- Email: [email protected]
Surgical treatment of large incisional hernias by an intraperitoneal dacron mesh and an aponeurotic graft
Surgical Treatment of Large Incisional Hernias by an Intraperitoneal Dacron Mesh and an Aponeurotic Graft Antoine Hamy, MD, Patrick Pessaux, MD, Ste´phanie Mucci-Hennekinne, MD, Serge Radriamananjo, MD, Nicolas Regenet, MD, Jean-Pierre Arnaud, MD The therapeutic problems of giant incisional hernias of the abdominal wall are difficult to resolve. The technique of repair must make up for the loss of abdominal wall substance and reestablish the interplay of the abdominal musculature. The use of prosthetic materials complies with these two imperatives. The aim of this prospective study was to evaluate the results of surgical treatment of postoperative incisional hernias by intraperitoneal insertion of Dacron (DuPont) mesh and an aponeurotic graft. STUDY DESIGN: We prospectively studied 350 consecutive patients who were operated on for giant postoperative incisional hernia. RESULTS: Postoperative mortality was 0.6%. Seven patients (2%) developed subcutaneous infections that did not affect the prostheses. Another seven patients (2%) developed deep-seated infections that necessitated removal of the mesh in five cases. Eleven patients (3.1%) had recurrence of incisional hernia. CONCLUSIONS: This prospective study shows that the intraperitoneal positioning of Dacron mesh and an aponeurotic graft can efficiently treat giant abdominal wall hernias. ( J Am Coll Surg 2003;196: 531–534. © 2003 by the American College of Surgeons) BACKGROUND:
must not be overlooked, because they can be the result of the forceful reintegration of viscera within a diminished abdominal cavity.1,2 The surgical repair must make up for the loss of abdominal wall substance and reestablish the interplay of the abdominal musculature. The use of prosthetic materials complies with these two imperatives. A prosthesis can provide reinforcement of a suture line or hernioplasty. In cases of large incisional hernia, the prosthesis acts as a substitute, avoiding a suture of the two opposite edges of the defect with tension. The aim of this prospective study was to evaluate the results of using intraperitoneal insertion of Dacron (DuPont) mesh and an aponeurotic graft in the treatment of giant postoperative incisional hernias.
The therapeutic problems accompanying giant incisional hernias of the abdominal wall are often difficult to resolve. Patients with gaint incisional hernias are often obese, have a history of several previous operations, and suffer from multiple comorbid medical problems that render them difficult therapeutic problems. Their abdominal wall musculature is often of poor quality and in certain cases, the herniated visceral mass is such that the right of domicile has been lost. The chronic nature of some of these hernias is such that the eviscerated organs have adapted to their extraabdominal site while the abdominal cavity retracts, enlarging the size of the fibrotic hernial ring. These various factors imply a difficult, if not impossible, primary repair. The resulting tension would spell an early recurrence and, possibly, deterioration beyond the state of the original herniation. Cardiac and pulmonary complications
METHODS Between January 1982 and December 1999, 350 patients (190 men, 160 women) were operated on for giant postoperative incisional hernia. The mean age was 56.5 years (range 17 to 80 years). Comorbid conditions of 90% of the patients (n ⫽ 315) are summarized in Table 1. A high incidence of incisional hernias after midline incisions (84%) was reported (Table 2). The average size
No competing interests declared.
Received June 4, 2002; Revised November 11, 2002; Accepted November 19, 2002. From the Department of Visceral Surgery, Chu-Angers, Angers, France. Correspondence address: Pr JP Arnaud, Department of Visceral Surgery, Chu-Angers- 4 rue Larrey, Angers 49100 France.
© 2003 by the American College of Surgeons Published by Elsevier Science Inc.
531
ISSN 1072-7515/03/$21.00 doi:10.1016/S1072-7515(02)00009-7
532
Hamy et al
Intraperitoneal Mesh Repair
J Am Coll Surg
Table 1. Comorbid Conditions Condition
Obesity Arterial hypertension Heavy smoking Chronic respiratory failure Alcoholism Diabetes mellitus Phlebothrombosis
n
%
150 112 118 91 56 49 35
43 32 34 26 16 14 10
of the hernia was 15 ⫻ 20 cm; the smallest hernia was 15 cm in diameter. Fifty-two percent of the patients (n ⫽ 182) had already undergone at least one previous surgical procedure for incisional hernia recurrence, and several patients had undergone between two and four operations. During this procedure, extraperitoneal mesh was removed in 30 patients (8.6%). Additional surgical procedures were performed in 20 patients: 14 cholecystectomies for chronic cholecystitis and 6 small bowel tears that were immediately sutured. The procedure used for the repair of incisional hernia is described here. After excision of the scar, the herniated sac is exposed and the adjacent anterior fascia is cleared of subcutaneous tissue up to 10 to 15 cm from the ring of the hernial sac. The sac is then excised and intestinal adhesions are dissected free. The quality of tissue adjacent to the parietal defect, muscle and sheath, is important for a strong attachment with the mesh. For this reason, placement of the mesh is at least 10 cm from the edge of the hernial neck. The mesh is secured to the musculofascial wall by through-and-through nonabsorbable sutures, through the parietal peritoneum.3 Stitches are spaced about 3 to 4 cm apart (Fig. 1). The musculoaponeurotic edges are closed together in the midline to isolate the prosthesis as far as possible from the surgical skin wound, decreasing the risk of infection of the prosthesis in the event of superficial Table 2. Previous Abdominal Incisions Incision
Xyphoumbilical midline Infraumbilical midline Xyphopubic midline Right upper transrectal McBurney Infraumbilical transverse Left upper transrectal Total
n
112 60 123 35 10 5 5 350
%
32 17 35 10 3 1.5 1.5 100
Figure 1. Dacron mesh in intraperitoneal position.
suppuration. Drawing the two opposite edges of the wound together must be performed without tension and is rarely possible in cases of major incisional hernia. The prosthesis can be covered by a musculoaponeurotic abdominoplasty according to the technique described by Welti and Eudel,4 along with reinforcing the parietal repair. The anterior lamina of the rectus sheath is incised longitudinally 4 cm back from its medial edge bilaterally. Both aponeurotic flaps are then reflected inward and sutured by interrupted absorbable stitches (Fig. 2). Subcutaneous tissue and skin are closed over four drains. Antibiotics are given as a prophylactic measure up to the sixth postoperative day. RESULTS The postoperative mortality rate was 0.6% (n ⫽ 2): One patient died on the second postoperative day of Mendelson syndrome and the other died 12 days after surgery of massive mesenteric infarction. In seven patients, superficial wound infections occurred without involvement of the mesh and with prompt recovery before hospital discharge. Deep wound infection occurred in seven other patients, and removal of the mesh became necessary in five cases despite incision, irrigation, and drainage. The mean followup time was 8.1 years (range 2 to 14 years). Eleven patients (3.1%) developed recurrence. Recurrences were related to parietal infection treated by removal of the mesh (n ⫽ 5) or by lateral detachment of the mesh (n ⫽ 6). Three of these recurrences took place at the beginning of our experience (40 cases). In these patients the mesh had been sutured too closely to the hernial ring. Five patients underwent reoperation for cholecystitis (n ⫽ 3) and adenocarcinoma of the colon (n ⫽ 2). The Dacron mesh was incorpo-
Figure 2. Coverage of the prosthesis with a myoaponeurotic flap according to the method of Welti and Eudel.4
Vol. 196, No. 4, April 2003
rated and its deeper wall covered by a “neo” peritoneum; intestinal adhesions were dissected easily. DISCUSSION Surgery for gaint incisional hernias has undergone drastic changes in the last 20 years, and patients can be treated with a high rate of success. To guarantee good results, special consideration should be given to the abdominal wall defect, the physiologic changes after chronic incisional hernias, and the use of prosthetic material. Dacron mesh seems to be the material that has the most advantages (moderate inflammatory reaction and marked fibroblastic response). It is associated with good elasticity, adequate strength, satisfactory tissue acceptance, and minimal risk of infection.5-7 The second consideration one faces during an incisional herniorrhaphy is the site of implantation of the prosthesis. Generally, this site is prefascial, retromuscular,8-9 preperitoneal, or premuscular,10 which often requires wide undermining. Following on the reports of Bourgeon and colleagues11 and our experimental study,5 we have chosen the intraperitoneal approach. This simple technique does not require dissection of the intermediate layers, a procedure associated with postoperative wound infections. Some authors emphasize the risk of postoperative intestinal occlusion and bowel fistula in intraperitoneal positioning of the mesh.12-14 These adhesions can be avoided by the interposition of the greater omentum whenever possible. No obstructive complications were reported in this series. To reduce the risk of adhesions, the use of a hydrophobic material with reduced porosity (ePTFE) has been contemplated for several years.15 Nonetheless, the lack of tissue integration with these meshes is often deemed to be responsible for recurrence.16 Indeed, it seems difficult to overcome the fact than an implant carried out using a single material may have opposite properties depending on the tissue with which it is in contact. It can be integrated quickly and closely into the muscular wall to provide an efficient reinforcement, but at the same time, not integrated with the wall of viscera that may be present on the other side.17,18 This is the reason why meshes with different sides have been proposed,19-21 one smooth side being positioned toward the cavity and one porous side in contact with the parietes to ensure tissue integration. Apart from the permanent smooth and hydrophobic membrane,21 some new-generation devices have recently
Hamy et al
Intraperitoneal Mesh Repair
533
been developed and showed remarkable antiadhesive properties.22 Most of these devices are smooth continuous film, made of absorbable and hydrophylic polymers. They display absorption kinetics spread over 1 to 2 weeks and a marked hydrophilia that rapidly changes the material into hydrogel within the body. The absorption of the film restores a natural cleavage plane between the structures first separated by this barrier. Different experimental studies have tested these new meshes. Mutter and associates21 demonstrated in rats the biocompatibility of the membrane and the dramatically superior performance of the patch compared with other commercially available ones. In a functional animal model (rat cecal abrasion and abdominal wall defect),23 the composite mesh was shown to significantly reduce the risk of adhesions (20% of weak adhesions reported) compared with conventional unprotected mesh (100% of severe adhesions). The product was tested in porcine models21 that demonstrated a bowel adhesion rate of 100% with conventional mesh and no visceral adhesion on composite mesh. A clinical prospective study22 confirmed this result with a good tolerance of the composite mesh and a low visceral adhesion rate (20%). In conclusion, more than 90% of our patients who underwent surgical treatment returned to normal activities. Intraperitoneal implantation of Dacron mesh and an aponeurotic graft is a safe and reliable procedure for the treatment of giant incisional hernias with an acceptably low incidence of reherniation and complications. Author contributions
Study conception and design: Hamy, Arnaud Acquisition of data: Mucci-Hennekinne, Pessaux Analysis and interpretation of data: Pessaux Critical revision: Radriamananjo, Regenet Statistical expertise: Pessaux, Regenet REFERENCES 1. Rives J, Lardennois B, Pirz JC, Hobow J. Les grandes e´ventrations. Importance du volet ⬍⬍abdominal⬎⬎ et des troubles respiratoires qui lui sont secondaires. Chirurgie 1973;99:547–563. 2. Stoppa R, Henry X, Canarelli JP, et al. Les indications des methods ope´ratoires se´lectionne´es dans le traitement des e´ventrations postope´ratoires de la paroi abdominale ante´ro-late´rale. Chirugie 1979;103:276–286. 3. Adloff M, Arnaud JP. Surgical management of large incisional hernias by an intraperitoneal mersilene mesh and an aponeurotic graft. Surg Gynecol Obstet 1987;165:204–205. 4. Welti H, Eudel F. Un proce´de´ de cure radicale des e´ventrations postope´ratoires par auto-e´talement des muscles grands droits
534
5.
6. 7. 8. 9.
10. 11. 12. 13.
Hamy et al
Intraperitoneal Mesh Repair
apre´s incision du feuillet ante´rieur de leur gaine. Mem Acad Chir 1941;12:791–798. Arnaud JP, Eloy R, Adloff M, Grenier JF. Critical evaluation of prosthetic materials in repair of abdominal wall hernias: new criteria of tolerance and resistance. Am J Surg 1977;133:338– 345. Cerise ES, Busutil RW, Graichead CC, Ogden EE. The use of mersilene mesh in repair of abdominal wall hernias. Ann Surg 1975;181:728–734. Rath AM, Zhang J, Amouroux J, Chevrel JP. Les prothe´ses parietals abdominales: etude biome´canique et histologique. Chirurgie 1996;121:253–265. MacLanahan D, King LT, Weems C, et al. Retrorectus prosthetic mesh repair of midline abdominal hernia. Am J Surg 1997;173:445–449. Temudom T, Siadati M, Sarr MG. Repair of complex giant or recurrent ventral hernias by using tension free intraperitoneal prosthetic mesh (Stoppa technique): Lessons learned from our initial experience (50 patients). Surgery 1996;120:738–744. Cubertafond P, Sava P, Gainant A, Ugazzi M. Cure chirurgicale dese´ventrations postope´ratoires par plaques prothe´tiques. Chirurgie 1989;115:66–71. Bourgeon R, Borelli JP, Lanfranchi JP. Utilisation des prothe`ses de Mersile´ne dans le traitement des e´ventrations postope´ratoires. Ann Chir 1972;86:541–545. Kaufman Z, Engelberg M, Zager M. Fecal fistula: a late complication of Marlex mesh repair. Dis Colon Rectum 1981;24:543– 544. De Guzman, Nyhus LM, Yared G, Schlesinger PK. Colocutaneous fistula formation following polypropylene mesh placement for repair of a ventral hernia: diagnosis by colonoscopy. Endoscopy 1995;25:459–461.
J Am Coll Surg
14. Marchal F, Brunaud L, Sebbag H, et al. Treatment of incisional hernias by placement of an intraperitoneal prosthesis: a series of 128 patients. Hernia 1999;3:141–147. 15. Goldberg JM, Toledu AA, Mitchell DR. An evaluation of the Gore-Tex surgical membrane for the prevention of postoperative peritoneal adhesions. Surg Gynecol Obstet 1987;70:846–848. 16. Ambrosiani N, Harb J, Gavelli A, Huguet C. Echec de la cure dese´ventrations et des hernies par plaque de PTFE. Ann Chir 1994;18:917–920. 17. Amid PK, Shulman AG, Lichtenstein I. Experimental evaluation of a new composite mesh with the selective property of incorporation to the abdominal wall without adhering to the intestine. J Biomed Mat Res 1994;28:373–375. 18. Bendavid R. Composite mesh (Polypropylene e PTFE) in the intraperitoneal position. Hernia 1997;11:5–8. 19. Alponat A, Lakshminarasappa SR, The M, et al. Effects of physical barriers in prevention of adhesions: an incisional hernia model in rats. J Surg Res 1997;68:126–132. 20. Hill-West JL, Chowdhury SM, Dunn RC, Hubbel JA. Efficacy of a resorbable hydrogel barrier, oxidized regenerated cellulose and hyaluronic acid in the prevention of ovarian adhesions in a rabbit model. Fertil Steril 1994;62:630–634. 21. Mutter D, Kodcheaver GT, Diemunsch P, et al. A new composite mesh (collagen- polyester) for intra-abdominal laparoscopic hernia repair. Surg Endosc 1998;12:595. 22. Balique JG, Alexandre JH, Arnaud JP, et al. Intraperitoneal treatment of incisional and umbilical hernias: intermediate results of a multicenter prospective clinical trial using an innovative composite mesh. Hernia 2000;4[Suppl]:510–516. 23. Rodeheaver GT, Harris ES, Morgan RF. Analysis of the kinetics of peritoneal adhesion formation in the rat and evaluation of potential antiadhesive agents. Surgery 1995;117:663–669.
must not be overlooked, because they can be the result of the forceful reintegration of viscera within a diminished abdominal cavity.1,2 The surgical repair must make up for the loss of abdominal wall substance and reestablish the interplay of the abdominal musculature. The use of prosthetic materials complies with these two imperatives. A prosthesis can provide reinforcement of a suture line or hernioplasty. In cases of large incisional hernia, the prosthesis acts as a substitute, avoiding a suture of the two opposite edges of the defect with tension. The aim of this prospective study was to evaluate the results of using intraperitoneal insertion of Dacron (DuPont) mesh and an aponeurotic graft in the treatment of giant postoperative incisional hernias.
The therapeutic problems accompanying giant incisional hernias of the abdominal wall are often difficult to resolve. Patients with gaint incisional hernias are often obese, have a history of several previous operations, and suffer from multiple comorbid medical problems that render them difficult therapeutic problems. Their abdominal wall musculature is often of poor quality and in certain cases, the herniated visceral mass is such that the right of domicile has been lost. The chronic nature of some of these hernias is such that the eviscerated organs have adapted to their extraabdominal site while the abdominal cavity retracts, enlarging the size of the fibrotic hernial ring. These various factors imply a difficult, if not impossible, primary repair. The resulting tension would spell an early recurrence and, possibly, deterioration beyond the state of the original herniation. Cardiac and pulmonary complications
METHODS Between January 1982 and December 1999, 350 patients (190 men, 160 women) were operated on for giant postoperative incisional hernia. The mean age was 56.5 years (range 17 to 80 years). Comorbid conditions of 90% of the patients (n ⫽ 315) are summarized in Table 1. A high incidence of incisional hernias after midline incisions (84%) was reported (Table 2). The average size
No competing interests declared.
Received June 4, 2002; Revised November 11, 2002; Accepted November 19, 2002. From the Department of Visceral Surgery, Chu-Angers, Angers, France. Correspondence address: Pr JP Arnaud, Department of Visceral Surgery, Chu-Angers- 4 rue Larrey, Angers 49100 France.
© 2003 by the American College of Surgeons Published by Elsevier Science Inc.
531
ISSN 1072-7515/03/$21.00 doi:10.1016/S1072-7515(02)00009-7
532
Hamy et al
Intraperitoneal Mesh Repair
J Am Coll Surg
Table 1. Comorbid Conditions Condition
Obesity Arterial hypertension Heavy smoking Chronic respiratory failure Alcoholism Diabetes mellitus Phlebothrombosis
n
%
150 112 118 91 56 49 35
43 32 34 26 16 14 10
of the hernia was 15 ⫻ 20 cm; the smallest hernia was 15 cm in diameter. Fifty-two percent of the patients (n ⫽ 182) had already undergone at least one previous surgical procedure for incisional hernia recurrence, and several patients had undergone between two and four operations. During this procedure, extraperitoneal mesh was removed in 30 patients (8.6%). Additional surgical procedures were performed in 20 patients: 14 cholecystectomies for chronic cholecystitis and 6 small bowel tears that were immediately sutured. The procedure used for the repair of incisional hernia is described here. After excision of the scar, the herniated sac is exposed and the adjacent anterior fascia is cleared of subcutaneous tissue up to 10 to 15 cm from the ring of the hernial sac. The sac is then excised and intestinal adhesions are dissected free. The quality of tissue adjacent to the parietal defect, muscle and sheath, is important for a strong attachment with the mesh. For this reason, placement of the mesh is at least 10 cm from the edge of the hernial neck. The mesh is secured to the musculofascial wall by through-and-through nonabsorbable sutures, through the parietal peritoneum.3 Stitches are spaced about 3 to 4 cm apart (Fig. 1). The musculoaponeurotic edges are closed together in the midline to isolate the prosthesis as far as possible from the surgical skin wound, decreasing the risk of infection of the prosthesis in the event of superficial Table 2. Previous Abdominal Incisions Incision
Xyphoumbilical midline Infraumbilical midline Xyphopubic midline Right upper transrectal McBurney Infraumbilical transverse Left upper transrectal Total
n
112 60 123 35 10 5 5 350
%
32 17 35 10 3 1.5 1.5 100
Figure 1. Dacron mesh in intraperitoneal position.
suppuration. Drawing the two opposite edges of the wound together must be performed without tension and is rarely possible in cases of major incisional hernia. The prosthesis can be covered by a musculoaponeurotic abdominoplasty according to the technique described by Welti and Eudel,4 along with reinforcing the parietal repair. The anterior lamina of the rectus sheath is incised longitudinally 4 cm back from its medial edge bilaterally. Both aponeurotic flaps are then reflected inward and sutured by interrupted absorbable stitches (Fig. 2). Subcutaneous tissue and skin are closed over four drains. Antibiotics are given as a prophylactic measure up to the sixth postoperative day. RESULTS The postoperative mortality rate was 0.6% (n ⫽ 2): One patient died on the second postoperative day of Mendelson syndrome and the other died 12 days after surgery of massive mesenteric infarction. In seven patients, superficial wound infections occurred without involvement of the mesh and with prompt recovery before hospital discharge. Deep wound infection occurred in seven other patients, and removal of the mesh became necessary in five cases despite incision, irrigation, and drainage. The mean followup time was 8.1 years (range 2 to 14 years). Eleven patients (3.1%) developed recurrence. Recurrences were related to parietal infection treated by removal of the mesh (n ⫽ 5) or by lateral detachment of the mesh (n ⫽ 6). Three of these recurrences took place at the beginning of our experience (40 cases). In these patients the mesh had been sutured too closely to the hernial ring. Five patients underwent reoperation for cholecystitis (n ⫽ 3) and adenocarcinoma of the colon (n ⫽ 2). The Dacron mesh was incorpo-
Figure 2. Coverage of the prosthesis with a myoaponeurotic flap according to the method of Welti and Eudel.4
Vol. 196, No. 4, April 2003
rated and its deeper wall covered by a “neo” peritoneum; intestinal adhesions were dissected easily. DISCUSSION Surgery for gaint incisional hernias has undergone drastic changes in the last 20 years, and patients can be treated with a high rate of success. To guarantee good results, special consideration should be given to the abdominal wall defect, the physiologic changes after chronic incisional hernias, and the use of prosthetic material. Dacron mesh seems to be the material that has the most advantages (moderate inflammatory reaction and marked fibroblastic response). It is associated with good elasticity, adequate strength, satisfactory tissue acceptance, and minimal risk of infection.5-7 The second consideration one faces during an incisional herniorrhaphy is the site of implantation of the prosthesis. Generally, this site is prefascial, retromuscular,8-9 preperitoneal, or premuscular,10 which often requires wide undermining. Following on the reports of Bourgeon and colleagues11 and our experimental study,5 we have chosen the intraperitoneal approach. This simple technique does not require dissection of the intermediate layers, a procedure associated with postoperative wound infections. Some authors emphasize the risk of postoperative intestinal occlusion and bowel fistula in intraperitoneal positioning of the mesh.12-14 These adhesions can be avoided by the interposition of the greater omentum whenever possible. No obstructive complications were reported in this series. To reduce the risk of adhesions, the use of a hydrophobic material with reduced porosity (ePTFE) has been contemplated for several years.15 Nonetheless, the lack of tissue integration with these meshes is often deemed to be responsible for recurrence.16 Indeed, it seems difficult to overcome the fact than an implant carried out using a single material may have opposite properties depending on the tissue with which it is in contact. It can be integrated quickly and closely into the muscular wall to provide an efficient reinforcement, but at the same time, not integrated with the wall of viscera that may be present on the other side.17,18 This is the reason why meshes with different sides have been proposed,19-21 one smooth side being positioned toward the cavity and one porous side in contact with the parietes to ensure tissue integration. Apart from the permanent smooth and hydrophobic membrane,21 some new-generation devices have recently
Hamy et al
Intraperitoneal Mesh Repair
533
been developed and showed remarkable antiadhesive properties.22 Most of these devices are smooth continuous film, made of absorbable and hydrophylic polymers. They display absorption kinetics spread over 1 to 2 weeks and a marked hydrophilia that rapidly changes the material into hydrogel within the body. The absorption of the film restores a natural cleavage plane between the structures first separated by this barrier. Different experimental studies have tested these new meshes. Mutter and associates21 demonstrated in rats the biocompatibility of the membrane and the dramatically superior performance of the patch compared with other commercially available ones. In a functional animal model (rat cecal abrasion and abdominal wall defect),23 the composite mesh was shown to significantly reduce the risk of adhesions (20% of weak adhesions reported) compared with conventional unprotected mesh (100% of severe adhesions). The product was tested in porcine models21 that demonstrated a bowel adhesion rate of 100% with conventional mesh and no visceral adhesion on composite mesh. A clinical prospective study22 confirmed this result with a good tolerance of the composite mesh and a low visceral adhesion rate (20%). In conclusion, more than 90% of our patients who underwent surgical treatment returned to normal activities. Intraperitoneal implantation of Dacron mesh and an aponeurotic graft is a safe and reliable procedure for the treatment of giant incisional hernias with an acceptably low incidence of reherniation and complications. Author contributions
Study conception and design: Hamy, Arnaud Acquisition of data: Mucci-Hennekinne, Pessaux Analysis and interpretation of data: Pessaux Critical revision: Radriamananjo, Regenet Statistical expertise: Pessaux, Regenet REFERENCES 1. Rives J, Lardennois B, Pirz JC, Hobow J. Les grandes e´ventrations. Importance du volet ⬍⬍abdominal⬎⬎ et des troubles respiratoires qui lui sont secondaires. Chirurgie 1973;99:547–563. 2. Stoppa R, Henry X, Canarelli JP, et al. Les indications des methods ope´ratoires se´lectionne´es dans le traitement des e´ventrations postope´ratoires de la paroi abdominale ante´ro-late´rale. Chirugie 1979;103:276–286. 3. Adloff M, Arnaud JP. Surgical management of large incisional hernias by an intraperitoneal mersilene mesh and an aponeurotic graft. Surg Gynecol Obstet 1987;165:204–205. 4. Welti H, Eudel F. Un proce´de´ de cure radicale des e´ventrations postope´ratoires par auto-e´talement des muscles grands droits
534
5.
6. 7. 8. 9.
10. 11. 12. 13.
Hamy et al
Intraperitoneal Mesh Repair
apre´s incision du feuillet ante´rieur de leur gaine. Mem Acad Chir 1941;12:791–798. Arnaud JP, Eloy R, Adloff M, Grenier JF. Critical evaluation of prosthetic materials in repair of abdominal wall hernias: new criteria of tolerance and resistance. Am J Surg 1977;133:338– 345. Cerise ES, Busutil RW, Graichead CC, Ogden EE. The use of mersilene mesh in repair of abdominal wall hernias. Ann Surg 1975;181:728–734. Rath AM, Zhang J, Amouroux J, Chevrel JP. Les prothe´ses parietals abdominales: etude biome´canique et histologique. Chirurgie 1996;121:253–265. MacLanahan D, King LT, Weems C, et al. Retrorectus prosthetic mesh repair of midline abdominal hernia. Am J Surg 1997;173:445–449. Temudom T, Siadati M, Sarr MG. Repair of complex giant or recurrent ventral hernias by using tension free intraperitoneal prosthetic mesh (Stoppa technique): Lessons learned from our initial experience (50 patients). Surgery 1996;120:738–744. Cubertafond P, Sava P, Gainant A, Ugazzi M. Cure chirurgicale dese´ventrations postope´ratoires par plaques prothe´tiques. Chirurgie 1989;115:66–71. Bourgeon R, Borelli JP, Lanfranchi JP. Utilisation des prothe`ses de Mersile´ne dans le traitement des e´ventrations postope´ratoires. Ann Chir 1972;86:541–545. Kaufman Z, Engelberg M, Zager M. Fecal fistula: a late complication of Marlex mesh repair. Dis Colon Rectum 1981;24:543– 544. De Guzman, Nyhus LM, Yared G, Schlesinger PK. Colocutaneous fistula formation following polypropylene mesh placement for repair of a ventral hernia: diagnosis by colonoscopy. Endoscopy 1995;25:459–461.
J Am Coll Surg
14. Marchal F, Brunaud L, Sebbag H, et al. Treatment of incisional hernias by placement of an intraperitoneal prosthesis: a series of 128 patients. Hernia 1999;3:141–147. 15. Goldberg JM, Toledu AA, Mitchell DR. An evaluation of the Gore-Tex surgical membrane for the prevention of postoperative peritoneal adhesions. Surg Gynecol Obstet 1987;70:846–848. 16. Ambrosiani N, Harb J, Gavelli A, Huguet C. Echec de la cure dese´ventrations et des hernies par plaque de PTFE. Ann Chir 1994;18:917–920. 17. Amid PK, Shulman AG, Lichtenstein I. Experimental evaluation of a new composite mesh with the selective property of incorporation to the abdominal wall without adhering to the intestine. J Biomed Mat Res 1994;28:373–375. 18. Bendavid R. Composite mesh (Polypropylene e PTFE) in the intraperitoneal position. Hernia 1997;11:5–8. 19. Alponat A, Lakshminarasappa SR, The M, et al. Effects of physical barriers in prevention of adhesions: an incisional hernia model in rats. J Surg Res 1997;68:126–132. 20. Hill-West JL, Chowdhury SM, Dunn RC, Hubbel JA. Efficacy of a resorbable hydrogel barrier, oxidized regenerated cellulose and hyaluronic acid in the prevention of ovarian adhesions in a rabbit model. Fertil Steril 1994;62:630–634. 21. Mutter D, Kodcheaver GT, Diemunsch P, et al. A new composite mesh (collagen- polyester) for intra-abdominal laparoscopic hernia repair. Surg Endosc 1998;12:595. 22. Balique JG, Alexandre JH, Arnaud JP, et al. Intraperitoneal treatment of incisional and umbilical hernias: intermediate results of a multicenter prospective clinical trial using an innovative composite mesh. Hernia 2000;4[Suppl]:510–516. 23. Rodeheaver GT, Harris ES, Morgan RF. Analysis of the kinetics of peritoneal adhesion formation in the rat and evaluation of potential antiadhesive agents. Surgery 1995;117:663–669.