Page 212 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 10
Introduction
Incisional hernia remains a major clinical problem for 2–20 % of all patients undergoing abdominal surgery(1, 2). Even higher incidences reaching 30–37 % are reported among obese and aortic aneurysm patients(3, 4). Despite the high frequency of incisional hernia operations, long-term results remain disappointing.
Burger et al.(5) reported 10-year recurrence rates up to 63 % after primary suture repair and up to 32 % after mesh repair. In addition, the recurrence rates increase after each reoperation, underscoring the importance of the best evidence-based method at the rst operation(6).
In recent years, laparoscopic incisional hernia repair has shown increased popularity. Although laparoscopic repair o ers no advantages in terms of recurrence rates, it may be associated with a shorter hospital stay, lower perioperative complication rates, and a shorter mean operation time than open repair(7-9).
In laparoscopic hernia repair, direct contact between the prosthesis and the abdominal viscera is inevitable. This contact may lead to an in ammatory reaction resulting in abdominal adhesion formation(10), which can induce small bowel obstruction(11), chronic pain(12), infertility, enterocutaneous stulas(13), and di culties at reoperation(14). The latter is illustrated by Halm et al.(15), who showed that 21 % of patients with an intraperitoneal polypropylene mesh required small bowel resection for entrance to be gained into the abdomen at reoperation.
Currently, a wide variety of synthetic and biologic hernia reinforcement materials is available on the market, complicating the selection of an appropriate prosthesis(16, 17). The most commonly used meshes are made of polypropylene. This material is relatively inexpensive and easy to handle and does incorporate well into the abdominal wall. However, when placed in contact with the abdominal viscera, polypropylene meshes may be associated with severe adhesion formation(15). Therefore, intraperitoneal utilization should be avoided(18).
Alternatives can be found in composite and biologically derived prostheses. Composite meshes consist of a synthetic material and an anti- adhesive layer or coating on the visceral side of the mesh. Biologic grafts are collagen meshes derived from bovine, porcine, human skin, or other tissue such as submucosa or pericardium.
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