Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia

Abstract

Background: The introduction of retromuscular, preperitoneal sublay technique using polypropylene (PP) meshes had significantly decreased the recurrence rates after open incisional hernia repair. Nevertheless, recent data of single institutions reported about non-acceptable high hernia recurrences. The objective of this study was to determine early complications and the long-term course of patients who underwent open sublay hernia repair using heavy-weight versus low-weight PP meshes.

Methods: Between January 1996 and December 1997, all consecutive patients received large pore-sized, monofilament heavy-weight PP meshes (Prolene); from January 1998 to December 2001, only large pore-sized, low-weight PP meshes (Vypro) composed of multifilaments were used. The clinical course of all patients was registered during the hospital stay as well as 3 months and at least 12 months after surgery.

Results: Sixty-nine patients (mean age 56 +/- 13 years) underwent sublay hernia repair with heavy-weight PP meshes, 106 patients (mean age 60 +/- 14 years) with low-weight PP meshes. No significant differences were determined concerning age, gender, BMI, ASA score, hernia size 25 - 99 cm(2) and number of primary midline incisions. In contrast, mean hernia size and number of hernia size > or = 100 cm(2) were significantly higher, whereas number of hernia size < 25 cm(2), ratio of recurrent hernia and length of hospital stay were lower in the low-weight PP mesh group. Minor complications (17%) appeared more frequently in the heavy-weight than in the low-weight PP mesh group (13%). One patient each with major bleeding required re-operation in both groups. One patient with lethal pulmonary embolism in the heavy-weight PP mesh group and one patient with unrecognised enterotomy and re-operation in the low-weight PP mesh group were registered. In the long-term run (mean follow-up 92 +/- 20 months), patients of the heavy-weight PP mesh group complained significantly more frequently about chronic pain and "stiff abdomen" than those of the low-weight PP mesh group (46 +/- 14 months). Two hernia recurrences occurred in each study group. Two of them were found after midline hernia repair at the edge of the mesh, the remainder were detected after lateral hernia repair.

Conclusion: Large pore-sized low-weight PP meshes composed of multifilaments are clearly to be favoured over large pore-sized, monofilament heavy-weight PP meshes because of better abdominal wall compliance and less chronic pain. However, both types of meshes are convincing due to high tensile strength and low recurrence rates in the long-term run.