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Primary ventral and incisional hernias of the abdominal wall are common, pose significant medical issues, and are associated with an economic burden [1, 2]. They may be unsightly, cause pain, interfere with professional activities and have an impact on quality of life (QoL). While up to one-third of hernias is asymptomatic, surgical repair is generally recommended to reduce the risk of obstruction and strangulation .
The laparoscopic approach to primary ventral and incisional hernia repair is increasingly popular, offering the potential advantages of similar recurrence rates but fewer post-operative complications in selected patients . A Cochrane Collaboration review of ten randomized controlled trials demonstrated that laparoscopic surgery was associated with fewer wound infections, improved cosmesis, and a shorter hospital stay . Outcomes are also widely accepted as being improved by the incorporation of mesh in both open and laparoscopic procedures . Incorporating mesh appears to offer advantages even for small defects such as primary umbilical hernias ≤ 4 cm in width .
Recurrence after surgery is influenced by several patient factors, including obesity, fitness, and defect size [3, 8]. Similarly, technical factors and the choice of mesh can affect outcomes after primary ventral or incisional repair. For example, recurrence rates are reported to be lower where there is mesh overlap of at least 5 cm and there is a high mesh area-to-defect area (M/D) ratio [9, 10].
Although the trend has moved away from mesh placement inside the abdominal cavity due to long-term complications related to adhesion formation, most laparoscopic ventral hernia repairs worldwide still employ an intraperitoneal onlay mesh (IPOM) technique. When using an intraperitoneal approach, reducing adhesion formation and prevention of damage to adjacent viscera are key aims . Device manufacturers have sought to minimize this problem by including a continuous protective layer in their mesh designs. One early product was Parietex composite mesh (PCO, Covidien LP, Trevoux, France, a wholly owned subsidiary of Medtronic plc). First introduced in 1998, this multifilament polyester associated with a strong safety profile and minimal adhesion formation proved a popular repair option with over a million units sold to date . Suggestions from surgeons regarding desired handling characteristics and memory shape resulted in a change from a multi- to a monofilament polyester-knitted structure and the development of Symbotex™ composite mesh (SCM; Covidien LP). SCM is a novel three-dimensional monofilament polyethylene terephthalate (polyester) textile. On its visceral surface is a modified absorbable hydrophilic film consisting of a mixture of collagen and glycerol . Other claimed design features include increased conformability, transparency, green centering marking, and a green flap, all designed to help visualize the fixation area and facilitate accurate position of the prosthesis against the abdominal wall.
Results, 12 months after laparoscopic or open mesh repair, suggest that the use of SCM is safe and effective . The present study, an update of this registry study, aimed to examine outcomes 24 months after surgery with reference to factors which are important to patients, e.g., have their symptoms resolved compared to baseline and are they satisfied with the outcome of their treatment. The need to focus on patient-reported outcome measures (PROMs) is increasingly recognized . From a surgical perspective, the researchers also sought to examine the effect of the M/D ratio on hernia recurrence . Because primary ventral and incisional hernias have been shown to differ in terms of patient characteristics and post-operative complications, data are presented and analyzed by subgroup .