INTRODUCTION:
During the last 10-20 years, there has been an on-going increase in the utilization of prosthetic materials for surgical treatment of abdominal wall defects: this is to be attributed to the availability of synthetic polymers highly biocompatible. Thus a sharp improvement in postoperative results has been reported in the surgical treatment of large laparoceles, especially in terms of incidence relapse, gone from 14,5-48,7 % of techniques with direct suture to 1-18,5% .We currently retain that, in the presence of a laparocele, the principal indications for utilization of a prosthesis can be summed as follows: -laparocele relaps; -large laparoceles (hernial porta with a diameter 10 cm); -marginal laparoceles (subcostal, inguinal, soprapubic). We must stress than an idealprosthesis does not exit as yet; however, if it did, it should have the following characteristics: biologically and chemically inert; easily moulded and elastic; resistant to infections; resistant to traction; radiotransparent; able to be incorporated to the fibroblastic reaction. METHODS: Between January 1990 and December 1998 we have treated 198 cases of laparocele performing surgical intervention with placement of prosthesis in all patients of this group. The prosthetic materials utilized were the following: polypropylene in 42 (21,21%) cases, dacron in 12 (6,06%) cases, vicryl in 4 (2,03%) cases and PTFE in 140 (70,7%) cases. In 78 patients the prosthesis was positioned in the preperitoneal location (39,39), in the remaining 120 (60,61) intraperitoneally placed. Concerning the total 140 prosthesis in PTFE, they were subdivided in the following: -67 Soft Tissue Patch; -48 Mycro-Mesh; -15 Dual-Mesh; -5 Mycro-Mesh PLUS; -5 Dual-Mesh PLUS. A subcutaneos aspiration drainage was constantly left in-situ. RESULTS: Operative mortality was nil; immediate postoperative morbidity on the whole was 7,5% (15/198), as follow: -5 superficial infections; -4 deep infections; -2 hematoma; -4 seromas. Only in one case of deep infection it was necessary to remove the prosthesis. Patients follow up showed relapse in 3 cases (1,5%). DISCUSSION and CONCLUSIONS: Separate analysis of the results achieved in patients with preperitoneal prosthesis and in patients with intraperitoneal prosthestis does not seem to reveal a substantial difference in terms of complications. In conclusion, based on our experience, we can safely state that, when ever it is possible to reconstruct the peritoneal layer, it is good practice to position the prosthesis in the preperitoneal location. In those cases where it is not possible to perform peritoneal plane reconstruction, the choice of PTFE-e prosthesis in the intraperitoneal location is clearly indicated.