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Comparative Study
. 2010 Oct-Dec;14(4):541-6.
doi: 10.4293/108680810X12924466008240.

Bulging of the mesh after laparoscopic repair of ventral and incisional hernias

Ernst J P Schoenmaeckers  1 , Eelco B Wassenaar, Johan T F J Raymakers, Srdjan Rakic
Affiliations
Comparative Study

Bulging of the mesh after laparoscopic repair of ventral and incisional hernias

Ernst J P Schoenmaeckers et al. JSLS. 2010 Oct-Dec.

Abstract

Background and objectives: To investigate the prevalence, diagnosis, clinical significance, and treatment strategies for bulging in the area of laparoscopic repair of ventral hernia that is caused by mesh protrusion through the hernia opening, but with intact peripheral fixation of the mesh and actually a still sufficient repair.

Methods: Medical records of all 765 patients who underwent laparoscopic ventral hernia repair were reviewed, and all patients with a swelling in the repaired area were identified and analyzed.

Results: Twenty-nine patients were identified. They all underwent a computed tomography assessment. Seventeen patients (2.2% of the total group) had a hernia recurrence; in an additional 12 patients (1.6%), radiologic examinations indicated only bulging of the mesh but no recurrence. Bulging was associated with pain in 4 patients who underwent relaparoscopy and got a new, larger mesh tightly stretched over the entire previous repair. Eight asymptomatic patients decided on "watchful waiting." All patients remained symptom free during a median follow-up of 22 months.

Conclusion: Symptomatic bulging, though not a recurrence, requires a new repair and must be considered as an important negative outcome of laparoscopic ventral hernia repair. In asymptomatic patients, "watchful waiting" seems justified.

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Figures

Figure 1.
Figure 1.
Computed tomographic scan demonstrating sufficient repair but with protrusion of the mesh into the hernia.
Figure 2.
Figure 2.
Computed tomographic scan 3 months after correction of symptomatic bulging by tightly stretching a new, larger mesh over the entire previous repair that was left in place. Note the presence of seroma between 2 meshes.
Figure 3.
Figure 3.
Photograph of the mesh removed at laparotomy shows central bulging of the mesh.
Figure 4.
Figure 4.
Early postoperative computed tomographic scan demonstrating an adequate position of the mesh that is properly stretched over the hernia opening and without any signs of bulging.
Figure 5.
Figure 5.
Computed tomographic scan 11 months after laparoscopic repair of a ventral or incisional hernia, demonstrating a still sufficient repair but showing bulging of the mesh into the hernia.
See this image and copyright information in PMC

References

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