2012, Number 1
Efficacy of dynamic plasty in repairing large defects of the abdominal wall with Proceed™ mesh at the General Hospital “Dr. Manuel Gea González”
PDF size: 133.26 Kb.
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.
Espinosa MA, de la Aorre JI, Ahumada LA, Person DW, Rosenberg LZ, Vásconez LO. Reconstruction of the abdominal wall for incisional hernia repair. Am J Surg 2006; 191: 173-177.
Yaghoobi Notash A, Yaghoobi Notash A Jr, Seied Farchi J, Ahmadi Amoli H, Salimi J, Mamarabadi M. Outcomes of the Rives-Stoppa technique in incisional hernia repair: ten years of experience. Hernia 2007; 11: 25-29.
Hadi HI, Maw A, Samah S, Kumar P. Intraperitoneal tension-free repair of small midline ventral abdominal wall hernias with a Ventralex hernia patch: initial experience in 51 patients. Hernia 2006; 10: 409-413.
Alaedeen DI, Lipman J, Medalie D, Rosen MJ. The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields. Hernia 2007; 11: 41-45.
Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2010; 343: 392-8.
Millikan KW, Baptista M, Amin B, Deziel DJ, Doolas A. Intraperitoneal underlay ventral hernia repair utilizing bilayer expanded polytetrafluoroethylene and polypropylene mesh. Am Surg 2003; 69: 287-292.
Trupka AW, Hallfeldt KK, Schmidbauer S, Schweiberer L. [Management of complicated incisional hernias with underlay-technique implanted polypropylene mesh. An effective technique in French hernia surgery]. Chirurg 1998; 69: 766-772.
Ronsen MJ, Williams C, Jin J, McGee MF, Schomisch S, Marks J, et al. Laparoscopic versus open-component separation: a comparative analysis in a porcine model. Am J Surg 2007; 194: 385-389.
Olmi S, Scaini A, Cesana GC, Erba L, Groce E. Laparoscopic versus open incisional hernia repair: an open randomized controlled study. Surg Endosc 2007; 21: 555-559.
Barbaros U, Asoglu O, Seven R, Erbil Y, Dinccag A, Deveci U, et al. The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 2007; 11: 51-56.
Catena F, Ansaloni L, Gazzotti F, Gagliardi S, Di Saverio S, D’Alessandro L, et al. Use of porcine dermal collagen graft (Permacol) for hernia repair in contaminated fields. Hernia 2007; 11: 57-60.
Bingener J, Buck L, Richards M, Michalek J, Schwesinger W, Sirinek K. Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg 2007; 142: 562-7.
Bleichrodt RP, Malyar AW, de ries Reilingh TS, Buyne O, Bonenkamp JJ, van H. The omentum-polypropylene sandwich technique: an attractive method to repair large abdominal-wall defects in the presence of contamination or infection. Hernia 2007; 11: 71-74.
Awad ZT, Puri V, LeBlanc K, Stoppa R, Fitzgibbons RJ Jr, Iqbal A, et al. Mechanisms of ventral hernia recurrence after mesh repair and new proposed classification. J Am Coll Surg 2005; 201: 132-140.
Finan KR, Vick CC, Kiefe CL, Neumayer L, Hawn MT. Predictors of wound infection in ventral hernia repair. Am J Surg 2005; 190: 676-681.
Alder AC, Alder SC, Livingston EH, Bellows CF. Current opinions about laparoscopic incisional hernia repair: a survey of practicing surgeons. Am J Surg 2007; 194: 659-662.
Amid PK. Classification of Biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1997; 1: 15-21.
Kaufman Z, Engelberg M, Zager M. Fecal fistula: A late complication of Marlex mesh repair. Dis Colon Rectum 1981; 24: 543-544.
Leber GE, Garb JL, Alexander AI, Reed WP. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 1998; 133: 378-382.
Hutchinson RW, et al. Pre-clinical abdominal adhesion studies with Proceed® surgical mesh. Business Briefing: Global Surgery 2004: 1-4.
Rasim ZM, Alzahrani MA, Sigman MH, Meakins JL, Fried GM. Comparison of adhesion formation and tensile strength after three laparoscopic herniorraphy techniques. Surg Laparosc Endosc 1997; 7: 133-136.
Kiudelis M, Jonciauskiene O. Effects of different kinds of meshes on postoperative adhesion formation in New Zealand White rabbit. Hernia 2007; 11: 19-23.
Baykal A, Onat D, Rasa K, Renda N, Sayek I. Effects of polyglycolic acid and polypropylene meshes on postoperative adhesion formation in mice. World J Surg 1997; 21: 579-583.
Kiudelis M, Jonciauskiene J, Deduchovas O, Radziunas A, Mickevicius A, Janciauskas D, et al. Effects of different kinds of meshes on postoperative adhesion formation in the New Zealand White rabbit. Hernia 2007; 11: 19-23.
Sullivan SR, Engrav LH, Anaya DA. Bulger EM, Foy HM. Bilateral anterior abdominal bipedicle flap with permanent prosthesis for massive abdominal skin-grafted hernia. Am J Surg 2007;193:651-655.
Ihedioha U, Leung E, Chung L, Burgess G, Hendry D, O’dwyer PJ. A complex fistula caused by eroding pelvic mesh sling. Hernia 2007; 11: 75-78.
Delikoukos S, Tzovaras G, Liakou P, Mantzos F, Hatzitheofilou C. Late-onset deep mesh infection after inguinal hernia repair. Hernia 2007; 11: 15-17.
Sakorafas G, Sarr MG. Repair of ventral and incisional hernias using modifications of the Rives-Stoppa technique. Prob Gen Surg 2002; 19: 51-58.
Aufenacker TJ, Keolemay MJ, Gourma DJ, Simons MP. Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia. Br J Surg 2006; 93: 5-10.
Pérez AR, Roxas MF, Hilvano SS. A randomized, double blind, placebo-controlled trial to determine effectiveness of antibiotic prophylaxis for tension-free mesh herniorrhaphy. J Am Coll Surg 2005; 3: 393-397.
Hernández LA. Tratamiento simultáneo de plastía de pared con malla y cierre intestinal. Cir Gen 2004; 26: 242-247.
Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg 1989; 13: 545-554.
Burger JW, Halm JA, Wijsmuller AR, ten Raa S, Jeedel J. Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc 2006; 20: 1320-1325.
Judge TW, Parker DM, Dinsmore RC. Abdominal wall hernia repair: a comparison of aepramesh and parietex composite mesh in a rabbit hernia model. Am Coll Surg 2007; 204: 276-281.
Lomanto D, Iyer SG, Shabbir A, Cheah WK. Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 2006; 20: 1030-5.
McCormack K, Scott NW, Go PM, Ross S, Grant AM; EU Hernia Trialists Collaboration. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2003; CD001785.
Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM. Pooled data analysis of laparoscopic vs open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 2007; 21: 378-386.
Earle D, Seymour N, Fellinger E, Perez A. Laparoscopic versus open incisional hernia repair: a single institution analysis of hospital resource utilization for 884 consecutive cases. Surg Endosc 2006; 20: 71-75.
Beldi G, Ipaktchi R, Wagner M, Candinas BD. Laparoscopic ventral hernia repair is safe and cost effective. Surg Endosc 2006; 20: 92-95