Expanded Polytetrafluoroethylene Mesh Research Articles

Commentator Discussion: Expanded polytetrafluoroethylene mesh in chest wall reconstruction: A 27-year experience

Commentator Discussion: Expanded polytetrafluoroethylene mesh in chest wall reconstruction: A 27-year experience

Expanded polytetrafluoroethylene mesh in chest-wall reconstruction: A 27-year experience

ObjectiveThe study objective was to evaluate the success of expanded polytetrafluoroethylene mesh in chest-wall reconstruction. MethodsWe retrospectively reviewed patients who underwent expanded polytetrafluoroethylene (Gore-Tex) chest-wall reconstruction. The main outcome was a mesh-related event, defined as a mesh-related reoperation (eg, mesh infection requiring debridement with/without explant, tumor recurrence with explant) or structural dehiscence/mesh loosening with/without a hernia. Demographics and surgical outcomes were reported. ResultsA total of 246 reconstructions met inclusion (1994-2021). Fifty-five reconstructions (22.4%) had mesh-related events within a median of 1.08 years (interquartile range, 0.08-4.53) postoperatively; those without had a stable chest for a median of 3.9 years (interquartile range, 1.59-8.23, P < .001). Forty-one meshes (16.6%) became infected, requiring reoperation. Eighty-eight percent (36/41) were completely explanted; 8.3% (3/36) required additional mesh placement. Predictors of mesh-related events were prior chest-wall radiation (odds ratio, 9.73, CI, 3.47-30.10, P < .001), higher body mass index (odds ratio, 1.08, CI, 1.01-1.16, P = .019), and larger defects (odds ratio, 1.48, CI, 1.02-2.17, P = .042). The risk of mesh-related events with obesity was higher with prior chest-wall radiation. ConclusionsMost patients (78%) with an expanded polytetrafluoroethylene mesh had a stable reconstruction after a median of 4 years. Obesity, larger defects, and prior chest-wall radiation were associated with a higher risk of a mesh-related event mostly due to mesh infections. Seventeen percent of reconstructions had reoperation for mesh infection; 88% were completely explanted. Only 8% required replacement mesh, suggesting that experienced surgeons can safely manage them without replacement. Future studies should compare various meshes for high-risk patients to help guide the optimal mesh selection.

Long-Term Outcomes of Abdominal Wall Reconstruction with Expanded Polytetrafluoroethylene Mesh in Pediatric Liver Transplantation.

Background: Large-for-size syndrome caused by organ size mismatch increases the risk of abdominal compartment syndrome. Massive transfusion and portal vein clamping during liver transplantation may cause abdominal compartment syndrome (ACS) related to mesenteric congestion. In general pediatric surgery—such as correcting gastroschisis—abdominal wall reconstruction for the reparation of defects using expanded polytetrafluoroethylene is an established method. The purpose of this study is to describe the ePTFE-Gore-Tex closure method in patients with or at a high risk of ACS among pediatric liver transplant patients and to investigate the long-term prognosis and outcomes. Methods: From March 1988 to March 2018, 253 pediatric liver transplantation were performed in Seoul National University Hospital. We retrospectively reviewed the cases that underwent abdominal wall reconstruction with ePTFE during liver transplantation. Results: A total of 15 cases underwent abdominal closure with ePTFE-GoreTex graft. We usually used a 2 mm × 10 cm × 15 cm sized Gore-Tex graft for extending the abdominal cavity. The median follow up was 59.5 (17–128.7) months and there were no cases of ACS after transplantation. There were no infectious complications related to ePTFE implantation. The patient and graft survival rate during the study period was 93.3% (14/15). Conclusions: Abdominal wall reconstruction using ePTFE is feasible and could be an alternative option for patients with a high risk of ACS.

Delayed mesh infection and mesh penetrating the transverse colon and small intestine after abdominal incisional hernia repair

The occurrence of late-onset mesh infection and mesh invasion into the intestine after abdominal incisional hernia repair is extremely rare. Herein, we describe the first case of late-onset mesh infection and mesh penetrating the transverse colon and small intestine 5 years after incisional hernia repair using an expanded polytetrafluoroethylene mesh. The symptom was drainage from the reddish wound, and computed tomography scan revealed intestinal prolapse with local wall thickening. The mesh removal and small intestine and colon resection were conducted because the small intestine and transverse colon formed a mass containing the mesh inside. The events were caused by the lack of mesh fixation, and the dislodged mesh penetrating the intestinal tract caused the infection. For mesh infections in which conservative treatment is not effective, mesh removal and organ excision should not be delayed regardless whether there is a strong adhesion of the abdominal cavity.

Persistent posterior seroma after laparoscopic repair of ventral abdominal wall hernias with expanded polytetrafluoroethylene mesh: prevalence, independent predictors and detached tacks : Retrospective review.

A persistent seroma located posterior to a mesh (PPS) remains a little known complication after laparoscopic ventral hernia repair (LVHR). The aim of this large case series was to analyse the prevalence and clinical course as well as identify related factors and independent predictors of PPS. All 1288 adult patients who underwent a LVHR with an expanded polytetrafluoroethylene mesh (ePTFE) between January 2003 and July 2014 were reviewed. Those who underwent an abdominal computed tomography (CT) scan more than 3months afterwards (n=166) were included and their scans were analysed. The primary outcome measure was the prevalence of a PPS and its characteristics. The secondary outcome measures were identification of significantly related factors and independent predictors of PPS. A PPS was observed in 14 of 166 analysed CT scans (8.4%). Eleven patients were symptomatic; conservative treatment (wait-and-see policy) was successful in eight. Three underwent relaparoscopy with removal of a thick neoperitoneum. Several instances of tack and/or mesh detachment were identified on CT scans and during relaparoscopy. Independent predictors were:>3 trocars (RR 5.0, 95% CI 1.6-15.8) and use of a mesh larger than>300cm2 (RR 9.9, 95% CI 1.9-51.2). A PPS is a relatively common complication after LVHR with an ePTFE mesh of usually larger hernias. A "wait-and-see" approach seems justified in most cases. Some require laparoscopic excision of the thick neoperitoneum. A PPS can cause tack and mesh detachment but the clinical consequences are unclear. Recurrences have not been observed in this series.

Mesh hiatal reinforcement in laparoscopic Nissen fundoplication for neurologically impaired children is safe and feasible.

ABSTRACTFundoplication is a standard treatment for gastroesophageal reflux disease (GERD) in neurologically impaired children. However, it has a high recurrence rate due to wrap herniation and disruption resulting from the failure or enlargement of the esophageal hiatus suture site. In adult patients with GERD, reinforcement of the sutured esophageal hiatus with a mesh significantly reduces the recurrence rate after surgery for esophageal hiatus hernia. In children, there are no big series of fundoplication with mesh reinforcement. Therefore, we confirmed the safety and feasibility of an expanded polytetrafluoroethylene mesh hiatal reinforcement with fundoplication as an additional procedure for neurologically impaired children. Neurologically impaired children (age, ≥5 years) who underwent laparoscopic fundoplication and gastrostomy at our institution between 2011 and 2013 were included in this study. The operative time, bleeding amount, complications, and recurrence were retrospectively evaluated. Thirteen patients were included in this study. The mean age at operation was 147.2 ± 37.8 months, and mean body weight was 18.5 ± 7.9 kg. The complication rate of epilepsy and scoliosis was 100% and 84.6%, respectively. The operative time was 265.1 ± 38.1 minutes, and mean blood loss was 26.5 ± 34.7 mL. There were no peri- or postoperative complications. None of the patients showed recurrent symptoms such as repeated vomiting and aspiration pneumonia during the mean follow-up period of 2.5 ± 0.6 years. The mesh hiatal reinforcement with fundoplication for neurologically impaired children is safe and feasible.

LDT classification and therapeutic strategy of congenital body wall defects

Repairing body wall defects is a critical step in the treatment of some congenital deformities, and this procedure may need the help from plastic surgeons. Although there are many articles about congenital deformities, body wall defects of these malformations are rarely studied as independent targets. In this article, the authors present an LDT classification for congenital body wall defects according to the position of the defects, the tissue layers involved, and the surgical urgency, each of which is represented by letters L, D, and T, respectively. That is, the defects in different areas (L), full-thickness (D1), or partial (D0A, D0B) defects, defects needing instant repair (T2), semi-elective repair (T1), or elective repair (T0). Based on this classification system, the authors have performed body wall reconstruction on two pairs of thoraco-omphalopagus twins, one pair of ischiopagus tetrapus twins, and an infant and an adult, both of whom were diagnosed with pentalogy of Cantrell associated with ectopia cordis. Except for one pair of thoraco-omphalopagus twins who died after emergency separation, all the other patients survived. Another pair of thoraco-omphalopagus twins suffered from wound dehiscence and partial flap necrosis, respectively, after surgery. An expanded polytetrafluoroethylene mesh in one sister of the ischiopagus twins was removed because of infection. LDT classification not only can help doctors categorise different congenital body wall defects rapidly and easily, but can also guide the reconstruction of these defects. It may have clinical value to plastic surgeons to some extent.

Temporary abdominal closure with polytetrafluoroethylene prosthetic mesh in critically ill non-trauma patients.

Survival in critically ill non-trauma patients may be improved by performing temporary abdominal closure using different surgical techniques. We describe the use of expanded polytetrafluoroethylene (ePTFE) mesh for temporary abdominal closure in a group of critical patients. We also evaluate definitive abdominal wall closure in these patients once they are in a stable condition. We conducted a study of 29 critically ill non-trauma patients who underwent temporary abdominal closure due to sepsis or abdominal compartment syndrome over 7 years at two university hospitals. We analysed factors related to surgical wound type and definitive abdominal wall closure. We evaluated the SAPS 3 severity score and used it to obtain expected mortality. We used the Clavien-Dindo System for Surgical Complications and the Ventral Hernia Working Group Classification during follow-up. Performing temporary abdominal closure with expanded polytetrafluoroethylene mesh was associated with a mortality rate of 20.68%, which was lower than the expected mortality calculated from the SAPS 3 severity score (38.87 ± 21.60). There was no fistula formation related with this type of prosthetic material. In our study group, definitive abdominal wall closure was performed in the 16 patients who survived (69.5%), and six of them underwent this procedure during the original hospital stay. Temporary abdominal closure with ePTFE mesh is an effective alternative in some circumstances. We observed a higher survival rate than the predicted figure and there were no cases of enteroatmospheric fistulae using this particular surgical technique. ePTFE facilitates definitive abdominal wall closure, once the patient is in a stable condition.

Long-Term Follow-Up of Laparoscopic Incisional and Ventral Hernia Repairs

Laparoscopic incisional and ventral hernia repair (LIVHR) has been advocated for short hospital stay, rapid ambulation, and low recurrence rates and has gained increasing popularity. We report here the outcomes of long-term follow-up of LIVHR. The series comprised 100 LIVHR procedures performed between June 2000 and February 2004. LIVHR was performed with the standard three-trocar configuration. Underlay expanded polytetrafluoroethylene mesh was placed in a tension-free manner and bridged the fascia defect with an adequate overlap of at least 4 cm. Enrolled patients were prospectively followed up at return visits. Two conversions due to densely scarred abdomen were inevitable. There were four true recurrences (4%) and three eventrations (loss of prosthetic elasticity) (3%). There was no difference in recurrence rate and eventrations among ventral, incisional, and recurrent incisional hernias. Patients with recurrent incisional hernias reported more seroma formations, and seroma formation was independently associated with adhesiolysis (adjusted odds ratio=4.57). Long-term follow-up of LIVHR was satisfactory both in complications and in recurrences. The efficacy of LIVHR was ascertained and reproducible for Taiwanese patients. The concerns with chronic pain necessitate preoperative counseling with patients indicated or planned for LIVHR.

Modified Rives-Stoppa Technique for Repair of Complex Incisional Hernias in 59 Patients

Incisional hernias develop in 2% to 11% of patients who undergo laparotomy. Prosthetic mesh repair provides more strength, tension-free closure, and decreased recurrence rates as compared to primary tissue repairs. Complications-fistula formation, adhesions, skin erosion, and seroma/abscess formation-however, include increased rates of infection, sometimes requiring complete mesh removal. The Rives-Stoppa repair for complex incisional hernias confers the benefits of prosthetic repair and lower recurrence rates, but decreases certain complications by preventing direct mesh contact with the bowel. A total of 89 consecutive patients (mean age, 58.1) underwent a modified Rives-Stoppa repair for purposes of this review, all the patients who lost to follow-up before 6 months postoperatively were excluded from the study. Of the remaining 59 patients, 32.2% (n = 19) had expanded polytetrafluoroethylene mesh, and 67.8% (n = 40) had polypropylene mesh. Average range of follow-up was 40.0 months. Hernia recurred in 1 patient (1.7%). Infection requiring explantation of the prosthesis occurred in 3 patients (5.1%). The Rives-Stoppa repair is reportedly the best open technique for complex incisional hernias with comparatively lower recurrence rates. Additionally, patients with inflammatory bowel disease (64.4% of our series), who often require later reoperation for their primary disease, may benefit from this technique of herniorrhaphy where no interface exists between intrabdominal contents and the prosthesis. This lack of interface decreases intrabdominal adhesions and facilitates re-entry if future surgery is needed for inflammatory bowel disease.

Does expanded polytetrafluoroethylene mesh really shrink after laparoscopic ventral hernia repair?

The shrinkage of mesh has been cited as a possible explanation for hernia recurrence. Expanded polytetrafluoroethylene (ePTFE) is unique in that it can be visualized on computed tomography (CT). Some animal studies have shown a greater than 40% rate of contraction of ePTFE; however, very few human studies have been performed. A total of 815 laparoscopic incisional/ventral hernia (LIVH) repairs were performed by a single surgical group. DualMesh Plus (ePTFE) (WL Gore & Associates, Newark, DE) was placed in the majority of these patients using both transfascial sutures and tack fixation. Fifty-eight patients had postoperative CTs of the abdomen and pelvis with ePTFE and known transverse diameter of the implanted mesh. The prosthesis was measured on the CT using the AquariusNet software program (TeraRecon, San Mateo, CA), which outlines the mesh and calculates the total length. Data were collected regarding the original mesh size, known linear dimension of mesh, seroma formation, and time interval since mesh implantation in months. The mean shrinkage rate was 6.7%. The duration of implantation ranged from 6 weeks to 78 months, with a median of 15 months. Seroma was seen in 8.6% (5) of patients. No relationship was identified between the percentage of shrinkage and the original mesh size (P = 0.78), duration of time implanted (P = 0.57), or seroma formation (P = 0.074). In 27.5% (16) of patients, no shrinkage of mesh was identified. Of the patients who did experience mesh shrinkage, the range of shrinkage was 2.6-25%. Our results are markedly different from animal studies and show that ePTFE has minimal shrinkage after LIVH repair. The use of transfascial sutures in addition to tack fixation may have an implication on the mesh contraction rates.

Mesh Infection in Ventral Incisional Hernia Repair: Incidence, Contributing Factors, and Treatment

Prosthetic mesh infection is a catastrophic complication of ventral incisional hernia (VIH) repair. The current surgical literature was reviewed to determine the incidence, microbiology, risk factors, and treatment of mesh infections. Mesh infections tend to present late. Diagnosis depends on high clinical suspicion and relies on culture of the fluid surrounding the mesh or of the mesh itself. Risk factors may include a high body mass index (obesity); chronic obstructive pulmonary disease; abdominal aortic aneurysm repair; prior surgical site infection; use of larger, microporous, or expanded polytetrafluoroethylene mesh; performance of other procedures via the same incision at the time of repair; longer operative time; lack of tissue coverage of the mesh; enterotomy; and enterocutaneous fistula. The best treatment is prevention. Treatment of mesh infection is evolving on a case-by-case basis from explantation toward mesh salvage, to prevent complications such as hernia recurrence. Higher-quality reporting on mesh infection in VIH repair must be achieved through better classification and quantification of these infections. Tactics to avoid mesh infection should be based on best evidence and high-quality prospective trials and observational studies.

Subsequent abdominal surgery after laparoscopic ventral and incisional hernia repair with an expanded polytetrafluoroethylene mesh: a single institution experience with 72 reoperations

PurposeLaparoscopic ventral and incisional hernia repair (LVIHR) carries a risk of adhesion formation and can influence subsequent abdominal operations (SAOs). We performed a retrospective study of findings during reoperations of patients who had previously had an LVIHR by using an expanded polytetrafluoroethylene mesh (DualMesh®; WL Gore, Flagstaff, AZ, USA).MethodsThe medical records of all 695 patients who had LVIHR at our hospital were reviewed. Patients who underwent SAO for various indications were identified (n = 72) and analyzed.ResultsSeven LVIHR patients (1%) had early SAO (within a few days). In six patients (86%), removal of the mesh was required. Intra-operatively, in all six of these patients with peritonitis, there were no adhesions against the implant identified. Late SAOs (after more than 1 month) were performed in 65 patients (9.4%). Only one patient required acute surgical intervention due to an LVIHR-related adhesion (0.15%). Laparoscopy was performed in 83% and laparotomy in 17% of patients. Adhesions against the implant were present in 83% of patients; in 65%, the adhesions involved omentum only, and in 18%, they involved the bowel. Adhesiolysis was always easy and caused no inadvertent enterotomies. SAOs were devoid of postoperative complications.ConclusionsIn this largest series of reoperations after LVIHR, the majority of patients had mild or moderate adhesions against the implant. The specific observations that: (1) no relaparoscopies had to be converted, (2) no inadvertent enterotomies were made during adhesiolysis, and (3) SAOs have practically been devoid of peri- and postoperative complications indicate that SAOs can be safely performed after previous LVIHR with DualMesh.

Computed tomographic measurements of mesh shrinkage after laparoscopic ventral incisional hernia repair with an expanded polytetrafluoroethylene mesh

The potential for shrinkage of intraperitoneally implanted meshes for laparoscopic repair of ventral and incisional hernia (LRVIH) remains a concern. Numerous experimental studies on this issue reported very inconsistent results. Expanded polytetrafluoroethylene (ePTFE) mesh has the unique property of being revealed by computed tomography (CT). We therefore conducted an analysis of CT findings in patients who had previously undergone LRVIH with an ePTFE mesh (DualMesh, WL Gore, Flagstaff, AZ, USA) in order to evaluate the shrinkage of implanted meshes. Of 656 LRVIH patients with DualMesh, all patients who subsequently underwent CT scanning were identified and only those with precisely known transverse diameter of implanted mesh and with CT scans made more than 3 months postoperatively were selected (n = 40). Two radiologists who were blinded to the size of the implanted mesh measured in consensus the maximal transverse diameter of the meshes by using the AquariusNET program (TeraRecon Inc., San Mateo, CA, USA). Mesh shrinkage was defined as the relative loss of transverse diameter as compared with the original transverse diameter of the mesh. The mean time from LRVIH to CT scan was 17.9 months (range 3-59 months). The mean shrinkage of the mesh was 7.5% (range 0-23.7%). For 11 patients (28%) there was no shrinkage at all. Shrinkage of 1-10% was found in 16 patients (40%), of 10-20% in 10 patients (25%), and of 20-24% in 3 patients (7.5%). No correlation was found regarding the elapsed time between LRVIH and CT, and shrinkage. There were two recurrences, one possibly related to shrinkage. Our observations indicate that shrinkage of DualMesh is remarkably lower than has been reported in experimental studies (8-51%). This study is the first to address the problem of shrinkage after intraperitoneal implantation of synthetic mesh in a clinical material.

Health-related quality-of-life changes after laparoscopic and open incisional hernia repair

The objective of this matched control study in patients suffering from incisional hernia was to compare laparoscopic open repair (LHR) with open hernia repair (OHR) in terms of long-term health-related quality of life (HRQL) according to the SF-36 Health Survey. Twenty-four consecutive patients (18 male, six female; mean age, 55 years) prospectively underwent LHR using expanded polytetrafluoroethylene mesh. The second group, which was matched for age and gender, was subjected to OHR using large pore-sized, low-weight polypropylene meshes. Before and after surgery, HRQL was assessed by the SF-36 Health Survey, which measures eight different health-quality domains, and the SF-36 Physical (PCS) and Mental Component Summary (MCS) score. The SF-36 values were compared to the scores of age-stratified German population controls. The patients were reevaluated 16 months (range, 12-25) after LHR and 28 months (range, 18-52) after OHR, respectively. Before surgery, all of the eight health-quality domains as well as the PCS and MCS scores of both study groups were significantly lower than the corresponding scores of the age-stratified healthy German population. However, the OHR patients had significantly higher physical functioning and vitality scores than the LHR patients. After LHR and OHR, the scores for all eight SF-36 domains significantly increased but were still lower than those of the controls. The LHR patients were still worse than the norm population on both PCS and MCS scores, whereas OHR patients were worse only on PCS but not on MCS. In the long-term follow-up, none of the SF-36 Health Survey domains or the PCS and the MCS scores revealed significant differences between LHR and OHR patients. LHR was not different from OHR for selected indications that measure long-term outcome and HRQL. SF-36 appears to be an appropriate instrument to measure postoperative HRQL, showing responsiveness to changes in objective outcome measures.

Laparoscopic Ventral Hernia Repair in Obese Patients

Ventral abdominal hernias represent a frequent and often formidable clinical problem, especially in obese patients. Because laparoscopic ventral hernia repair (LVHR) results in few complications and a low recurrence rate, the use of minimally invasive techniques in this subgroup of patients may minimize perioperative complications and failure rates. Retrospective review of prospectively collected data. Tertiary care hospital. One hundred sixty-three obese patients (body mass index [calculated as weight in kilograms divided by the square of height in meters], > or =30) who underwent LVHR at our institution between July 1, 1998, and December 31, 2003. Laparoscopic ventral hernia repair with an expanded polytetrafluoroethylene mesh. Patient age, sex, body mass index, size of fascial defect and mesh, operating time, operative blood loss, length of hospitalization, complications, and hernia recurrences. Ninety-eight women and 65 men, with a mean body mass index of 38, underwent LVHR. Twenty patients (12.3%) had 21 postoperative complications. There was no perioperative mortality. The mean length of hospital stay was 2.6 days. The recurrence rate was 5.5% at a mean follow-up of 25 months (range, 1-73 months). A low rate of conversion to laparotomy, minimal perioperative morbidity, and the absence of perioperative mortality in this series indicate the safety of LVHR in obese patients with complex hernias. In addition, a success rate of more than 94.5% suggests improved efficacy of LVHR compared with the historical rates among control subjects undergoing open surgery. In experienced hands, LVHR may be the approach of choice for most patients with a body mass index of 30 or more.

Ventral hernia repair using allogenic acellular dermal matrix in a swine model

This study was designed to assess the long-term efficacy of allogenic acellular dermal matrix (ADM) used as an interpositional graft for ventral hernia repair in a swine model. We created 12x4-cm full-thickness abdominal wall defects in 22 Yucatan miniature pigs. The defect was repaired with either two 6x4-cm pieces of AlloDerm (acellular dermal matrix processed from pig skin in order to avoid a xenogenic response, LifeCell Corporation, Branchburg, NJ USA) (n = 12), or expanded polytetrafluoroethylene mesh (ePTFE) (Gore-Tex, W.L. Gore & Associates, Inc., Newark, DE USA) (n = 10). In six pigs, a separate 3-cm fascial incision was made, which was then suture repaired as a control for tensiometry testing. The surgical sites were evaluated at either 3 months or 9 months for the presence of a hernia, stretching of the implant, adhesions, vascularity, and biomechanical strength. Two hernias occurred in both the ADM and the ePTFE groups. There was minimal stretching of the implants and minimal adhesions in both groups. Fluorescein testing and histology indicated vascular ingrowth into the ADM. There was no statistical difference between the mean breaking strengths of the ADM-fascial interface (106.5 N +/- SD 40.1), the interface between two pieces of ADM (149.1 N +/- SD 76.7), and the primary fascial repair (108.1 N +/- SD 20.9) at 9 months. The ADM-fascial interface had a significantly higher breaking strength than that of the ePTFE-fascia interface (66.1 N +/- SD 30.1) (P = 0.017, t-test, P = 0.043 Wilcoxon rank sum test). In this study, we were unable to demonstrate a difference between ADM and ePTFE in their ability to repair ventral hernias at 9 months in a swine model. The ADM additionally supports vascular ingrowth and exhibits increased breaking strength at the fascia-implant interface.

Medium-term follow-up confirms the safety and durability of laparoscopic ventral hernia repair with PTFE

Background Ventral abdominal wall hernias are common lesions and may be associated with life-threatening complications. The application of laparoscopic principles to the treatment of ventral hernias has reduced recurrence rates from a range of 25% to 52% to a range of 3.4% to 9%. In this study, we review our experience and assess the clinical outcome of patients who have undergone laparoscopic repair of ventral hernias. Methods We reviewed the outcome of 79 patients with more than 1 year of follow-up who underwent laparoscopic ventral hernia repair between March 1996 and December 2001. Patient demographics, hernia characteristics, operative parameters, and clinical outcomes were evaluated. Results Of the 79 patients, 37 were males. Mean age was 55.8 years (range 28–81). Sixty-eight patients had incisional hernias, including 17 with recurrent hernias. Eleven patients had primary ventral hernias. The mean defect size was 103 cm 2 (range 4–510); incarceration was present in 22 patients (27.8%), and multiple (Swiss-cheese) defects in 20 (25.3%). Laparoscopic expanded polytetrafluoroethylene mesh repair by the modified Rives-Stoppa technique was completed in 78 (98.7%). One conversion occurred because of bowel injury. The mean operating time was 110 minutes (range 45–210) and mean hospital stay was 1.7 days (range 0–20), with 46 patients (58.2%) being discharged within 24 hours of surgery. Complications included seroma formation (3), chronic pain (3), prolonged ileus (1), hematoma formation (1), and missed bowel injury (1) for a complication rate of (11.4%). There were no deaths. After a follow-up of up to 6 years (a mean of 34 months), there were 4 recurrences (5%). Conclusion The laparoscopic repair of ventral hernias is safe, effective, and durable with minimal morbidity. It is particularly successful in patients with recurrent lesions. The laparoscopic approach to ventral hernia repair should be considered the standard of care.

Surgical Repair of Inguinal Hernia: Tension Free Technique with Prosthetic Materials (Gore-Tex Mycro Mesh Expanded Polytetrafluoroethylene)

The purpose of this study is to report the results of a tension-free repair technique using expanded polytetrafluoroethylene Gore-Tex Mycro Mesh in patients with inguinal hernias. Over 3 years, 104 patients have undergone the aforementioned procedure for 118 hernias (85 indirect and 33 direct) in our clinic. Ninety-three of the patients were operated for the first time, whereas the remainder of them were operated for hernia recurrence. Fourteen patients had bilateral hernias, and six had incarcerated ones. The median patient's age was 53 years. Eighty-three patients were operated under general and 21 under local or epidural anesthesia. One hundred and two patients were offered a one-day surgery procedure, but three were readmitted with wound infection. Two of these patients were conservatively cured, and the third was submitted to mesh removal. Two patients developed hematoma in the scrotum and were discharged a week later after the absorption of the hematoma. All of the patients except the one who was submitted to mesh removal returned to normal life within a week after the operation. During the follow-up period, none of our patients experienced hernia recurrence. Our results are in accordance with those of the world literature. We perform the tension-free hernia repair by using the expanded polytetrafluoroethylene mesh in our patients because we believe it is a safe procedure without significant postoperative morbidity and with no hernia recurrences.

Surgical Repair of Incisional Ventral Hernias: Tension-Free Technique Using Prosthetic Materials (Expanded Polytetrafluoroethylene Gore-Tex Dual Mesh)

Repairing an incisional ventral hernia is a major challenge for a surgeon. The high recurrence rates observed during hernia repair by tissue approximation led to development of tension-free procedures by using prosthetic materials. The purpose of this study is to report the results of a tension-free repair technique using expanded polytetrafluoroethylene Gore-Tex Dual Mesh (Gore-Tex Soft Tissue Patch, W.L. Gore and Associates Inc, Flagstaff, AZ) in patients with primary or recurrent incisional ventral hernias. Over 3 years, 52 patients with incisional hernias have undergone this procedure in our clinic. Fourteen of them had recurrent hernias which had been primarily repaired by Mayo hernioplasty. Six of our patients had irreducible hernias preoperatively. Twenty-five patients had hernias on midline incisions, and the rest of them had hernias on transverse abdominal incisions. The median patient age was 65 years, and all were operated on under general anesthesia. The majority of the patients had 4 to 6 days of hospitalization. A subcutaneous seroma developed in eight patients. They all were treated by multiple paracentesis. Four of our patients experienced wound infection and were treated by mesh removal. None of the patients presented with cardiovascular or pulmonary complications. During the follow-up period, no other hernia recurrence, except the cases with mesh removal, has been noticed. The tension-free incisional hernia repair using expanded polytetrafluoroethylene mesh is, to our experience, a safe and easy procedure with no major morbidity or recurrence.