Long-term Complications Associated With Prosthetic Repair of Incisional Hernias

TLDR

The study aimed to assess whether prosthetic material type and placement technique affect long‑term complications after incisional hernia repair. A retrospective cohort of 200 patients was analyzed, comparing four mesh types—monofilament polypropylene, double‑filament polypropylene, expanded PTFE, and multifilament polyester—placed in onlay, underlay, sandwich, or finger‑interdigitation positions, with outcomes evaluated by univariate and multivariate analyses. Polyester mesh was associated with significantly higher complication rates, fistula formation, infections, recurrences, and longer hospital stays, and multivariate analysis confirmed its deleterious effect; placement technique had no impact, leading the authors to recommend discontinuing polyester mesh use.

Abstract

To determine whether the type of prosthetic material and technique of placement influenced long-term complications after repair of incisional hernias.Retrospective cohort analytic study.University-affiliated hospital.Two hundred patients undergoing open repair of abdominal incisional hernias with prosthetic material between 1985 and 1994.Four types of prosthetic material were used and placed either as an onlay, underlay, sandwich, or finger interdigitation technique. The materials were monofilamented polypropylene mesh (Marlex, Davol Inc, Cranston, RI), double-filamented mesh (Prolene, Ethicon Inc, Somerville, NJ), expanded polytetrafluroethylene patch (Gore-Tex, WL Gore & Associates, Phoenix, Ariz) or multifilamented polyester mesh (Mersilene, Ethicon Inc).The incidence of recurrence and complications such as enterocutaneous fistula, bowel obstruction, and infection with each type of material and technique of repair were compared with univariate and multivariate analysis.On univariate analysis, multifilamented polyester mesh had a significantly higher mean number of complications per patient (4.7 vs 1.4-2.3; P<.002), a higher incidence of fistula formation (16% vs 0%-2%; P<.001), a greater number of infections (16% vs 0%-6%; P<.05), and more recurrent hernias (34% vs 10%-14%; P<.05) than the other materials used. The additional mean length of stay to treat complications was also significantly longer (30 vs 3-7 days; P<.001) when polyester mesh was used. The deleterious effect of polyester mesh on long-term complications was confirmed on multiple logistic regression (P=.002). The technique of placement had no influence on outcome.Polyester mesh should no longer be used for incisional hernia repair.