Preventing Hernia Recurrence: Optimising Mesh Use in Incisional Hernia Repair

Case Study

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.