![]() 16 In addition, the length of time between reoperations progressively shortens after each additional repair. This fact is illustrated by the results of a retrospective cohort study of a population-based hospital discharge database which showed that 12% of patients undergoing incisional hernia repair required at least one subsequent reoperation within 5 years. 13, 14 After analyzing the results of a prospective randomized controlled trial, Luijendijk reported that nearly one quarter of ventral hernias repaired with synthetic mesh recur within 3 years, and this recurrence risk increases with each additional operation. 10, 11, 12 Even though ePTFE and ePTFE/macroporous mesh composite patches are strong, biocompatible, and less likely to adhere to the viscera, they do not perform well in the presence of contamination, infection, and enteric fistula. It is, however, associated with adhesions to intraabdominal viscera and enterocutaneous fistula formation. 5, 6, 7, 8, 9 The macroporous structure of polypropylene allows for fibrous ingrowth and mesh incorporation into the abdominal wall, thereby providing a strong repair. Gore & Associates, Inc., Elkton, MD), have become the mainstay of ventral hernia repair. Due to this advantage, synthetic biomaterials, such as polypropylene (Prolene ® Ethicon, Somerville, NJ) and expanded polytetrafluoroethylene (ePTFE, or Gore-Tex ® most commonly W.L. 1, 4 Prosthetic implants have significantly improved the results of primary fascial closure by minimizing tension on the repair site. Although primary fascial apposition may be appropriate in smaller defects (< 4 cm in width), the recurrence rate following primary repair is estimated to be in excess of 50%. Given the extensiveness of this problem, continuous efforts have been made to improve the outcome of ventral hernia repairs.
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