Bulging of the mesh after laparoscopic repair of ventral and incisional hernias

To investigate the prevalence, diagnosis, clinical significance, and treatment strategies for bulging in the area of laparoscopic repair of ventral hernia that is caused by mesh protrusion through the hernia opening, but with intact peripheral fixation of the mesh and actually a still sufficient rep...

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Bibliographic Details
Published in:Journal of the Society of Laparoendoscopic Surgeons 2010-10, Vol.14 (4), p.541-546
Main Authors: Schoenmaeckers, Ernst J P, Wassenaar, Eelco B, Raymakers, Johan T F J, Rakic, Srdjan
Format: Article
Language:English
Subjects:
Adult
Aged
Device Removal
Female
Follow-Up Studies
Hernia, Inguinal - surgery
Hernia, Ventral - surgery
Humans
Laparoscopy - adverse effects
Male
Middle Aged
Prosthesis Failure
Recurrence
Reoperation
Retrospective Studies
Scientific Papers
Surgical Mesh
Treatment Outcome
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Summary:To investigate the prevalence, diagnosis, clinical significance, and treatment strategies for bulging in the area of laparoscopic repair of ventral hernia that is caused by mesh protrusion through the hernia opening, but with intact peripheral fixation of the mesh and actually a still sufficient repair. Medical records of all 765 patients who underwent laparoscopic ventral hernia repair were reviewed, and all patients with a swelling in the repaired area were identified and analyzed. Twenty-nine patients were identified. They all underwent a computed tomography assessment. Seventeen patients (2.2% of the total group) had a hernia recurrence; in an additional 12 patients (1.6%), radiologic examinations indicated only bulging of the mesh but no recurrence. Bulging was associated with pain in 4 patients who underwent relaparoscopy and got a new, larger mesh tightly stretched over the entire previous repair. Eight asymptomatic patients decided on "watchful waiting." All patients remained symptom free during a median follow-up of 22 months. Symptomatic bulging, though not a recurrence, requires a new repair and must be considered as an important negative outcome of laparoscopic ventral hernia repair. In asymptomatic patients, "watchful waiting" seems justified.
ISSN:1086-8089
1938-3797
DOI:10.4293/108680810X12924466008240