Page 16 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 1
to lose its strength and fall apart. American vascular surgeon Michael DeBakey discovered a new fabric called dacron (polyester) and used it to develop long- lasting vascular grafts. In 1956, the polyester vascular grafts were modi ed into synthetic meshes for hernia repair, and introduced to the market under the brand names Dacron and Mersilene. Around the same time, another American surgeon, Francis Usher, instigated collaboration with a petroleum company and developed a hernia mesh from the polymer Marlex. This rst polyethylene Marlex mesh was further improved, and in 1963 the second generation Marlex mesh – of knitted polypropylene – was introduced, this compound being strong, biocompatible, and cheap. Over the following few years, Usher and other dedicated surgeons published good results for these synthetic meshes on recurrence rates and complications. But despite the positive reports, the surgical community, largely in uenced by the high complication rates of earlier metal and plastic prostheses, saw little or no need for the routine use of these new meshes in hernia surgery.
In the following years, a third kind of synthetic mesh, made from expanded-polyetra uoroethylene (e-PTFE), was developed by Gore. This new e-PTFE mesh was rst used clinically in hernia repair in 1983. Although surgeons were starting to use meshes more and more in hernia repair, implantation was still reserved for complex or recurrent cases – particularly in ventral hernia repair. It took the publication of a randomized controlled trial from the Dutch REPAIR-group in 2000(23), for the worldwide surgical community to start to accept the use of meshes as the standard of care for ventral hernia repair. The impressive results of this RCT were published in The New England Journal of Medicine in 2000(23). Three-year follow-up revealed recurrence rates of 43% for suture repair, and 24% for mesh repair. Several years later, the long-term follow- up of this RCT showed a 10-year cumulative recurrence rate of 63% for suture repair, and 32% for mesh repair(5). In the following years, clinical trials were conducted on the di erent repair techniques and mesh prostheses for small and medium-sized ventral hernias, but the treatment of large IHs (over 10cm) has not yet been properly addressed. To improve the evidence-base for IH- surgery, the EHS developed a classi cation for IH which takes into account the location, size, and possible recurrence of the IH(28). This classi cation system has, since its introduction in 2009, been widely accepted and used in scienti c publications about IH. However, a solid base of comparative research material on abdominal wall surgery has remained elusive, due to a strong heterogeneity in reported study population characteristics and outcome measurements.
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