Repair of small abdominal wall hernias. The comparison of open in-lay and on-lay techniques

Abstract

BACKGROUND: Our aim was to report the results of open in-lay placement of a composite mesh for repair of small abdominal wall hernias compared to a control group of on-lay polypropylene mesh placement. Materials and Methods: The patients were divided into two groups in which group-1 (n=27) included patients who underwent a repair with composite mesh, Ventralex Patch, which was fixed in-lay to the abdominal wall and group-2 (n=34) included patients with a repair with simple polypropylene mesh fixed on-lay to the abdominal wall. Due to the limited dimensions of the Ventralex Patch, in order to match the defects in both groups no randomization was done prior to the operation and patients were divided into groups consequently. All the patients were explored under general or spinal anesthesia. No further subcutaneous dissection was performed in order not to increase the seroma during onlay mesh placement. RESULTS: The demographic data between study groups were similar. The postoperative complication rate was significantly low in group 1 (0%), compared to group 2 (23.5%) which included seroma (n=3) and wound infection (n=5), however, the mean operative time was significantly high in group l (61 minutes) compared to group 2 (39 minutes). There were no recurrences occurred in both group. CONCLUSION: Although, the patch itself has tendency to make a dome formation when placed intra-abdominally, a composite polypropylene and ePTFE hernia patch has better outcomes if placed precisely with minimal extra-peritoneal and extensive intra-peritoneal dissection. We assume that inadequate liberation of omental attachments around the defect enhances the prior reported failures of the product.