Page 33 - World Journal of Laparoscopic Surgery

REVIEW ARTICLE
Laparoscopic Ventral Hernia Repair with Polypropylene

Mesh: A Literature Review

Elmutaz Kanani

AbstrAct
Background: Laparoscopic ventral hernia repair (LVHR) is currently considered the gold standard. However, the mesh selection is still
controversial. The aim of this review is to look for evidence that supports the use of polypropylene mesh (PPM) in the intraperitoneal position in
LVHR.
Materials and methods: The literature was searched systematically using Google Scholar and PubMed for controlled studies, prospective
descriptive series, and retrospective case series.
Results: A total of 11 studies were retrieved. All the studies were either retrospective or animal experiments. Their outcomes are heterogeneous
and they have multiple weaknesses.
Conclusion: The literature clearly lacks data from controlled randomized trials in humans that can give strong evidence. The use of intraperitoneal
PPM in LVHR remains an individual surgeon preference decision until well-designed prospective double-blind randomized controlled clinical
trials are available.
Keywords: Complication, Laparoscopy, Mesh, Polypropylene, Prolene, Ventral hernia.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1394

IntroductIon General Surgery Department, Khoula Hospital, Muscat, Oman

In laparoscopic ventral hernia repair (LVHR), there are different Corresponding Author: Elmutaz Kanani, General Surgery Department,
techniques practiced like three ports repair, two ports Khoula Hospital, Muscat, Oman, Phone: +968 99533569, e-mail:
repair, intraperitoneal, and totally extraperitoneal repair. The mutazkanani313@hotmail.com
intraperitoneal technique (IPOM), although simple and successful, How to cite this article: Kanani E. Laparoscopic Ventral Hernia Repair
faces the dilemma of mesh selection. A large number of variable with Polypropylene Mesh: A Literature Review. World J Lap Surg
mesh types are available in the market and each claimed to be 2020;13(1):31–34.
superior to others. Likewise, the cost is not uniform as some are very Source of support: Nil

expensive while others are cheaper. Reliable data on mesh safety Conflict of interest: None
1
and efficacy are not available to the clinician. The polypropylene
mesh (PPM) is among the cheapest and had stood the test of time They were four literature reviews, four case series, and three
in extraperitoneal hernia repair. Its use in intraperitoneal position animal experiments. The articles were then analyzed in terms of
still remains doubtful due to the possibility of its adhesion to year of publication, type of study, details of the study, number of
bowel causing serious complications like intestinal obstruction participant subjects, duration of the study and maximum duration
and fistulization. Newly developed meshes proved to reduce of follow-up, method of assessment of complications, and the final
the inflammatory response and therefore reduce the adhesion recommendations.
2
formation. Coatings added to newer meshes aim also to prevent
bowel adhesion to the mesh surface. In fact, this also had been results
scrutinized and some newer meshes were found to cause adhesions
3
in animal experiments. This conflicting information put the A total of eleven articles were retrieved. Three were animal
surgeon in a difficult situation especially when expensive types of experiments, four are case series, and four are literature reviews.
mesh cannot be provided because of financial restrictions. Patient Four studies concluded that PPM is safe however; none of them was
safety should not be simply jeopardized because of financial a prospective randomized study. On the other hand, four studies
aspects and this is a major ethical issue. gave recommendations against the PPM. The remaining three
In this review, we tried to answer the question of is it safe to studies either left the choice of mesh to the surgeon’s preference
use intraperitoneal PPM in ventral hernia repair by retrieving the or recommended a barrier between mesh and intestine. The
evidence from the published literature about the topic. case series have in common limited number of subjects and they
vary in follow-up duration as all had short-term follow-up. The

MAterIAls And Methods assessment methods were also different between the studies. The
results of animal experiments cannot be generalized to humans.
A systematic literature search using the databases of Google The literature review recommendations are heterogeneous and
Scholar and PubMed was performed. Eleven articles were retrieved. nonconclusive. Table 1 summarizes the findings of all these articles.

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