fibroblasts in a polypropylene mesh may cause contraction and a later recurrence. We assessed mesh contraction in intraabdominal and retromuscular implantation after incisional hernia repair. Methods: A cohort of patients within an RCT on laparoscopic (LHR) versus open hernia repair (OHR) had their mesh borders marked with metal clips. X-ray was performed on postoperative day 1 and after 1 year. Total length, width, and dislocation were measured. A tacker fixated large-pore polypropylene mesh was used in LHR, and a retromuscular small-pore heavy-weight mesh was sutured to the midline in OHR. Patient’s pain was assessed before surgery and after 1 year. Results: For analysis 37/47 patients remained: 20 LHR... (More)

Abstract: Purpose Ingrowth of fibroblasts in a polypropylene mesh may cause contraction and a later recurrence. We assessed mesh contraction in intraabdominal and retromuscular implantation after incisional hernia repair. Methods: A cohort of patients within an RCT on laparoscopic (LHR) versus open hernia repair (OHR) had their mesh borders marked with metal clips. X-ray was performed on postoperative day 1 and after 1 year. Total length, width, and dislocation were measured. A tacker fixated large-pore polypropylene mesh was used in LHR, and a retromuscular small-pore heavy-weight mesh was sutured to the midline in OHR. Patient’s pain was assessed before surgery and after 1 year. Results: For analysis 37/47 patients remained: 20 LHR and 17 OHR. Hernia defect area was median 41 cm2 in LHR and 25 cm2 in OHR (p < 0.140). Implanted mesh size was 300 cm2 for LHR and 240 cm2 for OHR (p < 0.341). After 1 year the mesh area decreased by 4.4% and 0.5% in LHR and OHR, respectively (p < 0.063). Longitudinal distance decreased by 2.8% in LHR and by 2.6% in OHR (p < 0.269). Transverse distance decreased by 1.6% in LHR but increased by 3.1% in OHR (p < 0.005). Dislocation was seen in four LHR and one OHR. Two recurrent and one port-site hernia were diagnosed after LHR. Measurements between observers were identical in 58% and consensus was made in the remainder. Pain was not correlated to mesh area change. Conclusions: Mesh contraction after 1 year is not a clinical issue for an intraperitoneal large-pore mesh or a retromuscular small-pore mesh. It is not correlated to postoperative pain.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Incisional hernia repair, IPOM, Mesh contraction, Retromuscular mesh
in
Hernia
pages
10 pages
publisher
Springer
external identifiers
  • scopus:85021109970
ISSN
1265-4906
DOI
10.1007/s10029-017-1624-9
language
English
LU publication?
yes
id
e6a5f90d-9aac-46b4-93da-6a1964658508
date added to LUP
2017-08-11 10:29:52
date last changed
2017-08-11 10:29:52
@article{e6a5f90d-9aac-46b4-93da-6a1964658508,
  abstract     = {<p>Abstract: Purpose Ingrowth of fibroblasts in a polypropylene mesh may cause contraction and a later recurrence. We assessed mesh contraction in intraabdominal and retromuscular implantation after incisional hernia repair. Methods: A cohort of patients within an RCT on laparoscopic (LHR) versus open hernia repair (OHR) had their mesh borders marked with metal clips. X-ray was performed on postoperative day 1 and after 1 year. Total length, width, and dislocation were measured. A tacker fixated large-pore polypropylene mesh was used in LHR, and a retromuscular small-pore heavy-weight mesh was sutured to the midline in OHR. Patient’s pain was assessed before surgery and after 1 year. Results: For analysis 37/47 patients remained: 20 LHR and 17 OHR. Hernia defect area was median 41 cm<sup>2</sup> in LHR and 25 cm<sup>2</sup> in OHR (p &lt; 0.140). Implanted mesh size was 300 cm<sup>2</sup> for LHR and 240 cm<sup>2</sup> for OHR (p &lt; 0.341). After 1 year the mesh area decreased by 4.4% and 0.5% in LHR and OHR, respectively (p &lt; 0.063). Longitudinal distance decreased by 2.8% in LHR and by 2.6% in OHR (p &lt; 0.269). Transverse distance decreased by 1.6% in LHR but increased by 3.1% in OHR (p &lt; 0.005). Dislocation was seen in four LHR and one OHR. Two recurrent and one port-site hernia were diagnosed after LHR. Measurements between observers were identical in 58% and consensus was made in the remainder. Pain was not correlated to mesh area change. Conclusions: Mesh contraction after 1 year is not a clinical issue for an intraperitoneal large-pore mesh or a retromuscular small-pore mesh. It is not correlated to postoperative pain.</p>},
  author       = {Rogmark, P. and Ekberg, O. and Montgomery, A.},
  issn         = {1265-4906},
  keyword      = {Incisional hernia repair,IPOM,Mesh contraction,Retromuscular mesh},
  language     = {eng},
  month        = {06},
  pages        = {1--10},
  publisher    = {Springer},
  series       = {Hernia},
  title        = {Long-term retromuscular and intraperitoneal mesh size changes within a randomized controlled trial on incisional hernia repair, including a review of the literature},
  url          = {http://dx.doi.org/10.1007/s10029-017-1624-9},
  year         = {2017},
}