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Correspondence and Brief Communications
October 1998

Incisional Hernioplasty With Polyester Mesh

Arch Surg. 1998;133(10):1137. doi:

Leber and associates1 looked at the long-term complications of prosthetic incisional hernia repair solely from the aspect of the type of mesh used, and they concluded from statistical analyses that multifilamented polyester mesh (Mersilene, Ethicon Inc, Somerville, NJ) should not be used to repair incisional hernias. I believe that this conclusion is biased and the concept of the study flawed. There are other variables that are more important to the success of prosthetic incisional hernioplasty than merely the type of mesh used. I am surprised that the editors of the ARCHIVES and the discussants of the article did not acknowledge this. Perhaps the authors' premise was to find support for their dislike of multifilamented polyester mesh or their preference for polypropylene mesh. Such an unwarranted opinion is held by many American surgeons who have an unabashed preference for polypropylene mesh although they, while rejecting polyester mesh (Dacron, Du Pont, Wilmington, Del) in the properitoneal space to repair an abdominal hernia, will, without hesitation, place a polyester (Dacron) arterial graft in a blood vessel in the same place. A thoughtful look at the article also indicates that the prosthetic repairs used in this retrospective analysis were not performed adequately, that the surgeons were unaware that polyester and polypropylene meshes should not be placed against the abdominal viscera if at all possible, that the ideal site to implant the prosthesis is extraperitoneal and retromuscular for the repair of major incisional hernias, and that the prosthesis should extend far enough beyond the parietal defect to both retain the visceral sac and consolidate the abdominal wall. It is not the mesh, per se, that causes complications and recurrences after an incisional herniation; it is how, where, and when the prosthetic material is implanted. In this review, the meshes were placed in the subcutaneous tissues and the peritoneal cavity, well-known sites that are likely to be complicated by infection, intestinal fistulations, and recurrences.