|Year : 2021 | Volume
| Issue : 1 | Page : 20-22
Long-term results of Progrip mesh for retromuscular repair of ventral hernia
Hazim A Eltyeb, Frederick Dowker, Duncan Light
Department of General Surgery, Northumbria Healthcare Trust, Newcastsle Upon Tyne, Uk
|Date of Submission||09-Dec-2020|
|Date of Decision||17-Dec-2020|
|Date of Acceptance||20-Dec-2020|
|Date of Web Publication||22-Feb-2021|
Mr. Hazim A Eltyeb
Departments of General Surgery, Northumbria Healthcare Trust, Newcastle Upon Tyne
Source of Support: None, Conflict of Interest: None
BACKGROUND: An issue that has become apparent in using Progrip in ventral hernias is the restriction in the available sizes. The area of dissection for mesh placement can be variable. This report is based on a subgroup analysis of the cases in which a combination of Progrip meshes was used.
MATERIALS AND METHODS: This was a retrospective review of our prospective database. Cases were identified of Progrip mesh used in ventral hernia repair from 2016 to 2020. Subgroup analysis was performed of cases which Progrip meshes were combined. Telephone follow-up was done in September 2020.
RESULTS: Sixty-eight cases were identified. The mean age of patients was 63.13 (26–87). Thirty-three were female. The mean American Society of Anesthesiologists grade was 2 (range: 1–4). The procedure time was 164.35 min (45–490). The mean defect size was 7.23 (2–25 cm). The mean mesh size was a 20 cm × 15 cm mesh. Follow-up was achieved in 63/68 cases. Follow-up ranged from 1 to 4 years. Recurrence was found in 4 (6%). Nine had ongoing abdominal pain. Fifty-nine (93.65%) returned to normal activity. Three returned to theater for wound dehiscence and seromas. Twelve cases required 2 meshes to be combined. All cases involved a mesh size of 30 cm × 30 cm. The mean age was 64 (44–78 years). Six were male. The mean defect size was 9 cm. The operative time was 235 min (120–320). The mean postoperative stay was 5 days (4–60). Three cases required component separation (2 anterior component separation and 1 posterior component separation). There were no recurrences or further surgery. One had ongoing pain. Nine cases had full return to activity.
CONCLUSION: Combining Progrip meshes in ventral hernia is an acceptable practice. Mesh may be sutured together or overlapped with equivalent results. Extending the product range to a 30 cm × 30 cm mesh would obviate the need for mesh overlap in our practice.
Keywords: Incisional hernia, Progrip mesh, ventral hernia
|How to cite this article:|
Eltyeb HA, Dowker F, Light D. Long-term results of Progrip mesh for retromuscular repair of ventral hernia. Int J Abdom Wall Hernia Surg 2021;4:20-2
| Introduction|| |
The Northumbria Healthcare Trust is a geographically large trust covering an area from Newcastle in the south and east to Cumbria in the west and the Scottish borders in the north. The trust serves a population of around 500,000 people.
Progrip mesh has been used for groin hernia repair in our institution for the last 10 years. Following the general consensus of many surgeons, we feel there are specific advantages to this mesh, principally through the self-fixation properties of the mesh technology. The principal advantage is in the reduced risk of nerve injury with fixation. A further benefit for surgeons is a reduction in operative time through the advantage of eliminating the need to suture the mesh to surrounding tissues.
As Progrip mesh was developed for the use in ventral hernia, we have been using Progrip mesh in this setting since 2016. Our team was intrigued by the opportunity to gain the advantages of Progrip mesh in the ventral hernia setting. The principal advantages were seen as a reduction in operative time and risks of collateral injury through suturing the mesh to surrounding structures.
An issue that has become apparent in this setting is the restriction in the available sizes of Progrip mesh. By the nature of ventral hernia surgery, the area of dissection for mesh placement can be variable. Occasionally, it can be encountered that the Progrip mesh is too small to cover the intended area of mesh placement. As a result, surgeons in our institution have utilized several techniques to combine Progrip mesh in this setting.
This report is based on a subgroup analysis of the cases in which a combination of Progrip meshes was used.
| Materials and Methods|| |
The Northumbria NHS Trust has a prospective database of all general surgery procedures over the past 20 years. This is an invaluable resource for audit and research purposes. A retrospective review of our prospective database was performed. Cases were identified of Progrip mesh used in ventral hernia repair from the commencement of the use of the mesh from 2016 to 2020. There were no exclusions.
A subgroup analysis was performed on the cases in which Progrip meshes were combined.
Surgical techniques including assembly procedure of the meshes, fixation method if applicable, mesh position, and additional technique (i.e., component separation technique)
Cases were assessed by a consultant surgeon in the outpatient setting before surgery. All cases had a computed tomography scan in their preoperative workup. In cases with an identified larger defect, consideration was given for Botox injection in selective cases (after discussion in our complex hernia MDT). Cases were seen in preassessment before surgery.
All cases were performed by a consultant surgeon with an interest in hernia surgery. All cases were commenced as open surgery with an evaluation of the hernia intraoperatively. A retromuscular dissection was performed in each case with a component separation utilized as necessary (surgeon's preference). Midline closure of hernia defects was undertaken along with a retromuscular placement of Progrip mesh. In larger areas for mesh placement, Progrip meshes were combined in various ways. The results will be presented in this report. The anterior fascia was closed over the mesh. Drain placement was at the discretion of the surgeon.
| Results|| |
Sixty-eight cases of Progrip mesh use in ventral hernia were identified. The mean age of patients was 63.13 (26–87). Thirty-three were female and 35 were male. The Mean American Society of Anesthesiologists (ASA) grade was 2 (range: 1–4). The time of procedure was 164.35 min (45–490). The mean defect size was 7.23 (2–25 cm). The mean mesh size required was a 20 cm × 15 cm mesh. Twelve out of 68 cases required 2 meshes to be combined. All cases involved the need for a mesh size of 30 cm × 30 cm.
Telephone follow-up was achieved in 63/68 cases, and the follow-up period ranged from 1 to 4 years. Recurrence was found in 4/63 patients (6%). Nine patients had ongoing abdominal pain. Fifty-nine (93.65%) had return to normal activity. Three cases were taken back to surgery in the early postoperative period after 2 weeks: 2 cases for wound hematoma and 1 case of wound dehiscence and debridement. One patient developed a symptomatic seroma which was managed conservatively. One patient developed pneumonia.
Combined mesh group
Twelve cases in which Progrip meshes were combined in a large area of mesh placement were included in the subanalysis.
The mean age of patients was 64 years (44–78 years). Six were male and 6 were female. The mean ASA grade was 2 (2–4). Eight were a primary ventral hernia and 4 were recurrent incisional hernia (1 laparoscopic hernia repair and 3 open hernia repair). The mean defect size was 9 cm (4–25 cm). Eight patients had multiple defects.
The mean operative time was 235 min (120–320). All cases involved an open retromuscular dissection. The mean postoperative stay was 5 days (4–60). Three out of 12 cases required a component separation to achieve midline closure (2 anterior component separation and 1 posterior component separation).
In these cases, 4/12 were sutured together with nonabsorbable suture. Eight out of 12 were placed with an overlap of the meshes alone. After mesh combination, in 4/12 cases, mesh was fixed to the adjacent tissues with nonabsorbable or absorbable sutures. Five patients with defects sizes of 8 cm and lower had combined mesh due to the presence of multiple incisional hernias.
The follow-up period ranged from 1 to 4 years. There were no recurrences or further surgery in the 12 cases. Two patients had died since surgery for unrelated reasons. One out of 12 had ongoing pain and had not returned to normal activity. Nine out of 12 cases had a full return to normal activity with no ongoing pain [Table 1].
|Table 1: Shows comparison between standard mesh technique vs combined mesh|
Click here to view
| Discussion|| |
Progrip mesh offers a number of theoretical advantages in ventral hernia repair. Surgeons in our institution were attracted to these advantages and commenced the use of Progrip mesh in ventral hernia cases from 2016.
A number of studies have demonstrated the safe use of Progrip in ventral hernia repair along with short-term follow-up.,, Our data show a similar finding that Progrip mesh is safe to use in ventral hernia repair with no observed early associated complications.
The crux issue in relation to Progrip is the available sizes for its uses in ventral hernia. In our series, a 20 cm × 15 cm mesh was required most commonly in a Rives–Stoppa repair. However, a larger size than commercially available was required on occasion. So far, there is no other data in the literature about combining any other types of mesh. Our data shows that a 30 cm × 30 cm mesh would be ideal and afford the coverage area required in larger dissections.
It should be noted that our series had relatively low number of component separations as well as low number of transversus abdominis release (TAR) technique. This is commonly associated with a larger dissection. Indeed, it would be anticipated that a mesh larger than 30 cm × 30 cm may be needed in these cases. We cannot comment specifically on this based on our experience reported here. However, data on TAR would suggest mesh sizes up to 40 cm may be required.
We have not shown any observable difference in the results for different methods of combining Progrip mesh. It would appear that overlapping the mesh gives a secure mesh to mesh fixation. Long-term follow-up of our cases has shown a durable result for combining Progrip meshes. There is no doubt that further research is required in this area. In particular in the distance needed to overlap combined meshes. It was not possible to examine this in our study.
| Conclusion|| |
Combining Progrip meshes in ventral hernia is an acceptable practice. Mesh combination technique could be used safely on patients with large as well as multiple defects. Mesh may be sutured together or overlapped with equivalent results. Extending the product range to a 30 cm × 30 cm mesh would obviate the need for mesh overlap in our common practice.
Declaration of patient consent
It was registered with the clinical governance at Northumbria Healthcare Trust, there was no need for written informed consent as this was a retrospective study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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