Page 324 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 16
A surgical procedure was planned to repair the bulging abdominal wall. During surgery the bulging was found to be caused by expansion of an intact mesh. The elongation was caused by a striking central pore expansion from 1.5 to 2.5 mm ( gure 4).
Figure 4. Pore size of explanted polyester mesh compared to original mesh (2102). (A) Pore size (1.5 mm) of original mesh (Parietex Composite®, Covidien, France). (B) Increased pore size (2.5 mm) of explanted mesh (Parietex Composite®, Covidien, France).
Surgical excision of the central part of the mesh was performed to tighten the mesh and reduce the bulging. 30 months later the patient developed swelling of the right abdominal wall again. The patient was planned for repair. During the procedure the mesh was still in tact but there was ongoing expansion of the mesh. The mesh has been removed and replaced by a 20*30 polypropylene collagen-coated mesh (Parietene Composite®, Covidien, France) in bridging position. A heavy-weight polypropylene mesh was implanted to provide the maximum tensile strength to prevent failure of the repair(5). Follow-up of over 1 year did not show any bulging.
322