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Previous Volume 343:392-398 August 10, 2000 Number 6 Next

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ABSTRACT

Background Incisional hernia is an important complication of abdominal surgery. Procedures for the repair of these hernias with sutures and with mesh have been reported, but there is no consensus about which type of procedure is best.

Methods Between March 1992 and February 1998, we performed a multicenter trial in which we randomly assigned to suture repair or mesh repair 200 patients who were scheduled to undergo repair of a primary hernia or a first recurrence of hernia at the site of a vertical midline incision of the abdomen of less than 6 cm in length or width. The patients were followed up by physical examination at 1, 6, 12, 18, 24, and 36 months. Recurrence rates and potential risk factors for recurrent incisional hernia were analyzed with the use of life-table methods.

Results Among the 154 patients with primary hernias and the 27 patients with first-time recurrent hernias who were eligible for the study, 56 had recurrences during the follow-up period. The three-year cumulative rates of recurrence among patients who had suture repair and those who had mesh repair were 43 percent and 24 percent, respectively, with repair of a primary hernia (P=0.02; difference, 19 percentage points; 95 percent confidence interval, 3 to 35 percentage points). The recurrence rates were 58 percent and 20 percent with repair of a first recurrence of hernia (P=0.10; difference, 38 percentage points; 95 percent confidence interval, –1 to 78 percentage points). The risk factors for recurrence were suture repair, infection, prostatism (in men), and previous surgery for abdominal aortic aneurysm. The size of the hernia did not affect the rate of recurrence.

Conclusions Among patients with midline abdominal incisional hernias, mesh repair is superior to suture repair with regard to the recurrence of hernia, regardless of the size of the hernia.

Source Information

From the Department of Plastic and Reconstructive Surgery, University Hospital Vrije Universiteit, Amsterdam (R.W.L.); the Department of Epidemiology and Biostatistics, Medical School, Erasmus University, Rotterdam (W.C.J.H.); the Department of General Surgery, University Hospital Rotterdam–Dijkzigt, Rotterdam (M.P.T., D.C.D.L., M.M.J.B., J.N.M.IJ., J.J.); the Department of General Surgery, Ikazia Hospital, Rotterdam (R.U.B.); the Department of General Surgery, Medisch Centrum Haaglanden, Westeinde Hospital, The Hague (B.C.V.); the Department of General Surgery, Zuiderziekenhuis, Rotterdam (M.K.M.S.); the Department of General Surgery, Sint Franciscus Gasthuis, Rotterdam (J.C.J.W.); and the Department of General Surgery, Leyenburg Ziekenhuis, The Hague (C.M.A.B.) — all in the Netherlands.

Address reprint requests to Professor Jeekel at the Department of General Surgery, University Hospital Rotterdam–Dijkzigt, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands, or at spek{at}hlkd.azr.nl.

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