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Kritharides N, Papaconstantinou D, Kykalos S, Machairas N, Schizas D, Nikiteas NI, Dimitroulis D. Laparoscopic parastomal hernia repair: keyhole, Sugarbaker, sandwich, or hybrid technique with 3D mesh? An updated systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:448. [PMID: 38017096 PMCID: PMC10684625 DOI: 10.1007/s00423-023-03177-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Parastomal hernia is the most common complication after stoma formation with an incidence that approaches 50% at 2 years postoperatively. In the last decade, different approaches of minimally invasive procedures have been proposed for the treatment of parastomal hernia. Nevertheless, the superiority of one technique over the others remains still unclear. Our objective was to update and systematically analyze current state of research concerning the postoperative outcomes of the four most prevalent minimally invasive techniques. METHODS A systematic literature search of three databases (Medline, Scopus, Google Scholar) was undertaken for articles published from January 2015 to November 2022. Fifteen studies from a previous meta-analysis on the topic were included. RESULTS Thirty-three studies incorporating 1289 total patients were deemed eligible for inclusion in the final analysis. The keyhole technique was associated with the highest incidence of postoperative complications and recurrences (31.3% and 24.1%, respectively), followed by the Sugarbaker technique (27.6% and 9%, respectively). Operative time was among the lowest in patients operated with the 3D mesh technique, while patients undergoing the keyhole technique experienced the shortest cumulative length of hospital stay (6 days). CONCLUSION Each technique demonstrates a unique profile of effectiveness offset by the propensity towards developing postoperative complications. While no conclusive evidence on the optimal technique exist to date, newer minimally invasive techniques show promising results, albeit based on limited data. The future of parastomal hernia repair seems to rely on a highly individualized approach, tailored to the distinctive characteristics of both the hernia and the patient.
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Affiliation(s)
- Nicos Kritharides
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece.
- Department of Surgery, General Hospital of Athens «Elpis», 11522, Athens, Greece.
| | - Dimitrios Papaconstantinou
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462, Chaidari, Greece
| | - Stylianos Kykalos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Nikolaos I Nikiteas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Dimitrios Dimitroulis
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
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Belousov AM, Armashov VP, Shkarupa DD, Anushchenko TY, Filipenko TS, Zhukovskiy VA, Matveev NL. [Safety of mesh with fluoropolymer coating during intra-abdominal placement in large animals: results of the pilot study]. Khirurgiia (Mosk) 2023:43-58. [PMID: 36748870 DOI: 10.17116/hirurgia202302143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE When performing laparoscopic intraperitoneal hernioplasty (IPOM), endoprostheses made of fluoropolymers are often used. However, there is no data in the literature on the intra-abdominal use of inexpensive polyester prostheses with a fluoropolymer coating compared to composite implants. Thus, the aim of the pilot study was a preliminary assessment of the safety profile of FTOREX mesh endoprostheses during intra-abdominal placement in large animals. MATERIAL AND METHODS 6 endoprostheses were installed laparoscopically intraperitoneally in each of the 3 pigs: 1) FTOREX; 2) FTOREX with a layer of carboxymethylcellulose; 3) REPEREN-16-2; 4) SYMBOTEX; 5) VENTRALIGHT ST; 6) decellularized pork peritoneum. Fixation was performed with a herniator, transfascial sutures were not used. Relaparoscopy was performed after 45 days, and withdrawal from the experiment was performed after 90 days. Performance characteristics, signs of deformation and retraction, parameters of spike formation were evaluated. RESULTS All the animals survived, no complications were observed. There were no clinical manifestations or behavioral reactions indicating the presence of adhesions. The most convenient to use were the SYMBOTEX and FTOREX implants (5.0 points each). By the end of the experiment, deformation and retraction were noted in both variants of the FTOREX implants and the REPEREN prosthesis. These changes were completely absent only when using the SYMBOTEX endoprosthesis. According to the number of implants with adhesions, by the end of the observation, both variants of FTOREX prostheses occupied an intermediate position between the Reference (the worst indicator) and VENTRALIGHT ST (the best indicator). However, both FTOREX endoprostheses showed the best performance among all implants in the integral assessment of adhesions, as well as in terms of parameters such as the area and appearance of adhesions, and in terms of the strength of the joints, they were second only to the VENTRALIGHT ST endoprosthesis (0.67 vs. 0.5 points). During the study, there was no reliable dependence of deformation, retraction and adhesion formation indicators on the type of implant. CONCLUSION The results of the pilot study showed that all the implants used did not cause any clinically significant adverse reactions or complications. FTOREX endoprostheses with their intraperitoneal installation have anti-adhesive properties that are not inferior to VENTRALIGHT ST or SYMBOTEX composite implants. However, having less rigidity, they are more often deformed and subjected to retraction.
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Affiliation(s)
- A M Belousov
- St. Petersburg University's, St. Petersburg, Russia
| | - V P Armashov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - D D Shkarupa
- St. Petersburg University's, St. Petersburg, Russia
| | | | | | | | - N L Matveev
- Pirogov Russian National Research Medical University, Moscow, Russia
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Sugarbaker Versus Keyhole Repair for Parastomal Hernia: a Systematic Review and Meta-analysis of Comparative Studies. J Gastrointest Surg 2022; 27:573-584. [PMID: 36469282 DOI: 10.1007/s11605-022-05412-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/03/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Parastomal hernia is a debilitating complication of stoma creation. Parastomal hernia repair with mesh reduces recurrence rates in open and laparoscopic settings. Recent comparative studies conflict with previously pooled data on optimal mesh repair technique. The objective of this study is to examine parastomal hernia recurrence rates after Sugarbaker and keyhole repairs by performing an updated systematic review and meta-analysis of comparative studies. METHODS A systematic review of PubMed, MEDLINE, EMBASE, the Cochrane database, SCOPUS, and the PROSPERO registry was performed according to PRISMA 2020 guidelines (PROSPERO ID: CRD42021290483). Studies comparing parastomal hernia recurrences after Sugarbaker and keyhole repairs were included. Studies with overlapping patient cohorts (duplicate data), non-comparative studies, studies that did not report the primary outcome of interest, and studies not in the English language were excluded. Study bias was assessed using the Newcastle-Ottawa scale. Pooled mean differences (MD), odds ratios (OR), and risk ratios (RR) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I2 statistic. Forest plots and funnel plots were generated. Study quality was analyzed using MINORS. Additional subgroup analysis of modern studies was performed. RESULTS Ten comparative studies published between 2005 and 2021 from 5 countries were included for analysis comprising 347 Sugarbaker repairs and 246 keyhole repairs. There were no differences in patient age, sex, or BMI between the groups. There was no difference between the groups regarding surgical site infection (OR 0.78; CI 0.31-1.98; P = 0.61) or post-operative bowel obstruction (OR 0.76; CI 0.23-2.56; P = 0.66). Sugarbaker repairs were significantly less often associated with parastomal hernia recurrence when compared to keyhole repairs (OR 0.38; CI 0.18-0.78; P = 0.008). There was no significant heterogeneity among the studies comparing parastomal hernia recurrence (I2 = 32%; P = 0.15). Quality analysis revealed a median MINORS score of 11 (range 6-16). Subgroup analysis of studies performed after the previously published pooled analysis (2015-2021) revealed no significant difference in parastomal hernia recurrence between the two groups (OR 0.58; CI 0.24-1.38; P = 0.22) with a significant subgroup effect (P = 0.05). CONCLUSIONS Though there were lower rates of parastomal hernia recurrence with Sugarbaker repairs on overall analysis, this phenomenon disappeared on subgroup analysis of modern studies. Randomized controlled trials with contemporary cohorts would help further evaluate these repairs and minimize potential bias.
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CARUSO R, VICENTE E, QUIJANO Y, AMATO L, DURAN H, DIAZ E, FABRA I, MALAVE L, NOLA V, AGRESOTT R, FERRI V. Laparoscopic two-stage parastomal hernia repair using a sugarbaker approach overlapping the previous keyhole technique: a case report with video. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery. Dis Colon Rectum 2022; 65:1173-1190. [PMID: 35616386 DOI: 10.1097/dcr.0000000000002498] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Birolini C, Tanaka EY, de Miranda JS, Murakami AH, Damous SHB, Utiyama EM. The early outcomes of complex abdominal wall reconstruction with polyvinylidene (PVDF) mesh in the setting of active infection: a prospective series. Langenbecks Arch Surg 2022; 407:3089-3099. [PMID: 35906299 DOI: 10.1007/s00423-022-02625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/22/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The use of synthetic mesh to repair infected abdominal wall defects remains controversial. Polyvinylidene fluoride (PVDF) mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. METHODS This prospective clinical trial started in 2016 and was designed to evaluate the short- and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh (DynaMesh®-CICAT) reinforcement to treat their defects. RESULTS Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and required a longer operative and anesthesia time. At 30 days, surgical site occurrences were observed in 16 (42.1%) AI vs. 17 (44.7%) CC, p = 0.817; surgical site infection occurred in 4 (10.5%) AI vs. 6 (15.8%) CC, p = 0.497; and a higher number of procedural interventions were required in the CC group, 15.8 AI vs. 28.9% CC, p = 0.169. Both groups did not have chronic infections at 1 year of follow-up, and one hernia recurrence was observed in the AI group. CONCLUSIONS The use of PVDF mesh in the infected setting presented favorable results with a low incidence of wound infection.
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Affiliation(s)
- Claudio Birolini
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil.
| | - Eduardo Yassushi Tanaka
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil
| | - Jocielle Santos de Miranda
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil
| | - Abel Hiroshi Murakami
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil
| | - Sergio Henrique Bastos Damous
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil
| | - Edivaldo Massazo Utiyama
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil
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Gao X, Li RF, Sun LX, Liu ZJ, Tian GJ, Qi H, Li XB. Prophylactic Effect of Simultaneous Placement of Mesh on Incidence of Parastomal Hernia After Miles' Surgical Resection of Colorectal Cancer: A Prospective Study. J Surg Res 2022; 277:27-36. [PMID: 35453054 DOI: 10.1016/j.jss.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/15/2022] [Accepted: 03/19/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To assess the prophylactic effect of simultaneous placement of mesh and the incidence of parastomal hernia (PSH) after abdominoperineal resection of rectal cancer. METHODS This study included real-world data of 56 surgically resected patients with colorectal cancer who were consecutively assigned to two groups: control (no mesh, n = 32) and experimental (received mesh, n = 24). An artificial patch was placed under the tunica vaginalis of rectus abdominis for patients in the experimental group, whereas those in the control group received routine sigmoidostomy. The median follow-up time was >20 mo. The difference in hazards function was analyzed by cox regression analysis. The Kaplan-Meir analysis was used to determine the survival curves. A P value of <0.05 was considered as significant. RESULTS The postoperative incidence rate of PSH was lower in the experimental (41.7%) group than in the control group (71.9%; P = 0.045). The PSH postoperative time in the experimental group was significantly delayed compared to the control group (48 mo versus 10 mo; P < 0.001). The risk of progression from H1 to H2 was less in the experimental group compared to the control group (49.28% versus 60.86%; P = 0.14). CONCLUSIONS Prophylactic mesh placement significantly prolonged postoperative time for the recurrence of PSH. The incidence of recurrence of H2 (severe PSH) requiring secondary surgical repair was also reduced.
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Affiliation(s)
- Xu Gao
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Ruo-Fan Li
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Li-Xin Sun
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
| | - Zuo-Jun Liu
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Guang-Jian Tian
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hui Qi
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiao-Bin Li
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Chegireddy V, Doval AF, Zavlin D, Ellsworth WA, Dinh TA. Parastomal Hernia Repair Using a Silo Biologic Mesh. Ann Plast Surg 2021; 87:e97-e102. [PMID: 33560001 DOI: 10.1097/sap.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A parastomal hernia (PSH) is an enlargement of the stoma's original opening through the abdominal wall's musculature around a colostomy, ileostomy, or urostomy. Its incidence can be up to 48%. The described methods for its repair have high recurrence rate.This article presents a 3-dimensional silo technique for PSH repair (PSH-R). The aims of this technique are to enhance the structural strength of the tunnel wall, to reinforce both the sidewalls and the fascia above and below the muscular opening, and to maintain a stable stoma opening. METHODS All consecutive patients undergoing PSH-R with the silo technique between January 2009 and May 2018 by 2 plastic surgeons were included. The outcome parameters of interest were hernia recurrence and wound-related complications. RESULTS This study reports 22 patients (9 male, 13 female) with a mean age of 66.7 years and an average body mass index of 29.2. The variety of ostomy types included 10 colostomies, 7 ileostomies, and 5 urostomies. Postoperatively, there were 3 surgical site infections, 1 seroma, and 2 wound healing delays. Six patients were readmitted, 3 of those because of small bowel obstruction. These 3 cases all required reoperation, in addition to 1 operative revision for stoma retraction. During our average follow-up of 19.9 months, 3 cases of PSH recurrence were diagnosed for a recurrence rate of 13.6%. CONCLUSIONS This silo technique is associated with favorable complication and low recurrence rates compared with the available techniques in surgical literature. In our practice, it has established itself as a new and safe technique for complex or recurrent PSHs and should be considered in a surgeon's armamentarium. This technique has become our standard for treatment of recurrent PSHs.
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Affiliation(s)
- Vishwanath Chegireddy
- From the Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
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Serrano-Aroca Á, Pous-Serrano S. Prosthetic meshes for hernia repair: State of art, classification, biomaterials, antimicrobial approaches, and fabrication methods. J Biomed Mater Res A 2021; 109:2695-2719. [PMID: 34021705 DOI: 10.1002/jbm.a.37238] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/23/2022]
Abstract
Worldwide, hernia repair represents one of the most frequent surgical procedures encompassing a global market valued at several billion dollars. This type of surgery usually requires the implantation of a mesh that needs the appropriate chemical, physical and biological properties for the type of repair. This review thus presents a description of the types of hernias, current hernia repair methods, and the state of the art of prosthetic meshes for hernia repair providing the most important meshes used in clinical practice by surgeons working in this area classified according to their biological or chemical nature, morphology and whether bioabsorbable or not. We emphasise the importance of surgical site infection in herniatology, how to deal with this microbial problem, and we go further into the future research lines on the production of advanced antimicrobial meshes to improve hernia repair and prevent microbial infections, including multidrug-resistant strains. A great deal of progress has been made in this biomedical field in the last decade. However, we are still far from an ideal antimicrobial mesh that can also provide excellent integration to the abdominal wall, mechanical performance, low visceral adhesion and minimal inflammatory or foreign body reactions, among many other problems.
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Affiliation(s)
- Ángel Serrano-Aroca
- Biomaterials and Bioengineering Lab, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Salvador Pous-Serrano
- Surgical Unit of Abdominal Wall, Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
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Analysis of the Outcome of Laparoscopic Repair for Parastomal Hernia Using the Sandwich Technique. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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The Role of Mesh Implants in Surgical Treatment of Parastomal Hernia. MATERIALS 2021; 14:ma14051062. [PMID: 33668318 PMCID: PMC7956701 DOI: 10.3390/ma14051062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
A parastomal hernia is a common complication following stoma surgery. Due to the large number of hernial relapses and other complications, such as infections, adhesion to the intestines, or the formation of adhesions, the treatment of hernias is still a surgical challenge. The current standard for the preventive and causal treatment of parastomal hernias is to perform a procedure with the use of a mesh implant. Researchers are currently focusing on the analysis of many relevant options, including the type of mesh (synthetic, composite, or biological), the available surgical techniques (Sugarbaker’s, “keyhole”, or “sandwich”), the surgical approach used (open or laparoscopic), and the implant position (onlay, sublay, or intraperitoneal onlay mesh). Current surface modification methods and combinations of different materials are actively explored areas for the creation of biocompatible mesh implants with different properties on the visceral and parietal peritoneal side. It has been shown that placing the implant in the sublay and intraperitoneal onlay mesh positions and the use of a specially developed implant with a 3D structure are associated with a lower frequency of recurrences. It has been shown that the prophylactic use of a mesh during stoma formation significantly reduces the incidence of parastomal hernias and is becoming a standard method in medical practice.
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Mäkäräinen-Uhlbäck E, Vironen J, Falenius V, Nordström P, Välikoski A, Kössi J, Kechagias A, Kalliala M, Mattila A, Rantanen T, Scheinin T, Ohtonen P, Rautio T. Parastomal Hernia: A Retrospective Nationwide Cohort Study Comparing Different Techniques with Long-Term Follow-Up. World J Surg 2021; 45:1742-1749. [PMID: 33560501 PMCID: PMC8093171 DOI: 10.1007/s00268-021-05990-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Parastomal hernia repair is a complex surgical procedure with high recurrence and complication rates. This retrospective nationwide cohort study presents the results of different parastomal hernia repair techniques in Finland. METHODS All patients who underwent a primary end ostomy parastomal hernia repair in the nine participating hospitals during 2007-2017 were included in the study. The primary outcome measure was recurrence rate. Secondary outcomes were complications and re-operation rate. RESULTS In total, 235 primary elective parastomal hernia repairs were performed in five university hospitals and four central hospitals in Finland during 2007-2017. The major techniques used were the Sugarbaker (38.8%), keyhole (16.3%), and sandwich techniques (15.4%). In addition, a specific intra-abdominal keyhole technique with a funnel-shaped mesh was utilized in 8.3% of the techniques; other parastomal hernia repair techniques were used in 21.3% of the cases. The median follow-up time was 39.0 months (0-146, SD 35.3). The recurrence rates after the keyhole, Sugarbaker, sandwich, specific funnel-shaped mesh, and other techniques were 35.9%, 21.5%, 13.5%, 15%, and 35.3%, respectively. The overall re-operation rate was 20.4%, while complications occurred in 26.3% of patients. CONCLUSION The recurrence rate after parastomal hernia repair is unacceptable in this nationwide cohort study. As PSH repair volumes are low, further multinational, randomized controlled trials and hernia registry data are needed to improve the results.
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Affiliation(s)
- Elisa Mäkäräinen-Uhlbäck
- Department of Surgery, Medical Research Center, University of Oulu, Oulu University Hospital, 29, 90029 OYS, Oulu, PL, Finland.
| | - Jaana Vironen
- Abdominal Center, Helsinki University Hospital, PL 8000, 00029 HUS, Helsinki, Finland
| | - Ville Falenius
- Department of Surgery, University of Turku, PL 52, 20521, Turku, Finland
| | - Pia Nordström
- Department of Surgery, Tampere University Hospital, PL 2000, 3352o, Tampere, Finland
| | - Anu Välikoski
- Department of Surgery, Tampere University Hospital, PL 2000, 3352o, Tampere, Finland
| | - Jyrki Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
| | - Aristotelis Kechagias
- Department of Surgery, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530, Hämeenlinna, Finland
| | - Maija Kalliala
- Department of Surgery, Joensuu Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Anne Mattila
- Department of Surgery, Keski-Suomi Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Tuomo Rantanen
- Department of Surgery, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland
| | - Tom Scheinin
- Abdominal Center, Helsinki University Hospital, PL 8000, 00029 HUS, Helsinki, Finland
| | - Pasi Ohtonen
- Division of Operative Care, Oulu University Hospital, PL 29, 90029 OYS, Oulu, Finland.,The Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Oulu, Finland
| | - Tero Rautio
- Department of Surgery, Medical Research Center, University of Oulu, Oulu University Hospital, 29, 90029 OYS, Oulu, PL, Finland
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Santos Filho PVD, Santos RS, Leão SC, Duarte IX, Lima SO. Experimental evaluation of intra-abdominal adhesions comparing two different intraperitoneal meshes and the effect of a natural anti-inflammatory product on their formation. Acta Cir Bras 2021; 35:e351205. [PMID: 33503218 PMCID: PMC7819683 DOI: 10.1590/acb351205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/13/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose: In laparoscopic incisional hernia repair, meshes with a tissue-separating
barrier are positioned intraperitoneally. Despite this property, the close
contact between mesh and viscera involves a risk of adhesion formation. Some
natural products, such as red propolis (RP), could reduce these adhesions
owing to their anti-inflammatory properties. This study aimed to compare two
different intraperitoneal meshes with respect to their characteristics of
adhesion formation, histological findings and evaluate the role of RP in the
development of these adhesions. Methods: 40 Wistar rats received placement of two different meshes (Symbotex and
Dynamesh IPOM) on peritoneum. The animals were divided into two groups:
control group (mesh) and treatment group (mesh and RP). After 7 and 14 days,
20 animals of each group underwent midline laparotomy to determine the
adhesions and histological characteristics. Results: Out of the 40 animals, there were two deaths in the test group and two in the
control group. All animals in both groups developed adherence to the mesh.
At postoperative day (POD) 7, two Symbotex meshes presented firm adhesions
and at POD 14, two Dynamesh meshes had firm adhesions as well. The
comparison between the meshes under the effect of RP in relation to the
control group showed no statistical difference. Conclusions: Both meshes showed intraperitoneal adhesions in all evaluated samples with
similar results on the characteristics of adhesions. RP showed no effect on
the incidence or gradation of intraperitoneal adhesions with the mesh.
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Vettoretto N, Caprioli M, Botteri E. Emergency laparoscopic treatment of complicated parastomal hernias. MINERVA CHIR 2020; 75:313-319. [PMID: 33210527 DOI: 10.23736/s0026-4733.20.08462-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parastomal hernia is not a rare event. Being by definition a complication of ostomy creation, a parastomal hernia also carries the risk of becoming symptomatic and complicated. At present, there are not enough solid data in literature to allow an evidence-based approach to this condition and to its possible complications, especially in the emergency setting. The aim of this paper is to describe through a narrative review of the literature the different surgical approaches concerning parastomal hernias. In order to exemplify the emergency complications we also present two cases in which the watchful waiting approach eventually led to the necessity of urgent surgical treatment, due to bowel incarceration into the parastomal hernia. We chose to tailor the surgical plan on the patient's anatomic and clinical condition, pursuing the laparoscopic approach with two different surgical technique (Sugarbaker and keyhole), each time estimated by the operating surgeon to be the more suitable option for the patient. We acknowledge that laparoscopy can be an optimal choice for the emergency and elective treatment of parastomal hernias, whenever an appropriate know-how is present.
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Affiliation(s)
- Nero Vettoretto
- Department of Surgery, ASST Spedali Civili Brescia, Montichiari, Brescia, Italy
| | - Michela Caprioli
- Department of Surgery, ASST Spedali Civili Brescia, Montichiari, Brescia, Italy
| | - Emanuele Botteri
- Department of Surgery, ASST Spedali Civili Brescia, Montichiari, Brescia, Italy -
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15
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Portale G, Cipollari C, Zuin M, Spolverato Y, Fiscon V. Modified laparoscopic keyhole technique for repair of stomal prolapse - a video vignette. Colorectal Dis 2020; 22:1795-1796. [PMID: 32579745 DOI: 10.1111/codi.15212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/05/2020] [Indexed: 02/08/2023]
Affiliation(s)
- G Portale
- Department of Surgery, ULSS6 Euganea, Cittadella, Italy
| | - C Cipollari
- Department of Surgery, ULSS6 Euganea, Cittadella, Italy
| | - M Zuin
- Department of Surgery, ULSS6 Euganea, Cittadella, Italy
| | - Y Spolverato
- Department of Surgery, ULSS6 Euganea, Cittadella, Italy
| | - V Fiscon
- Department of Surgery, ULSS6 Euganea, Cittadella, Italy
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16
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Permanent end-colostomy parastomal hernia prevention using a novel three-dimensional mesh. Hernia 2020; 25:655-663. [PMID: 33128679 DOI: 10.1007/s10029-020-02326-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/19/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Prophylactic mesh placement has been proposed to reduce the high occurrence of parastomal hernia (PSH) after stoma formation. METHODS This is an observational study comparing two cohorts of patients: a mesh prophylaxis group (who received mesh prevention since introduction at our Institution) and a no mesh prophylaxis group (retrospectively selected from our historical series). Same exclusion criteria were applied for both groups. The study was conducted at a tertiary referral center for colorectal surgery. 43 patients were operated with mesh prophylaxis between May 2015 and may 2019. 45 patients underwent end-colostomy formation without prophylaxis between April 2011 and April 2015. The primary outcome measure was PSH development at 12-month follow up. RESULTS Demographic variables and risk factors for PSH were comparable between the two groups. There was no difference between the two cohorts in terms of operative time and main early postoperative outcomes. 37 patients completed the 12-month follow up in each group. PSH occurrence after 12-months was 11% in the mesh prophylaxis group and 54% in the no mesh prophylaxis group (p < 0.0001). There were no differences in long-term complications. 5% of patients who received mesh prophylaxis underwent emergency surgery for bowel occlusion at 7 and 10 months after surgery, with partial or complete mesh removal. At multivariate analysis, mesh prophylaxis was a protective factor for PSH development at 12 months (p < 0.0001). CONCLUSIONS Prophylactic intraperitoneal mesh placement appears to be effective in preventing PSH.
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Sánchez-Arteaga A, Tallón-Aguilar L, Tinoco-González J, Perea Del-Pozo E, Navas-Cuellar A, Padillo-Ruíz J. Use of polyvinylidene fluoride (PVDF) meshes for ventral hernia repair in emergency surgery. Hernia 2020; 25:99-106. [PMID: 32445081 DOI: 10.1007/s10029-020-02209-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The implantation of non-absorbable meshes is the gold standard technique for ventral hernia (VH) repairs. However, emergency surgeries are often related to contaminated/infected fields, where the implantation of prosthetic materials may not be recommendable. Our aim was to evaluate the results of polyvinylidene fluoride (PVDF) meshes used for contaminated and/or complicated VH repairs in the acute setting. METHODS We conducted a retrospective analysis of patients with VH who underwent emergency surgery involving PVDF meshes, in a tertiary hospital (from November 2013 to September 2019). We analyzed postoperative complications and 1-year recurrence rates. We evaluated the relationships between contamination grade, mesh placement, infectious complications, and recurrences. RESULTS We gathered data on 123 patients; their mean age was 62.3 years, their mean BMI was 31.1 kg/m2, and their mean CeDAR index was 51.6. 96.4% of patients had a grade 2-3 ventral hernia according to the Rosen index. The mean defect width was 8 cm (IQR 2-18). 93 cases (75.6%) were described as contaminated or dirty surgeries. A PVDF mesh was placed using an IPOM technique in 56.3% of cases, and via interposition location in 39.9%. The one-month recurrence rate was 5.7% and recurrence after one year was 19.1%. The overall mortality rate was 27.6%. Risk of recurrence was related to patients with a Rosen score over 2 (p < 0.001), as well as with postoperative SSI (p = 0.045). Higher recurrence rates were not related to PVDF mesh placement. CONCLUSION The use of PVDF meshes for emergency VH repairs in contaminated surgeries seems safe and useful, with reasonable recurrence rates, and acceptable infectious complication rates, similar to those published in the literature.
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Affiliation(s)
- A Sánchez-Arteaga
- Surgery Department, Virgen del Rocío University Hospital, Avenida Manuel Siurot s/n, 41013, Seville, Spain
| | - L Tallón-Aguilar
- Surgery Department, Virgen del Rocío University Hospital, Avenida Manuel Siurot s/n, 41013, Seville, Spain.
| | - J Tinoco-González
- Surgery Department, Virgen del Rocío University Hospital, Avenida Manuel Siurot s/n, 41013, Seville, Spain
| | - E Perea Del-Pozo
- Surgery Department, Virgen del Rocío University Hospital, Avenida Manuel Siurot s/n, 41013, Seville, Spain
| | - A Navas-Cuellar
- Surgery Department, Virgen del Rocío University Hospital, Avenida Manuel Siurot s/n, 41013, Seville, Spain
| | - J Padillo-Ruíz
- Surgery Department, Virgen del Rocío University Hospital, Avenida Manuel Siurot s/n, 41013, Seville, Spain
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From keyhole to sandwich: change in laparoscopic repair of parastomal hernias at a single centre. Surg Endosc 2020; 35:1863-1871. [PMID: 32342214 DOI: 10.1007/s00464-020-07589-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nearly 50% of patients with an ostomy will develop a parastomal hernia (PSH). Its repair remains a surgical challenge. Both laparoscopic "modified Sugarbaker" (SB) and Keyhole (KH) repair are currently in use, frequently with unsatisfactory results.''Sandwich Repair'' (SR) may be an alternative to reduce recurrence rates. We present the change of our technique from KH to SR. METHODS We collected data from all consecutive laparoscopic PSH repairs at our institution from 2004 until now (from 2004 to 2013 treated with KH, from 2014 with SR) and compared the results of the two groups. Primary endpoint was recurrence rate at 1 year. Secondary outcomes were operative time, PO length of hospital stay (LOS), and short and long-term complications. RESULTS 13 patients underwent SR. Main changes in surgical technique concerned primary defect closure, no stay sutures, use of glue for first mesh fixation, and partial lateral covering of the underlying mesh with a peritoneal flap. Early postoperative course after SR was uneventful and no recurrence at 1 year was recorded. In the KH group (19 patients), short-term complications occurred in two cases (10%), with one parietal hematoma and one case of intensive pain; we had four recurrences at 1 year (21%). LOS was shorter in the SR group (mean 4 days vs 6, p = 0.004). The KH group had 2 (10%) occurrences of chronic seroma and one bowel perforation (5%), while the SR group had one (8%) occurrence of chronic pain. Median follow-up was 26 months (range 13-78) for the SR group and 47 months (12-105) for the KH group. CONCLUSION SR is safe and effective in expert hands and provides promising preliminary results.
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Krysiak ZJ, Gawlik MZ, Knapczyk-Korczak J, Kaniuk Ł, Stachewicz U. Hierarchical Composite Meshes of Electrospun PS Microfibers with PA6 Nanofibers for Regenerative Medicine. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E1974. [PMID: 32340243 PMCID: PMC7216289 DOI: 10.3390/ma13081974] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 01/05/2023]
Abstract
One of the most frequently applied polymers in regenerative medicine is polystyrene (PS), which is commonly used as a flat surface and requires surface modifications for cell culture study. Here, hierarchical composite meshes were fabricated via electrospinning PS with nylon 6 (PA6) to obtain enhanced cell proliferation, development, and integration with nondegradable polymer fibers. The biomimetic approach of designed meshes was verified with a scanning electron microscope (SEM) and MTS assay up to 7 days of cell culture. In particular, adding PA6 nanofibers changes the fibroblast attachment to meshes and their development, which can be observed by cell flattening, filopodia formation, and spreading. The proposed single-step manufacturing of meshes controlled the surface properties and roughness of produced composites, allowing governing cell behavior. Within this study, we show the alternative engineering of nondegradable meshes without post-treatment steps, which can be used in various applications in regenerative medicine.
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Affiliation(s)
| | | | | | | | - Urszula Stachewicz
- International Center of Electron Microscopy for Material Science, Faculty of Metals Engineering and Industrial Computer Science, AGH University of Science and Technology, 30-059 Cracow, Poland; (Z.J.K.); (M.Z.G.); (J.K.-K.); (Ł.K.)
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Kohler A, Lavanchy JL, Lenoir U, Kurmann A, Candinas D, Beldi G. Effectiveness of Prophylactic Intraperitoneal Mesh Implantation for Prevention of Incisional Hernia in Patients Undergoing Open Abdominal Surgery: A Randomized Clinical Trial. JAMA Surg 2019; 154:109-115. [PMID: 30476940 DOI: 10.1001/jamasurg.2018.4221] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Incisional hernia is a frequent complication after open abdominal surgery. Prophylactic mesh implantation in the onlay or sublay position requires dissection of the abdominal wall, potentially leading to wound-associated complications. Objective To compare the incidence of incisional hernia among patients after prophylactic intraperitoneal mesh implantation with that among patients after standard abdominal closure. Design, Setting, and Participants An open-label randomized clinical trial was performed in 169 patients undergoing elective open abdominal surgery from January 1, 2011, to February 29, 2014. Follow-up examinations were performed 1 year and 3 years after surgery. The study was conducted at Bern University Hospital, Bern, Switzerland, a referral center that offers the whole spectrum of abdominal surgical interventions. Patients with 2 or more of the following risk factors were included: overweight or obesity, diagnosis of neoplastic disease, male sex, or history of previous laparotomy. Patients were randomly assigned to prophylactic intraperitoneal mesh implantation or standard abdominal closure. Data were analyzed in August 2017. Interventions Intraperitoneal implantation of a polypropylene-polyvinylidene fluoride mesh with circumferential fixation. Main Outcomes and Measures The primary end point was the incidence of incisional hernia 3 years after surgery. Secondary end points included mesh-related complications. Results After the exclusion of 19 patients, 150 patients (81 in the control group and 69 in the mesh group; mean [SD] age, 64.2 [11.1] years; 102 [68.0%] male) were studied. The cumulative incidence of incisional hernia was significantly lower in the mesh group compared with the control group (5 of 69 [7.2%] vs 15 of 81 [18.5%], log-rank test P = .03). Abdominal pain was observed in significantly more patients in the mesh group compared with the control group at 6 weeks (34 of 52 [65%] vs 26 of 59 [44%], P = .04) but not at 12 and 36 months postoperatively. No difference in surgical site infections was observed, but time to complete wound healing of surgical site infection was significantly longer in patients with mesh implantation (median [interquartile range], 8 [6-24] weeks compared with 5 [1-9] weeks; P = .03). Trunk extension was significantly decreased after mesh implantation compared with the control group (mean [SD], 1.73 [0.97] cm vs 2.40 [1.23] cm, P = .009). Conclusions and Relevance In patients at elevated risk for incisional hernia, prophylactic intraperitoneal mesh implantation reduces the incidence of hernia formation but with increased early postoperative pain and prolonged wound healing of surgical site infection. Trial Registration ClinicalTrials.gov Identifier: NCT01203553.
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Affiliation(s)
- Andreas Kohler
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joel L Lavanchy
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ursina Lenoir
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita Kurmann
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Callewaert G, Housmans S, Cattani L, Pacquée S, D'Hoore A, Wyndaele J, Van der Aa F, Deprest J. Medium-term outcome of laparoscopic sacrocolpopexy using polivinylidene fluoride as compared to a hybrid polyglecaprone and polypropylene mesh: A matched control study. Neurourol Urodyn 2019; 38:1874-1882. [PMID: 31290173 DOI: 10.1002/nau.24083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/07/2019] [Indexed: 11/11/2022]
Abstract
AIM To compare 2-year outcomes of laparoscopic sacrocolpopexy (LSCP) either with polyvinylidene fluoride (PVDF) or hybrid polypropylene containing a resorbable polyglecaprone (PP+ PG) mesh. MATERIALS AND METHODS Retrospective audit on 105 consecutive patients undergoing LSCP a with PVDF-mesh (DynaMesh, FEG Textiltechniken), matched by prolapse stage and cervicopexy or vault suspension to 105 controls undergoing LSCP with a hybrid PP + PG-mesh (Ultrapro, Ethicon). Patients are part of an ongoing prospective study. The primary outcome measure was the Patient Global Impression of Change score (PGIC), the coprimary variable was failure rate at the vault (≤1 cm). Other outcomes were intraoperative and postoperative complications within 3 months categorized by the Clavien-Dindo classification, reinterventions, graft-related complications (GRCs) and functional outcomes. All assessments were performed by an independent assessor. Data are reported as median (interquartile range) number and percent as appropriate, the Mann-Whitney U, χ2 , or Fisher exact were used for comparison. RESULTS Patient satisfaction in the PVDF group, as measured with the PGIC, was high (90.9% PGIC, ≥4) as well as was the anatomical success (97.3%) at a follow-up of 26 months. These outcomes were comparable to those of PP + PG-patients (84.8% PGIC, ≥4; 94.9% anatomical success). There were five patients (2.4%) with Dindo-III or higher complications and three patients had GRCs (1.5%), without differences between mesh type. Level-II posterior defects (Bp ≥ -1) were less likely in PVDF patients (34.1% vs 50% for PP + PG-patients; P = .003). Women in the PVDF group also were less bothered by prolapse (7.5% vs 26.4%; P = .001), yet they complained more of constipation (15.0% vs 9.0%; P = .01). CONCLUSION There were no differences in patient satisfaction and anatomical outcomes after LSCP either with PVDF or PP + PG mesh.
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Affiliation(s)
- Geertje Callewaert
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Susanne Housmans
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Laura Cattani
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stefaan Pacquée
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - André D'Hoore
- Pelvic Floor Unit, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.,Oncology and Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Wyndaele
- Pelvic Floor Unit, Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Pelvic Floor Unit, Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Deprest
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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22
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Yu S, Ma P, Cong H, Jiang G. Preparation and Performances of Warp-Knitted Hernia Repair Mesh Fabricated with Chitosan Fiber. Polymers (Basel) 2019; 11:polym11040595. [PMID: 30960579 PMCID: PMC6523771 DOI: 10.3390/polym11040595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 12/30/2022] Open
Abstract
In this paper, warp-knitted knitted fabrics with chitosan fibers for ventral hernia repair were fabricated with three kinds of structures. The properties of chitosan fiber, yarns, and fabrics were tested. The results demonstrated that the properties of a mesh fabricated with 1-0/1-2/2-3/2-1// structure were slightly better than those of other fabrics. The mechanical properties of the three produced fabrics were weak. However, the results demonstrated that chitosan meshes have many advantages, such as excellent hygroscopicity, and thermal and antimicrobial properties, which makes them one of the best materials for ventral hernia repair. The findings have theoretical and practical significance for the industrial uses of chitosan in ventral hernia repair.
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Affiliation(s)
- Shuang Yu
- Engineering Research Center for Knitting Technology, Ministry of Education, Jiangnan University, Wuxi 214122, China.
| | - Pibo Ma
- Engineering Research Center for Knitting Technology, Ministry of Education, Jiangnan University, Wuxi 214122, China.
- State Key Laboratory of Bio-Fibers and Eco-Textiles, Qingdao University, Qingdao 266071, China.
| | - Honglian Cong
- Engineering Research Center for Knitting Technology, Ministry of Education, Jiangnan University, Wuxi 214122, China.
| | - Gaoming Jiang
- Engineering Research Center for Knitting Technology, Ministry of Education, Jiangnan University, Wuxi 214122, China.
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Evaluation of synthetic reticular hybrid meshes designed for intraperitoneal abdominal wall repair: Preclinical and in vitro behavior. PLoS One 2019; 14:e0213005. [PMID: 30811503 PMCID: PMC6392302 DOI: 10.1371/journal.pone.0213005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 02/13/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Reticular hybrid meshes represent an alternative material for intraperitoneal repair of abdominal hernias. These consist of a reticular mesh coated or interwoven/knitted with inert materials. This study assesses the performance of two reticular polypropylene-containing hybrid meshes, TiMESH (coated with titanium) and DynaMesh (interwoven with polyvinylidene fluoride), in vitro, as well as their efficiency in adhesion prevention and tissue incorporation in an intraperitoneal model. Methods The mesothelialization capacity of TiMESH and DynaMesh was evaluated in vitro and compared to that of Surgipro (reticular bare polypropylene) and Preclude (laminar expanded polytetrafluoroethylene). Mesh fragments were placed on the intact parietal peritoneum of New Zealand white rabbits (n = 24), and laparoscopy performed 7 days post-surgery. Fourteen days post-implantation, adhesions were evaluated and host tissue incorporation, macrophage response, collagen expression (immunohistochemistry/RT-PCR) and neoperitoneum formation assessed. Adhesions and omental tissue were also examined. Results Mesh pores in reticular meshes were devoid of cells in the in vitro study. TiMESH, DynaMesh and Surgipro showed similar adhesion rates at 7/14 days and optimal tissue integration, with significant differences in comparison to Preclude. The greatest presence of macrophages was observed for TiMESH and was significant versus that for Preclude. Hybrid meshes revealed significantly higher collagen 1 mRNA expression in implants, with no differences in the levels of collagen 3. Omental samples from animals with a reticular mesh showed significantly greater collagen 1 mRNA levels. Conclusions The reticular structure of a mesh limits the formation of a continuous mesothelial monolayer in vitro, regardless of its composition. The presence of titanium as a coating or polyvinylidene fluoride interwoven with polypropylene in a reticular structure did not prevent adhesions. The hybrid meshes showed proper integration and an increase in the mRNA Col 1 levels in the implant area compared to Surgipro or Preclude.
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Dreger NZ, Fan Z, Zander ZK, Tantisuwanno C, Haines MC, Waggoner M, Parsell T, Søndergaard CS, Hiles M, Premanandan C, Becker ML. Amino acid-based Poly(ester urea) copolymer films for hernia-repair applications. Biomaterials 2018; 182:44-57. [DOI: 10.1016/j.biomaterials.2018.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022]
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Fernández-Moreno MC, Martí-Cuñat E, Pou G, Ortega J. Intraperitoneal Onlay Mesh Technique for Spigelian Hernia in an Outpatient and Short-Stay Surgery Unit: What’s New in Intraperitoneal Meshes? J Laparoendosc Adv Surg Tech A 2018; 28:700-704. [DOI: 10.1089/lap.2017.0319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | | | - Guillermo Pou
- Department of Surgery, Clinic University Hospital, Valencia, Spain
| | - Joaquín Ortega
- Department of Surgery, Clinic University Hospital, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
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26
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Wiessner R, Vorwerk T, Gehring A. Laparoscopic repair for parastomal hernia with ongoing barbed suture followed by sandwich-technique: 'Sandwich-plus-technique'. J Minim Access Surg 2018; 15:148-153. [PMID: 29582804 PMCID: PMC6438069 DOI: 10.4103/jmas.jmas_236_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of parastomal hernias after a permanent stoma is between 50% and 80% depending on the type of stoma, the definition of the hernia (clinical or radiological), and the length of the follow-up. Surgical therapy is complex and involves several techniques with different recurrence rates. We present three cases where we have closed the hernia gap with continuous, non-resorbable, self-retaining sutures with subsequent use of the sandwich technique (’Sandwich-plus-technique’). There were pronounced parastomal hernias in three female patients (mean age was 72 years and the range was 63–78 years) with permanent colostomata. After laparoscopic adhesiolysis, the closure of the hernia defect was completed with ongoing, barbed non-resorbable 1-0 sutures (polybutester) followed by the sandwich technique. There were no intraoperative complications and currently no clinical or radiological evidence for recurrences of the parastomal hernia. Closure of the hernia gap leads to the additional reconstruction of the lateral abdominal wall, resulting in a larger contact surface for integration of the keyhole mesh and thus prior to implantation of the Sugarbaker mesh. The laparoscopic augmentation of large parastomal hernias using the ‘Sandwich-plus-technique’ is technically complex but achieves very good results in our case series. Further studies and long-term results should prove that the low recurrence rate of the sandwich technique can be further reduced.
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Affiliation(s)
- Reiko Wiessner
- Department of General and Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
| | - Thomas Vorwerk
- Department of General and Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
| | - Alexander Gehring
- Department of General and Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
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Dreger NZ, Wandel MB, Robinson LL, Luong D, Søndergaard CS, Hiles M, Premanandan C, Becker ML. Preclinical in Vitro and in Vivo Assessment of Linear and Branched l-Valine-Based Poly(ester urea)s for Soft Tissue Applications. ACS Biomater Sci Eng 2018; 4:1346-1356. [PMID: 33418665 DOI: 10.1021/acsbiomaterials.7b00920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | | | | | - Michael Hiles
- Cook Biotech Incorporated, West Lafayette, Indiana 47906, United States
| | - Christopher Premanandan
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, United States
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Parastomal hernia - current knowledge and treatment. Wideochir Inne Tech Maloinwazyjne 2018; 13:1-8. [PMID: 29643952 PMCID: PMC5890847 DOI: 10.5114/wiitm.2018.72685] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/17/2017] [Indexed: 11/24/2022] Open
Abstract
Intestinal stoma creation is one of the most common surgical procedures. The most common long-term complication following stoma creation is parastomal hernia, which according to some authors is practically unavoidable. Statistical differences of its occurrence are mainly due to patient observation time and evaluation criteria. Consequently, primary prevention methods such as placement of prosthetic mesh and newly developed minimally invasive methods of stoma creation are used. It seems that in the light of evidence-based medicine, the best way to treat parastomal hernia is the one that the surgeon undertaking therapy is the most experienced in and is suited to the individuality of each patient, his condition and comorbidities. As a general rule, reinforcing the abdominal wall with a prosthetic mesh is the treatment of choice, with a low rate of complications and relapses over a long period of time. The current trend is to use lightweight, large pore meshes.
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S Somasundaram S, Ackermann TG, Beenen E. Laparoscopic repair of a complex Morgagni hernia in a patient with Marfan syndrome. ANZ J Surg 2018; 89:E284-E285. [PMID: 29316125 DOI: 10.1111/ans.14365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Shanmugam S Somasundaram
- Department of General Surgery, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia
| | - Travis G Ackermann
- Department of General Surgery, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia
| | - Edwin Beenen
- Department of General Surgery, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia
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Knaapen L, Buyne O, van Goor H, Slater NJ. Synthetic vs biologic mesh for the repair and prevention of parastomal hernia. World J Meta-Anal 2017; 5:150-166. [DOI: 10.13105/wjma.v5.i6.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/29/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.
METHODS Relevant databases were searched for studies reporting hernia recurrence, wound and mesh infection, other complications, surgical techniques and mortality. Weighted pooled proportions (95%CI) were calculated using StatsDirect. Heterogeneity concerning outcome measures was determined using Cochran’s Q test and was quantified using I2. Random and fixed effects models were used. Meta-analysis was performed with Review Manager software with the statistical significance set at P ≤ 0.05.
RESULTS Forty-four studies were included: 5 reporting biologic mesh repairs; 21, synthetic mesh repairs; and 18, prophylactic mesh repairs. Most of the studies were retrospective cohorts of low to moderate quality. The hernia recurrence rate was higher after undergoing biologic compared to synthetic mesh repair (24.0% vs 15.1%, P = 0.01). No significant difference was found concerning wound and mesh infection (5.6% vs 2.8%; 0% vs 3.1%). Open and laparoscopic techniques were comparable regarding recurrences and infections. Prophylactic mesh placement reduced the occurrence of a parastomal hernia (OR = 0.20, P < 0.0006) without increasing wound infection [7.8% vs 8.2% (OR = 1.04, P = 0.91)] and without differences between the mesh types.
CONCLUSION There is no superiority of biologic over synthetic mesh for parastomal hernia repair. Prophylactic mesh placement during the initial surgery significantly reduces parastomal hernia occurrence regardless of the mesh type.
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Affiliation(s)
- Loes Knaapen
- Department of Surgery, Radboud University Medical Centre, Nijmegen 6500 HB, The Netherlands
| | - Otmar Buyne
- Department of Surgery, Radboud University Medical Centre, Nijmegen 6500 HB, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Centre, Nijmegen 6500 HB, The Netherlands
| | - Nicholas J Slater
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Nijmegen 6500 HB, The Netherlands
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Prospective cohort study on mesh shrinkage measured with MRI after laparoscopic ventral hernia repair with an intraperitoneal iron oxide-loaded PVDF mesh. Surg Endosc 2017; 32:2822-2830. [PMID: 29270800 PMCID: PMC5956096 DOI: 10.1007/s00464-017-5987-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/19/2017] [Indexed: 11/02/2022]
Abstract
BACKGROUND Current data on shrinkage of intraperitoneal meshes come mainly from animal studies. High-quality human data in prospective studies are scarce. METHODS We used the ability to visualize intraperitoneal PVDF meshes enhanced with iron particles (DynaMesh IPOM visible) with magnetic resonance imaging (MRI) to determine the amount of shrinkage between 1 and 13 months postoperatively. All measurements of the width, length, and surface area of the mesh were performed with a standardized methodology independently by four radiologists blinded for the timing of the MRI. RESULTS Of the 15 patients undergoing laparoscopic ventral hernia repair, 13 patients received an MRI both at 1 and at 13 months. Evaluation of inter-rater reliability between the radiologists showed intra-class correlations of 0.95 (95% CI 0.92-0.98) for the width, 0.96 (95% CI 0.93-0.98) for the length, and 0.99 (90% CI 0.99-1.00) for the surface area of the mesh. The change between measurement at implantation and 1-month MRI was - 0.7 cm (P = 0.023; - 3.6%) for the width and - 1.9 cm (P = 0.001; - 7.2%) for the length. The change between 1 and 13 months was - 0.06 cm (P = 0.74; shrinkage = 0.3%) for the width, - 0.12 cm (P = 0.56; shrinkage = 0.5%) for the length, and - 4.0 cm2 (P = 0.20; shrinkage = 1.0%) for the surface area of the mesh. CONCLUSION There is excellent inter-rater reliability between radiologists when measuring width, length, and surface area of visible intraperitoneal PVDF mesh with MRI. There is no significant shrinkage between 1 and 13 months of intraperitoneal PVDF mesh after laparoscopic ventral hernia repair.
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Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Jänes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, López-Cano M, Maggiori L, Mandalà V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Śmietański M, Szczepkowski M, Stabilini C, Muysoms FE. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 2017; 22:183-198. [PMID: 29134456 DOI: 10.1007/s10029-017-1697-5] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 08/19/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. METHODS The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. RESULTS End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. CONCLUSION An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.
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Affiliation(s)
- S A Antoniou
- Department of General Surgery, University Hospital of Herakion, Crete, Greece.
| | - F Agresta
- Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - J M Garcia Alamino
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - D Berger
- Clinic of Abdominal, Thoracic and Pediatric Surgery, Klinikum Mittelbaden/Balg, Baden-Baden, Germany
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - H-T Brandsma
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - K Bury
- Department Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - J Conze
- Herniacenter Dr. Muschaweck/Dr. Conze, Munich, Germany
- Herniacenter Dr. Muschaweck/Dr. Conze, London, UK
- Department of General, Visceral and Transplant Surgery, University Hospital, RWTH Aachen University, Aachen, Germany
| | - D Cuccurullo
- Department of General, Laparoscopic, and Robotic Surgery, Ospedale Monaldi, Azienda Ospedaliera dei Colli, Naples, Italy
| | - U A Dietz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - R H Fortelny
- Certified Hernia Center, Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - C Frei-Lanter
- Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - B Hansson
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - F Helgstrand
- Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - A Hotouras
- National Bowel Research Centre, The Royal London Hospital, London, United Kingdom
| | - A Jänes
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - L F Kroese
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J R Lambrecht
- Surgical Department, Innlandet Hospital Trust, Gjøvik, Norway
| | - I Kyle-Leinhase
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | - M López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - V Mandalà
- Department of General Surgery, Buccheri La Ferla Hospital, Palermo, Italy
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | | | - M Prudhomme
- Digestive Surgery Department, CHU Nîmes, Nîmes, France
| | - T Rautio
- Department of Surgery, Division of Gastroenterology, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - N Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - M Śmietański
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
- Department of General Surgery and Hernia Centre, District Hospital in Puck, Puck, Poland
| | - M Szczepkowski
- Department of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
- Clinical Department of General and Colorectal Surgery, Bielanski Hospital, Warsaw, Poland
| | - C Stabilini
- Department of Surgery, University of Genoa, Genoa, Italy
| | - F E Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
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Parastomal Hernia Repair with Intraperitoneal Mesh. Surg Res Pract 2017; 2017:8597463. [PMID: 29204515 PMCID: PMC5674517 DOI: 10.1155/2017/8597463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/14/2017] [Indexed: 01/03/2023] Open
Abstract
Purpose Parastomal hernia is a common complication following a stoma and may cause leakage or incarceration. No optimal treatment has been established, and existing methods using mesh repair are associated with high recurrence rates and a considerable risk for short- and long-term complications including death. A double-layer intraperitoneal on-lay mesh (IPOM), the Parastomal Hernia Patch (BARD™), consisting of ePTFE and polypropylene, has been developed and tailored to avoid recurrence. To evaluate the safety of and recurrence rate using this mesh, a nonrandomised prospective multicentre study was performed. Method Fifty patients requiring surgery for parastomal hernia were enrolled. Clinical examination and CT scan prior to surgery were performed. All patients were operated on using the Parastomal Hernia Patch (BARD). Postoperative follow-up at one month and one year was scheduled to detect complications and hernia recurrence. Results The postoperative complication rate at one month was 15/50 (30%). The parastomal hernia recurrence rate at one year was 11/50 (22%). The reoperation rate at one month was 7/50 (14%), and further 5/50 (10%) patients were reoperated on during the following eleven months.
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Celik SU, Kocaay AF, Akyol C. Parastomal Hernia. Hernia 2017. [DOI: 10.5772/intechopen.68876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The use of a composite synthetic mesh in the vicinity of bowel - For repair and prophylaxis of parastomal hernias. Does it increase the risk of short term infective complications? Int J Surg 2017; 45:67-71. [PMID: 28751222 DOI: 10.1016/j.ijsu.2017.07.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 12/21/2022]
Abstract
AIMS The use of synthetic meshes in potentially infected operative fields such as in the vicinity of large bowel, is controversial. This study describes our experience with the use of a synthetic composite mesh for prophylaxis and repair of parastomal hernias. METHODS Data were collected retrospectively over a 7-year period from 2008 to 2015. An IPOM (DynaMesh™) was used either during the formation of the stoma to reinforce the abdominal wall around the stoma or during the surgical repair of existing parastomal hernias, using keyhole or sandwich technique. Majority of meshes were placed laparoscopically. Clinical data and outcomes any stoma wound complications were collected. RESULTS Forty seven patients were included with a male to female ratio of 34:13. Median age was 66 years (38-91 years) with median follow-up of 17 months (3-73 months). Twenty seven patients had a prophylactic mesh placement (PMP) around colostomy after resection of colorectal cancer. None of these patients had any wound complications. Twenty patients had repair of parastomal hernias (RPH). One patient (1/20) in this group had a superficial wound infection around the stoma site and underwent an incision and drainage. One patient developed seroma and one had parastomal wound haematoma. CONCLUSIONS The use of a composite synthetic mesh using a laparoscopic IPOM technique for the prophylaxis and treatment of parastomal hernias, even in a clean contaminated surgical field, is safe and feasible.
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Yang GPC. From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg 2017; 10:119-127. [PMID: 28547932 DOI: 10.1111/ases.12388] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Abstract
Laparoscopic repair for ventral and incisional hernias was first reported in the early 1990s. It uses intraperitoneal only mesh placement to achieve a tension-free repair of the hernia. However, in recent years, there has been greater concern about long-term complication involving intraperitoneal mesh placement. Many case reports and case series have found evidence of mesh adhesion, mesh fistulation, and mesh migration into hollow organs including the esophagus, small bowel, and large bowel, resulting in various major acute abdominal events. Subsequent management of these complications may require major surgery that is technically demanding and difficult; in such cases, laparotomy and bowel resection have often been performed. Because of these significant, but not common, adverse events, many surgeons favor open sublay repair for ventral and incisional hernias. Investigators are therefore searching for a laparoscopic approach for ventral and incisional hernias that might overcome the mesh-induced visceral complications seen after intraperitoneal only mesh placement repair. Laparoscopic preperitoneal onlay mesh is one such approach. This article will explore the fundamental of intraperitoneal only mesh placement and its problems, the currently available peritoneal visceral-compatible meshes, and upcoming developments in laparoscopic ventral and incisional hernia repair. The technical details of preperitoneal onlay mesh, as well as its potential advantages and disadvantages, will also be discussed.
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Wang XC, Zhang D, Yang ZX, Gan JX, Yin LN. Mesh reinforcement for the prevention of incisional hernia formation: a systematic review and meta-analysis of randomized controlled trials. J Surg Res 2017; 209:17-29. [DOI: 10.1016/j.jss.2016.09.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/04/2016] [Accepted: 09/27/2016] [Indexed: 02/07/2023]
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Prophylactic mesh placement for the PREvention of paraSTOmal hernias: The PRESTO systematic review and meta-analysis. PLoS One 2017; 12:e0171548. [PMID: 28182642 PMCID: PMC5300283 DOI: 10.1371/journal.pone.0171548] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/22/2017] [Indexed: 11/19/2022] Open
Abstract
Background Parastomal hernia (PH) is the most common complication after ostomy formation. Prophylactic mesh placement may be effective in reducing the rate of PH at the stoma site. The aims of this systematic review were to summarize the evidence with regard to the safety and effectiveness in comparison with the standard procedure without mesh placement and to identify important risk constellations. Method A systematic literature search was performed in PubMed, EMBASE and the Cochrane library with no language or date restrictions. Randomized (RCTs) and non-randomized controlled trials (nRCTs) were included. The main outcomes of interest were PH (primary outcome) rate and stoma-related complications (secondary outcomes) such as stenosis or fistula. Statistical analysis included meta-analyses of pooled data and subgroup analyses. Results Eleven trials (eight RCTs; three nRCTs) with a total of 755 patients were included. PH rate varied from 0% to 59% in the intervention and from 20% to 94% in the control group. RCTs showed a significant reduction of PH rate in the mesh group (OR 0.24; 95% CI 0.10 to 0.58, p = 0.034), whereas included nRCTs did not. No significant differences were observed in postoperative complication rates. Subgroup analyses showed superiority of non-absorbable meshes and sublay mesh positioning in open surgery. Conclusion Prophylactic mesh placement is safe and reduces PH rate. A recommendation for prophylactic non-absorbable meshes in a sublay position can be made for patients undergoing open colorectal operations with end-ostomies. Further research endeavors should focus on patient-oriented outcomes, not only PH rate, with respect to tailored treatment in specific patient populations.
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Yang X, He K, Hua R, Shen Q, Yao Q. Laparoscopic repair of parastomal hernia. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:45. [PMID: 28251124 DOI: 10.21037/atm.2017.02.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Parastomal hernia is one of the most common long-term complications after abdominal ostomy. Surgical treatment for parastomal hernia is the only cure but a fairly difficult field because of the problems of infection, effects, complications and recurrence. Laparoscopic repair operations are good choices for Parastomal hernia because of their mini-invasive nature and confirmed effects. There are several major laparoscopic procedures for parastomal hernioplasty. The indications, technical details and complications of them will be introduced and discussed in this article.
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Affiliation(s)
- Xuefei Yang
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, the University of Hong Kong, Shenzhen 518053, China
| | - Kai He
- Hernia Center, Department of General Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Rong Hua
- Hernia Center, Department of General Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Qiwei Shen
- Hernia Center, Department of General Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Qiyuan Yao
- Hernia Center, Department of General Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
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D'Amore L, Ceci F, Mattia S, Fabbi M, Negro P, Gossetti F. Adhesion prevention in ventral hernia repair: an experimental study comparing three lightweight porous meshes recommended for intraperitoneal use. Hernia 2016; 21:115-123. [PMID: 27757549 DOI: 10.1007/s10029-016-1541-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/08/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND In ventral hernia repair, when prosthetic material is placed intraperitoneally, it may lead to an inflammatory reaction resulting in adhesions between the mesh and abdominal viscera. Several meshes have been developed to minimize this process. In this experimental study, the ability of different combined meshes to attenuate the adhesion formation was examined. METHODS Three commercially available lightweight porous combined meshes were placed intraperitoneally to repair an abdominal wall defect in rats: DynaMesh-IPOM (PVDF + PP), TiMesh (titanium-coated filament PP) and C-QUR/FX (omega-3 fatty acid-coated filament PP). The DynaMesh-CICAT (PVDF) was implanted in the control group. Adhesion formation was macroscopically evaluated and scored after 7 and 21 days. RESULTS All animals except two presented intra-abdominal adhesions. None of the meshes examined in the study demonstrated to prevent adhesions. C-QUR/FX reduced adhesion formation at 7 days' follow-up compared with all other meshes but by 21 days this effect was diminished. Between 7 and 21 days adhesion extension significantly decreased for TiMesh. TAS did not show significant modifications between 7 and 21 days' follow-up for each mesh. CONCLUSIONS The combined porous meshes tested in the present study demonstrated to reduce but not to prevent the adhesion formation, even if with some differences. Combined porous meshes could be chosen instead of simple meshes for retro-rectus preperitoneal prosthetic ventral hernia repair.
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Affiliation(s)
- L D'Amore
- Department of Surgery P.Stefanini, Sapienza University of Rome, Rome, Italy.
| | - F Ceci
- Department of Surgery P.Stefanini, Sapienza University of Rome, Rome, Italy
| | - S Mattia
- School of Surgery, Sapienza University of Rome, Rome, Italy
| | - M Fabbi
- School of Surgery, Sapienza University of Rome, Rome, Italy
| | - P Negro
- Department of Surgery P.Stefanini, Sapienza University of Rome, Rome, Italy
| | - F Gossetti
- Department of Surgery P.Stefanini, Sapienza University of Rome, Rome, Italy
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Glasgow SC, Dharmarajan S. Parastomal Hernia: Avoidance and Treatment in the 21st Century. Clin Colon Rectal Surg 2016; 29:277-84. [PMID: 27582655 DOI: 10.1055/s-0036-1584506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Despite medical and surgical advances leading to increased ability to restore or preserve gastrointestinal continuity, creation of stomas remains a common surgical procedure. Every ostomy results in a risk for subsequent parastomal herniation, which in turn may reduce quality of life and increase health care expenditures. Recent evidence-supported practices such as utilization of prophylactic reinforcement, attention to stoma placement, and laparoscopic-based stoma repairs with mesh provide opportunities to both prevent and successfully treat parastomal hernias.
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Affiliation(s)
- Sean C Glasgow
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; USAF Center for the Sustainment of Trauma and Resuscitative Skills (C-STARS), St. Louis, Missouri
| | - Sekhar Dharmarajan
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; John Cochrane VA Medical Center, St. Louis, Missouri
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Wada T, Kawada K, Hasegawa S, Sakai Y. Laparoscopic repair for recurrent parastomal hernia of an end stoma using the sandwich technique while preserving an ileal conduit: A case report. Int J Surg Case Rep 2016; 25:75-8. [PMID: 27337702 PMCID: PMC4919719 DOI: 10.1016/j.ijscr.2016.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/19/2016] [Accepted: 06/11/2016] [Indexed: 11/30/2022] Open
Abstract
This is a quite rare case report of laparoscopic repair for recurrent parastomal hernia in a patient with an ileal conduit. Laparoscopic sandwich technique is to combine the keyhole and Sugarbaker techniques. Laparoscopic sandwich technique can be useful for parastomal hernia.
Introduction Parastomal hernia is a common complication following stoma creation. The surgical approaches included local repair by suture, stoma relocation and mesh-based techniques; but none has been able to provide satisfactory results. Presentation of case A 60-year-old asian female was referred complaining of abdominal pain and constipation caused by recurrent parastomal hernia of an end stoma. She had undergone total cystectomy with creation of an ileal conduit at the age of 53 years, and laparoscopic sigmoid colostomy at the age of 55 years. Parastomal hernia of an end stoma had developed postoperatively, and she had undergone recreation of colostomy at the same place with fasciorrhaphy at the age of 59 years, but parastomal hernia recurred 6 months later because of split fascia sutures. Laparoscopic repair for recurrent parastomal hernia was conducted using the sandwich technique while preserving an ileal conduit. The patient has been followed postoperatively for more than 3 years without any sign of recurrence. Discussion Although further cases are required to get definitive conclusions, we suppose that the laparoscopic sandwich technique can be useful for parastomal hernia. Conclusion We herein report a case of recurrent parastomal hernia treated laparoscopically while preserving an ileal conduit using the sandwich technique which combines the keyhole and Sugarbaker techniques. This is a quite rare case report of laparoscopic repair for recurrent parastomal hernia in a patient with an ileal conduit.
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Affiliation(s)
- Toshiaki Wada
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Kenji Kawada
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Suguru Hasegawa
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Long-term assessment of parastomal hernia prevention by intra-peritoneal mesh reinforcement according to the modified Sugarbaker technique. Surg Endosc 2016; 30:5372-5379. [PMID: 27059972 DOI: 10.1007/s00464-016-4891-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/23/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Parastomal hernia (PSH) is a very frequent complication after creation of a permanent colostomy. The aim of that study is to assess the safety and the long-term efficacy of an intra-peritoneal onlay mesh (IPOM) positioned at the time of primary stoma formation to prevent PSH occurrence. MATERIALS AND METHODS That multicentre prospective study concerned 29 consecutive patients operated for cancer of the low rectum between 2008 and 2014. There were 14 men and 15 women with a median age of 73 years (range 39-88) and a BMI of 28 (range 21-43). All the patients had potentially curative abdominoperineal excision associated with IPOM reinforcement of the abdominal wall with a round non-slit composite mesh centred on the stoma site and covering the lateralized colon according to the modified Sugarbaker technique. The major outcomes analysed were operative time, complications related to mesh and PSH incidence. Patients were evaluated at 6-month intervals for the first 2 years and thereafter annually with physical examination and CT scan control. For PSH evaluation, we used the classification of Moreno-Matias. RESULTS Surgery was performed by laparoscopy in 24 patients and by laparotomy in 5; 17 had a trans-peritoneal colostomy and 12 an extra-peritoneal colostomy. The median size of the mesh was 15 cm (range 12-20), the operative time 225 min. (range 123-311) and the specific time for mesh placement 15 min. (range 10-30). With a median follow-up of 48 months (range 6-88), no mesh infection or complication requiring mesh removal were recorded. No patient developed a true PSH; two of them had a type Ia PSH (only containing the bowel forming the colostomy with a sac < 5 cm) and were totally asymptomatic. CONCLUSION In our series, the incidence of PSH was 7 % and no specific mesh-related complication was noted. Prophylactic mesh reinforcement according to the modified Sugarbaker is an effective technique that addresses the issues related to the occurrence of PSH.
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Köhler G, Emmanuel K, Schrittwieser R. Single-port parastomal hernia repair by using 3-D textile implants. JSLS 2016; 18:JSLS-D-14-00034. [PMID: 25392655 PMCID: PMC4208891 DOI: 10.4293/jsls.2014.00034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Parastomal hernias (PSHs) are a frequent complication and remain a surgical challenge. We present a new option for single-port PSH repair with equilateral stoma relocation using preshaped, prosthetic 3-dimensional implants and flat mesh insertion in intraperitoneal onlay placement for additional augmentation of the abdominal wall. Methods: We describe our novel technique in detail and performed an analysis of prospectively collected data from patients who underwent single-port PSH repair, focusing on feasibility, conversions, and complications. Results: From September 2013 to January 2014, 9 patients with symptomatic PSHs were included. Two conversions to reduced-port laparoscopy using a second 3-mm trocar were required because of difficult adhesiolysis, dissection, and reduction of the hernia sac content. No major intra- or postoperative complications or reoperations were encountered. One patient incurred a peristomal wound healing defect that could be treated conservatively. Conclusion: We found that single-port PSH repair using preshaped, elastic 3-dimensional devices and additional flat mesh repair of the abdominal wall is feasible, safe, and beneficial, relating to optimal coverage of unstable stoma edges with wide overlap to all sides and simultaneous augmentation of the midline in the IPOM technique. The stoma relocation enables prolapse treatment and prevention. The features of a modular and rotatable multichannel port system offer benefits in clear dissection ongoing from a single port. Long-term follow-up data on an adequate number of patients are awaited to examine efficacy.
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Affiliation(s)
- Gernot Köhler
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
| | - Klaus Emmanuel
- Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria
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Physical Characteristics of Medical Textile Prostheses Designed for Hernia Repair: A Comprehensive Analysis of Select Commercial Devices. MATERIALS 2015; 8:8148-8168. [PMID: 28793704 PMCID: PMC5458830 DOI: 10.3390/ma8125453] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/17/2015] [Accepted: 11/25/2015] [Indexed: 01/25/2023]
Abstract
Inguinal hernia repairs are among the most frequent operations performed worldwide. This study aims to provide further understanding of structural characteristics of hernia prostheses, and better comprehensive evaluation. Weight, porosity, pore size and other physical characteristics were evaluated; warp knitting structures were thoroughly discussed. Two methods referring to ISO 7198:1998, i.e., weight method and area method, were employed to calculate porosity. Porosity ranged from 37.3% to 69.7% measured by the area method, and 81.1% to 89.6% by the weight method. Devices with two-guide bar structures displayed both higher porosity (57.7%–69.7%) and effective porosity (30.8%–60.1%) than single-guide bar structure (37.3%–62.4% and 0%–5.9%, respectively). Filament diameter, stitch density and loop structure combined determined the thickness, weight and characteristics of pores. They must be well designed to avoid zero effective porosity regarding a single-bar structure. The area method was more effective in characterizing flat sheet meshes while the weight method was perhaps more accurate in describing stereoscopic void space for 3D structure devices. This article will give instructive clues for engineers to improve mesh structures, and better understanding of warp knitting meshes for surgeons.
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Influence of gentamicin-coded PVDF suture material on the healing of intestinal anastomosis in a rat model. Int J Colorectal Dis 2015; 30:1571-80. [PMID: 26260480 DOI: 10.1007/s00384-015-2345-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Intestinal anastomosis is a fundamental procedure in general surgery and required to restore intestinal continuity following resection. The aim of this study was to evaluate whether a gentamicin-coated polyvinylidene fluoride (PVDF) suture material has beneficial effect on anastomotic healing. METHODS Ninety Sprague-Dawley rats were divided into three groups: a PVDF-suture group, a gentamicin-coated PVDF (GPVDF)-suture group and a control group using Maxon® (polyglycolid-co-trimethylene carbonate). For each animal, a colonic anastomosis was performed. Ten animals from each group were sacrificed on postoperative days 3, 5, and 14. Measurements of anastomotic bursting pressure were performed on days 3 and 5. At each time, collagen type I/III ratio, MMP 2 and MMP-9 expression and the proliferation index (Ki67) were analyzed. RESULTS In total, 90 animals underwent surgery without postoperative complications. Bursting strength in the GPVDF group was significantly elevated on day 5. Immunohistochemistry showed significant increase of the collagen type I/III ratio for PVDF and GPVDF on days 3 and 5. MMP2 was significantly increased for PVDF on days 3 and 5 and for GPVDF on day 5. The analysis of MMP9 revealed significant increase compared to control on day 3 and 5 (GPVDF) as well as on day 5 (PVDF). Staining for Ki67 revealed a significant elevation on postoperative day 3 for the PVDF and the GPVDF group. CONCLUSIONS The present data shows the feasibility of PVDF as suture material for colonic anastomosis and confirms the ability of gentamicin to increase the stability of colonic anastomosis when used as coating material.
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DeAsis FJ, Lapin B, Gitelis ME, Ujiki MB. Current state of laparoscopic parastomal hernia repair: A meta-analysis. World J Gastroenterol 2015; 21:8670-8677. [PMID: 26229409 PMCID: PMC4515848 DOI: 10.3748/wjg.v21.i28.8670] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/08/2015] [Accepted: 05/21/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature.
METHODS: A systematic review of PubMed and MEDLINE databases was conducted using various combination of the following keywords: stoma repair, laparoscopic, parastomal, and hernia. Case reports, studies with less than 5 patients, and articles not written in English were excluded. Eligible studies were further scrutinized with the 2011 levels of evidence from the Oxford Centre for Evidence-Based Medicine. Two authors reviewed and analyzed each study. If there was any discrepancy between scores, the study in question was referred to another author. A meta -analysis was performed using both random and fixed-effect models. Publication bias was evaluated using Begg’s funnel plot and Egger’s regression test. The primary outcome analyzed was recurrence of parastomal hernia. Secondary outcomes were mesh infection, surgical site infection, obstruction requiring reoperation, death, and other complications. Studies were grouped by operative technique where indicated. Except for recurrence, most postoperative morbidities were reported for the overall cohort and not by approach so they were analyzed across approach.
RESULTS: Fifteen articles with a total of 469 patients were deemed eligible for review. Most postoperative morbidities were reported for the overall cohort, and not by approach. The overall postoperative morbidity rate was 1.8% (95%CI: 0.8-3.2), and there was no difference between techniques. The most common postoperative complication was surgical site infection, which was seen in 3.8% (95%CI: 2.3-5.7). Infected mesh was observed in 1.7% (95%CI: 0.7-3.1), and obstruction requiring reoperation also occurred in 1.7% (95%CI: 0.7-3.0). Other complications such as ileus, pneumonia, or urinary tract infection were noted in 16.6% (95%CI: 11.9-22.1). Eighty-one recurrences were reported overall for a recurrence rate of 17.4% (95%CI: 9.5-26.9). The recurrence rate was 10.2% (95%CI: 3.9-19.0) for the modified laparoscopic Sugarbaker approach, whereas the recurrence rate was 27.9% (95%CI: 12.3-46.9) for the keyhole approach. There were no intraoperative mortalities reported and six mortalities during the postoperative course.
CONCLUSION: Laparoscopic intraperitoneal mesh repair is safe and effective for treating parastomal hernia. A modified Sugarbaker approach appears to provide the best outcomes.
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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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Magnetic resonance visible 3-D funnel meshes for laparoscopic parastomal hernia prevention and treatment. Eur Surg 2015. [DOI: 10.1007/s10353-015-0319-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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