Hernia recurrence after laparotomy: how to close an incised light-weight mesh?

A rising number of patients require relaparotomy after implantation of mesh materials for incisional hernia (IH) repair. No published recommendation concerning how to close the incision in a surgical mesh exists. We describe a central IH recurrence through a partly absorbable mesh positioned in the retromuscular plane 16 months after laparotomy due to a small bowel ileus. This recurrence was repaired using a heavy-weight, monofilament polypropylene mesh, again in the retromuscular position. Reducing the amount of nonabsorbable material in large pore hernia meshes leads to markedly reduced scar formation rather than the formation of a thick scar plate. Once cut and resutured, this scar may be too weak to withstand the mechanical strain, giving rise to a 'blow-out' IH recurrence, as demonstrated in our case. In these cases, re-enforcement with a nonabsorbable, small, porous polypropylene mesh in the retromuscular space is feasible and leads to the development of a mechanically stable scar.