Roturas de malla: una causa poco frecuente de recidiva herniaria

Abstract

The central mesh rupture is a rare cause of hernia recurrence. We analyze our experience. Material and methodsRetrospective search in our database of surgery of the abdominal wall, from 02/2008 to 10/2014, looking for cases with a diagnosis of «recurrent hernia» or «recurrent ventral hernia». Afterwards, the surgical report is reviewed to identify any mesh breakage. ResultsCase 1 Obese patient with giant ventral hernia. Treatment: retromuscular ventral hernia repair with polypropylene mesh (60g/m2) without closing the anterior sheet. At 32 months hernia recurrence appears with central defect of 3×3cm.Case 2 Patient with giant ventral hernia. Treatment: anterior components separation with onlay polypropylene mesh (48g/m2). At 16 months appears hernia recurrence with central defect 7×5cm.Case 3 Obese patient with 8 previous surgeries of ventral hernia, presenting colocutaneous fistula and ventral hernia. Treatment: retromuscular polypropylene mesh (35g/m2) without closing the anterior sheet. It is reoperated three days after due to septic shock, five zones of mesh rupture were found.Case 4 Obese patient with giant incisional hernia after open abdomen 20 years ago. Treatment: ventral hernia repair with retromuscular polypropylene mesh (28g/m2) without closing the anterior sheet. At 20 days central rupture mesh appears about 5cm in diameter. ConclusionsCentral mesh rupture appears especially in obese patients with large hernias or with multiple previous surgeries on the abdominal wall. In these patients, especially if we cannot close the anterior myofascial layer we should avoid using lightweight meshes.