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Massive incisional hernia: abdominal wall replacement with Marlex mesh
R G Molloy1, K T Moran, R P Waldron
1University Department of Surgery, Regional Hospital, Cork, Ireland.
Abstract:
Marlex (polypropylene) mesh was used to replace the abdominal wall in massive incisional herniation in 50 patients. Seventeen unsuccessful attempts at primary repair had previously been made on nine patients. Patient follow-up ranged from 6 to 120 months (mean = 45 months). There was minor hernia recurrence in four (8 per cent) patients. In each instance it was due to partial detachment of the peripheral fixation of the patch. Complications were: wound infection, four (8 per cent); wound seroma, two (4 per cent); wound haematoma, one (2 per cent); and wound sinus, six (12 per cent). Complications did not necessitate removal of the patch in any case. Inadequate peripheral attachment of the patch has been the only cause of hernia recurrence and should be avoidable.
Insights
Polypropylene mesh effectively repaired massive incisional hernias in 50 patients, with only 8% recurrence due to fixation issues. Complications were manageable and did not require mesh removal.
Area of Science:
- Abdominal surgery
- Surgical materials science
Background:
- Massive incisional hernias present complex surgical challenges.
- Previous repair attempts may have failed, necessitating advanced solutions.
Purpose of the Study:
- To evaluate the efficacy and safety of Marlex (polypropylene) mesh for abdominal wall reconstruction in massive incisional hernias.
- To identify potential complications and recurrence factors associated with mesh repair.
Main Methods:
- Marlex (polypropylene) mesh was utilized for abdominal wall replacement in 50 patients with massive incisional hernias.
- Follow-up ranged from 6 to 120 months (mean 45 months) to assess outcomes.
- Complications and hernia recurrence were systematically recorded.
Main Results:
- A low recurrence rate of 8% (4 patients) was observed, exclusively linked to partial detachment of peripheral mesh fixation.
- Complications included wound infection (8%), wound sinus (12%), wound seroma (4%), and wound haematoma (2%).
- No complications necessitated the removal of the polypropylene mesh.
Conclusions:
- Marlex (polypropylene) mesh is a viable option for reconstructing abdominal walls in cases of massive incisional hernias.
- Ensuring adequate peripheral fixation of the mesh is crucial to prevent hernia recurrence.
- The observed complications are generally manageable and do not typically require mesh explantation.