2012, Number 1
Cir Gen 2012; 34 (1)
Efficacy of dynamic plasty in repairing large defects of the abdominal wall with Proceed™ mesh at the General Hospital “Dr. Manuel Gea González”
Hernández LA, López-Toledo GA
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ABSTRACTObjective: To compare the efficacy and safety of hernioplasty technique with the intraperitoneal Proceed® mesh with the use of a polypropylene mesh.
Setting: General Hospital “Dr. Manuel Gea González”.
Design: Observational, longitudinal comparative study with historical control.
Statistical analysis: Chi square test and prevalence ratio association measures, as well as linear regression.
Material and methods: The study included 110 patients. Control group consisted of 55 patients operated with the ONLAY technique (supra-aponeurotic location) using polypropylene mesh. The experimental group consisted of 55 patients operated with the IPOM technique using Proceed® mesh. Analyzed variables were age, gender, surgical time, wound dehiscence, infection of the surgical site, fistula, intestinal occlusion, seromas, and size of the defect.
Results: Both groups were comparable in terms of age and gender. There was no difference in the average surgical time (80 vs 84 min, respectively, p › 0.05), nor in total complications (20 vs 32%, p › 0.05); neither in wound dehiscence, surgical site infection, fistula or intestinal occlusion between both groups (p › 0.05). Seromas were more frequent in the group of patients with IPOM technique using Proceed® mesh, with a relative risk of 1.59 (p = 0.06). The CI (1.08-2.35) revealed an association between seroma formation and use of the Proceed® mesh. The size of the abdominal wall defect was significantly greater in the group of patients included in the IPOM group with Proceed® mesh than in the group of ONLAY plasty using polypropylene mesh (12 vs 6 cm, p ‹ 0.05). Linear regression revealed that there is a relation between the size of the defect and seroma occurrence in the group of patients with IPOM technique using Proceed® mesh (regression coefficient 0.26, p ‹ 0.05). Recurrence was significantly greater in the ONLAY group with polypropylene mesh than in the IPOM group with Proceed® mesh (18 vs 3%, respectively, p ‹ 0.05), and the risk of recurrence in patients with co-morbidities is 2.5 times higher in the ONLAY group with polypropylene mesh than in the IPOM group with Proceed® (p › 0.05)
Conclusions: We suggest the use of the Proceed® mesh with IPOM technique for this type of patients. The Proceed® mesh has been demonstrated to be efficacious and safe for the repair of large abdominal wall defects.