Littekenbreukcorrectie met een polypropyleenmat: minder recidieven dan na primaire sluiting; een prospectief, gerandomiseerd onderzoek

Determine the effectiveness of incisional hernia repair by using sutures or a mesh.

Design

Randomised, multicentre.

Method

In the period 1 March 1992 to 31 January 1998, suture repair or mesh repair was assigned to 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, less than 6 cm in length or width, in 12 hospitals. The patients were followed up by several physical examinations. Cumulative three-year recurrence rates were calculated using life-table methods (Kaplan-Meier) and potential risk factors were analysed using multivariate analysis.

Results

Among the 154 patients with primary hernias (average follow-up period of 26 months) and the 27 patients with first-time recurrent hernias (average follow-up period of 30 months) who were eligible for the study, 56 had recurrences during the follow-up period. In the group where suture repair was carried out (n = 97), the male to female ratio was 1:1 and the average age was 63 years (range: 25-82); in the group where mesh repair was carried out (n = 84), the male to female ratio was 1.5:1 and the average age was 57 years (range: 23-85). For primary incisional hernia repair, the three-year cumulative rate of recurrence amongst patients who had undergone suture repair or mesh repair were 43 and 24 respectively (p = 0.02). For the repair of a first recurrence of hernia, the recurrence rates were 58 and 20 respectively (p = 0.10). 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 significantly affect the rate of recurrence.

Conclusion

Among patients with midline abdominal incisional hernias, mesh repair led to less recurrence than suture repair and this was also the case for smaller hernias.