Page 313 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Possible factors a ecting the collagenesis and consequential recurrence rate of hernias are high rates of postoperative infectious adverse-events. Ambivalent results have been published previously: Basta et al reported a 51.4% incidence of wound complications leading to recurrence hernia rate of 18.9% with postoperative wound infection being the only predictor of recurrence with an odds ratio of 22.1(36). Increased infection rate of biological meshes could be due to bacterial niches in biomesh pores and bacterial formation of bio lms(37).
Perhaps the advantage of biological meshes over synthetic material is the possibility of performing aggressive salvage procedures with removing parts of an infected mesh in situ to avert removal of all material with subsequently recurrence of hernia.
An important factor when choosing a mesh are the associated costs. Biological meshes are substantially more expensive than synthetic meshes(4, 6). However costs can be reduced when delayed primary closure with implantation of a biological mesh is possible during one hospital admission. In this way the number of admissions and in-hospital days can be reduced compared to staged repair(38). Additional bene t is earlier restoration of abdominal wall function which may lead to accelerated return to work.
A limitation of our study might be the implantation of the mesh in an intraperitoneal position. After intraperitoneal placement of the mesh there
is no close vascular supply to facilitate neovascularisation and broblasts
have di culty reaching the mesh(39). However in previous animal studies intraperitoneal or extraperitoneal implantation of the mesh did not a ect
host tissue incorporation or mesh degradation(19). Contact of the mesh with
the intraperitoneal compartment can often not be avoided due to the large
dimensions of the hernia defect(11, 36). In the retrospective analysis of the RICH
study there was no di erence in hernia recurrence rate when the retro-rectus 15 plane was compared to intraperitoneal placement. In 2 trials sublay procedures
are found to result in less wound complications and seromas compared to
onlay procedures(40, 41). It is suggested that further randomized trials on the
optimal placement is needed to guide decision-making(17, 38).
Another limitation is that this research was performed in animals without any predisposing collagen disease or hernia defect.
Incorporation of biological meshes
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