Éventrations postopératoires: prothèse intraou extrapéritonéale?

Abstract

Study aim The aim of this retrospective study concerning the repair of postoperative incisional hernia using Dacron mesh was to compare results according to the extraor intraperitoneal mesh position in order to assess the respective indications of each option. Materials and methods From January 1985 to December 1996, 172 patients (mean age: 61.3 years) were operated on using Dacron mesh extraperitoneally ( n = 99) or intraperitoneally located ( n = 73). For statistical analysis, both groups were compared using Chi square test or Fisher's test. Results There were no postoperative deaths in the group with extraperitoneal mesh and two postoperative deaths in the group with intraperitoneal mesh. There were no significant differences when results comparing parietal complications (sepsis: 2% vs 2.7%, pain: 9.1% vs 16.9%), secondary intestinal disorders (2% vs 4.2%) and recurrence rate (4% vs 5.6%) were assessed between extraperitoneal and intraperitoneal mesh. Recurrences were related to parietal infection treated by partial removal of the mesh ( n = 2) or to the lateral detachment of the mesh ( n = 6). Conclusions In the group of patients receiving extraperitoneal mesh there were no postoperative deaths and morbidity was low (this technique is generally used in the treatment of large incisional hernia). In the group of patients receiving intraperitoneal mesh, similar parietal and general complications were observed. But the risk of serious complications and postoperative death is higher; this technique must be limited to the most serious incisional hernia and to high risk patients.