Incisional hernia recurrence after mesh repair of the abdominal wall

Introduction: Depending on the surgical technique, mesh material and follow -up, the figures for recurrences of incisional hernia vary from 0 to 31 %. What are the reasons for recurrences, and which options exist for more succ essful therapy? Methods: Fourteen operations for recurrences after mesh rep air of incisional hernias were analyzed retrospectively and correlated with a literature review of the years 1990-2000. Results: An inadequate surgica l technique is the main reason for recurrences after the use of polypropyle ne or polyester, but with PTFE, it is instead the properties of the materia l. In our patients we found central mesh recurrences. The first results wit h laparoscopic technique are very promising. Conclusions: Open incisional h ernia mesh repair should be performed with the sublay technique, preferably with polypropylene; the use of polyester can be recommended only with rese rvations and the use of PTFE ought to be limited to very few indications. T he entire incision should always be prepared with safe fixation of the mesh and wide overlap of the hernia. Recurrences after polypropylene implantati on can be treated with additional mesh; concerning PTFE, a different materi al is recommended. A final evaluation of laparoscopic mesh repair cannot be assessed yet.