Central mesh recurrence after incisional hernia repair with Marlex--are the meshes strong enough?

The use of biomaterial meshes in the repair of incisional abdominal wall hernias is now widely accepted internationally. The introduction of synthetic meshes to achieve tension-free repair has led to a satisfactory reduction in the recurrence rate to less than 10%. However, the use of such biomaterials can result in the occurrence of undesirable complications such as increased risk of infection, seromas, restriction of the abdominal wall and failure caused by mesh shrinkage. Additionally, at the time of writing there is much discussion concerning the potential risk of a persistent foreign body reaction directly associated with the meshes with regard to possible malignant transformation. As such, the trend seems to be toward the use of lighter meshes utilizing less non-absorbable material. One particular novel mesh theoretically capable of guaranteeing the necessary mechanical stability uses 70% less biomaterial. Against this background, we report a central mesh recurrence through the mesh following incisional hernia repair with a Marlex mesh. To our knowledge, this is the first description of a central mesh recurrence, and we discuss a possible mechanism with particular emphasis on the required abdominal wall forces both physiologically and after incisional hernia repair.