Second Look After Retromuscular Repair With the Combination of Absorbable and Permanent Meshes.
Autor: Robin Valle de Lersundi, Álvaro; Muñoz Rodríguez, Joaquín; López Monclús, Javier; Blazquez Hernando, Luis Alberto; San Miguel Méndez, Carlos; Minaya Bravo, Ana; Pérez Flecha , Marina; García Ureña, Miguel Ángel
Resumen: Objective: The aim of this study is to describe the macroscopic features and histologic
details observed after retromuscular abdominal wall reconstruction with the combination
of an absorbable mesh and a permanent mesh.
Methods: We have considered all patients that underwent abdominal wall
reconstruction (AWR) with the combination of two meshes that required to be reoperated
for any reason. Data was extracted from a prospective multicenter study from 2012 to
2019.Macroscopic evaluation of parietal adhesions and histological analysis were carried
out in this group of patients.
Results: Among 466 patients with AWR, we identified 26 patients that underwent a
reoperation after abdominal wall reconstruction using absorbable and permanent mesh.
In eight patients, the reoperation was related to abdominal wall issues: four patients were
reoperated due to recurrence, three patients required an operation for chronic mesh
infection and one patient for symptomatic bulging. A miscellanea of pathologies was
the cause for reoperation in 18 patients. During the second surgical procedures made
after a minimum of 3 months follow-up, a fibrous tissue between the permanent mesh
covering and protecting the peritoneum was identified. This fibrous tissue facilitated blunt
dissection between the permanent material and the peritoneum. Samples of this tissue
were obtained for histological examination. No case of severe adhesions to the abdominal
wall was seen. In four cases, the reoperation could be carried out laparoscopically with
minimal adhesions from the previous procedure.
Conclusions: The reoperations performed after the combination of absorbable and
permanent meshes have shown that the absorbable mesh acts as a protective barrier
and is replaced by a fibrous layer rich in collagen. In the cases requiring new hernia
repair, the layer between peritoneum and permanent mesh could be dissected without
special difficulty. Few intraperitoneal adhesions to the abdominal wall were observed,
mainly filmy, easy to detach, facilitating reoperations.
Identificador universal: http://hdl.handle.net/10641/2704
Fecha: 2021
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