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TAPP surgery with mesh fixation and peritoneal closure using n-butyl-2-cyanoacrylate (LiquiBand®FIX8TM)—initial experience. Eur Surg 2015. [DOI: 10.1007/s10353-015-0367-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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52
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Bellón JM, Fernández-Gutiérrez M, Rodríguez M, Sotomayor S, Pérez-Köhler B, Kuhnhardt A, Pascual G, San Román J. Bioassay of cyanoacrylate tissue adhesives used for intraperitoneal mesh fixation. J Biomed Mater Res B Appl Biomater 2015; 105:312-319. [DOI: 10.1002/jbm.b.33558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/27/2015] [Accepted: 10/11/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Juan M. Bellón
- Department of Surgery; Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Alcalá de Henares; Madrid Spain
| | - Mar Fernández-Gutiérrez
- Polymeric Biomaterials Group, Polymer Science and Technology Institute-Consejo Superior de Investigaciones Científicas (ICTP-CSIC), Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN); Madrid Spain
| | - Marta Rodríguez
- Department of Surgery; Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Alcalá de Henares; Madrid Spain
| | - Sandra Sotomayor
- Department of Surgery; Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Alcalá de Henares; Madrid Spain
| | - Bárbara Pérez-Köhler
- Department of Surgery; Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Alcalá de Henares; Madrid Spain
| | - Andree Kuhnhardt
- Department of Surgery; Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Alcalá de Henares; Madrid Spain
| | - Gemma Pascual
- Department of Medicine and Medical Specialities; Faculty of Medicine and Health Sciences, University of Alcalá. Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Alcalá de Henares; Madrid Spain
| | - Julio San Román
- Polymeric Biomaterials Group, Polymer Science and Technology Institute-Consejo Superior de Investigaciones Científicas (ICTP-CSIC), Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN); Madrid Spain
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Guillaume O, Teuschl AH, Gruber-Blum S, Fortelny RH, Redl H, Petter-Puchner A. Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio-Functionality to Meshes. Adv Healthc Mater 2015; 4:1763-89. [PMID: 26111309 DOI: 10.1002/adhm.201500201] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/12/2015] [Indexed: 12/19/2022]
Abstract
Abdominal wall hernia is a recurrent issue world-wide and requires the implantation of over 1 million meshes per year. Because permanent meshes such as polypropylene and polyester are not free of complications after implantation, many mesh modifications and new functionalities have been investigated over the last decade. Indeed, mesh optimization is the focus of intense development and the biomaterials utilized are now envisioned as being bioactive substrates that trigger various physiological processes in order to prevent complications and to promote tissue integration. In this context, it is of paramount interest to review the most relevant bio-functionalities being brought to new meshes and to open new avenues for the innovative development of the next generation of meshes with enhanced properties for functional abdominal wall hernia repair.
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Affiliation(s)
- Olivier Guillaume
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Andreas Herbert Teuschl
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- University of Applied Sciences Technikum Wien; Department of Biochemical Engineering; Höchstädtplatz 5 1200 Vienna Austria
| | - Simone Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - René Hartmann Fortelny
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Alexander Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
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Escobar Dominguez JE, Gonzalez A, Donkor C. Robotic inguinal hernia repair. J Surg Oncol 2015; 112:310-4. [DOI: 10.1002/jso.23905] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/08/2015] [Indexed: 11/08/2022]
Affiliation(s)
| | - Anthony Gonzalez
- Baptist Health South Florida; Baptist Health Medical Group
- Florida International University College of Medicine
| | - Charan Donkor
- Baptist Health South Florida; Baptist Health Medical Group
- Florida International University College of Medicine
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Silecchia G, Campanile FC, Sanchez L, Ceccarelli G, Antinori A, Ansaloni L, Olmi S, Ferrari GC, Cuccurullo D, Baccari P, Agresta F, Vettoretto N, Piccoli M. Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected]. Surg Endosc 2015; 29:2463-84. [PMID: 26139480 DOI: 10.1007/s00464-015-4293-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/27/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of the first evidence-based Italian Consensus Conference Guidelines 2010 because a large amount of literature has been published in the last 4 years about the topics examined and new relevant issues. METHODS The scientific committee selected the topics to be addressed: indications to surgical treatment including special conditions (obesity, cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of intraperitoneal meshes (synthetic and biologic); fixing devices (absorbable/non-absorbable); abdominal border and parastomal hernia; intraoperative and perioperative complications; and recurrent ventral/incisional hernia. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The process was supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective, transparent, and reliable work. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence") was used by the panel to grade clinical outcomes according to levels of evidence. The recommendations were based on the grading system suggested by the GRADE working group. RESULTS AND CONCLUSIONS The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.
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Affiliation(s)
- Gianfranco Silecchia
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Via Faggiana 1668, 04100, Latina, LT, Italy
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Fenger AQ, Helvind NM, Pommergaard HC, Burcharth J, Rosenberg J. Fibrin sealant for mesh fixation in laparoscopic groin hernia repair does not increase long-term recurrence. Surg Endosc 2015; 30:986-92. [DOI: 10.1007/s00464-015-4280-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/19/2015] [Indexed: 12/25/2022]
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Abstract
In the United States and Europe, the number of topical adhesives, surgical sealants, and hemostats approved for use in the surgical setting is ever expanding although no single device fills all medical and surgical needs to replace sutures. As more surgical procedures are performed through laparoscopic and robotic approaches, these devices are becoming more important, and current research is focused on solving the limitations of conventional wound treatments. This review article discusses clinical applications of various biologically derived and synthetic products that are currently available to surgeons and those that are in development.
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Affiliation(s)
- Lindsey Sanders
- Department of Bioengineering, Clemson University, Clemson, South Carolina
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58
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Zhang G, Zhang X, Zhan H, Hu S. Vacuum suction fixation versus staple fixation in TAPP laparoscopic hernia repair: introduction of a new technique for mesh fixation. Surg Endosc 2015; 30:114-20. [DOI: 10.1007/s00464-015-4168-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 03/14/2015] [Indexed: 12/20/2022]
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59
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Li Y, Meng H, Liu Y, Lee BP. Fibrin gel as an injectable biodegradable scaffold and cell carrier for tissue engineering. ScientificWorldJournal 2015; 2015:685690. [PMID: 25853146 PMCID: PMC4380102 DOI: 10.1155/2015/685690] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/27/2015] [Indexed: 12/28/2022] Open
Abstract
Due to the increasing needs for organ transplantation and a universal shortage of donated tissues, tissue engineering emerges as a useful approach to engineer functional tissues. Although different synthetic materials have been used to fabricate tissue engineering scaffolds, they have many limitations such as the biocompatibility concerns, the inability to support cell attachment, and undesirable degradation rate. Fibrin gel, a biopolymeric material, provides numerous advantages over synthetic materials in functioning as a tissue engineering scaffold and a cell carrier. Fibrin gel exhibits excellent biocompatibility, promotes cell attachment, and can degrade in a controllable manner. Additionally, fibrin gel mimics the natural blood-clotting process and self-assembles into a polymer network. The ability for fibrin to cure in situ has been exploited to develop injectable scaffolds for the repair of damaged cardiac and cartilage tissues. Additionally, fibrin gel has been utilized as a cell carrier to protect cells from the forces during the application and cell delivery processes while enhancing the cell viability and tissue regeneration. Here, we review the recent advancement in developing fibrin-based biomaterials for the development of injectable tissue engineering scaffold and cell carriers.
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Affiliation(s)
- Yuting Li
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Hao Meng
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Yuan Liu
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Bruce P. Lee
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
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Short-term results of a randomized controlled trial comparing primary suture with primary glued mesh augmentation to prevent incisional hernia. Ann Surg 2015; 261:276-81. [PMID: 24983993 DOI: 10.1097/sla.0000000000000798] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Incisional hernia is one of the most frequent postoperative complications after abdominal surgery. Patients with an abdominal aortic aneurysm and patients with a body mass index of 27 or higher have an increased risk to develop incisional hernia. Primary mesh augmentation is a method in which the abdominal wall is strengthened to reduce incisional hernia incidence. This study focused on the short-term results of the PRImary Mesh Closure of Abdominal Midline Wounds trial, a multicenter double blind randomized controlled trial. METHODS Between 2009 and 2012 patients were included if they were operated via midline laparotomy, and had an abdominal aortic aneurysm or a body mass index of 27 or higher. Patients were randomly assigned to either receive primary suture, onlay mesh augmentation (OMA), or sublay mesh augmentation. RESULTS Outcomes represent results after 1-month follow-up. A total of 480 patients were randomized. During analysis, significantly (P = 0.002) more seromas were detected after OMA (n = 34, 18.1%) compared with primary suture (n = 5, 4.7%) and sublay mesh augmentation (n = 13, 7%). No differences were discovered in any of the other outcomes such as surgical site infection, hematoma, reintervention, or readmission. Multivariable analysis revealed an increase in seroma formation after OMA with an odds ratio of 4.3 (P = 0.004) compared with primary suture and an odds ratio of 2.9 (P = 0.003) compared with sublay mesh augmentation. CONCLUSIONS On the basis of these short-term results, primary mesh augmentation can be considered a safe procedure with only an increase in seroma formation after OMA, but without an increased risk of surgical site infection.
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de Goede B, Timmermans L, van Kempen BJ, van Rooij FJ, Kazemier G, Lange JF, Hofman A, Jeekel J. Risk factors for inguinal hernia in middle-aged and elderly men: Results from the Rotterdam Study. Surgery 2015; 157:540-6. [DOI: 10.1016/j.surg.2014.09.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/04/2014] [Accepted: 09/18/2014] [Indexed: 11/25/2022]
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Reynvoet E, Van Cleven S, Van Overbeke I, Chiers K, De Baets P, Troisi R, Berrevoet F. The use of cyanoacrylate sealant as simple mesh fixation in laparoscopic ventral hernia repair: a large animal evaluation. Hernia 2015; 19:661-70. [DOI: 10.1007/s10029-015-1347-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 01/17/2015] [Indexed: 11/24/2022]
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Lomanto D, Cheah WK, Faylona JM, Huang CS, Lohsiriwat D, Maleachi A, Yang GPC, Li MKW, Tumtavitikul S, Sharma A, Hartung RU, Choi YB, Sutedja B. Inguinal hernia repair: toward Asian guidelines. Asian J Endosc Surg 2015; 8:16-23. [PMID: 25598054 DOI: 10.1111/ases.12141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/20/2014] [Indexed: 01/09/2023]
Abstract
Groin hernias are very common, and surgical treatment is usually recommended. In fact, hernia repair is the most common surgical procedure performed worldwide. In countries such as the USA, China, and India, there may easily be over 1 million repairs every year. The need for this surgery has become an important socioeconomic problem and may affect health-care providers, especially in aging societies. Surgical repair using mesh is recommended and widely employed in Western countries, but in many developing countries, tissue-to-tissue repair is still the preferred surgical procedure due to economic constraints. For these reason, the development and implementation of guidelines, consensus, or recommendations may aim to clarify issues related to best practices in inguinal hernia repair in Asia. A group of Asian experts in hernia repair gathered together to debate inguinal hernia treatments in Asia in an attempt to reach some consensus or develop recommendations on best practices in the region. The need for recommendations or guidelines was unanimously confirmed to help overcome the discrepancy in clinical practice between countries; the experts decided to focus mainly on the technical aspects of open repair, which is the most common surgery for hernia in our region. After the identification of 12 main topics for discussion (indication, age, and sex; symptomatic and asymptomatic hernia: type of hernia; type of treatment; hospital admission; preoperative care; anesthesia; surgical technique; perioperative care; postoperative care; early complications; and long-term complications), a search of the literature was carried out according to the five levels of the Oxford Classification of Evidence and the four grades of recommendation.
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Affiliation(s)
- Davide Lomanto
- Minimally Invasive Surgery Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Health System, National University Singapore, Singapore
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Guérin G, Bourges X, Turquier F. Biomechanical evaluation of three fixation modalities for preperitoneal inguinal hernia repair: a 24-hour postoperative study in pigs. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:437-44. [PMID: 25525396 PMCID: PMC4267587 DOI: 10.2147/mder.s71035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Tacks and sutures ensure a strong fixation of meshes, but they can be associated with pain and discomfort. Less invasive methods are now available. Three fixation modalities were compared: the ProGrip™ laparoscopic self-fixating mesh; the fibrin glue Tisseel™ with Bard™ Soft Mesh; and the SorbaFix™ absorbable fixation system with Bard™ Soft Mesh. MATERIALS AND METHODS Meshes (6 cm ×6 cm) were implanted in the preperitoneal space of swine. Samples were explanted 24 hours after surgery. Centered defects were created, and samples (either ten or eleven per fixation type) were loaded in a pressure chamber. For each sample, the pressure, the mesh displacement through the defect, and the measurements of the contact area were recorded. RESULTS At all pressures tested, the ProGrip™ laparoscopic self-fixating mesh both exhibited a significantly lower displacement through the defect and retained a significantly higher percentage of its initial contact area than either the Bard™ Soft Mesh with Tisseel™ system or the Bard™ Soft Mesh with SorbaFix™ absorbable fixation system. Dislocations occurred with the Bard™ Soft Mesh with Tisseel™ system and with the Bard™ Soft Mesh with SorbaFix™ absorbable fixation system at physiological pressure (,225 mmHg). No dislocation was recorded for the ProGrip™ laparoscopic self-fixating mesh. CONCLUSION At 24 hours after implantation, the mechanical fixation of the ProGrip™ laparoscopic self-fixating mesh was found to be significantly better than the fixation of the Tisseel™ system or the SorbaFix™ absorbable fixation system.
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Affiliation(s)
- Gaëtan Guérin
- Covidien-Surgical Solutions, Research and Development, Trévoux, France
| | - Xavier Bourges
- Covidien-Surgical Solutions, Research and Development, Trévoux, France
| | - Frédéric Turquier
- Covidien-Surgical Solutions, Research and Development, Trévoux, France
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Fortelny RH, Petter-Puchner AH, Redl H, May C, Pospischil W, Glaser K. Assessment of Pain and Quality of Life in Lichtenstein Hernia Repair Using a New Monofilament PTFE Mesh: Comparison of Suture vs. Fibrin-Sealant Mesh Fixation. Front Surg 2014; 1:45. [PMID: 25593969 PMCID: PMC4286975 DOI: 10.3389/fsurg.2014.00045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/10/2014] [Indexed: 11/13/2022] Open
Abstract
Background: Inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become the gold standard in open inguinal hernia repair. Despite the low recurrence rates, pain and discomfort remain a problem for a large number of patients. The aim of this study was to compare suture fixation vs. fibrin sealing by using a new monofilament PTFE mesh, i.e., the Infinit® mesh by W. L. Gore & Associates. Methods: This study was designed as a controlled prospective single-center two-cohort study. A total of 38 patients were enrolled and operated in Lichtenstein technique either standard suture mesh fixation or fibrin-sealant mesh fixation were used as described in the TIMELI trial. Primary outcome parameters were postoperative complications with the new mesh (i.e., seroma, infection), pain, and quality of life evaluated by the VAS and the SF-36 questionnaire. Secondary outcome was recurrence assessed by ultrasound and physical examination. Follow-up time was 1 year. Results: Significantly, less postoperative pain was reported in the fibrin-sealant group compared to the suture group at 6 weeks (P = 0.035), 6 months (P = 0.023), and 1 year (P = 0.011) postoperatively. Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay were seen in the fibrin-sealant group. Conclusion: Fibrin-sealant mesh fixation in Lichtenstein hernioplasty effectively reduces acute and chronic postoperative pain. Monofilament, macro-porous, knitted PTFE meshes seem to be a practicable alternative to commonly used polypropylene meshes in open inguinal hernia repair.
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Affiliation(s)
- René H Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital , Vienna , Austria ; Paracelsus Private Medical University , Salzburg , Austria
| | - Alexander H Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration , Vienna , Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration , Vienna , Austria
| | - Christopher May
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital , Vienna , Austria
| | | | - Karl Glaser
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital , Vienna , Austria
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Muehleder S, Ovsianikov A, Zipperle J, Redl H, Holnthoner W. Connections matter: channeled hydrogels to improve vascularization. Front Bioeng Biotechnol 2014; 2:52. [PMID: 25453032 PMCID: PMC4231943 DOI: 10.3389/fbioe.2014.00052] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/27/2014] [Indexed: 11/13/2022] Open
Abstract
The use of cell-laden hydrogels to engineer soft tissue has been emerging within the past years. Despite, several newly developed and sophisticated techniques to encapsulate different cell types the importance of vascularization of the engineered constructs is often underestimated. As a result, cell death within a construct leads to impaired function and inclusion of the implant. Here, we discuss the fabrication of hollow channels within hydrogels as a promising strategy to facilitate vascularization. Furthermore, we present an overview on the feasible use of removable spacers, 3D laser-, and planar processing strategies to create channels within hydrogels. The implementation of these structures promotes control over cell distribution and increases oxygen transport and nutrient supply in vitro. However, many studies lack the use of endothelial cells in their approaches leaving out an important factor to enhance vessel ingrowth and anastomosis formation upon implantation. In addition, the adequate endothelial cell type needs to be considered to make these approaches bridge the gap to in vivo applications.
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Affiliation(s)
- Severin Muehleder
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center , Vienna , Austria ; Austrian Cluster for Tissue Regeneration , Vienna , Austria
| | - Aleksandr Ovsianikov
- Austrian Cluster for Tissue Regeneration , Vienna , Austria ; Institute of Material Science and Technology, Vienna University of Technology , Vienna , Austria
| | - Johannes Zipperle
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center , Vienna , Austria ; Austrian Cluster for Tissue Regeneration , Vienna , Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center , Vienna , Austria ; Austrian Cluster for Tissue Regeneration , Vienna , Austria
| | - Wolfgang Holnthoner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center , Vienna , Austria ; Austrian Cluster for Tissue Regeneration , Vienna , Austria
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Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias. Surg Endosc 2014; 29:1769-80. [PMID: 25294541 DOI: 10.1007/s00464-014-3859-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/16/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND The role of laparoscopic repair of ventral hernias remains incompletely defined. We hypothesize that laparoscopy, compared to open repair with mesh, decreases surgical site infection (SSI) for all ventral hernia types. METHODS MEDLINE, EMBASE, and Cochrane databases were reviewed to identify studies evaluating outcomes of laparoscopic versus open repair with mesh of ventral hernias and divided into groups (primary or incisional). Studies with high risk of bias were excluded. Primary outcomes of interest were recurrence and SSI. Fixed effects model was used unless significant heterogeneity, assessed with the Higgins I square (I(2)), was encountered. RESULTS There were 5 and 15 studies for primary and incisional cohorts. No difference was seen in recurrence between laparoscopic and open repair in the two hernia groups. SSI was more common with open repair in both hernia groups: primary (OR 4.17, 95%CI [2.03-8.55]) and incisional (OR 5.16, 95%CI [2.79-9.57]). CONCLUSIONS Laparoscopic repair, compared to open repair with mesh, decreases rates of SSI in all types of ventral hernias with no difference in recurrence. These data suggest that laparoscopic approach may be the treatment of choice for all types of ventral hernias.
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Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review. Langenbecks Arch Surg 2014; 399:55-63. [PMID: 24121735 DOI: 10.1007/s00423-013-1126-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/27/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study is to distinguish the optimal mesh fixation technique used in laparoscopic ventral hernia repair (LVHR). A particular fixation technique of the mesh to the abdominal wall is required, which should be strong enough to prevent migration of the mesh and, at the same time, keep injury to the abdominal wall minimal to prevent postoperative discomfort and pain. METHODS An extensive literature search was performed in the PubMed database from its onset until November 2012. All series of at least 30 patients operated by laparoscopy for a ventral hernia, with the use of a standardized surgical technique well-defined in the “Methods” section, and with a follow-up of at least 12 months were included. The series were categorized according to the technique of mesh fixation described: “tacks and sutures,” “tacks only,” and “sutures only.” For each treatment group, the recurrence rate was adjusted to the number of patients treated and the 95 % confidence interval was calculated. No overlap between two intervals was defined as a significant difference in recurrence rate. RESULTS A total of 25 series were included for statistical evaluation. Thirteen trials used both tacks and sutures, ten used only tacks, and two used only sutures. Overall recurrence rate was 2.7 % (95 % CI [1.9–3.4 %]). CONCLUSION None of the currently available mesh fixation techniques used for LVHR was found to be superior in preventing hernia recurrence as well as in reducing abdominal wall pain. The pain reported was remarkably high with all different fixation devices. Further research to develop solid and atraumatic fixation devices is warranted.
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Gruber-Blum S, Brand J, Keibl C, Redl H, Fortelny RH, May C, Petter-Puchner AH. The impact of hydrophobic hernia mesh coating by omega fatty acid on atraumatic fibrin sealant fixation. Hernia 2014; 19:651-7. [DOI: 10.1007/s10029-014-1304-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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Köhler G, Mayer F, Lechner M, Bittner R. Small bowel obstruction after TAPP repair caused by a self-anchoring barbed suture device for peritoneal closure: case report and review of the literature. Hernia 2014; 19:389-94. [PMID: 25112384 DOI: 10.1007/s10029-014-1301-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 07/28/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Transabdominal preperitoneal hernioplasty (TAPP) is a common procedure for groin hernia repair in adults. The peritoneal closure after mesh placement can be performed in various ways. In any case, thorough closure is recommended to avoid mesh exposure to the viscera with the risk of adhesions and bowel incarceration into peritoneal defects. Postoperative intestinal obstructions can mainly occur due to adhesions or bowel herniation through peritoneal defects into the dissected preperitoneal space. Incarcerations can also occur as a consequence of trocar site herniation. RESULTS AND CONCLUSION Recently barbed self-anchoring knotless suturing devices are frequently used for peritoneal closure. The correct handling of such sutures is crucial to avoid potential complications. Despite of accurate management, bowel adherence and injuries or volvulus can occur. METHODS We present an unusual case of a postoperative small bowel obstruction owing to strained adhesions and ingrowth between a small bowel segment and a polyglyconate unidirectional self-anchoring barbed suture device. Medline and PudMed databases were searched using the below-mentioned keywords and the literature on efficacy and safety of barbed sutures for peritoneal closure is reviewed as well as the usage of such devices in other fields of surgery.
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Affiliation(s)
- G Köhler
- Academic Teaching Hospital of the Universities Graz and Innsbruck, Linz, Austria,
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Prevention of Subcutaneous Seroma Formation in Open Ventral Hernia Repair Using a New Low-Thrombin Fibrin Sealant. World J Surg 2014; 38:2797-803. [DOI: 10.1007/s00268-014-2691-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Agresta F, Torchiaro M, Tordin C. Laparoscopic transabdominal inguinal hernia repair in community hospital settings: a general surgeon's last 10 years experience. Hernia 2014; 18:745-50. [PMID: 24760165 DOI: 10.1007/s10029-014-1251-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/06/2014] [Indexed: 12/01/2022]
Abstract
UNLABELLED Numerous studies have documented the laparoscopic TransAbdominal Pre-Peritoneal (TAPP) approach as an excellent choice for inguinal hernia repair, especially with an experienced surgeon. A cohort population of patients who underwent TAPP laparoscopic surgery for inguinal hernias over the last 10 years, with follow-up, were evaluated, focusing on the feasibility, safety and benefits of this procedure in a community hospital setting. MATERIALS AND METHODS A total of 533 patients underwent TAPP for inguinal hernias between January 2003 and March 2013 in two community hospitals in the Northeast of Italy-"Civil Hospital" in Vittorio Veneto (TV) and "Civil Hospital" in Adria (RO). RESULTS The total number of hernias treated was 1,000. The overall mean operative time was 43.50 min (±13.2). All but three of the procedures were done on a day surgery basis. There were no conversions to open repair or deaths in our series. We had two cases of small bowel obstruction and eight relapses (0.8 %) in our series. The mean follow-up was 59.4 months (±5.6; range 3-120). No patients reported severe pain at 10 days, 21 patients (3.9 %) reported mild pain at 3-month follow-up. Over 90 % of the patients had a return of physical work capacity within 2 weeks, the remaining within 30 days. All patients were completely satisfied (numerical rating scale 10/10) 3 months after the operation. CONCLUSIONS The analysis of the short- and long-term post-operative outcomes of our experience enabled us to conclude that in an appropriate setting, TAPP is feasible, effective, safe and beneficial for patients. It should be incorporated into general surgeons' expertise and selectively used for the management of patients with hernias, as long as adequate training is obtained and appropriate preparation performed.
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Affiliation(s)
- F Agresta
- Department of General Surgery, Ulss1 9 del Veneto, Ospedale Civile, Piazzale Etruschi 9, 45011, Adria (TV), Italy,
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Fibrin Sealant: The Only Approved Hemostat, Sealant, and Adhesive-a Laboratory and Clinical Perspective. ISRN SURGERY 2014; 2014:203943. [PMID: 24729902 PMCID: PMC3960746 DOI: 10.1155/2014/203943] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/18/2013] [Indexed: 02/07/2023]
Abstract
Background. Fibrin sealant became the first modern era material approved as a hemostat in the United States in 1998. It is the only agent presently approved as a hemostat, sealant, and adhesive by the Food and Drug Administration (FDA). The product is now supplied as patches in addition to the original liquid formulations. Both laboratory and clinical uses of fibrin sealant continue to grow. The new literature on this material also continues to proliferate rapidly (approximately 200 papers/year). Methods. An overview of current fibrin sealant products and their approved uses and a comprehensive PubMed based review of the recent literature (February 2012, through March 2013) on the laboratory and clinical use of fibrin sealant are provided. Product information is organized into sections based on a classification system for commercially available materials. Publications are presented in sections based on both laboratory research and clinical topics are listed in order of decreasing frequency. Results. Fibrin sealant remains useful hemostat, sealant, and adhesive. New formulations and applications continue to be developed. Conclusions. This agent remains clinically important with the recent introduction of new commercially available products. Fibrin sealant has multiple new uses that should result in further improvements in patient care.
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Ultrasound biomicroscopy (UBM) and scanning acoustic microscopy (SAM) for the assessment of hernia mesh integration: a comparison to standard histology in an experimental model. Hernia 2013; 18:579-85. [PMID: 24346242 DOI: 10.1007/s10029-013-1201-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mesh integration is a key parameter for reliable and safe hernia repair. So far, its assessment is based on histology obtained from rare second-look operations or experimental research. Therefore, non-invasive high-resolution imaging techniques would be of great value. Ultrasound biomicroscopy (UBM) and scanning acoustic microscopy (SAM) have shown potential in the imaging of hard and soft tissues. This experimental study compared the detection of mesh integration, foreign body reaction and scar formation in UBM/SAM with standard histology. MATERIALS AND METHODS Ten titanized polypropylene meshes were implanted in rats in a model of onlay repair. 17 days postoperative animals were killed and samples were paraffin embedded for histology (H&E, Cresyl violet) or processed for postmortem UBM/SAM. The observation period was uneventful and meshes appeared well integrated. RESULTS Relocation of neighboring cross-sectional levels could easily be achieved with the 40-MHz UBM and granulation tissue could be distinguished from adjacent muscle tissue layers. The spatial resolution of approximately 8 μm of the 200-MHz UBM system images was comparable to standard histology (2.5-5× magnification) and allowed a clear identification of mesh fibers and different tissue types, e.g., scar, fat, granulation, and muscle tissues, as well as vessels, abscedations, and foreign body giant cell clusters. CONCLUSION This pilot study demonstrates the potential of high-frequency ultrasound to assess hernia mesh integration non-invasively. Although the methods lack cell-specific information, tissue integration could reliably be assessed. The possibility of conducting UBM in vivo advocates this method as a guidance tool for the indication of second-look operations and subsequent elaborate histological analyses.
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Abstract
The laparoscopic approach to inguinal hernia surgery is safe and reliable. It has a similar recurrence rate as open tension-free mesh repair. Because the laparoscopic approach has less chronic postoperative pain and numbness, fast return to normal activities, and decreased incidence of wound infection and hematoma, it should be considered an appropriate approach for inguinal hernia surgery. These results can be achieved if a surgeon is proficient in the technique, has a clear understanding of the anatomy, and performs it on a regular basis. This article focuses on questions related to laparoscopic inguinal hernia surgery and provides answers based on published literature.
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Affiliation(s)
- Leandro Totti Cavazzola
- Department of Surgery, Universidade Federal do Rio Grande do Sul, Avenida Montenegro 163, Apartment 802, Bairro Petrópolis, Porto Alegre, Rio Grande do Sul 90460-160, Brazil.
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Nieuwenhuizen J, Eker HH, Timmermans L, Hop WCJ, Kleinrensink GJ, Jeekel J, Lange JF. A double blind randomized controlled trial comparing primary suture closure with mesh augmented closure to reduce incisional hernia incidence. BMC Surg 2013; 13:48. [PMID: 24499111 PMCID: PMC3840708 DOI: 10.1186/1471-2482-13-48] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
Background Incisional hernia is the most frequently seen long term complication after laparotomy causing much morbidity and even mortality. The overall incidence remains 11-20%, despite studies attempting to optimize closing techniques. Two patient groups, patients with abdominal aortic aneurysm and obese patients, have a risk for incisional hernia after laparotomy of more than 30%. These patients might benefit from mesh augmented midline closure as a means to reduce incisional hernia incidence. Methods/design The PRImary Mesh Closure of Abdominal Midline Wound (PRIMA) trial is a double-blinded international multicenter randomized controlled trial comparing running slowly absorbable suture closure with the same closure augmented with a sublay or onlay mesh. Primary endpoint will be incisional hernia incidence 2 years postoperatively. Secondary outcomes will be postoperative complications, pain, quality of life and cost effectiveness. A total of 460 patients will be included in three arms of the study and randomized between running suture closure, onlay mesh closure or sublay mesh closure. Follow-up will be at 1, 3, 12 and 24 months with ultrasound imaging performed at 6 and 24 months to objectify the presence of incisional hernia. Patients, investigators and radiologists will be blinded throughout the whole follow up. Disccusion The use of prosthetic mesh has proven effective and safe in incisional hernia surgery however its use in a prophylactic manner has yet to be properly investigated. The PRIMA trial will provide level 1b evidence whether mesh augmented midline abdominal closure reduces incisional hernia incidence in high risk groups. Trial registration Clinical trial.gov NCT00761475.
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Sharma A, Sandhya J, Sharma E, Guleria K, Suneja A, Vaid N. Improvising Vaginoplasty Using Fibrin Glue with Vacuum Expandable Condom Mold. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2013.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Abha Sharma
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Jain Sandhya
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Esha Sharma
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Amita Suneja
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Neelam Vaid
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Brand J, Gruber-Blum S, Gruber K, Fortelny RH, Redl H, Petter-Puchner AH. Transporous hernia mesh fixation with fibrin sealant in an in vitro model of spray application. J Surg Res 2013; 183:726-32. [DOI: 10.1016/j.jss.2013.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/10/2013] [Accepted: 03/01/2013] [Indexed: 11/28/2022]
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Wang MG, Tian ML, Zhao XF, Nie YS, Chen J, Shen YM. Effectiveness and safety of n-butyl-2-cyanoacrylate medical adhesive for noninvasive patch fixation in laparoscopic inguinal hernia repair. Surg Endosc 2013; 27:3792-8. [DOI: 10.1007/s00464-013-2970-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
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Sanders DL, Waydia S. A systematic review of randomised control trials assessing mesh fixation in open inguinal hernia repair. Hernia 2013; 18:165-76. [PMID: 23649403 DOI: 10.1007/s10029-013-1093-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 04/26/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE The technique for fixation of mesh has been attributed to adverse patient and surgical outcomes. Although this has been the subject of vigorous debate in laparoscopic hernia repair, the several methods of fixation in open, anterior inguinal hernia repair have seldom been reviewed. The aim of this systematic review was to determine whether there is any difference in patient-based (recurrence, post-operative pain, SSI, quality of life) or surgical outcomes (operative time, length of operative stay) with different fixation methods in open anterior inguinal hernioplasty. METHODS A literature search was performed in PubMed, EMBASE and the Cochrane Library databases. Randomised clinical trials assessing more than one method of mesh fixation (or fixation versus no fixation) of mesh in adults (>18 years) in open, anterior inguinal hernia repair, with a minimum of 6-month follow-up and including at least one of the primary outcome measures (recurrence, chronic pain, surgical site infection) were included in the review. Secondary outcomes analysed included post-operative pain (within the first week), quality of life, operative time and length of hospital stay. RESULTS Twelve randomised clinical trials, which included 1,992 primary inguinal hernia repairs, were eligible for inclusion. Four studies compared n-butyl-2 cyanoacrylate (NB2C) glues to sutures, two compared self-fixing meshes to sutures, four compared fibrin sealant to sutures, one compared tacks to sutures, and one compared absorbable sutures to non-absorbable sutures. The majority of the trials were rated as low or very low-quality studies. There was no significant difference in recurrence or surgical site infection rates between fixation methods. There was significant heterogeneity in the measurement of chronic pain. Three trials reported significantly lower rates of chronic pain with fibrin sealant or glue fixation compared to sutures. A further three studies reported lower pain rates within the first week with non-suture fixation techniques compared to suture fixation. A significant reduction in operative time, ranging form 6 to 17.9 min with non-suture fixation, was reported in five of the studies. Although infrequently measured, there were no significant differences in length of hospital stay or quality of life between fixation methods. CONCLUSIONS There is insufficient evidence to promote fibrin sealant, self-fixing meshes or NB2C glues ahead of suture fixation. However, these products have been shown to be at least substantially equivalent, and moderate-quality RCTs have suggested that both fibrin sealant and NB2C glues may have a beneficial effect on reducing immediate post-operative pain and chronic pain in at-risk populations, such as younger active patients. It will ultimately be up to surgeons and health-care policy makers to decide whether based on the limited evidence these products represent a worthwhile cost for their patients.
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Affiliation(s)
- D L Sanders
- Department of Upper GI Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, UK,
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82
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de Goede B, Klitsie PJ, van Kempen BJH, Timmermans L, Jeekel J, Kazemier G, Lange JF. Meta-analysis of glue versus sutured mesh fixation for Lichtenstein inguinal hernia repair. Br J Surg 2013; 100:735-42. [DOI: 10.1002/bjs.9072] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Chronic pain remains a frequent complication after Lichtenstein inguinal hernia repair. As a consequence, mesh fixation using glue instead of sutures has become popular. This meta-analysis aimed to clarify which fixation technique is to be preferred for elective Lichtenstein inguinal hernia repair.
Methods
A meta-analysis was conducted according to the PRISMA guidelines. Articles published between January 1990 and April 2012 were searched for in MEDLINE, Embase and the Cochrane Library. Randomized controlled trials (RCTs) comparing glue and sutured mesh fixation in elective Lichtenstein repair for unilateral inguinal hernia were included. The quality of the RCTs and the potential risk of bias were assessed using the Cochrane risk of bias tool.
Results
Of 254 papers found in the initial search, a meta-analysis was conducted of seven RCTs comprising 1185 patients. With the use of glue mesh fixation, the duration of operation was shorter (mean difference −2·57 (95 per cent confidence interval (c.i.) –4·88 to −0·26) min; P = 0·03), patients had lower visual analogue scores for postoperative pain (mean difference −0·75 (−1·18 to −0·33); P = 0·001), early chronic pain occurred less often (risk ratio 0·52, 95 per cent c.i. 0·31 to 0·87; P = 0·01), and time to return to daily activities was shorter (mean difference −1·17 (−2·30 to −0·03) days; P = 0·04). The hernia recurrence rate did not differ significantly.
Conclusion
Elective Lichtenstein repair for inguinal hernia using glue mesh fixation compared with sutures is faster and less painful, with comparable hernia recurrence rates.
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Affiliation(s)
- B de Goede
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - P J Klitsie
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - B J H van Kempen
- Department of Epidemiology and Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - L Timmermans
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - G Kazemier
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Randomized clinical trial of fibrin glue versus tacked fixation in laparoscopic groin hernia repair. Surg Endosc 2013; 27:2727-33. [PMID: 23355162 DOI: 10.1007/s00464-012-2766-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Preliminary studies have indicated clinical advantages of mesh fixation using fibrin glue in transabdominal preperitoneal groin hernia repair (TAPP) compared with tack fixation. The aim of this randomized double-blinded, controlled, clinical trial is to compare fibrin glue with tacks fixation of mesh during TAPP. METHODS One hundred and twelve men with unilateral inguinal hernia were enrolled. Primary outcome was pain during coughing on postoperative day 1. Secondary outcomes were postoperative scores of pain at rest, discomfort, and fatigue (day 1 and cumulated day 0-3), incidence of moderate/severe nausea and/or vomiting, foreign-body sensation, and recurrence after 6 months. Outcome measures were assessed by visual analogue scale (VAS, 0-100 mm), verbal rating scale (no, light, moderate or severe) and numerical rating scales (NRS, 1-10). RESULTS One hundred patients were available for analysis. The fibrin group (n = 50) had significantly less pain during coughing on day 1 compared with the tacks group (n = 50) [median 23 (range 0-80) vs 35 (2-100) mm] (p = 0.020). Moreover, day 1 scores and all cumulated scores of pain during rest, discomfort, and fatigue were significantly lower in the fibrin group compared with the tacks group (all p-values ≤ 0.02). There was no significant difference in the incidence of nausea and/or vomiting (p > 0.05) or recurrence (fibrin glue n = 2, tacks n = 0, p = 0.241). Incidence of foreign-body sensation was significantly lower in the fibrin group at 1 month (p = 0.006). CONCLUSIONS Fibrin glue compared with tacks fixation improved the early postoperative outcome after TAPP. The trial was registered at clinicaltrials.gov NCT01000116.
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Berney CR, Yeo AET. Mesh fixation with fibrin sealant during endoscopic totally extraperitoneal inguinal hernia approach: a review of 640 repairs. Hernia 2013; 17:709-17. [PMID: 23344667 DOI: 10.1007/s10029-012-1034-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 12/27/2012] [Indexed: 12/17/2022]
Abstract
PURPOSE Endoscopic repair of inguinal hernia can decrease the incidence of chronic groin pain. Staple mesh fixation is the surgical technique preferentially used but may also cause residual pain. Although a substantial number of specialists advocate no mesh fixations, concerns are that this could lead to an increase in recurrence rates. This study aimed to assess the safety and the effectiveness of fibrin sealant, as an alternative technique to staple mesh fixation after totally extraperitoneal (TEP) inguinal hernia repair. METHODS A total of 472 patients underwent elective TEP inguinal hernia repair between February 2005 and July 2011. Mesh fixation was achieved using fibrin sealant. Patients were reviewed postoperatively at Week 2, Week 6, and Month 6. Patient satisfaction was assessed in a subgroup of 116 patients using a comprehensive scoring system designed for hernia repairs, and pain was assessed using a standard Visual Analog pain Scale. RESULTS No conversion to open surgery was observed. There were two cases of major morbidities and no mortality. Three months after surgery, only three patients (0.6 %) experienced chronic groin or testicular discomfort. At Week 6, 98.9 % of the patients were either satisfied or very satisfied with their outcome, and 96.8 % denied any residual pain. Finally, only six hernia recurrences (0.9 %) were reported, of which five occurred during the first months of the study. CONCLUSIONS Fibrin sealant is safe and reliable for mesh fixation of inguinal hernia during TEP repair with a very high satisfaction index and limited risk of developing chronic pain.
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Affiliation(s)
- C R Berney
- Bankstown-Lidcombe Hospital, University of New South Wales, Bankstown, NSW, 2200, Australia,
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Risk of postoperative urinary retention after laparoscopic (TAPP) or endoscopic (TEP) inguinal hernia repair. Surg Endosc 2012; 27:694-5. [PMID: 22810154 DOI: 10.1007/s00464-012-2482-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
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