Abstract
Objective: The aim of this study is to describe the macroscopic features and histologic details observed after retromuscular abdominal wall reconstruction with the combination of an absorbable mesh and a permanent mesh.Methods: We have considered all patients that underwent abdominal wall reconstruction (AWR) with the combination of two meshes that required to be reoperated for any reason. Data was extracted from a prospective multicenter study from 2012 to 2019. Macroscopic evaluation of parietal adhesions and histological analysis were carried out in this group of patients.Results: Among 466 patients with AWR, we identified 26 patients that underwent a reoperation after abdominal wall reconstruction using absorbable and permanent mesh. In eight patients, the reoperation was related to abdominal wall issues: four patients were reoperated due to recurrence, three patients required an operation for chronic mesh infection and one patient for symptomatic bulging. A miscellanea of pathologies was the cause for reoperation in 18 patients. During the second surgical procedures made after a minimum of 3 months follow-up, a fibrous tissue between the permanent mesh covering and protecting the peritoneum was identified. This fibrous tissue facilitated blunt dissection between the permanent material and the peritoneum. Samples of this tissue were obtained for histological examination. No case of severe adhesions to the abdominal wall was seen. In four cases, the reoperation could be carried out laparoscopically with minimal adhesions from the previous procedure.Conclusions: The reoperations performed after the combination of absorbable and permanent meshes have shown that the absorbable mesh acts as a protective barrier and is replaced by a fibrous layer rich in collagen. In the cases requiring new hernia repair, the layer between peritoneum and permanent mesh could be dissected without special difficulty. Few intraperitoneal adhesions to the abdominal wall were observed, mainly filmy, easy to detach, facilitating reoperations.
Highlights
Treatment of complex incisional hernias of the anterolateral abdominal wall is a surgical challenge
We identified 26 patients that had previously undergone abdominal wall reconstruction (AWR) with Posterior components separation technique (PCS) and reconstruction with the combination of absorbable mesh (AM)
We started to use an AM along with a permanent mesh (PM) mainly to provide a barrier between intra-abdominal contents and PM in urologic cases
Summary
Treatment of complex incisional hernias of the anterolateral abdominal wall is a surgical challenge These defects are usually repaired with non-absorbable materials to minimize hernia recurrence. Adhesions to intraabdominal contents, internal hernias through openings on the peritoneum and posterior rectus sheaths, postoperative pain due to transparietal fixations and mesh wrinkling or migration due to permanent mesh structure are the most common. Those reasons guided us to develop a strategy using two types of meshes in the same retro-muscular plane, an absorbable mesh (AM) along with a non-absorbable permanent mesh (PM) [5, 6]. The aim of this study is to report the macroscopic evaluation and histological features observed among 26 patients that underwent a reoperation after retromuscular abdominal wall reconstruction with AM and PM for complex incisional hernia repair
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
