Long-term results of incisional hernia repair by non-absorbable intraperitoneal prosthetic mesh in a series of 149 patients.

The authors report a series of 149 cases of incisional hernia, operatead be tween 1983 and 1993, by insertion of a non-absorbable prosthetic mesh withi n the intraperitoneal cavity. This series consisted of 93 women and 56 men, with a mean age 57 years. One third of repairs were performed because of p rimary treatment failure. One or more operative risk factors were present i n 127 patients. A non-absorbable intraperitoneal prosthetic mesh was insert ed with tension to allow good musculo-aponeurotic repair. Postoperative mor tality was 0.6 %. All but 13 of the patients, were reviewed with a mean fol low-up of 83 months. Twenty eight patients (20 %) developed recurrence. In 8 cases, the cause of recurrence was failure of prosthetic mesh insertion b ecause of excessive tension. Three patients (1.7 %) developed a fistula in contact with the prosthetic mesh, that had to be removed. A small bowel fis tula was observed in 2 cases after an intraoperative wound in 1 case, and a colonic fistula in 1 case. The results of incisional hernia repair with no nabsorbable intraperitoneal prosthetic mesh can be compared with thase of o ther techniques using prosthetic materials. This technique does not require dissection of the intermediate planes and avoids undermining which causes substantial bleeding. The risk of sepsis is also decreased by deep placemen t of the prosthesis. The exceptional cases of fistula or the possibility of migration of the prosthesis are not exclusively observed with this techniq ue, but must clearly encourage a very strict aseptic technique, with placem ent of omentum between the prosthetic mesh and the viscera.