Central failures of lightweight monofilament polyester mesh causing hernia recurrence: a cautionary note

Introduction: Uncoated, lightweight, macroporous, monofilament mesh has been shown to demonstrate improved bacterial clearance, better tissue integration, reduced foreign body response, and less chronic pain with equivalent durability for hernia repair. These findings led us to use a new lightweight monofilament polyester mesh (Parietex TCM, Covidien). Here, we report our experience with this mesh in open incisional hernia repair.

Methods: Patients undergoing incisional hernia repair with Parietex TCM were retrospectively identified within our prospectively maintained database. Patient demographics, operative characteristics, and follow-up were reviewed. Outcome parameters included 90-day wound morbidity and hernia recurrence.

Results: In 2011, 36 patients (mean age 56.8; mean BMI 32.4 kg/m²) underwent open incisional hernia repair with retrorectus mesh placement by two surgeons (MJR, YWN) at Case Medical Center. Anterior and posterior fascial closure was achieved in all cases. Wound morbidity included seven surgical site occurrences: four superficial infections that resolved with antibiotics, one wound dehiscence requiring wet-to-dry packing, and two seromas that resolved without intervention. With a mean follow-up of 13 months, 8 (22 %) recurrences have occurred. On reoperation, 7 (19 %) of these patients had mechanical failure or fracturing of the mesh. No confounding variables were identified by univariate analysis of patient demographics, operative characteristics, or wound morbidity.

Conclusion: Lightweight monofilament polyester mesh (Parietex TCM) appears to have a high incidence of mechanical failure in the context of open incisional hernia repair. While this limitation may ultimately be revealed as a weakness of all lightweight mesh, surgeons should be aware that these failures have already been documented.