Mesh repair is more effective than suture repair for incisional abdominal herniaA comparison of suture repair with mesh repair for incisional hernia.

Petersen, Sven MD
Luijendijk, RW
Hop, WCJ
van den Tol, MP
de Lange, DCD
Braaksma, MMJ
Ijzermans, JNM
Boelhouwer, RU
de Vries, BC
Salu, MKM
Wereldsma, JCJ
Bruijninckx, CMA
Jeekel, J

General Hospital Dresden-Friedrichstadt, Dresden, Germany

Abstracted from:Luijendijk RW, Hop WCJ, van den Tol MP, de Lange DCD, Braaksma MMJ, Ijzermans JNM, Boelhouwer RU, de Vries BC, Salu MKM, Wereldsma JCJ, Bruijninckx CMA, Jeekel J. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2000;343:392-398LuijendijkRWHopWCJvan den TolMPde LangeDCDBraaksmaMMJIjzermansJNMBoelhouwerRUde VriesBCSaluMKMWereldsmaJCJBruijninckxCMAJeekelJA comparison of suture repair with mesh repair for incisional hernia.N Engl J Med2000343392-398 .

Evidence-based Healthcare 5(2):p 45, June 2001.

BACKGROUND

Incisional hernia resulting from abdominal surgery can be repaired with sutures or mesh. Although mesh repair has received favourable reviews, there is little systematic evidence about which method is more effective for preventing hernia recurrence. Recurrence rates range between 24% and 54%.

OBJECTIVE

To compare sutures and mesh repair of midline abdominal incisional hernia.

SETTING

The Netherlands, 1992-1998.

METHOD

Randomised controlled trial.

LITERATURE REVIEW

No explicit strategy; 40 references.

PARTICIPANTS

One hundred and fifty-four people undergoing repair of primary abdominal hernia less than 6 cm long and 27 people with first recurrence of hernia.

INTERVENTION

Hernia repair with either suture or mesh. Follow-up at 1, 6, 12, 18, 24, and 36 months.

OUTCOMES

Hernia recurrence rates.

MAIN RESULTS

Thirty-one percent of patients had hernia recurrences during the 3-year study period. For primary hernia, the cumulative recurrence rate was 43% for suture repair, 24% for mesh repair (19% difference, 95% CI 3% to 35%). There was no significant difference in recurrence rates for first recurrence hernia repairs. The overall difference in risk was 23% (95% CI 8% to 38%). Recurrence risk factors were suture repair, infection, past abdominal aortic aneurysm surgery, prostatism in men.

AUTHORS' CONCLUSIONS

For primary midline abdominal hernia repair, mesh is more effective than sutures for avoiding hernia recurrence, regardless of hernia size. The use of polypropylene mesh avoids the excessive tension that occurs with sutures and induces an inflammation which encourages collagen synthesis. It is recommended that mesh is attached to the dorsal side of the defect with a large overlap and minimal tension.