LONG-TERM COMPLICATIONS ASSOCIATED WITH PROSTHETIC REPAIR OF INCISIONAL HERNIAS

Objective: To determine whether the type of prosthetic material and te chnique of placement influenced longterm complications after repair of incisional hernias. Design: Retrospective cohort analytic study. Sett ing: University-affiliated hospital. Patients: Two hundred patients un dergoing open repair of abdominal incisional hernias with prosthetic m aterial between 1985 and 1994. Interventions: Four types of prosthetic material were used and placed either as an onlay, underlay, sandwich, or finger interdigitation technique. The materials were monofilamente d polypropylene mesh (Marlex, Davol Inc, Cranston, RI), double-filamen ted mesh (Prolene, Ethicon Inc, Somerville, NJ), expanded polytetraflu roethylene patch (Gore-Tex, MIL Gore & Associates, Phoenix, Ariz) or m ultifilamented polyester mesh (Mersilene, Ethicon Inc). Main Outcome M easures: The incidence of recurrence and complications such as enteroc utaneous fistula, bowel obstruction, and infection with each type of m aterial and technique of repair were compared with univariate and mult ivariate analysis. Results: On univariate analysis, multifilamented po lyester mesh had a significantly higher mean number of complications p er patient (4.7 vs 1.4-2.3; P<.002), a higher incidence of fistula for mation (16% vs 0%-2%; P<.001), a greater number of infections (16% vs 0%-6%; P<.05), and more recurrent hernias (34% vs 10%-14%; P<.05) than the other materials used. The additional mean length of stay to treat complications was also significantly longer (30 vs 3-7 days; P<.001) when polyester mesh was used. The deleterious effect of polyester mesh on long-term complications was confirmed on multiple logistic regress ion (P=.002). The technique of placement had no influence on outcome. Conclusion: Polyester mesh should no longer be used for incisional her nia repair.