Skip to main content
SpringerLink
Log in

Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Intraperitoneal positioning of conventional parietal mesh provides efficient reconstruction but causes visceral adhesion formation in 80–100% of the cases. The purpose of this clinical trial was to assess the performance and tolerance of a new generation of polyester mesh protected by a hydrophilic resorbable film. Eighty patients were included in a prospective multicenter clinical trial. Patients were treated for ventral hernia via an open approach (64%) or laparoscopically (36%). All meshes were implanted in a midline intraperitoneal location. The main objective was to evaluate the anti-adhesive capability of the mesh in relation to the viscera. In order to assess the absence of visceral adhesion objectively, an ultrasound (US) specific examination was initially validated (pre-operative prediction vs. per-operative findings) and then used during the follow-up. The usual clinical parameters were also collected to follow the patients on a period up to 4 years. Pre-operative US prediction vs. per-operative macroscopic findings: sensitivity 79%, overall accuracy 76%, negative predictive value 85%. After 12 months, 86% of the patients were ultrasonically adhesion free. Early post-operative complications were: seroma/hematoma (16%), subcutaneous infection (4%), cutaneous necrosis (1%) and occlusions (outside the mesh) (2.5%). No mortality was reported. Clinically, after 12-month follow-up, no complication related to post-operative adhesions to the mesh was noted: (occlusion 0%, fistula 0%). Late complications were: mesh sepsis (1%), new defects (4%) and recurrence (2.5%). Finally, 56 patients (75.7%) were clinically evaluated with a mean follow-up of 48±6 months. One direct recurrence was noted while six patients experienced new defect outside the mesh. No long-term severe complication such as occlusion or enterocutaneous fistula was observed. Based on a mean clinical follow-up of 4 years, the results of this prospective multicenter clinical trial demonstrate the safety and the efficiency of this composite mesh in the intraperitoneal treatment of incisional and umbilical hernia. In particular there was no early or long-term main complication due to the intraperitoneal location of the mesh.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. George CD, Ellis H (1986) The results of incisional hernia repair: a twelve year review. Ann R Coll Surg Engl 68:185–187

    CAS  PubMed  Google Scholar 

  2. Hesselink VJ, Luijendijk RW, deWilt JH, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176:228–234

    CAS  PubMed  Google Scholar 

  3. Luijendijk RW, Hop WC, Van der Tol MP, De Lange DC, Braaksma MM, Ijzermans JN, Boelhouwer RU, De Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398

    Article  CAS  PubMed  Google Scholar 

  4. Rives J, Lardennois B, Pire JC, Hibon J (1973) Large incisional hernias. The importance of flail abdomen and of subsequent respiratory disorders. Chirurgie 99:547–563

    CAS  PubMed  Google Scholar 

  5. Rives J, Pire JC, Flament JB, Palot JP (1987) Major incisional hernias. In: Chevrel JP (ed) Surgery of the abdominal wall. Springer, Berlin, Heidelberg, New York, pp 116–144

  6. Benchetrit S, Debaert M, Detruit B, Dufilho A, Gaujoux D, Lagoutte J, Lepère M, Martin Saint Leon L, Pavis d’Escurac X, Rico E, Sorrentino J, Therin M (1998) Laparoscopic and open abdominal wall reconstruction using PARIETEX(r) meshes: clinical results on 2700 hernias. Hernia 2:57–62

    Google Scholar 

  7. Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190:645–650

    Article  CAS  PubMed  Google Scholar 

  8. Le Blanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:420–424

    Google Scholar 

  9. Amid PK, Shulman G, Lichtenstein L, Sostrin S, Young J, Hakakha M (1995) Preliminary evaluation of composite materials for the repair of incisional hernias. Ann Chir 49:539–543

    CAS  PubMed  Google Scholar 

  10. Morris-Stiff G, Hughes LE (1998) The continuing challenge of parastomal hernia: failure of a novel polypropylene mesh repair. Ann R Coll Surg Engl 80:184–187

    CAS  PubMed  Google Scholar 

  11. Karakousis CP, Volpe C, Tanski J, Colby ED, Winston J, Driscoll DL (1995) Use of a mesh for musculoaponeurotic defects of the abominal wall in cancer surgery and the risk of bowel fistulas. J Am Coll Surg 181:11–16

    CAS  PubMed  Google Scholar 

  12. Flament JB, Avisse C, Palot JP, Delattre JF (2000) Complications in incisional hernia repairs by the placement of retromuscular prostheses. Hernia 4[Suppl]: S25–S29

  13. Bauer JJ, Harris MT, Kreel I, Gelernt IM (1999) Twelve-year experience with expanded polytetrafluoroethylene in the repair of abdominal wall defects. Mt Sinai J Med 66:20–25

    CAS  PubMed  Google Scholar 

  14. Goldberg JM, Toledo AA, Mitchell DE (1987) An evaluation of the Gore-Tex surgical membrane for the prevention of post-operative peritoneal adhesions. Obstet Gynecol 70:846–848

    CAS  PubMed  Google Scholar 

  15. Le Blanc KA, Booth WV, Whitaker JM, Bellanger DE (2001) Laparoscopic incisional and ventral herniorraphy: our initial 100 patients. Hernia 5:41–45

    Article  PubMed  Google Scholar 

  16. Amid PK, Shulman AG, Lichtenstein IL, Sostrin S, Young J, Hakakha H (1994) Experimental evaluation of a new composite mesh with the selective property of incorporation to the abdominal wall without adhering to the intestines. J Biomed Mater Res 28:373–375

    CAS  PubMed  Google Scholar 

  17. Bendavid R (1997) Composite mesh (polypropylene-e PTFE) in the intraperitoneal position. Hernia 1:5–8

    Google Scholar 

  18. Mutter D, Rodeheaver GT, Diemunsch P, Therin M, Moody DL, Raffaelli M, Marescaux J (1998) A new composite mesh (collagen-polyester) for intra-abdominal laparoscopic hernia repair. Surg Endosc 12:595

    Google Scholar 

  19. Arnold PB, Green CW, Foresman PA, Rodeheaver GT (2000) Evaluation of resorbable barriers for preventing surgical adhesions. Fertil Steril 73:157–161

    Article  CAS  PubMed  Google Scholar 

  20. Balique JG, Alexandre JH, Arnaud JP, Benchetrit S, Bouillot JL, Fagniez PL, Flament, JB, Gouillat C, Jarsaillon P, Lepère M, Magne E, Mantion G (2000) Intraperitoneal treatment of incisional and umbilical hernias: intermediate results of a multicenter prospective clinical trial using an innovative composite mesh. Hernia, 4[Suppl 1]: S10–S16

  21. Sigel B, Golub RM, Loiacono LA, Parsons RE, Kodama I, Machi J, Justin J, Sachdeva AK, Zaren HA (1991) Technique of ultrasonic detection and mapping of abdominal wall adhesions. Surg Endosc 5:161–165

    CAS  PubMed  Google Scholar 

  22. Arnaud JP, Cervi C, Tuech JJ, Cattan F (1997) Surgical treatment of post-operative incisional hernias by intraperitoneal insertion of a Dacron mesh. Hernia 1:97–99

    Google Scholar 

  23. Pedersen T, Eliasen K, Henriksen E (1990) A prospective study of mortality associated with anaesthesia and surgery: risk indicators of mortality in hospital. Acta Anaesthesiol Scand 34:176–182

    CAS  PubMed  Google Scholar 

  24. Moreno-Egea A, Liron R, Girela E, Aguayo JL (2001) Laparoscopic repair of ventral and incisional hernia using a new composite mesh (Parietex). Surg Laparosc Endosc & Percutaneous Tech 11:103–106

    Google Scholar 

  25. Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827–832

    CAS  PubMed  Google Scholar 

  26. Oussoultzoglou E, Baulieux J, De La Roche E, Peyregne V, Adham M, Berthoux N, Ducerf C (1999) Long-term results of 186 patients with large incisional abdominal wall hernia treated by intraperitoneal mesh. Ann Chir 53:33–40

    CAS  PubMed  Google Scholar 

  27. Leber GE, Garb JL, Alexander AL, Reed WP (1998) Long-term complications associated with prosthetic repair of incisional hernia. Arch Surg 133:378–382

    Article  CAS  PubMed  Google Scholar 

  28. Ramshaw B, Abiad F, Voeller G, Wilson R, Mason E (2003) Polyester (Parietex) mesh for total extraperitoneal laparoscopic inguinal hernia repair: initial experience in the United States. Surg Endosc 17:498–501

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Mr. Patrice Becker-Sofradim (Trévoux) for his contribution to the coordination of this study.

Author information

Authors and Affiliations

  1. Clinique du Parc, 9 rue de la Piot, 42270 , Saint Priest en Jarez, France

    J. G. Balique

  2. Clinique Jeanne d’Arc, 44 cours Albert Thomas, 69008 , Lyon, France

    S. Benchetrit

  3. Hôtel Dieu, 1 place du Parvis Notre Dame, 75004 , Paris, France

    J. L. Bouillot

  4. Hôpital Robert Debré, Av du Général Koenig, 51000 , Reims, France

    J. B. Flament

  5. Hôtel Dieu, 1 place de l’Hôpital, 69002 , Lyon, France

    C. Gouillat

  6. Clinique du Renaison, 75 cours Général Giraud, 42300 , Roanne, France

    P. Jarsaillon

  7. Clinique St Charles, 11 bd René Lévesque, 85016 , La Roche/Yon cedex, France

    M. Lepère

  8. Hôpital Jean Minjoz, 3 bd Fleming, 25000 , Besançon, France

    G. Mantion

  9. CHRU, 4 Rue Larrey, 49100 , Angers, France

    J. P. Arnaud

  10. Clinique Tivoli, 33000 , Bordeaux, France

    E. Magne

  11. Hôpital Henri Mondor, 94010 , Créteil, France

    F. Brunetti

Authors
  1. J. G. Balique
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Benchetrit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. L. Bouillot
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. B. Flament
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Gouillat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Jarsaillon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Lepère
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. Mantion
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. P. Arnaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. E. Magne
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. F. Brunetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. G. Balique.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Balique, J.G., Benchetrit, S., Bouillot, J.L. et al. Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial. Hernia 9, 68–74 (2005). https://doi.org/10.1007/s10029-004-0300-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-004-0300-z

Keywords

Search

Navigation