Long-term retromuscular and intraperitoneal mesh size changes within a randomized controlled trial on incisional hernia repair, including a review of the literature

P Rogmark, O Ekberg, A Montgomery, P Rogmark, O Ekberg, A Montgomery

Abstract

Purpose Ingrowth of fibroblasts in a polypropylene mesh may cause contraction and a later recurrence. We assessed mesh contraction in intraabdominal and retromuscular implantation after incisional hernia repair.

Methods: A cohort of patients within an RCT on laparoscopic (LHR) versus open hernia repair (OHR) had their mesh borders marked with metal clips. X-ray was performed on postoperative day 1 and after 1 year. Total length, width, and dislocation were measured. A tacker fixated large-pore polypropylene mesh was used in LHR, and a retromuscular small-pore heavy-weight mesh was sutured to the midline in OHR. Patient's pain was assessed before surgery and after 1 year.

Results: For analysis 37/47 patients remained: 20 LHR and 17 OHR. Hernia defect area was median 41 cm2 in LHR and 25 cm2 in OHR (p < 0.140). Implanted mesh size was 300 cm2 for LHR and 240 cm2 for OHR (p < 0.341). After 1 year the mesh area decreased by 4.4% and 0.5% in LHR and OHR, respectively (p < 0.063). Longitudinal distance decreased by 2.8% in LHR and by 2.6% in OHR (p < 0.269). Transverse distance decreased by 1.6% in LHR but increased by 3.1% in OHR (p < 0.005). Dislocation was seen in four LHR and one OHR. Two recurrent and one port-site hernia were diagnosed after LHR. Measurements between observers were identical in 58% and consensus was made in the remainder. Pain was not correlated to mesh area change.

Conclusions: Mesh contraction after 1 year is not a clinical issue for an intraperitoneal large-pore mesh or a retromuscular small-pore mesh. It is not correlated to postoperative pain.

Trial registration: ClinicalTrials.gov NCT00472537.

Keywords: IPOM; Incisional hernia repair; Mesh contraction; Retromuscular mesh.

Conflict of interest statement

Conflict of interest

PR declares no conflict of interest. OE declares no conflict of interest. AM declares no conflict of interest.

Funding

The funders have not taken part in the design, conduction, and evaluation of this trial.

Ethical approval

The trial protocol, part of the PROLOVE trial [11], was approved by the Regional Ethic Review Board in Lund, Sweden (H4710/2004) and the Regional Committee on Radiation Protection (RK 2005:5). The PROLOVE trial was registered at http://www.ClinicalTrials.gov (NCT00472537).

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

All participants signed informed consents when recruited.

Figures

Fig. 1
Fig. 1
Abdominal supine examination after laparoscopic incisional hernia repair. The mesh is fixed with concentric rows of metal spiral tackers. The marker has a 10-mm hole and a 25 mm diameter. a Postoperative 1 day. b Postoperative 1 year
Fig. 2
Fig. 2
Abdominal supine examination after open incisional hernia repair. Mesh is placed in the retromuscular plane of the rectus abdominis muscles. Metal clips mark the longitudinal and transverse edges of the mesh and the hernia defect. The marker has a 10-mm hole and a 25 mm diameter. a Postoperative 1 day. b Postoperative 1 year
Fig. 3
Fig. 3
Change of mesh measurements after 1 year relative to the immediate postoperative measurement. The horizontal black line is the mean change. Area defined as length × width

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