[The problem of mesh shrinkage in laparoscopic incisional hernia repair].

INTRODUCTION

Mesh shrinkage is one of the unsolved problems of laparoscopic hernia repair.

METHODS

A literature search via the online database DIMDI and Pubmed with the key words "ventral hernia, incisional hernia, laparoscopic hernia repair, mesh shrinkage" was carried out. Surface and volume changes caused by insufflation of the abdomen were estimated with a simplified hemisphere model.

RESULTS

Eleven experimental and 3 clinical studies published data referring to shrinkage of intraperitoneally placed meshes. Polypropylene meshes showed shrinkage in the order of 3.6-25.4 %, PTFE meshes 4.0-51.0 %, coated polypropylene and polyester meshes 6.1-33.6 %. Three clinical studies confirmed these data (5-57 %). Since gas insufflation of the abdomen is essential for laparoscopic hernia repair, the volume and surface of the abdominal wall are intraoperatively significantly increased. An additional volume of 3 l increases the abdominal surface by about 80 %. This is more than the published shrinkage rates can compensate.

CONSEQUENCES

The surgeon has to anticipate significant mesh shrinkage in laparoscopic hernia repair. The measurement of the proper mesh dimensions has to consider the changes of volume and surface of the insufflated abdomen and the expected mesh shrinkage.