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Watanabe J, Izumi N, Kobayashi F, Miki A, Sata N. Efficacy and Safety of Transcutaneous Electrical Nerve Stimulation in Patients Undergoing Inguinal Hernia Repair: A Systematic Review and Meta-analysis. JMA J 2023; 6:371-380. [PMID: 37941690 PMCID: PMC10628323 DOI: 10.31662/jmaj.2023-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/22/2023] [Indexed: 11/10/2023] Open
Abstract
Background Postoperative pain is a major cause of delayed recovery following inguinal hernia repair. Transcutaneous electrical nerve stimulation (TENS) is a simple, low-cost method of noninvasive analgesia. This study aimed to assess the efficacy and safety of TENS for pain management following inguinal hernia repair. Methods We searched nine electronic databases and trial registries to identify randomized controlled trials (RCTs). The primary outcomes were postoperative pain and the use of rescue analgesics. The Risk of Bias 2 tool was used to evaluate the risk of bias in the included trials. The certainty of the evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Subgroup analyses were conducted based on the anesthesia type or TENS dose and frequency. This study is registered with PROSPERO (CRD42022353932). Results Eleven RCTs, with a total of 559 patients, were included. The overall risk of bias was concerning due to the lack of information about concealment or published protocols. TENS may reduce pain on postoperative day (POD) 0 (standardized mean difference [SMD], -2.14; 95% confidence interval [CI], -3.54 to -0.73; moderate certainty of the evidence), POD 1 (SMD, -1.22; 95% CI, -1.92 to -0.52; moderate certainty of the evidence), and POD 2 (SMD, -0.97; 95% CI, -2.04 to 0.10; low certainty of the evidence). According to the subgroup analyses, postoperative pain was reduced, particularly with local anesthesia or repetitive and frequent TENS (P < 0.05). TENS may result in little-to-no difference in rescue analgesic use (risk ratio, 0.75; 95% CI, 0.47-1.18; low certainty of the evidence). No serious adverse events occurred (moderate certainty of the evidence). Conclusions TENS may reduce pain in patients who have undergone inguinal hernia repair. Further trials are warranted to confirm our findings.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Naoto Izumi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Fuyumi Kobayashi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Miki
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
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Xiao Y, Zuo X, Li H, Zhao Y, Wang X. Impact of titanium-coated polypropylene mesh on functional outcome and quality of life after inguinal hernia repair. Heliyon 2023; 9:e17691. [PMID: 37455954 PMCID: PMC10345250 DOI: 10.1016/j.heliyon.2023.e17691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Objective This study aims to compare the clinical outcomes of complications, quality of life, and chronic pain between titanium-coated polypropylene mesh and polypropylene mesh after Lichtenstein or TAPP surgery. Methods A retrospective cohort study was conducted, involving patients who underwent inguinal hernia repair using Timesh light®, Optilene LP®, or 3DMax™ meshes between January 2020 and May 2022. Based on the surgical method, patients were divided into Lichtenstein and TAPP groups, and further categorized according to the type of mesh used. The primary endpoints assessed postoperative complications, postoperative pain, and postoperative quality of life. Secondary endpoints included postoperative sensation in the surgical area and postoperative recurrence rate. Results A total of 180 Lichtenstein procedures and 478 TAPP procedures were included in the analysis after propensity score matching. The findings revealed that patients with titanium-coated polypropylene mesh did not exhibit significant advantages in perioperative data. Within three months to one year after TAPP surgery, patients with the titanium-coated polypropylene mesh reported improved foreign body sensation during activities (P = 0.002) and a lower incidence of chronic pain (P = 0.008). However, after one year, these advantages of titanium-coated polypropylene mesh were no longer significant during activity or at rest. In the TAPP group, the titanium-coated polypropylene mesh depicted advantages in the single score of the SF-36 questionnaire. Conclusions The utilization of titanium-coated polypropylene mesh resulted in reduced foreign body sensation and chronic pain in activity within one year after TAPP surgery, significantly enhancing certain aspects of the patient's quality of life compared to polypropylene mesh.
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Affiliation(s)
| | | | | | | | - Xuehu Wang
- Corresponding author. Department of the Hernia Surgery, The First Affiliated hospital of Chongqing Medical university, Chongqing Medical University, Chongqing, 400016, China.
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Yang Y, Wang J, Wang L, Wu Q, Ling L, Yang Y, Ning S, Xie Y, Cao Q, Li L, Liu J, Ling Q, Zang J. Magnetic soft robotic bladder for assisted urination. SCIENCE ADVANCES 2022; 8:eabq1456. [PMID: 36001667 PMCID: PMC9401625 DOI: 10.1126/sciadv.abq1456] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
The poor contractility of the detrusor muscle in underactive bladders (UABs) fails to increase the pressure inside the UAB, leading to strenuous and incomplete urination. However, existing therapeutic strategies by modulating/repairing detrusor muscles, e.g., neurostimulation and regenerative medicine, still have low efficacy and/or adverse effects. Here, we present an implantable magnetic soft robotic bladder (MRB) that can directly apply mechanical compression to the UAB to assist urination. Composed of a biocompatible elastomer composite with optimized magnetic domains, the MRB enables on-demand contraction of the UAB when actuated by magnetic fields. A representative MRB for a UAB in a porcine model is demonstrated, and MRB-assisted urination is validated by in situ computed tomography imaging after 14-day implantation. The urodynamic tests show a series of successful urination with a high pressure increase and fast urine flow. Our work paves the way for developing MRB to assist urination for humans with UABs.
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Affiliation(s)
- Youzhou Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Jiaxin Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Liu Wang
- CAS Key Laboratory of Mechanical Behavior and Design of Materials, Department of Modern Mechanics, University of Science and Technology of China, Hefei 230026, PR China
| | - Qingyang Wu
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Le Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Yueying Yang
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Shan Ning
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Yan Xie
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan 430074, PR China
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Quanliang Cao
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan 430074, PR China
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Liang Li
- Wuhan National High Magnetic Field Center, Huazhong University of Science and Technology, Wuhan 430074, PR China
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Jianfeng Zang
- School of Optical and Electronic Information and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, PR China
- The State Key Laboratory of Digital Manufacturing Equipment and Technology, Huazhong University of Science and Technology, Wuhan 430074, PR China
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Radiological Characterization of Synthetic Mesh in Female Urological Procedures: a Review of the Literature. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Christ B, Glaubitt W, Berberich K, Weigel T, Probst J, Sextl G, Dembski S. Sol-Gel-Derived Fibers Based on Amorphous α-Hydroxy-Carboxylate-Modified Titanium(IV) Oxide as a 3-Dimensional Scaffold. MATERIALS 2022; 15:ma15082752. [PMID: 35454448 PMCID: PMC9024846 DOI: 10.3390/ma15082752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022]
Abstract
The development of novel fibrous biomaterials and further processing of medical devices is still challenging. For instance, titanium(IV) oxide is a well-established biocompatible material, and the synthesis of TiOx particles and coatings via the sol-gel process has frequently been published. However, synthesis protocols of sol-gel-derived TiOx fibers are hardly known. In this publication, the authors present a synthesis and fabrication of purely sol-gel-derived TiOx fiber fleeces starting from the liquid sol-gel precursor titanium ethylate (TEOT). Here, the α-hydroxy-carboxylic acid lactic acid (LA) was used as a chelating ligand to reduce the reactivity towards hydrolysis of TEOT enabling a spinnable sol. The resulting fibers were processed into a non-woven fleece, characterized with FTIR, 13C-MAS-NMR, XRD, and screened with regard to their stability in physiological solution. They revealed an unexpected dependency between the LA content and the dissolution behavior. Finally, in vitro cell culture experiments proved their potential suitability as an open-mesh structured scaffold material, even for challenging applications such as therapeutic medicinal products (ATMPs).
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Affiliation(s)
- Bastian Christ
- Fraunhofer Institute for Silicate Research ISC, Translational Center Regenerative Therapies TLC-RT, Neunerplatz 2, 97082 Würzburg, Germany; (W.G.); (K.B.); (T.W.); (J.P.); (G.S.); (S.D.)
- Correspondence:
| | - Walther Glaubitt
- Fraunhofer Institute for Silicate Research ISC, Translational Center Regenerative Therapies TLC-RT, Neunerplatz 2, 97082 Würzburg, Germany; (W.G.); (K.B.); (T.W.); (J.P.); (G.S.); (S.D.)
| | - Katrin Berberich
- Fraunhofer Institute for Silicate Research ISC, Translational Center Regenerative Therapies TLC-RT, Neunerplatz 2, 97082 Würzburg, Germany; (W.G.); (K.B.); (T.W.); (J.P.); (G.S.); (S.D.)
| | - Tobias Weigel
- Fraunhofer Institute for Silicate Research ISC, Translational Center Regenerative Therapies TLC-RT, Neunerplatz 2, 97082 Würzburg, Germany; (W.G.); (K.B.); (T.W.); (J.P.); (G.S.); (S.D.)
| | - Jörn Probst
- Fraunhofer Institute for Silicate Research ISC, Translational Center Regenerative Therapies TLC-RT, Neunerplatz 2, 97082 Würzburg, Germany; (W.G.); (K.B.); (T.W.); (J.P.); (G.S.); (S.D.)
| | - Gerhard Sextl
- Fraunhofer Institute for Silicate Research ISC, Translational Center Regenerative Therapies TLC-RT, Neunerplatz 2, 97082 Würzburg, Germany; (W.G.); (K.B.); (T.W.); (J.P.); (G.S.); (S.D.)
- Department Chemical Technology of Material Synthesis, University Würzburg, Röntgenring 11, 97070 Würzburg, Germany
| | - Sofia Dembski
- Fraunhofer Institute for Silicate Research ISC, Translational Center Regenerative Therapies TLC-RT, Neunerplatz 2, 97082 Würzburg, Germany; (W.G.); (K.B.); (T.W.); (J.P.); (G.S.); (S.D.)
- Department Tissue Engineering and Regenerative Medicine, University Hospital Würzburg, Röntgenring 11, 97070 Würzburg, Germany
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Rodríguez M, Gómez-Gil V, Pérez-Köhler B, Pascual G, Bellón JM. Polymer Hernia Repair Materials: Adapting to Patient Needs and Surgical Techniques. MATERIALS 2021; 14:ma14112790. [PMID: 34073902 PMCID: PMC8197346 DOI: 10.3390/ma14112790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 12/03/2022]
Abstract
Biomaterials and their applications are perhaps among the most dynamic areas of research within the field of biomedicine. Any advance in this topic translates to an improved quality of life for recipient patients. One application of a biomaterial is the repair of an abdominal wall defect whether congenital or acquired. In the great majority of cases requiring surgery, the defect takes the form of a hernia. Over the past few years, biomaterials designed with this purpose in mind have been gradually evolving in parallel with new developments in the different surgical techniques. In consequence, the classic polymer prosthetic materials have been the starting point for structural modifications or new prototypes that have always strived to accommodate patients’ needs. This evolving process has pursued both improvements in the wound repair process depending on the implant interface in the host and in the material’s mechanical properties at the repair site. This last factor is important considering that this site—the abdominal wall—is a dynamic structure subjected to considerable mechanical demands. This review aims to provide a narrative overview of the different biomaterials that have been gradually introduced over the years, along with their modifications as new surgical techniques have unfolded.
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Affiliation(s)
- Marta Rodríguez
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (M.R.); (V.G.-G.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, España; (B.P.-K.); (G.P.)
- Ramón y Cajal Health Research Institute (IRYCIS), Colmenar Viejo, 28034 Madrid, Spain
| | - Verónica Gómez-Gil
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (M.R.); (V.G.-G.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, España; (B.P.-K.); (G.P.)
| | - Bárbara Pérez-Köhler
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, España; (B.P.-K.); (G.P.)
- Ramón y Cajal Health Research Institute (IRYCIS), Colmenar Viejo, 28034 Madrid, Spain
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain
| | - Gemma Pascual
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, España; (B.P.-K.); (G.P.)
- Ramón y Cajal Health Research Institute (IRYCIS), Colmenar Viejo, 28034 Madrid, Spain
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain
| | - Juan Manuel Bellón
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (M.R.); (V.G.-G.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, España; (B.P.-K.); (G.P.)
- Ramón y Cajal Health Research Institute (IRYCIS), Colmenar Viejo, 28034 Madrid, Spain
- Correspondence:
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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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Akalin C, Karagulle OO. The effects of onlay titanium-coated mesh on recurrence, foreign body sensation and chronic pain after ventral hernia repair. Asian J Surg 2021; 44:1158-1165. [PMID: 33771424 DOI: 10.1016/j.asjsur.2021.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE There are many complications of meshes in hernia repair. The aim of this study was to investigate the effects of onlay titanium-coated meshes (TCM) on recurrence, foreign body sensation and chronic pain in ventral hernia repair. METHODS In this retrospective study, 160 patients undergone TCM or polypropylene mesh (PM) surgery for onlay repair of ventral hernia were examined between May 2014 and January 2018 at our center. Patient characteristics, type of hernia, defect size, operative time, follow-up time, surgical site occurrence (infection, seroma and hematoma), recurrence, foreign body sensation and chronic pain were analyzed. Patients were divided into two groups according to mesh used: TCM (titanium group) or PM (polypropylene group). RESULTS Out of 160 patients, 63 (32.6%) had TCM and 97 (67.4%) had PM. There was no significant difference between groups in terms of recurrence (p = 0.757). Chronic pain and foreign body sensation were low in the titanium group (p = 0.047 and p = 0.029, respectively), a positive correlation was found between surgical site infection and recurrence (p = 0.020). In the polypropylene group, an increase in defect size was significantly associated with foreign body sensation and chronic pain (p < 0.001 for both comparisons). CONCLUSION In onlay repair of ventral hernia, TCM led to less foreign body sensation and chronic pain then PM. The surgical site infection was associated with recurrence for these meshes. Additionally, the increase in defect size causes a risk for foreign body sensation and chronic pain in repair using PM.
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Affiliation(s)
- Cagri Akalin
- Department of General Surgery, Ordu Training and Research Hospital, Ordu, Turkey
| | - Onur Olgac Karagulle
- Department of General Surgery, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
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Azimov RH, Akhmedov TZ, Kurbanov FS, Chinikov MA, Al'-Ariki MK, Tarkhani MKM, Dzhumanov AK. [Treatment of postoperative ventral hernias with the use of mesh implants made of titanium thread]. Khirurgiia (Mosk) 2020:64-69. [PMID: 32500691 DOI: 10.17116/hirurgia202005164] [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: 11/17/2022]
Abstract
AIM Study of the results of the use of titanium thread mesh implants in the treatment of postoperative ventral hernias. METHODS The study included 84 patients with postoperative ventral hernias. All performed open-access prosthetic hernioplasty. 2 groups were formed: the main group consisted of 32 patients who used a mesh implant made of titanium thread as an implant, the comparison group consisted of 52 patients whose hernioplasty was performed using a polypropylene mesh implant. There were no statistically significant differences between groups of patients by age, gender, average body mass index, risk class of anesthesia (ASA), size and location of hernias. RESULTS The frequency of postoperative complications in the main group was 6.2%, in the comparison group - 3.8%. There were no statistically significant differences in this indicator between the groups. At the time of discharge from the hospital, the level of plasma C-reactive protein in patients of the main group was significantly lower than in patients of the comparison group. CONCLUSION The use of titanium thread mesh implants in the treatment of postoperative ventral hernias is accompanied by a less inflammatory response of the body to the implant and does not lead to an increase in the frequency of postoperative complications.
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Affiliation(s)
- R H Azimov
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Moscow, Russia
| | - T Z Akhmedov
- The Department of hospital surgery with the course of pediatric surgery of the RUDN University, Moscow, Russia
| | - F S Kurbanov
- The Department of hospital surgery with the course of pediatric surgery of the RUDN University, Moscow, Russia
| | - M A Chinikov
- The Department of hospital surgery with the course of pediatric surgery of the RUDN University, Moscow, Russia
| | - M K Al'-Ariki
- The Department of hospital surgery with the course of pediatric surgery of the RUDN University, Moscow, Russia
| | - M K M Tarkhani
- The Department of hospital surgery with the course of pediatric surgery of the RUDN University, Moscow, Russia
| | - A K Dzhumanov
- The Department of hospital surgery with the course of pediatric surgery of the RUDN University, Moscow, Russia
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Min L, Yong P, Yun L, Balde AI, Chang Z, Qian G, He L, Fang P. Propensity score analysis of outcomes between the transabdominal preperitoneal and open Lichtenstein repair techniques for inguinal hernia repair: a single-center experience. Surg Endosc 2020; 34:5338-5345. [PMID: 32157406 DOI: 10.1007/s00464-019-07324-6] [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: 04/23/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The mechanism of persistent chronic pain after TAPP and OLR remains controversial. Therefore, more prospective and well-designed studies are needed to determine the predictive risk factors that will lead to better pain prevention and possibly elimination. The aim of the present study was to investigate the risk factors of chronic pain after TAPP repair and OLR in a single institution. METHODS A single-center, retrospective study of propensity score-matched patients who underwent TAPP or OLR surgery between 2008 and 2018 was conducted. To overcome selection bias, we performed 1:1 matching using 6 covariates to generate the propensity score. RESULTS A total of 400 patients treated with TAPP and 424 patients treated with OLR were balanced to 400 pairs of matched patients. The patients' age (P < 0.001), BMI (P < 0.001), foreign body sensation within 3 months after surgery (P < 0.001), and persistent sensation loss (P = 0.002) were different between the two groups. The OLR group had a shorter operative time than did the TAPP group (P < 0.001). The univariate analysis of factors predicting a difference in VAS between the preoperative assessment and the assessment 3 months after surgery showed that the type of surgery (P = 0.004), hernia grade (P = 0.001), type of mesh (P < 0.001), presence of scrotal invasion (P = 0.024), and foreign body sensation within 3 months (P = 0.047) were risk factors. The multivariate analysis revealed that only hernia grade III (CI - 8.524, - 2.783; P < 0.001), OLR operation type (CI 1.069, 4.987; P = 0.002), and the use of polypropylene mesh (CI - 5.400, - 1.489; P = 0.001) were independently associated with chronic pain. CONCLUSION These results suggest that compared to OLR, TAPP leads to less postoperative pain and a better long-term quality of life.
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Affiliation(s)
- Liuwei Min
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China.
| | - Pengzhi Yong
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Liuying Yun
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Alpha I Balde
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China.
| | - Zhanghuan Chang
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Gao Qian
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Liangzheng He
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Panyan Fang
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
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Rajapaksha K. Analysis of guideline conformity, surgical techniques, devices, consumables, and outcomes of the first 100 cases of laparoscopic inguinal hernia repair in adults during institutional hernia programme in a single surgical center. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_40_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Azimov RK, Al-Ariki M, Akhmedov TZ, Tarxani M. [Titanium mesh implants in herniology]. Khirurgiia (Mosk) 2019:126-131. [PMID: 31825353 DOI: 10.17116/hirurgia2019121126] [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: 11/17/2022]
Abstract
Literature review is devoted to the main implants used in hernia surgery and their disadvantages. Advisability of titanium mesh implants in surgery of anterior abdominal wall hernias is shown.
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Affiliation(s)
- R Kh Azimov
- The Department of hospital surgery with the course of pediatric surgery of the RUDN University, Moscow, Russia
| | - M Al-Ariki
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - T Z Akhmedov
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - M Tarxani
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
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13
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Titanized polypropylene mesh in laparoscopic sacral colpopexy. Int Urogynecol J 2019; 31:763-768. [PMID: 31807800 DOI: 10.1007/s00192-019-04146-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This study investigated perioperative and mid-term clinical outcomes after laparoscopic sacrocolpopexy (LSCP) with light titanium-coated polypropylene (TCP) mesh in a large group of patients affected by International Continence Society stage II-IV pelvic organ prolapse (POP). METHODS This multicenter retrospective study included 217 patients treated with LSCP using TCP mesh. We aimed to (1) analyze the intra- and postoperative complication rates according to the ICS/IUGA Complication Classification Code guidelines, (2) evaluate the anatomical results and (3) assess postoperative patient satisfaction with the Patient Global Impression Improvement questionnaire. Nonparametric Wilcoxon signed-rank tests, χ2 test and Fisher's exact test were used where appropriate. RESULTS The intraoperative complications were two (0.9%) cases of hemorrhage, two (0.9%) cases of incidental cystotomy and four (1.8%) cases of incidental colpotomy. During the postoperative follow-up, we recorded mesh exposure in 3 (1.4%) out of 217 patients. These 3 patients were from a group of 22 women who underwent vaginal opening during surgery, while in the remaining 195 patients without incidental colpotomy, no mesh exposure was observed (13.6% vs. 0.0%, p < 0.001). No failure of the apical compartment was observed, while 3 (1.4%) out of 217 patients experienced isolated anterior recurrence, and 1 (0.4%) patient had isolated posterior recurrence. All patients reported PGI-I scores ≥ 3, and 209 patients (96.3%) had a PGI-I score ≥ 2. CONCLUSIONS The use of light TCP mesh is safe and effective during LSCP for POP repair from both an anatomical and a functional point of view, posing a very low postoperative mesh-related complication risk.
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Khaled I, Priego P, Faisal M, Cuadrado M, García-Moreno F, Ballestero A, Galindo J, Lobo E. Assessment of short-term outcome with TiO 2 mesh in laparoscopic repair of large paraesophageal hiatal hernias. BMC Surg 2019; 19:156. [PMID: 31660930 PMCID: PMC6816156 DOI: 10.1186/s12893-019-0607-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 09/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic large para-oesophageal hiatal hernia (LPHH) repair using mesh reinforcement significantly reduces postoperative recurrence rates compared to conventional suture repair, especially within short follow-up times. However, the ideal strategy for repairing LPHH remains disputable because no clear guidelines are given regarding indications, mesh type, shape or position. The aim of this study was to survey our short-term results of LPHH management with a biosynthetic monofilament polypropylene mesh coated with titanium dioxide to enhance biocompatibility (TiO2Mesh™). Methods A retrospective study was performed at Ramon y Cajal University Hospital, Spain from December 2014 to October 2018. Data were collected on 27 consecutive patients with extensive hiatal hernia defects greater than 5 cm for which a laparoscopic repair was performed by primary suture and additional reinforcement with a TiO2Mesh™. Study outcomes were investigated, including clinical and radiological recurrences, dysphagia and mesh-related drawbacks. Results Twenty-seven patients were included in our analysis; 10 patients were male, and 17 were female. The mean age was 73 years (range, 63–79 years). All operations were performed laparoscopically. The median postoperative hospital stay was 3 days. After a mean follow-up of 18 months (range, 8-29 months), only 3 patients developed clinical recurrence of reflux symptoms (11%), and 2 had radiological recurrences (7%). No mesh-related complications occurred. Conclusions TiO2Mesh™ was found to be safe for laparoscopic repair of LPHH with a fairly low recurrence rate in this short-term study. Long-term studies conducted over a period of years with large sample sizes will be essential for confirming whether this mesh is suitable as a standard method of care with few drawbacks.
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Affiliation(s)
- Islam Khaled
- Department of Surgery, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Pablo Priego
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain.
| | - Mohammed Faisal
- Department of Surgery, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Marta Cuadrado
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Francisca García-Moreno
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Araceli Ballestero
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Julio Galindo
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Eduardo Lobo
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
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15
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Mereu L, Tateo S, D'Alterio MN, Russo E, Giannini A, Mannella P, Pertile R, Cai T, Simoncini T. Laparoscopic lateral suspension with mesh for apical and anterior pelvic organ prolapse: A prospective double center study. Eur J Obstet Gynecol Reprod Biol 2019; 244:16-20. [PMID: 31770687 DOI: 10.1016/j.ejogrb.2019.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study analyzed long-term outcomes and complications of laparoscopic lateral suspension (LLS) with mesh to treat apical and anterior pelvic organ prolapse (POP). STUDY DESIGN A prospective cohort study on 125 patients with vaginal bulge and apical +/- anterior prolapse scheduled for LLS who consecutively underwent LLS between April 2013 and January 2017 in Gynecologic Department of Santa Chiara Hospital in Trento and University of Pisa. The main outcome measure was anatomic and symptomatic POP outcome; the secondary outcomes measures were recurrence, reoperation rate, de novo posterior POP and complications. Percentage distribution of the pre- and postoperative POP-Q stages was compared at mean follow-up. Wilcoxon signed rank sum test was used to compare preoperative POP-Q stage and postoperative POP-Q stage ate mean follow up, for each patient (paired data) and for each type of prolapse. RESULTS 120 patients were included in the study. At 2 years 89 % of patients were asymptomatic and anatomic success rate was 94.2 % for the anterior compartment, 94.9 % for the apical compartment. Concerning posterior compartment prolapse 2 (1.7 %) patients referred stage 3 de novo prolapse during follow-up. The complication rate of Clavien-Dindo >3 was 0,8 %. Repeat surgery for POP occurred in 6.4 % of cases. The appearance of POP-Q recurrences was concentrated at 6 months follow-up. BMI > 25 was correlated with de novo posterior compartment appearance during follow-up. CONCLUSIONS LLS for the treatment of apical and anterior POP is a technique with optimal results in term of safety and effectiveness after 2 years follow-up.
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Affiliation(s)
- Liliana Mereu
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy.
| | - Saverio Tateo
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy
| | - Maurizio Nicola D'Alterio
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy; University of Cagliari, Italy
| | - Eleonora Russo
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Andrea Giannini
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Paolo Mannella
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Riccardo Pertile
- Clinical and Evaluative Epidemiology Department - Trento Health Service, Trento, Italy
| | - Tommaso Cai
- Department of Urology, S Chiara Hospital, Trento, Italy
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Ai FF, Mao M, Zhang Y, Kang J, Zhu L. The in vivo biocompatibility of titanized polypropylene lightweight mesh is superior to that of conventional polypropylene mesh. Neurourol Urodyn 2019; 39:96-107. [PMID: 31584215 DOI: 10.1002/nau.24159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/23/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the histological response to and changes in the biomechanical properties of titanized polypropylene lightweight mesh and conventional polypropylene mesh at 1 and 12 weeks following implantation in the sheep vagina. METHODS We compared a titanized polypropylene lightweight mesh (TiLOOP Mesh) to a conventional polypropylene mesh (Gynemesh PS) in a sheep vagina model. Explants were harvested after 1 and 12 weeks (n = 6/mesh type/time point) for histological observation. After 12 weeks, mesh-tissue complex specimens were biomechanically assessed by a uniaxial tension system. RESULTS One week after implantation, there was no significant difference in the inflammatory response between the two groups. Twelve weeks after implantation, the TiLOOP light mesh elicited a lower inflammatory response than was observed for the Gynemesh PS (1.44 ± 0.61 vs 2.05 ± 0.80, P = .015). Twelve weeks after implantation, the collagen I/III ratio was lower in the TiLOOP light mesh group than in the Gynemesh PS group (9.41 ± 5.06 vs 15.21 ± 8.21, P = .019). The messenger RNA expression levels of the inflammatory factors interleukin 10 and tumor necrosis factor α were lower in the TiLOOP Mesh group than in the Gynemesh PS group at both 1 and 12 weeks (P < .05). There were no significant differences in any of the evaluated biomechanical characteristics between the two meshes (P > .05). CONCLUSION Although the titanized polypropylene lightweight mesh induces slightly less tissue reactivity and has better in vivo biocompatibility, further studies should be conducted including the complications and the success rate of pelvic organ prolapse in patients before recommending it in pelvic floor reconstruction.
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Affiliation(s)
- Fang-Fang Ai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Meng Mao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jia Kang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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17
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Double traumatic diaphragmatic injury: A case report. Int J Surg Case Rep 2019; 61:82-85. [PMID: 31352318 PMCID: PMC6664163 DOI: 10.1016/j.ijscr.2019.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 12/02/2022] Open
Abstract
Diaphragmatic injuries are rare complications from trauma. Bilateral diaphragmatic injuries are extremely rare and just a few cases are reported. Sometimes the diagnosis is delayed or even missed. Both primary repair or mesh repair are safe and feasible. The use of a polypropylene mesh with titanized surface has not been attempted before.
Introduction Traumatic diaphragmatic injuries are rare complications resulting from a thoracic-abdominal blunt or penetrating trauma. Left-sided diaphragmatic injuries are more commonly reported in literature. Bilateral injuries are extremely rare, occurring in about 3% of the patients and just few cases reported in literature. Traumatic diaphragmatic hernias are definitely a marker of a severe trauma, in fact diaphragmatic injuries are often related to thoracic and abdominal organs injuries. Sometimes the classic clinical signs and symptoms of diaphragmatic injuries may initially not be present so that definitive evaluation is delayed or even missed. Case report A 62-years old woman was admitted in Emergency Department after a pedestrian accident. A whole-body CT scan showed multiple fractures (ribs, pelvic and vertebral) but no organ injury. The next CT detected a left-sided posterior diaphragmatic hernia involving transverse colon. Thus we performed an explorative laparoscopy and found a double diaphragmatic injury. A primary repair with non-absorbable sutures and a prosthetic titanized patch was performed.
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18
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Wirth U, Saller ML, von Ahnen T, Köckerling F, Schardey HM, Schopf S. Long-term outcome and chronic pain in atraumatic fibrin glue versus staple fixation of extra light titanized meshes in laparoscopic inguinal hernia repair (TAPP): a single-center experience. Surg Endosc 2019; 34:1929-1938. [DOI: 10.1007/s00464-019-06965-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/01/2019] [Indexed: 12/22/2022]
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19
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Weyhe D, Klinge U, Uslar VN, Tabriz N, Kluge A. Follow Up Data of MRI-Visible Synthetic Meshes for Reinforcement in Large Hiatal Hernia in Comparison to None-Mesh Repair-A Prospective Cohort Study. Front Surg 2019; 6:17. [PMID: 31058163 PMCID: PMC6477929 DOI: 10.3389/fsurg.2019.00017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Mesh augmentation for large hiatal hernia is still controversial because of high alleged risk of chronic reaction or shrinkage of mesh orifice surrounding the esophagus. The aim of this cohort study was to develop and establish an image analysis scheme, including 3D reconstruction, for MRI-visible meshes (DynaMesh®) to measure postoperative mesh shrinkage in order to observe potential complications. Methods: Between 12/2012 and 10/2016, n = 33 patients underwent surgery to correct symptomatic hiatal hernia (implantation indicated: n = 18). Intraoperative measurement of the hiatal surface area (HSA) > 5 cm2 was indication for mesh implantation. Early postoperatively, and during long-term follow-up, MRI was performed and patients filled out the gastrointestinal quality of life index (GIQLI score). Results: Follow-up rate was 76% (n = 25/33). Overall recurrence rate was 4% (1/25). No other patient showed reflux or dysphagia symptoms. Mesh related complications were not observed during follow-up period. Median GIQLI score of patients with mesh was 123 (range: 67-144), and 93 (52-141) for patients without mesh. Comparison of early and mid-term postoperative MRI for patients with mesh showed changes in mesh orifice size of 3% (corresponding to a slight increase in size of about 6 mm2) without any significant correlations with BMI, HSA, or patient age. Conclusion: We established an image analysis and 3D reconstruction scheme for MRI visible meshes in hiatal hernia repair. MRI images of normal clinical quality are sufficient for this analysis. Mesh orifice size in MRI-visible meshes does not seem to change at a clinically relevant level in the small cohort observed here. Further studies of large cohorts are necessary to establish if HSA >5 cm2 could be a suitable measure for indication of mesh implantation.
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Affiliation(s)
- Dirk Weyhe
- School of Medicine and Health Sciences, Pius-Hospital Oldenburg, University Hospital for Visceral Surgery, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Uwe Klinge
- Clinic for General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Verena Nicole Uslar
- School of Medicine and Health Sciences, Pius-Hospital Oldenburg, University Hospital for Visceral Surgery, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Navid Tabriz
- School of Medicine and Health Sciences, Pius-Hospital Oldenburg, University Hospital for Visceral Surgery, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Alexander Kluge
- Institute of Diagnostic and Interventional Radiology, Pius-Hospital Oldenburg, Oldenburg, Germany
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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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21
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Yang S, Shen YM, Wang MG, Zou ZY, Jin CH, Chen J. Titanium-coated mesh versus standard polypropylene mesh in laparoscopic inguinal hernia repair: a prospective, randomized, controlled clinical trial. Hernia 2018; 23:255-259. [PMID: 30259252 DOI: 10.1007/s10029-018-1823-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/14/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We aimed to compare the clinical outcome of titanium-coated mesh and polypropylene mesh in laparoscopic inguinal hernia repair. METHODS A total of 102 patients who received laparoscopic inguinal hernia repair in January-June 2016 in Beijing Chao-Yang Hospital were enrolled in this study. Patients were randomly divided into two groups, receiving either titanium-coated mesh (n = 50) or standard polypropylene mesh (n = 52). Multiple clinical parameters were collected and analyzed, including clinical manifestations, operative time, intraoperative blood loss, hospital stay, hospital cost, recovery time, and postoperative complications. RESULTS All procedures were completed. A statistical difference between two groups was not identified in regards to operative time, intraoperative blood loss, hospital stay, and recovery time (P > 0.05). Three cases with seroma and 15 with foreign body sensation were reported in the titanium-coated mesh group; 9 cases with seroma and 17 with foreign body sensation were reported in the standard polypropylene mesh group. There was no significant difference in the incidence of seroma and/or foreign body sensation. A lower hospital cost but longer recovery period was documented in the standard polypropylene mesh group (P < 0.05). No recurrence, infection or chronic pain was observed during 1-year follow-up in both groups. CONCLUSION Titanium-coated mesh possesses comparable clinical qualities as the standard polypropylene mesh but with a shorter recovery period. Therefore, this mesh is promising for clinical practice though the cost is higher than the standard polypropylene mesh.
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Affiliation(s)
- S Yang
- Department of Hernia and Abdominal wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Y-M Shen
- Department of Hernia and Abdominal wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - M-G Wang
- Department of Hernia and Abdominal wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Z-Y Zou
- Department of Hernia and Abdominal wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - C-H Jin
- Department of Hernia and Abdominal wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - J Chen
- Department of Hernia and Abdominal wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
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22
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Zhang JS, Wu LS. New advances in prophylactic mesh placement in end colostomy. Shijie Huaren Xiaohua Zazhi 2018; 26:1470-1477. [DOI: 10.11569/wcjd.v26.i24.1470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Patients with end colostomy often undergo multiple operations because of high incidence and recurrence rates of parastoml hernia. Therefore, it is particularly important to prevent the occurrence of parastomal hernia when undergoing an end colostomy. Using a prophylactic mesh, which is developed and gradually recognized in recent years, is one of the methods to prevent parastomal hernia. Here, we review the application and new advances in prophylactic mesh placement in end colostomy.
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Affiliation(s)
- Jun-Song Zhang
- Department of Emergency Minimally Invasive Surgery, Hefei Binhu Hospital, Third Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Li-Sheng Wu
- Department of Hernia and Weight-loss Metabolism, the First Affiliated Hospital of the University of Science and Technology of China, Hefei 230001, Anhui Province, China
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23
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Veit-Rubin N, Dubuisson J, Constantin F, Lange S, Eperon I, Gomel V, Dubuisson JB. Uterus preservation is superior to hysterectomy when performing laparoscopic lateral suspension with mesh. Int Urogynecol J 2018; 30:557-564. [PMID: 29961113 PMCID: PMC6450845 DOI: 10.1007/s00192-018-3678-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/28/2018] [Indexed: 01/30/2023]
Abstract
Introduction and hypothesis We aimed to compare differences between laparoscopic lateral suspension with mesh (LLS) performed with supracervical hysterectomy (LLSHE) and without hysterectomy (LLSUP). Methods We retrospectively collected data from women operated by a single surgeon between 2003 and 2011. From a total of 339 women with symptomatic anterior and/or apical pelvic organ prolapse (POP) and an intact uterus, 224 had LLSUP (70.4%) and 94 had LLSHE (29.6%). Three hundred and sixteen patients were examined at 1 year. Primary outcomes were objective and subjective success at 1 year during clinical evaluation. Secondary outcomes were complications (Clavien-Dindo scale) and mesh exposure. Patient satisfaction was evaluated by telephone interview using a 10-point scale and the Patient Global Impression of Improvement Scale (PGI-I). Results LLSUP and LLSHE did not differ for age (mean 57 and 55 years, respectively), preoperative status, complications, and participation at the interview (52 vs 53%). LLSHE is associated with higher mesh exposure (6.5 vs 1.3%, p = 0.014) and more frequent use of Mersilene. Titanium-coated and noncoated polypropylene was more frequently used in LLSUP. At 1 year, both anatomic success rate for the anterior compartment (98.7 vs 94.6%, p = 0.021) and subjective success rate (83.5 vs 72.8%, p = 0.035) were higher for LLSUP. Without hysterectomy, patients more often improved (90.5 vs 76.5%, p = 0.013) and would more frequently recommend the procedure (94.5 vs 80.4%, p = 0.004). Conclusions LLS with or without hysterectomy is a safe technique with high patient satisfaction. The uterus-preserving approach appears to result in better anatomic outcome for the anterior compartment, better subjective outcome, and higher patient satisfaction. Electronic supplementary material The online version of this article (10.1007/s00192-018-3678-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Jean Dubuisson
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Obstetrics and Gynecology, University Hospitals Geneva, Geneva, Switzerland
| | - Florin Constantin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Obstetrics and Gynecology, University Hospitals Geneva, Geneva, Switzerland
| | - Sören Lange
- Department of Obstetrics and Gynecology, Cantonal Hospital of Yverdon-les-Bains, Yverdon-les-Bains, Switzerland
| | - Isabelle Eperon
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Obstetrics and Gynecology, University Hospitals Geneva, Geneva, Switzerland
| | - Victor Gomel
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Bernard Dubuisson
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Gynecology Centre, Clinique La Colline, Geneva, Switzerland
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Köhler G, Fischer I, Kaltenböck R, Mitteregger M, Seitinger G, Szyszkowitz A. Critical evaluation of an innovative mesh for bilateral transabdominal preperitoneal (TAPP) repair of inguinal hernias. Hernia 2018; 22:857-862. [PMID: 29869074 DOI: 10.1007/s10029-018-1786-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/31/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Transabdominal preperitoneal hernia mesh plasty (TAPP) offers significant benefits to patients undergoing bilateral inguinal hernia repair. We evaluated a novel pre-shaped, large-pored, titanium-coated, lightweight polypropylene mesh for bilateral placement as an alternative to two separate meshes. METHODS Thirty-six patients underwent elective surgical repair of bilateral inguinal hernias with the new mesh at three departments of surgery in Linz and Graz, Austria, between May 1, 2015 and June 30, 2017. RESULTS All operations were completed without intraoperative complications or conversion to open procedures. The mean operation time was 74 min. There were no postoperative procedure-related complications with the exception of one hematoseroma of the spermatic cord. Two symptomatic medial recurrences (2/36 patients = 5.6%, 2/72 hernia repairs = 2.8%, respectively) after supravesical and medial hernia repair with the bilateral mesh were seen at structured follow-up examinations 6 and 12 months postoperatively. CONCLUSION Treatment of bilateral inguinal hernias with the newly designed bilateral mesh for TAPP theoretically brings benefits in terms of resistance to forces acting on the mesh. The larger area may decrease the risk for mesh bulging and recurrence, and one large mesh might provide more stable support than two separate meshes overlapping at the midline. The results of our study do not confirm these theoretical benefits regarding a high recurrence rate (2.8%) after treatment of medial hernia defects. We recommend re-designing the mesh with only a small central slit, which would provide a broader mesh bridge with sufficient overlap for all types of inguinal and femoral hernias, including medial and supravesical defects. After the mesh has been re-designed, a new study should evaluate its real benefits before it is marketed.
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Affiliation(s)
- G Köhler
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), 4010, Linz, Austria. .,Department of Surgery, Paracelsus Medical University, Salzburg, Austria. .,Academic Teaching Hospital, Medical University of Vienna, Vienna, Austria. .,Academic Teaching Hospital, Medical University of Graz, Graz, Austria. .,Academic Teaching Hospital, Medical University of Innsbruck, Innsbruck, Austria.
| | - I Fischer
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), 4010, Linz, Austria.,Academic Teaching Hospital, Medical University of Vienna, Vienna, Austria.,Academic Teaching Hospital, Medical University of Graz, Graz, Austria.,Academic Teaching Hospital, Medical University of Innsbruck, Innsbruck, Austria
| | - R Kaltenböck
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), 4010, Linz, Austria.,Academic Teaching Hospital, Medical University of Vienna, Vienna, Austria.,Academic Teaching Hospital, Medical University of Graz, Graz, Austria.,Academic Teaching Hospital, Medical University of Innsbruck, Innsbruck, Austria
| | - M Mitteregger
- Department of Surgery, St John of God Hospital, Graz, Austria
| | - G Seitinger
- Department of Surgery, St John of God Hospital, Graz, Austria
| | - A Szyszkowitz
- Department of Surgery, St John of God Hospital, Graz, Austria
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Gordon AC, Gillespie C, Son J, Polhill T, Leibman S, Smith GS. Long-term outcomes of laparoscopic large hiatus hernia repair with nonabsorbable mesh. Dis Esophagus 2018; 31:4850447. [PMID: 29444215 DOI: 10.1093/dote/dox156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/06/2017] [Indexed: 12/11/2022]
Abstract
The use of mesh to augment suture repair of large hiatus hernias remains controversial. Repair with mesh may help reduce the recurrence rate of primary repair, but concerns about the potential for serious complications, such as mesh erosion or stricturing, continue to limit its use. We aim to evaluate the long-term outcome of primary hiatus hernia repair with lightweight polypropylene mesh (TiMesh) specifically looking at rates of clinical recurrence, dysphagia, and mesh-related complications. From a prospectively maintained database, 50 consecutive patients who underwent elective primary laparoscopic hiatal hernia repair with TiMesh between January 2005 and December 2007 were identified. Case notes and postoperative endoscopy reports were reviewed. Clinical outcomes were evaluated using a structured questionnaire, including a validated dysphagia score. Of the 50 patients identified, 36 (72%) were contactable for follow-up. At a median follow-up of 9 years, the majority of patients (97%) regarded their surgery as successful. Twelve patients (33%) reported a recurrence of their symptoms, but only 4 (11%) reported that their symptoms were as severe as prior to the surgery. There was no significant difference between pre- and postoperative dysphagia scores. Postoperative endoscopy reports were available for 32 patients at a median time point of 4 years postoperatively, none of which revealed any mesh-related complications. One patient had undergone a revision procedure for a recurrent hernia at another institution. In this series, primary repair of large hiatus hernia with nonabsorbable mesh was not associated with any adverse effects over time. Patient satisfaction with symptomatic outcome remained high in the long term.
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Affiliation(s)
- A C Gordon
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - C Gillespie
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - J Son
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - T Polhill
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - S Leibman
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - G S Smith
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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26
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Veit-Rubin N, Dubuisson JB, Gayet-Ageron A, Lange S, Eperon I, Dubuisson J. Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients. Int Urogynecol J 2017. [PMID: 28417156 DOI: 10.1007/s00192-017-3327-2.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Sacropexy is considered the gold standard for the treatment of pelvic organ prolapse (POP) although dissection of the promontory may be challenging, particularly in obese women. Laparoscopic lateral suspension with mesh (LLS) could be an alternative. METHODS LLS provides lateral attachment by fibrosis of a vesicovaginal mesh. Clinical evaluation was performed at 1 year using the simplified POP quantification system (POP-Q). Primary outcomes were objective and subjective cure at 1 year. After a mean of 7.2 years the rates of reoperation and complications were assessed as secondary outcomes. Patient satisfaction was evaluated by telephone interview using a ten-point-scale and the PGI-I scale. Factors predicting satisfaction were determined by logistic regression analysis. RESULTS A total of 417 patients were treated between 2003 and 2011. At 1 year 78.4% of patients were asymptomatic and anatomic success rates were 91.6% for the anterior compartment, 93.6% for the apical compartment and 85.3% for the posterior compartment. The complication rate of Clavien-Dindo grade III or higher was 2.2%. The mesh exposure rate was 4.3% and the reoperation rate was 7.3%. Of the 417 patients, 214 participated in the telephone interview. Over 85% rated their situation as improved and satisfaction was associated with the absence of concomitant hysterectomy. CONCLUSIONS LLS is a safe technique with promising results in terms of a composite outcome, low complication rates and high long-term patient satisfaction. However, a randomized controlled trial is needed to establish the technique as an alternative to sacropexy in the treatment of POP in obese and high morbidity patients.
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Affiliation(s)
- Nikolaus Veit-Rubin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria.
| | - Jean-Bernard Dubuisson
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Gynaecology Centre, Clinique La Colline, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Sören Lange
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Obstetrics and Gynecology, University Hospitals Geneva, Geneva, Switzerland
| | - Isabelle Eperon
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Obstetrics and Gynecology, University Hospitals Geneva, Geneva, Switzerland
| | - Jean Dubuisson
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Obstetrics and Gynecology, University Hospitals Geneva, Geneva, Switzerland
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27
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Lightweight Titanium-coated Mesh Versus Standard-Weight Polypropylene Mesh in Totally Extraperitoneal Inguinal Hernia Repair (TEP): A Cohort Analysis. Surg Laparosc Endosc Percutan Tech 2017; 26:e113-e116. [PMID: 27846168 DOI: 10.1097/sle.0000000000000352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The study objective is to compare the outcomes of laparoscopic to tally extraperitoneal repair using the standard-weight polypropylene mesh or a lightweight titanium-coated mesh. METHODS A retrospective review was conducted on 138 adult patients with unilateral inguinal hernias, who underwent totally extraperitoneal inguinal hernia repair between 2010 and 2013 using either a standard-weight polypropylene mesh (Prolene mesh, 80 g/m) or a lightweight titanium-coated mesh (Ti Mesh light, 35 g/m). RESULTS There was no difference in reported pain at 24 hours postoperatively. The difference in reported pain at follow-up (mean: 21 mo) was insignificant [PP vs. Ti: 7.8% (n=5) vs. 8.3% (n=3), P=0.92], the differences regarding chronic inguinal pain was also insignificant [PP vs. Ti: 14% (n=9) vs. 5.5% (n=2), P=0.191], and there was no difference in the development of hernia recurrence [PP vs. Ti: 1.5% (n=1) vs. 0, P=0.42]. CONCLUSIONS No statistically significant differences of the overall postoperative outcome were observed between the 2 mesh types.
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28
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Veit-Rubin N, Dubuisson JB, Gayet-Ageron A, Lange S, Eperon I, Dubuisson J. Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients. Int Urogynecol J 2017; 28:1685-1693. [PMID: 28417156 DOI: 10.1007/s00192-017-3327-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Sacropexy is considered the gold standard for the treatment of pelvic organ prolapse (POP) although dissection of the promontory may be challenging, particularly in obese women. Laparoscopic lateral suspension with mesh (LLS) could be an alternative. METHODS LLS provides lateral attachment by fibrosis of a vesicovaginal mesh. Clinical evaluation was performed at 1 year using the simplified POP quantification system (POP-Q). Primary outcomes were objective and subjective cure at 1 year. After a mean of 7.2 years the rates of reoperation and complications were assessed as secondary outcomes. Patient satisfaction was evaluated by telephone interview using a ten-point-scale and the PGI-I scale. Factors predicting satisfaction were determined by logistic regression analysis. RESULTS A total of 417 patients were treated between 2003 and 2011. At 1 year 78.4% of patients were asymptomatic and anatomic success rates were 91.6% for the anterior compartment, 93.6% for the apical compartment and 85.3% for the posterior compartment. The complication rate of Clavien-Dindo grade III or higher was 2.2%. The mesh exposure rate was 4.3% and the reoperation rate was 7.3%. Of the 417 patients, 214 participated in the telephone interview. Over 85% rated their situation as improved and satisfaction was associated with the absence of concomitant hysterectomy. CONCLUSIONS LLS is a safe technique with promising results in terms of a composite outcome, low complication rates and high long-term patient satisfaction. However, a randomized controlled trial is needed to establish the technique as an alternative to sacropexy in the treatment of POP in obese and high morbidity patients.
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Affiliation(s)
- Nikolaus Veit-Rubin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Department of Obstetrics and Gynecology, Medical University Vienna, Vienna, Austria.
| | - Jean-Bernard Dubuisson
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Gynaecology Centre, Clinique La Colline, Geneva, Switzerland
| | - Angèle Gayet-Ageron
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Sören Lange
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Obstetrics and Gynecology, University Hospitals Geneva, Geneva, Switzerland
| | - Isabelle Eperon
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Obstetrics and Gynecology, University Hospitals Geneva, Geneva, Switzerland
| | - Jean Dubuisson
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Obstetrics and Gynecology, University Hospitals Geneva, Geneva, Switzerland
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Kalaba S, Gerhard E, Winder JS, Pauli EM, Haluck RS, Yang J. Design Strategies and Applications of Biomaterials and Devices for Hernia Repair. Bioact Mater 2016; 1:2-17. [PMID: 28349130 PMCID: PMC5365083 DOI: 10.1016/j.bioactmat.2016.05.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/10/2016] [Accepted: 05/20/2016] [Indexed: 12/17/2022] Open
Abstract
Hernia repair is one of the most commonly performed surgical procedures worldwide, with a multi-billion dollar global market. Implant design remains a critical challenge for the successful repair and prevention of recurrent hernias, and despite significant progress, there is no ideal mesh for every surgery. This review summarizes the evolution of prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias. Next, the major milestones in implant design are discussed. Commonly encountered complications and strategies to minimize these adverse effects are described, followed by a thorough description of the implant characteristics necessary for successful repair. Finally, available implants are categorized and their advantages and limitations elucidated, including non-absorbable and absorbable (synthetic and biologically derived) prostheses, composite prostheses, and coated prostheses. This review not only summarizes the state of the art in hernia repair, but also suggests future research directions toward improved hernia repair utilizing novel materials and fabrication methods.
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Affiliation(s)
- Surge Kalaba
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Ethan Gerhard
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Joshua S. Winder
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Eric M. Pauli
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Randy S. Haluck
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Jian Yang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
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30
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Parshikov VV, Mironov AA, Kazantsev AA, Alekhin AI. [Intraperitoneal and retromuscular abdominal wall repair using ultra-light and titanium-containing polypropylene mesh (experimental research)]. Khirurgiia (Mosk) 2016:40-44. [PMID: 27239913 DOI: 10.17116/hirurgia2016440-44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study experimental possibility of light, ultra-light and titanium-containing endoprostheses implantation for postoperative hernias correction. MATERIAL AND METHODS Abdominal wall repair was simulated in 72 rabbits. In the first group polypropylene mesh with fibers diameter of 90 microns and surface density of 36 g/m2 was used. In the second group we applied polypropylene mesh with fibers diameter of 65 microns and thin layer of titanium. Their surface density was 16 g/m2. Intraperitoneal onlay mesh (IPOM) and sublay retromuscular (SRM) techniques were used in group 1 and 2 respectively. Animals were taken out from the experiment in 30 and 60 days. Adhesive process in implantation area was evaluated using the method of Egiev V.N. and Lyadov V.K. RESULTS The most pronounced adhesive process was observed in IPOM series. Type of endoprosthesis and terms of postoperative period did not significant effect adhesive process. SRM method was associated with significantly less pronounced adhesions. Analysis of all data showed that severity of adhesive process was significantly higher in IPOM series compared with SRM technique. CONCLUSION Our study showed that severity of abdominal adhesive process associated with repair using ultra-light mesh is completely determined by surgical technique and did not depend on type of endoprosthesis and terms of postoperative period. Described implants should be used for retromuscular implantation rather intraperitoneal position.
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Affiliation(s)
- V V Parshikov
- Nizhny Novgorod State Medical Academy, Nizhny Novgorod
| | - A A Mironov
- Nizhny Novgorod State Medical Academy, Nizhny Novgorod; N.I.Lobachevsky Nizhny Novgorod State University, Nizhny Novgorod
| | | | - A I Alekhin
- Central Clinical Hospital of RAS, Moscow, Russia
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31
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Farthmann J, Mengel M, Henne B, Grebe M, Watermann D, Kaufhold J, Stehle M, Fuenfgeld C. Improvement of pelvic floor-related quality of life and sexual function after vaginal mesh implantation for cystocele: primary endpoint of a prospective multicentre trial. Arch Gynecol Obstet 2016; 294:115-21. [PMID: 26781262 DOI: 10.1007/s00404-016-4014-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Pelvic organ prolapse (POP) impairs quality of life (QoL) due to vaginal bulge symptoms and changes in bladder/bowel and sexual function. The effect of alloplastic meshes on QoL is still being discussed. The purpose of this study was to prospectively evaluate the effect of mesh implantation on QoL and sexual function over 1 year. METHODS 289 women with cystocele > stage I were included in this prospective multicenter study, with nine hospitals participating (ClinicalTrials.gov NCT01084889). Mesh exposures rates and pelvic floor-related QoL using the validated German version of the p-QoL questionnaire were evaluated as the primary endpoints. Based on a single-sided binominal test with α = 0.05 and a power of 0.80, a sample size of 225 for the mesh exposures was calculated. The mesh used was a 6-arm mesh with titanium coating (TILOOP(®) Total 6, sponsor pfm medical ag, Germany). Preoperative data were compared to 6 and 12 months postoperative data, using Wilcoxon test. RESULTS The mean age of the patients was 67 years (min 43, max 87). All domains of QoL improved significantly compared after surgery: mean prolapse score dropped from 73.7 to 19.4 after 6 and 16.2 after 12 months (p < 0.001). Sexual function also improved significantly. The rate of dyspareunia was lower at follow-up. CONCLUSIONS In this prospective trial, a significant positive effect of mesh implantation on pelvic floor-related QoL was observed. These findings remained stable 1 year after surgery with further improvement. This trial adds further data to the ongoing discussion on the role and risk of meshes in POP surgery.
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Affiliation(s)
- Juliane Farthmann
- Department of Obstetrics and Gynecology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Mathias Mengel
- Department of Obstetrics and Gynecology, Klinikum Oberlausitzer Bergland, Zittau, Germany
| | - Birgit Henne
- Department of Obstetrics and Gynecology, St. Elisabeth-Krankenhaus, Leipzig, Germany
| | - Markus Grebe
- Department of Obstetrics and Gynecology, Staedtisches Klinikum Friedrichstadt, Dresden, Germany
| | - Dirk Watermann
- Department of Obstetrics and Gynecology, Evangelisches Diakoniekrankenhaus, Freiburg, Germany
| | - Jan Kaufhold
- Department of Obstetrics and Gynecology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Margit Stehle
- Department of Obstetrics and Gynecology, Klinik Tettnang, Tettnang, Germany
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32
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Kazantsev AA, Parshikov VV, Shemyatovsky KA, Alekhin AI, Titarov DL, Kolpakov AA, Osadchenko SV. [The titanium-containing mesh as a perspective group of implants for abdominal wall repair]. Khirurgiia (Mosk) 2016. [PMID: 28635687 DOI: 10.17116/hirurgia2016486-95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- A A Kazantsev
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow
| | - V V Parshikov
- Chair of Hospital Surgery of Nizhny Novgorod State Medical Academy, Nizhny Novgorod
| | - K A Shemyatovsky
- Chair of Operative Surgery of Nizhny Novgorod State Medical Academy, Nizhny Novgorod
| | - A I Alekhin
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow
| | - D L Titarov
- Chair of Operative Surgery of Nizhny Novgorod State Medical Academy, Nizhny Novgorod
| | | | - S V Osadchenko
- D.I. Mendeleev Russian Chemical-Technological University, Moscow
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Pérez-Köhler B, Bayon Y, Bellón JM. Mesh Infection and Hernia Repair: A Review. Surg Infect (Larchmt) 2015; 17:124-37. [PMID: 26654576 DOI: 10.1089/sur.2015.078] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The use of a prosthetic mesh to repair a tissue defect may produce a series of post-operative complications, among which infection is the most feared and one of the most devastating. When occurring, bacterial adherence and biofilm formation on the mesh surface affect the implant's tissue integration and host tissue regeneration, making preventive measures to control prosthetic infection a major goal of prosthetic mesh improvement. METHODS This article reviews the literature on the infection of prosthetic meshes used in hernia repair to describe the in vitro and in vivo models used to examine bacterial adherence and biofilm formation on the surface of different biomaterials. Also discussed are the prophylactic measures used to control implant infection ranging from meshes soaked in antibiotics to mesh coatings that release antimicrobial agents in a controlled manner. RESULTS Prosthetic architecture has a direct effect on bacterial adherence and biofilm formation. Absorbable synthetic materials are more prone to bacterial colonization than non-absorbable materials. The reported behavior of collagen biomeshes, also called xenografts, in a contaminated environment has been contradictory, and their use in this setting needs further clinical investigation. New prophylactic mesh designs include surface modifications with an anti-adhesive substance or pre-treatment with antibacterial agents or metal coatings. CONCLUSIONS The use of polymer coatings that slowly release non-antibiotic drugs seems to be a good strategy to prevent implant contamination and reduce the onset of resistant bacterial strains. Even though the prophylactic designs described in this review are mainly focused on hernia repair meshes, these strategies can be extrapolated to other implantable devices, regardless of their design, shape or dimension.
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Affiliation(s)
- Bárbara Pérez-Köhler
- 1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .,2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Yves Bayon
- 3 Covidien - Sofradim Production , Trévoux, France
| | - Juan Manuel Bellón
- 1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .,2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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34
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Vorst AL, Kaoutzanis C, Carbonell AM, Franz MG. Evolution and advances in laparoscopic ventral and incisional hernia repair. World J Gastrointest Surg 2015; 7:293-305. [PMID: 26649152 PMCID: PMC4663383 DOI: 10.4240/wjgs.v7.i11.293] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/19/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20th century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4th century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair.
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35
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Zhu LM, Schuster P, Klinge U. Mesh implants: An overview of crucial mesh parameters. World J Gastrointest Surg 2015; 7:226-236. [PMID: 26523210 PMCID: PMC4621472 DOI: 10.4240/wjgs.v7.i10.226] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/17/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Hernia repair is one of the most frequently performed surgical interventions that use mesh implants. This article evaluates crucial mesh parameters to facilitate selection of the most appropriate mesh implant, considering raw materials, mesh composition, structure parameters and mechanical parameters. A literature review was performed using the PubMed database. The most important mesh parameters in the selection of a mesh implant are the raw material, structural parameters and mechanical parameters, which should match the physiological conditions. The structural parameters, especially the porosity, are the most important predictors of the biocompatibility performance of synthetic meshes. Meshes with large pores exhibit less inflammatory infiltrate, connective tissue and scar bridging, which allows increased soft tissue ingrowth. The raw material and combination of raw materials of the used mesh, including potential coatings and textile design, strongly impact the inflammatory reaction to the mesh. Synthetic meshes made from innovative polymers combined with surface coating have been demonstrated to exhibit advantageous behavior in specialized fields. Monofilament, large-pore synthetic meshes exhibit advantages. The value of mesh classification based on mesh weight seems to be overestimated. Mechanical properties of meshes, such as anisotropy/isotropy, elasticity and tensile strength, are crucial parameters for predicting mesh performance after implantation.
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36
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Guillaume O, Teuschl AH, Gruber-Blum S, Fortelny RH, Redl H, Petter-Puchner A. Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio-Functionality to Meshes. Adv Healthc Mater 2015; 4:1763-89. [PMID: 26111309 DOI: 10.1002/adhm.201500201] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/12/2015] [Indexed: 12/19/2022]
Abstract
Abdominal wall hernia is a recurrent issue world-wide and requires the implantation of over 1 million meshes per year. Because permanent meshes such as polypropylene and polyester are not free of complications after implantation, many mesh modifications and new functionalities have been investigated over the last decade. Indeed, mesh optimization is the focus of intense development and the biomaterials utilized are now envisioned as being bioactive substrates that trigger various physiological processes in order to prevent complications and to promote tissue integration. In this context, it is of paramount interest to review the most relevant bio-functionalities being brought to new meshes and to open new avenues for the innovative development of the next generation of meshes with enhanced properties for functional abdominal wall hernia repair.
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Affiliation(s)
- Olivier Guillaume
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Andreas Herbert Teuschl
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- University of Applied Sciences Technikum Wien; Department of Biochemical Engineering; Höchstädtplatz 5 1200 Vienna Austria
| | - Simone Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - René Hartmann Fortelny
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Alexander Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
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