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Updated: Jul 18, 2026
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery
J A Halm1, L L de Wall, E W Steyerberg
1Department of Surgery, 10M, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
Insights
Subsequent surgery after prosthetic incisional hernia repair (PIHR) is more complicated with intraperitoneal mesh. Preperitoneal mesh placement is associated with fewer complications during re-laparotomy following PIHR.
Area of Science:
- Surgical innovation and patient outcomes
- Hernia repair techniques
- Biomaterials in surgery
Background:
- Prosthetic incisional hernia repair (PIHR) offers superior recurrence prevention compared to primary closure.
- However, prosthetic materials are linked to serious complications.
- The impact of mesh position on complications during re-operation after PIHR is not well-defined.
Purpose of the Study:
- To evaluate complications of subsequent surgical interventions after PIHR.
- To determine if the anatomical position of the prosthetic mesh influences complication rates.
Main Methods:
- A retrospective review of patients undergoing laparotomy/laparoscopy after PIHR between 1992 and 2005.
- Analysis of complication rates based on whether the mesh was placed intraperitoneally or preperitoneally.
Main Results:
- Re-laparotomy after PIHR was performed in 66 of 335 patients.
- Intraperitoneal mesh placement was associated with significantly higher complication rates (76%) compared to preperitoneal placement (29%).
- Small bowel resections and surgical site infections were more frequent with intraperitoneal mesh.
Conclusions:
- Re-operation following PIHR with polypropylene mesh is linked to increased complications when the mesh is placed intraperitoneally.
- Avoidance of intraperitoneal positioning for polypropylene mesh in incisional hernia repair is recommended.
Background:
Prosthetic incisional hernia repair (PIHR) is superior to primary closure in preventing hernia recurrence. Serious complications have been associated with the use of prosthetic material. Complications of subsequent surgical interventions after prior PIHR in relation to its anatomical position were the objectives of this study.
Patients And Methods:
Patients who underwent subsequent laparotomy/laparoscopy after PIHR between January 1992 and February 2005 at our institution were evaluated. Intraperitoneal and preperitoneal mesh was related to complication rates after subsequent surgical interventions.
Results:
Sixty-six of 335 patients underwent re-laparotomy after PIHR. The perioperative course was complicated in 76% (30/39) of procedures with intraperitoneal placed grafts compared to 29% (8/27) of interventions with preperitoneally positioned meshes (P < 0.001). Small bowel resections were necessary in 21% of the intraperitoneal group (8/39) versus 0% in the preperitoneal group. Surgical site infection rates were higher in the intraperitoneal group (10/39, 26%, versus 1/27, 4%). Enterocutaneous fistula formation was rare and occurred in two patients after subsequent laparotomy (5%).
Conclusions:
Re-laparotomy after PIHR with polypropylene meshes are associated with more preoperative and postoperative complications when the mesh is placed intraperitoneally. Therefore 0intraperitoneal positioning of polypropylene mesh at incisional hernia repair should be avoided if possible.
