Preventing Hernia Recurrence: Optimising Mesh Use in Incisional Hernia Repair

Abstract

Incisional hernia is a common complication of abdominal surgery, affecting up to a quarter of patients undergoing laparotomy. This case report discusses a 72-year-old lady with a recurrent incisional hernia following an emergency Hartman’s procedure. The discussion covers the properties of synthetic vs biological meshes, the significance of the anatomical location of the mesh, fixation methods, laparoscopic surgery, short and long term complications.
 Key points:
 
 The ideal mesh is biocompatible, strong, resistant to infection, has minimal bioreactivity and non-immunogenic
 Pore size is important to the degree of mesh integration, infection risk and the development of chronic pain
 Synthetic mesh is useful in contaminated cases but adds a significant cost to the procedure
 Sublay mesh placement is associated with a reduced risk of recurrence
 Most recurrences occur at the edge of the mesh. Surgeons should ensure a 5cm overlap between the mesh and native tissues and consider dual fixation methods
 Laparoscopic hernia repair has been associated with a shorter post-op recovery, less pain and a short term reduced risk of recurrence, however there is a greater risk of bowel injury and development of adhesions
 Composite meshes can reduce the risk of adhesions with intraperitoneal mesh placement
 Chronic pain is associated with the use of tacks, heavy weight synthetic meshes and chronic infection
 Resorbable meshes have not been shown to reduce chronic pain
 The choice of mesh, method of repair and surgical approach should be individualised to the patient.