1
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Wiener J, Novis E, Rabindran J, Fenton-Lee D. Initial experience of minimally invasive mesh explantation for inguinodynia. ANZ J Surg 2024. [PMID: 38995051 DOI: 10.1111/ans.19158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/26/2024] [Accepted: 06/22/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Chronic pain after minimally invasive inguinal hernia repair with mesh can have debilitating effects on quality of life (QOL), limiting daily activities and ability to work. Many medical and surgical options for treatment have been proposed, however there is no consensus on the role of mesh explantation in the management of these patients. METHODS We performed a retrospective review of all patients who underwent groin mesh removal by robotic or laparoscopic approach from July 2012 to July 2023 at our institution. Patients were interviewed post-operatively to determine their overall pain scores and QOL was assessed using the Carolinas Comfort Scale (CCS) Questionnaire. Patient characteristics, operative times, pre-operative imaging techniques and analgesia use was also recorded. RESULTS Twenty-two patients underwent groin mesh removal for chronic pain, including 12 robotic and 10 laparoscopic operations. The mean pre-operative pain score in all patients was 7.6/10 compared to 4.0/10 post-operatively. The mean post-operative CCS score was 24, indicating moderate discomfort. Four patients demonstrated CCS scores <11 indicating no discomfort and no patients demonstrated CCS scores >90, indicating severe debilitating discomfort. The majority of patients had a reduction or total cessation of analgesia intake post-operatively. CONCLUSION Both laparoscopic and robotic mesh explantation for treatment of chronic pain post-inguinal hernia repair is safe and effective in achieving a reduction in pain and reducing the need for long-term analgesia.
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Affiliation(s)
- Jonathan Wiener
- General Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
- General Surgery, St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Elan Novis
- General Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
- General Surgery, St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Joel Rabindran
- General Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
- General Surgery, St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Douglas Fenton-Lee
- General Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
- General Surgery, St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- St Vincent's Private Hospital, Sydney, New South Wales, Australia
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Sapiyeva ST, Abatov NT, Aliyakparov MT, Badyrov RM, Yoshihiro N, Brizitskaya LV, Yesniyazov DK, Yukhnevich YA. Non-mesh inguinal hernia repair: Review. Asian J Surg 2024:S1015-9584(24)01272-7. [PMID: 38960759 DOI: 10.1016/j.asjsur.2024.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/13/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024] Open
Abstract
Hernioplasty stands as one of the most common abdominal surgical interventions. The "gold standard" treatment for inguinal hernias remains Lichtenstein mesh hernioplasty. Nonetheless, clinical practice continues to grapple with issues concerning complications such as recurrence, chronic postoperative pain, and infection. The myriad types of surgery lead to conflicting opinions regarding the superiority and drawbacks of inguinal canal plastic surgery methods. This article presents current data on the surgical treatment of non-mesh inguinal hernias, delineating the most prevalent techniques while exploring their respective advantages and disadvantages. Additionally, the researchers' experiences are analyzed in detail.
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Affiliation(s)
- S T Sapiyeva
- Department of Surgery, Non-commercial Joint-stock Company "Karaganda Medical University", Karaganda, 100000, Kazakhstan
| | - N T Abatov
- Department of Surgery, Non-commercial Joint-stock Company "Karaganda Medical University", Karaganda, 100000, Kazakhstan
| | - M T Aliyakparov
- Department of Surgery, Non-commercial Joint-stock Company "Karaganda Medical University", Karaganda, 100000, Kazakhstan
| | - R M Badyrov
- Department of Surgery, Non-commercial Joint-stock Company "Karaganda Medical University", Karaganda, 100000, Kazakhstan
| | - N Yoshihiro
- Department of Surgery, Non-commercial Joint-stock Company "Karaganda Medical University", Karaganda, 100000, Kazakhstan
| | - L V Brizitskaya
- Department of Surgery, Non-commercial Joint-stock Company "Karaganda Medical University", Karaganda, 100000, Kazakhstan
| | - D K Yesniyazov
- Department of Surgery, Non-commercial Joint-stock Company "Karaganda Medical University", Karaganda, 100000, Kazakhstan
| | - Y A Yukhnevich
- Department of Surgery, Non-commercial Joint-stock Company "Karaganda Medical University", Karaganda, 100000, Kazakhstan.
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3
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Van Rest KLC, Gielen MJCAM, Warmerdam LM, Kowalik CR, Roovers JPWR, Zwaans WAR. Prediction of successful revision surgery for mesh-related complaints after inguinal hernia and pelvic organ prolapse repair. Hernia 2024; 28:401-410. [PMID: 36753034 PMCID: PMC10997688 DOI: 10.1007/s10029-023-02748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/22/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE With this retrospective case series, we aim to identify predictors for reduction of pain after mesh revision surgery in patients operated for inguinal hernia or pelvic organ prolapse with a polypropylene implant. Identifying these predictors may aid surgeons to counsel patients and select appropriate candidates for mesh revision surgery. METHODS Clinical records before and after mesh revision surgery from 221 patients with chronic postoperative inguinal pain (CPIP) and 59 patients with pain after pelvic organ prolapse (POP) surgery were collected at two experienced tertiary referral centers. Primary outcome was patient reported improvement of pain after revision surgery. A multivariable logistic regression model was used to specify predictors for pain reduction. RESULTS The multivariable logistic regression was performed for each patient group separately. Patients with CPIP had higher chances of improvement of pain when time between mesh placement and mesh revision surgery was longer, with an OR of 1.19 per year. A turning point in chances of risks and benefits was demonstrated at 70 months, with improved outcomes for patients with revision surgery ≥ 70 months (OR 2.86). For POP patients, no statistically significant predictors for reduction of pain after (partial) removal surgery could be identified. CONCLUSION A longer duration of at least 70 months between implantation of inguinal mesh and revision surgery seems to give a higher chance on improvement of pain. Caregivers should not avoid surgery based on a longer duration of symptoms when an association between symptoms and the location of the mesh is found.
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Affiliation(s)
- K L C Van Rest
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - M J C A M Gielen
- Department of Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands
| | | | - C R Kowalik
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Bergman Clinics Vrouw, Amsterdam, The Netherlands
- Research Consortium Mesh, Utrecht, The Netherlands
| | - J P W R Roovers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Bergman Clinics Vrouw, Amsterdam, The Netherlands
- Research Consortium Mesh, Utrecht, The Netherlands
| | - W A R Zwaans
- Department of Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands
- Research Consortium Mesh, Utrecht, The Netherlands
- SolviMáx, Center of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC+, Maastricht, The Netherlands
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4
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Kirkpatrick AW, Coccolini F, Tolonen M, Minor S, Catena F, Celotti A, Gois E, Perrone G, Novelli G, Garulli G, Ioannidis O, Sugrue M, De Simone B, Tartaglia D, Lampella H, Ferreira F, Ansaloni L, Parry NG, Colak E, Podda M, Noceroni L, Vallicelli C, Rezende-Netos J, Ball CG, McKee J, Moore EE, Mather J. Are Surgeons Going to Be Left Holding the Bag? Incisional Hernia Repair and Intra-Peritoneal Non-Absorbable Mesh Implant Complications. J Clin Med 2024; 13:1005. [PMID: 38398318 PMCID: PMC10889414 DOI: 10.3390/jcm13041005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Ventral incisional hernias are common indications for elective repair and frequently complicated by recurrence. Surgical meshes, which may be synthetic, bio-synthetic, or biological, decrease recurrence and, resultingly, their use has become standard. While most patients are greatly benefited, mesh represents a permanently implanted foreign body. Mesh may be implanted within the intra-peritoneal, preperitoneal, retrorectus, inlay, or onlay anatomic positions. Meshes may be associated with complications that may be early or late and range from minor to severe. Long-term complications with intra-peritoneal synthetic mesh (IPSM) in apposition to the viscera are particularly at risk for adhesions and potential enteric fistula formation. The overall rate of such complications is difficult to appreciate due to poor long-term follow-up data, although it behooves surgeons to understand these risks as they are the ones who implant these devices. All surgeons need to be aware that meshes are commercial devices that are delivered into their operating room without scientific evidence of efficacy or even safety due to the unique regulatory practices that distinguish medical devices from medications. Thus, surgeons must continue to advocate for more stringent oversight and improved scientific evaluation to serve our patients properly and protect the patient-surgeon relationship as the only rationale long-term strategy to avoid ongoing complications.
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Affiliation(s)
- Andrew W. Kirkpatrick
- Regional Trauma Services, Department of Surgery, Critical Care Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, AB T3H 3W8, Canada
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, 56124 Pisa, Italy;
| | - Matti Tolonen
- Emergency Surgery Department, HUS Helsinki University Hospital, 00029 Helsinki, Finland;
| | - Samual Minor
- Department of Surgery and Critical Care Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Fausto Catena
- Head Emergency and General Surgery Department, Bufalini Hospital, 47521 Cesena, Italy; (F.C.); (C.V.)
| | | | - Emanuel Gois
- Department of Surgery, Londrina State University, Londrina 86038-350, Brazil;
| | - Gennaro Perrone
- Department of Emergency Surgery, Parma University Hospital, 43125 Parma, Italy;
| | - Giuseppe Novelli
- Chiurgia Generale e d’Urgenza, Osepedale Buffalini Hospital, 47521 Cesna, Italy;
| | | | - Orestis Ioannidis
- 4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece;
| | - Michael Sugrue
- Letterkenny University Hospital, F92 AE81 Donegal, Ireland;
| | - Belinda De Simone
- Unit of Emergency Minimally Invasive Surgery, Academic Hospital of Villeneuve-Saint-Georges, 91560 Villeneuve-Saint-Georges, France;
| | - Dario Tartaglia
- Emergency and General Surgery Unit, New Santa Chiara Hospital, University of Pisa, 56126 Pisa, Italy;
| | - Hanna Lampella
- Gastrointestinal Surgery Unit, Helsinki University Hospital, Helsinki University, 00100 Helsinki, Finland;
| | - Fernando Ferreira
- GI Surgery and Complex Abdominal Wall Unit, Hospital CUF Porto, Faculty of Medicine of the Oporto University, 4200-319 Porto, Portugal;
| | - Luca Ansaloni
- San Matteo Hospital of Pavia, University of Pavia, 27100 Pavia, Italy;
| | - Neil G. Parry
- Department of Surgery and Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Elif Colak
- Samsun Training and Research Hospital, University of Samsun, 55000 Samsun, Turkey;
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy;
| | - Luigi Noceroni
- Hospital Infermi Rimini, 47923 Rimini, Italy; (G.G.); (L.N.)
| | - Carlo Vallicelli
- Head Emergency and General Surgery Department, Bufalini Hospital, 47521 Cesena, Italy; (F.C.); (C.V.)
| | - Joao Rezende-Netos
- Trauma and Acute Care Surgery, General Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON M5T 1P8, Canada;
| | - Chad G. Ball
- Acute Care, and Hepatobiliary Surgery and Regional Trauma Services, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.G.B.); (J.M.)
| | - Jessica McKee
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, AB T3H 3W8, Canada
| | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO 80204, USA;
| | - Jack Mather
- Acute Care, and Hepatobiliary Surgery and Regional Trauma Services, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.G.B.); (J.M.)
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Bulging after DIEP Breast Reconstruction: New Insights Concerning Rectus Diastasis and Medial Perforator Harvest. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4840. [PMID: 36910724 PMCID: PMC9995098 DOI: 10.1097/gox.0000000000004840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/12/2023] [Indexed: 03/10/2023]
Abstract
The aim of this study was to evaluate the association between flap harvest technique and occurrence of abdominal bulging. Methods A retrospective analysis of 159 patients undergoing DIEP flap breast reconstruction between 2014 and 2021 in the University Medical Center Utrecht was conducted. Outcomes measured were preoperative rectus diastasis, flap weight, laterality of flap harvest (unilateral or bilateral), timing of the harvest (immediate or delayed), number of perforators harvested (single or multiple), and location of the harvested perforator (medial, lateral, or both). Results In 159 patients, 244 DIEP flaps were performed, 16 of these donor-sites (6.6%) developed a clinically evident abdominal bulge. When preoperative rectus abdominis diastasis was found (n = 97), postoperative bulging occurred significantly more often (P < 0.01). Patients in whom the medial perforator artery was harvested for reconstruction (n = 114) showed less abdominal bulging than patients in whom the lateral (n = 92) was harvested (P = 0.02). Using single versus multiple perforators for the DIEP flap, bilateral versus unilateral reconstruction or timing of the operation showed no significant difference in outcome of bulging (P = 1.00, P = 0.78, P = 0.59, respectively). Conclusions The incidence of bulging in our study cohort is comparable to the literature. Harvesting the medial perforator artery for the DIEP flap showed less abdominal bulging than using the lateral perforator artery in a DIEP flap breast reconstruction. Also, preoperative rectus diastasis was found to be an important risk factor for the occurrence of bulging.
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6
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Bueno-Lledó J, Martinez-Hoed J, Bonafe-Diana S, Pous-Serrano S. Mesh Infection After Hernia Repair and Negative Pressure Wound Therapy. A Systematic Review. World J Surg 2023; 47:1495-1502. [PMID: 36802233 DOI: 10.1007/s00268-023-06943-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Surgical mesh infection (SMI) after abdominal wall hernia repair (AWHR) is a challenging and highly debated clinical problem with no current consensus. The purpose of this review was to analyze the literature about the use of negative pressure wound therapy (NPWT) in the management of the conservative treatment of SMI and report results about infected mesh salvage. METHODS A systematic review of EMBASE and PUBMED was performed describing the use of NPWT in patients with SMI following AWHR. Reviewed articles evaluating data about the association between clinical, demographic, analytic and surgical characteristics about SMI after AWHR were analyzed. The high heterogeneity of these studies did not allow a meta-analysis of outcomes. RESULTS The search strategy yielded 33 studies from PubMed, and 16 studies from EMBASE. NPWT was performed in 230 patients across 9 studies being achieved the mesh salvage in 196 (85.2%). Of these 230 cases, 46% were polypropylene (PPL), 9.9% polyester (PE), 16.8% polytetrafluoroethylene (PTFE), 4% biologic and 10.2% composite mesh (PPL and PTFE). Infected mesh location was onlay (43%), retromuscular (22%), preperitoneal (19%), intraperitoneal (10%) and between the oblique muscles (5%). The better option on salvageability with the use of NPWT was the combination of macroporous PPL mesh in an extraperitoneal position (19.2% onlay, 23.3% preperitoneal, 48.8% retromuscular). CONCLUSION NPWT is a sufficient approach to treat SMI following AWHR. In most cases, infected prostheses can be salvaged with this management. Further studies with a larger sample size are needed to confirm our analysis results.
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Affiliation(s)
- Jose Bueno-Lledó
- Unit of Abdominal Wall Surgery. Department of Digestive Surgery, La Fe" Hospital University of Valencia, Calle Gabriel Miró 28, Puerta 12, 46008, Valencia, Spain.
| | | | - Santiago Bonafe-Diana
- Unit of Abdominal Wall Surgery. Department of Digestive Surgery, La Fe" Hospital University of Valencia, Calle Gabriel Miró 28, Puerta 12, 46008, Valencia, Spain
| | - Salvador Pous-Serrano
- Unit of Abdominal Wall Surgery. Department of Digestive Surgery, La Fe" Hospital University of Valencia, Calle Gabriel Miró 28, Puerta 12, 46008, Valencia, Spain
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7
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Slooter CD, Perquin CW, Zwaans WA, Roumen RM, Scheltinga MR, Slooter GD. Laparoscopic mesh removal for chronic postoperative inguinal pain following endoscopic hernia repair: a cohort study on the effect on pain. Hernia 2023; 27:77-84. [PMID: 36445507 DOI: 10.1007/s10029-022-02712-9] [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: 07/26/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Chronic postoperative inguinal pain (CPIP) after pre-peritoneal hernia repair is rare but may be severely invalidating. Mesh may be a contributing factor to the development of CPIP. International guidelines acknowledge mesh removal as a treatment option for CPIP after open repair, but experience in laparoscopic mesh removal is limited. Surgeons are hesitant to remove pre-peritoneal meshes because of fear of operative complications. This observational study describes risks and effectiveness of laparoscopic mesh removal in patients with CPIP after endoscopic inguinal hernia repair. METHODS Questionnaires and operative findings of consecutive patients undergoing a laparoscopic mesh removal for CPIP between August 2014 and February 2019 in the center for groin pain were prospectively recorded. Long-term efficacy was determined using pre and postoperative questionnaires on pain and quality of life. RESULTS Forty-four patients were included (37 males, median age 51 years). Complete or sufficient pain relief was reported in every two out of three patients (68%) and quality of life improved significantly. Intraoperative findings included wrinkled mesh (n = 19), meshoma (n = 14) and infected mesh (n = 1). Surprisingly, over half of the meshes (n = 23) did not fully cover the groin, with three clear recurrent hernias. Intraoperative complications included two bladder injuries. One patient undergoing removal of 3 meshes on one side developed a necrotic testicle. During follow-up, three patients developed a recurrent hernia requiring open surgery. CONCLUSION Laparoscopic mesh removal is safe and effective in selected patients with CPIP after endoscopic hernia repair. We believe that this technique should be adopted by dedicated hernia surgeons.
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Affiliation(s)
- C D Slooter
- Department of Surgery, Máxima Medical Center, Dominee Theodor Fliednerstraat 1, 5631 BM, Eindhoven, The Netherlands.
- Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands.
| | - C W Perquin
- Department of Anesthesiology & Pain and Palliative Care, Máxima Medical Center, Eindhoven, The Netherlands
| | - W A Zwaans
- Department of Surgery, Máxima Medical Center, Dominee Theodor Fliednerstraat 1, 5631 BM, Eindhoven, The Netherlands
| | - R M Roumen
- Department of Surgery, Máxima Medical Center, Dominee Theodor Fliednerstraat 1, 5631 BM, Eindhoven, The Netherlands
- Center of Excellence for Chronic Abdominal Wall and Groin Pain, SolviMáx, Máxima Medical Center, Eindhoven, The Netherlands
| | - M R Scheltinga
- Department of Surgery, Máxima Medical Center, Dominee Theodor Fliednerstraat 1, 5631 BM, Eindhoven, The Netherlands
- Center of Excellence for Chronic Abdominal Wall and Groin Pain, SolviMáx, Máxima Medical Center, Eindhoven, The Netherlands
| | - G D Slooter
- Department of Surgery, Máxima Medical Center, Dominee Theodor Fliednerstraat 1, 5631 BM, Eindhoven, The Netherlands
- Center of Excellence for Chronic Abdominal Wall and Groin Pain, SolviMáx, Máxima Medical Center, Eindhoven, The Netherlands
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8
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Fadaee N, Huynh D, Khanmohammed Z, Mazer L, Capati I, Towfigh S. Patients With Systemic Reaction to Their Hernia Mesh: An Introduction to Mesh Implant Illness. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:10983. [PMID: 38312397 PMCID: PMC10831643 DOI: 10.3389/jaws.2023.10983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2024]
Abstract
In our practice, we have noticed an increased number of patients requiring mesh removal due to a systemic reaction to their implant. We present our experience in diagnosing and treating a subpopulation of patients who require mesh removal due to a possible mesh implant illness (MII). All patients who underwent mesh removal for indication of mesh reaction were captured from a hernia database. Data extraction focused on the patients' predisposing medical conditions, presenting symptoms suggestive of mesh implant illness, types of implants to which reaction occurred, and postoperative outcome after mesh removal. Over almost 7 years, 165 patients had mesh removed. Indication for mesh removal was probable MII in 28 (17%). Most were in females (60%), average age was 46 years, with average pre-operative pain score 5.4/10. All patients underwent complete mesh removal. Sixteen (57%) required tissue repair of their hernia; 4 (14%) had hybrid mesh implanted. Nineteen (68%) had improvement and/or resolution of their MII symptoms within the first month after removal. We present insight into a unique but rising incidence of patients who suffer from systemic reaction following mesh implantation. Predisposing factors include female sex, history of autoimmune disorder, and multiple medical and environmental allergies and sensitivities. Presenting symptoms included spontaneous rashes, erythema and edema over the area of implant, arthralgia, headaches, and chronic fatigue. Long-term follow up after mesh removal confirmed resolution of symptoms after mesh removal. We hope this provides greater attention to patients who present with vague, non-specific but debilitating symptoms after mesh implantation.
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Affiliation(s)
- Negin Fadaee
- California Health Sciences University College of Osteopathic Medicine, Clovis, CA, United States
| | - Desmond Huynh
- Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Zayan Khanmohammed
- Department of Surgery, University of California, Berkeley, Berkeley, CA, United States
| | - Laura Mazer
- Higher Ground Education, Lake Forest, CA, United States
| | - Isabel Capati
- Beverly Hills Hernia Center, Beverly Hills, CA, United States
| | - Shirin Towfigh
- Beverly Hills Hernia Center, Beverly Hills, CA, United States
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9
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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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10
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In Vitro Cytotoxicity, Colonisation by Fibroblasts and Antimicrobial Properties of Surgical Meshes Coated with Bacterial Cellulose. Int J Mol Sci 2022; 23:ijms23094835. [PMID: 35563224 PMCID: PMC9105287 DOI: 10.3390/ijms23094835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
Hernia repairs are the most common abdominal wall elective procedures performed by general surgeons. Hernia-related postoperative infective complications occur with 10% frequency. To counteract the risk of infection emergence, the development of effective, biocompatible and antimicrobial mesh adjuvants is required. Therefore, the aim of our in vitro investigation was to evaluate the suitability of bacterial cellulose (BC) polymer coupled with gentamicin (GM) antibiotic as an absorbent layer of surgical mesh. Our research included the assessment of GM-BC-modified meshes’ cytotoxicity against fibroblasts ATCC CCL-1 and a 60-day duration cell colonisation measurement. The obtained results showed no cytotoxic effect of modified meshes. The quantified fibroblast cells levels resembled a bimodal distribution depending on the time of culturing and the type of mesh applied. The measured GM minimal inhibitory concentration was 0.47 µg/mL. Results obtained in the modified disc-diffusion method showed that GM-BC-modified meshes inhibited bacterial growth more effectively than non-coated meshes. The results of our study indicate that BC-modified hernia meshes, fortified with appropriate antimicrobial, may be applied as effective implants in hernia surgery, preventing risk of infection occurrence and providing a high level of biocompatibility with regard to fibroblast cells.
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11
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Mikamori M, Kinjo A, Nakahara Y, Iwamoto K, Hyuga S, Naito A, Ohtsuka M, Furukawa K, Moon J, Imasato M, Asaoka T, Kishi K, Mizushima T. Laparoscopic mesh removal for mesh infection related to pararectal incision of previous appendectomy after laparoscopic total extraperitoneal inguinal hernia repair: A case report. Asian J Endosc Surg 2022; 15:368-371. [PMID: 34994072 DOI: 10.1111/ases.13006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/08/2021] [Accepted: 10/16/2021] [Indexed: 12/01/2022]
Abstract
A 67-year-old man with a history of appendectomy 40 years ago underwent single-incision laparoscopic surgery for total extraperitoneal inguinal hernia repair. Postoperatively, the pararectal incisional scar obtained from the appendectomy was infected; thus, antibiotic therapy and drainage were performed. However, the infection persisted. After 5 postoperative months, the mesh was laparoscopically removed at a sufficient distance from the infected site. No enterocutaneous fistula was observed. After 1 year and 10 months, no recurrence of hernia or infection was observed. Thus, laparoscopic mesh removal is feasible. Infection of a 40-year-old incision rarely results in mesh infection. Therefore, in pararectal incision, the extent of mesh coverage should be considered; if the overlap is large, changing the technique by not covering the incision may be necessary.
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Affiliation(s)
| | - Ayaka Kinjo
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | | | - Kazuya Iwamoto
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Satoshi Hyuga
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Atsushi Naito
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | | | - Kenta Furukawa
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Jeongho Moon
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | | | | | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
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Williams DF. Biocompatibility pathways and mechanisms for bioactive materials: The bioactivity zone. Bioact Mater 2021; 10:306-322. [PMID: 34901548 PMCID: PMC8636667 DOI: 10.1016/j.bioactmat.2021.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/07/2021] [Indexed: 12/14/2022] Open
Abstract
This essay analyzes the scientific evidence that forms the basis of bioactive materials, covering the fundamental understanding of bioactivity phenomena and correlation with the mechanisms of biocompatibility of biomaterials. This is a detailed assessment of performance in areas such as bone-induction, cell adhesion, immunomodulation, thrombogenicity and antimicrobial behavior. Bioactivity is the modulation of biological activity by characteristics of the interfacial region that incorporates the material surface and the immediate local host tissue. Although the term ‘bioactive material’ is widely used and has a well understood general meaning, it would be useful now to concentrate on this interfacial region, considered as ‘the bioactivity zone’. Bioactivity phenomena are either due to topographical/micromechanical characteristics, or to biologically active species that are presented in the bioactivity zone. Examples of topographical/micromechanical effects are the modulation of the osteoblast – osteoclast balance, nanotopographical regulation of cell adhesion, and bactericidal nanostructures. Regulation of bioactivity by biologically active species include their influence, especially of metal ions, on signaling pathways in bone formation, the role of cell adhesion molecules and bioactive peptides in cell attachment, macrophage polarization by immunoregulatory molecules and antimicrobial peptides. While much experimental data exists to demonstrate the potential of such phenomena, there are considerable barriers to their effective clinical translation. This essay shows that there is solid scientific evidence of the existence of bioactivity mechanisms that are associated with some types of biomaterials, especially when the material is modified in a manner designed to specifically induce that activity.
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Affiliation(s)
- David F Williams
- Wake Forest Institute of Regenerative Medicine, 391 Technology Way. Winston-Salem, North Carolina, 27101, USA
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13
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Mandujano CC, Tchokouani L, Lima DL, Malcher F, Jacob B. Robotic mesh explantation (RoME): a novel approach for patients with chronic pain following hernia repair. Surg Endosc 2021; 36:4862-4868. [PMID: 34724577 DOI: 10.1007/s00464-021-08835-x] [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: 02/22/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Post-herniorrhaphy pain is common with an estimated 8-10% incidence of mesh-related complications, requiring mesh explantation in up to 6% of cases, most commonly after inguinal hernia repairs. Reoperation for mesh explantation poses a surgical challenge due to adhesions, scarring and mesh incorporation to the surrounding tissues. Robotic technology provides a versatile platform for enhanced exposure to tackle these complex cases. We aim to share our experience with a novel robotic approach to address these complex cases. METHODS A descriptive, retrospective analysis of patients undergoing a robotic mesh explantation (RoME) for mesh-related chronic pain, or recurrent ventral hernia by two surgeons between the period of March 2016 and January of 2020. The patients were evaluated for resolution of mesh related abdominal pain as well as early post-operative complications. RoME was performed with concomitant hernia repair in cases of recurrences. RESULTS Twenty-nine patients underwent a robotic mesh explantation (RoME) for mesh-related chronic pain, or recurrent ventral hernia between March 2016 and January of 2020. Nineteen patients (65.5%) had a prior inguinal hernia repair and 10 patients (34.5%) had a prior ventral hernia repair. Indications for mesh removal included chronic pain with or without hernia recurrence. Seventeen patients (58.6%) reported improvement or resolution of pain postoperatively (63% with a prior inguinal hernia repair and 50% of patients with a prior ventral hernia repair). Five patients (17.2%) required mesh reinforcement after explantation. Nineteen patients (65.5%) underwent mesh explantation with primary fascial closure or no mesh reinforcement. The mean follow-up was 36.4 days. The most common postoperative complication was seroma formation (6.8%), with one reported recurrence (3.4%). CONCLUSION Robotic mesh explantation in challenging cases due to the effect of chronic scarring, adhesions and mesh incorporation to the surrounding tissues is safe and provides an advantageous platform for concomitant hernia repair in these complex cases.
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Affiliation(s)
- Cosman Camilo Mandujano
- Department of Surgery, Montefiore Medical Center, 182 East 210th street BSMT, Bronx, NY, 10467, USA.
| | - Loic Tchokouani
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Diego L Lima
- Department of Surgery, Montefiore Medical Center, 182 East 210th street BSMT, Bronx, NY, 10467, USA
| | - Flavio Malcher
- Director Abdominal Wall Reconstruction Program, Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Brian Jacob
- Department of Surgery, Mount Sinai Health System, New York, NY, USA
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Parker BK, Manning S. Postprocedural Gastrointestinal Emergencies. Emerg Med Clin North Am 2021; 39:781-794. [PMID: 34600637 DOI: 10.1016/j.emc.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Postprocedural complications encompass a wide array of conditions that vary in acuity, symptoms, index procedure, and treatment. Continued advancements in diagnostic and therapeutic procedures have led to a significant shift of procedures to the ambulatory setting. This trend is of particular interest to the emergency physician, as patients who develop complications often present to an emergency department for evaluation and treatment. Here the authors examine a high-yield collection of procedures, both ambulatory and inpatient, notable for their frequent utilization and unique complication profiles including common laparoscopic surgical procedures, bariatric surgery, endoscopic procedures, interventional radiology procedures, and hernia repairs with implantable mesh.
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Affiliation(s)
- Brian K Parker
- Department of Emergency Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7736, San Antonio, TX 78229, USA
| | - Sara Manning
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue
- FOB 3rd Floor, Indianapolis, IN 46202, USA.
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Hori T, Yasukawa D. Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty. World J Methodol 2021; 11:160-186. [PMID: 34322367 PMCID: PMC8299909 DOI: 10.5662/wjm.v11.i4.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
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16
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Gachabayov M, Latifi R. Different etiopathogeneses in early-onset and late-onset inguinal hernia mesh infections in a prospectively evaluated cohort. Acta Chir Belg 2021; 121:164-169. [PMID: 31690215 DOI: 10.1080/00015458.2019.1689648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Inguinal hernia mesh infection (IHMI) is a rare but a significant problem. The aim of this study was to determine whether etiopathogeneses of early-onset and late-onset IHMIs differ in terms of the origin of infectious agents, and route of dissemination. PATIENTS AND METHODS This was a retrospective cohort study with prospective data collection of patients operated on from 2013 to 2015. Early-onset IHMI was defined as symptoms developed within one year after the index surgery, whereas late-onset IHMI was defined as infection developed later than a year after the index surgery. Age, gender, ASA score, BMI, time from index surgery, isolated infectious agents and possible pathogeneses were analyzed. RESULTS During the study period, 1438 patients underwent inguinal hernia repair. Sixteen patients (1.1%) had IHMI, of whom nine were early-onset and seven late-onset. The groups were comparable for age (p = .54), gender (p = 1.0), BMI (p = .79), and ASA score (p = 1.0). The most common infectious agent in early-onset IHMI was St. aureus, whereas Enterococci and Enterobacter prevailed in late-onset IHMI. The possible pathogenesis of IHMI in seven patients with early-onset IHMI was primary exogenous infection, whereas in patients with late-onset IHMI the pathogenesis might be hematogenous or contact spread. All patients with IHMI underwent mesh removal. In two patients (one from each group), partial mesh removal was performed previously and IHMI recurred. CONCLUSIONS Early-onset hernia mesh infection is mostly caused by St. aureus through exogenous contamination, whereas its late-onset counterpart might be a result of hematogenous or contact spread of intestinal flora.
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Affiliation(s)
- Mahir Gachabayov
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Rifat Latifi
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Intra-Operative Vascular Injury and Control During Laparoscopic and Robotic Mesh Explantation for Chronic Post Herniorrhaphy Inguinal Pain (CPIP). Surg Technol Int 2021. [PMID: 33878193 DOI: 10.52198/21.sti.38.hr1426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Chronic postherniorrhaphy inguinal pain (CPIP) is common following inguinal hernia repair. As even primary minimally-invasive inguinal hernia repairs carry a risk of significant intra-operative bleeding, it is unsurprising that reoperative groin exploration and mesh explantation for chronic post-inguinal herniorrhaphy pain confers an even higher risk of arteriotomy or venotomy due to a distorted anatomy and the presence of adhesions. In this report, we present a single institution's experience with the management of intra-operative vascular injury encountered during minimally invasive groin exploration and mesh explantation for CPIP. MATERIALS AND METHODS We performed a retrospective consecutive case series study at a single academic center of patients with CPIP who underwent minimally invasive groin exploration and mesh removal during which an iatrogenic arteriotomy or venotomy occurred from September 2015 to September 2020. Descriptive statistics were collected for age, laterality of hernia repair, mean follow-up time, surgical approach (robotic vs. laparoscopic), type of intra-operative vascular injury, vascular control technique, and post-operative complications. RESULTS Of 196 minimally invasive groin exploration and mesh removal cases, 46 were performed with robotic assistance and 150 were performed using traditional laparoscopy. The overall incidence of intra-operative vascular injury was 43 (22%). Fifteen of 46 (32%) robotic groin exploration and mesh removal cases and 28 of 150 (19%) laparoscopic cases involved vascular control. Three of 15 (20%) robotic cases and 23 of 28 (82%) laparoscopic cases involved a hybrid open inguinal approach to address anterior pathology (neurectomy, anterior mesh removal, hernia repair) or facilitate exposure for vascular repair. The most common site of injury was the inferior epigastric vessels. Other sites included the iliac vein, iliac artery, corona mortis, and accessory obturator vessels. Vascular control techniques included ligation with an energy device or suture, primary suture repair of injured vessel, or bovine pericardium patch angioplasty. All were managed without intra-operative vascular surgery intervention except for one case with extensive calcification that required endarterectomy and angioplasty to improve patency. No cases required conversion to midline laparotomy. Ninety three percent of the cases with large vessel bleeding during laparoscopic-assisted procedures were repaired via an open groin incision, whereas all cases of large vessel bleeding during robotic-assisted procedures were repaired robotically. None of the patients required transfusion. Postoperative complications occurred in 3 patients (7%), 2 (5%) developed hematoma formation requiring surgical evacuation, and 1 (2%) developed ipsilateral iliofemoral deep vein thrombosis (DVT) and underwent peripheral angiography and thrombolysis. CONCLUSIONS Although minimally invasive groin exploration and mesh explantation for CPIP is technically challenging, it is a safe and effective operation when performed at experienced centers. Iatrogenic vascular injury should be anticipated but can be effectively controlled laparoscopically, robotically, or via a hybrid open inguinal incision without conversion to a midline laparotomy and with low post-operative complication rates.
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Hagiwara K, Hayashi S, Suzuki T, Song K, Takayama T. Urinary bladder fistula following laparoscopic inguinal hernioplasty: a case report. BMC Surg 2021; 21:183. [PMID: 33827542 PMCID: PMC8028706 DOI: 10.1186/s12893-021-01183-6] [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: 09/05/2020] [Accepted: 03/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Fistula formation due to mesh erosion into hollow viscera, such as the urinary bladder, is uncommon. To date, there have been no reports of fistula formation into the urinary bladder without evidence of mesh erosion after hernioplasty; herein, we report one such rare case, in which the clinical symptoms improved without any surgical intervention. Case presentation A 73-year-old man underwent a trans-abdominal preperitoneal repair for bilateral direct inguinal hernia. One month later, the patient experienced a painful induration in the right inguinal region, and computed tomography revealed fluid collection in this region. A culture of the aspirated fluid yielded no bacteria. Seven months later, he experienced another episode of painful induration in the same region. However, blood examination revealed a normal white blood cell count and C-reactive protein level. Moreover, no organisms were detected by aspirated fluid culture. Although the painful induration subsided after aspiration of the fluid collection, he developed gross hematuria and dysuria a month later. Cystoscopy revealed a fistula in the right wall of the urinary bladder that discharged a purulent fluid. Culture of the fluid revealed no bacteria, and there was no evidence of mesh erosion. Hematuria improved without therapeutic or surgical intervention. The patient’s clinical symptoms improved without mesh removal. Moreover, cystoscopy revealed that the fistula was scarred 12 months after the initial appearance of urinary symptoms. No further complications were observed during a 42-month follow-up period. Conclusions We report a rare case of a fistula in the urinary bladder without evidence of mesh erosion after laparoscopic hernioplasty. The patient’s condition improved without mesh removal. Fluid collection due to foreign body reaction to meshes can cause fistula formation in the urinary bladder without direct mesh contact.
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Affiliation(s)
- Ken Hagiwara
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
| | - Shigeoki Hayashi
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Takeki Suzuki
- Department of Surgery, Toride Medical Association Hospital, Ibaraki, Japan
| | - Keio Song
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
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Dipp Ramos R, O'Brien WJ, Gupta K, Itani KMF. Incidence and Risk Factors for Long-Term Mesh Explantation Due to Infection in More than 100,000 Hernia Operation Patients. J Am Coll Surg 2021; 232:872-880.e2. [PMID: 33601005 DOI: 10.1016/j.jamcollsurg.2020.12.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infectious complications after hernia operation are potentially disastrous, often requiring long-term antibiotic administration, debridement, and mesh explantation. Our objective was to describe the long-term incidence and risk factors for synthetic mesh explantation due to infection after hernia operation in a large cohort. STUDY DESIGN Retrospective database study using Veterans Affairs Surgical Quality Improvement Program and chart review of veterans undergoing abdominal or groin hernia repair with synthetic mesh implantation during 2008-2015. The main outcome was mesh explantation due to infection within 5 years. RESULTS The study population consisted of 103,869 hernia operations, of which 74.3% were inguinal, 10.7% umbilical, and 15.0% ventral. Explantation incidence was highest among ventral (1.5%). Median explantation interval overall was 208 days. In multivariable logistic regression, all obesity levels from pre-obesity to obesity class III were associated with higher explantation risk. American Society of Anesthesiology physical status classification of 3 to 5 was associated with odds ratio (OR) of 1.7 (95% CI, 1.28 to 2.26), as was longer operative duration (OR 1.83; 95% CI, 1.51 to 2.21), and contaminated or dirty surgical wound classification (OR 2.27; 95% CI, 1.11 to 4.64). Umbilical repair (OR 6.11; 95% CI, 4.14 to 9.02) and ventral repair (OR 14.35; 95% CI, 10.39 to 19.82) were associated with higher risk compared with inguinal. Open repair was associated with a higher risk compared with laparoscopic (OR 3.57; 95% CI, 2.52 to 5.05). Deep incisional surgical site infection within 30 days of operation was more likely to result in long-term mesh explantation (29.2%) than either superficial (6.4%) or organ space infection (22.4%). CONCLUSIONS Mesh explantation for infection is most common after ventral hernia repair. Risk factor optimization is crucial to minimize such an end point.
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Affiliation(s)
| | - William J O'Brien
- Department of Surgery, Boston, MA; Center for Organization and Implementation Research, Boston, MA
| | | | - Kamal M F Itani
- Department of Surgery, Boston, MA; Veterans Affairs Boston, Department of Surgery, Boston University, Boston, MA; Harvard Medical School, Boston, MA.
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Shin CS, Cabrera FJ, Lee R, Kim J, Ammassam Veettil R, Zaheer M, Adumbumkulath A, Mhatre K, Ajayan PM, Curley SA, Scott BG, Acharya G. 3D-Bioprinted Inflammation Modulating Polymer Scaffolds for Soft Tissue Repair. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2003778. [PMID: 33325594 DOI: 10.1002/adma.202003778] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/14/2020] [Indexed: 06/12/2023]
Abstract
Development of inflammation modulating polymer scaffolds for soft tissue repair with minimal postsurgical complications is a compelling clinical need. However, the current standard of care soft tissue repair meshes for hernia repair is highly inflammatory and initiates a dysregulated inflammatory process causing visceral adhesions and postsurgical complications. Herein, the development of an inflammation modulating biomaterial scaffold (bioscaffold) for soft tissue repair is presented. The bioscaffold design is based on the idea that, if the excess proinflammatory cytokines are sequestered from the site of injury by the surgical implantation of a bioscaffold, the inflammatory response can be modulated, and the visceral adhesion formations and postsurgical complications can be minimized. The bioscaffold is fabricated by 3D-bioprinting of an in situ phosphate crosslinked poly(vinyl alcohol) polymer. In vivo efficacy of the bioscaffold is evaluated in a rat ventral hernia model. In vivo proinflammatory cytokine expression analysis and histopathological analysis of the tissues have confirmed that the bioscaffold acts as an inflammation trap and captures the proinflammatory cytokines secreted at the implant site and effectively modulates the local inflammation without the need for exogenous anti-inflammatory agents. The bioscaffold is very effective in inhibiting visceral adhesions formation and minimizing postsurgical complications.
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Affiliation(s)
- Crystal S Shin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Fernando J Cabrera
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Richard Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - John Kim
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Remya Ammassam Veettil
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Mahira Zaheer
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Aparna Adumbumkulath
- Department of Materials Science and Nanoengineering, Rice University, Houston, TX, 77030, USA
| | - Kirti Mhatre
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Pulickel M Ajayan
- Department of Materials Science and Nanoengineering, Rice University, Houston, TX, 77030, USA
| | - Steven A Curley
- Oncology Institute, Christus Health Institute, 910 East Houston St., Suite 270, Tyler, TX, 75702, USA
| | - Bradford G Scott
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ghanashyam Acharya
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
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Bueno-Lledó J, Ceno M, Pérez-Alonso C, Martinez-Hoed J, Pous-Serrano S. Abdominal wall reconstruction with biosynthetic absorbable mesh after infected prosthesis explantation: single stage is better than two-stage approach of chronic mesh infection. Hernia 2020; 25:1005-1012. [PMID: 33001317 DOI: 10.1007/s10029-020-02309-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the efficacy of surgical management of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in single-stage approach (complete removal of infected prosthesis and simultaneous replacement with poly-4-hydroxybutyrate mesh or BAM group), comparing results with two-stage treatment (complete mesh excision and abdominal wall repair with synthetic mesh after several months or SPM group). METHODS Retrospective comparative study of all patients who underwent surgery for CMI between January 2006 and January 2019 at a tertiary center. We compared results in terms of epidemiological data, hernia and prosthesis characteristics, surgical and postoperative variables of both two groups. RESULTS Over the 13-year study period, 2791 AWHR was performed at our hospital; the overall CMI rate was 2.5%. Of 71 patients, 30 (42.2%) were in BAM group and 41 (57.8%) in SPM group. The median cumulative operative time (252 min versus 132 min) and length of stay (16.6 days versus 6.2 days) were significatively longer in SPM group compared with BAM group, due to the need of two surgical procedures. There were a higher number of postoperative complications in SPM group (p = 0.002), some of them grade III. With mean follow-up of 36.5 months (range 21-59), there were no significant differences in terms of overall hernia recurrence and mesh reinfection in both groups. CONCLUSION The use of a poly-4-hydroxybutyrate resorbable mesh in single-stage management of CMI may be a safe and better option than two-stage approach, although more studies are needed to confirm our results.
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Affiliation(s)
- J Bueno-Lledó
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain.
| | - M Ceno
- Klinikum Mittelbaden, Balger Strasse 50, 76530, Baden-Baden, Germany
| | - C Pérez-Alonso
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
| | - J Martinez-Hoed
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
| | - S Pous-Serrano
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
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22
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Petersen K, Morrison J, Oprea V, Grischkan D, Koch A, Lorenz R, Bendavid R, Iakovlev V. Necessary duration of follow-up to assess complications of mesh in hernia surgery: a time-lapse study based on 460 explants. Hernia 2020; 25:1239-1251. [PMID: 32960368 DOI: 10.1007/s10029-020-02297-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Risk of complications following hernia repair is the key parameter to assess risk/benefit ratio of a technique. As mesh devices are permanent, their risks are life-long. Too many reports in the past assessed mesh safety prematurely after short follow-ups. We aimed to explore what length of follow up would reveal the full extent of complications. METHODS Time lapses between implantation and excision were analyzed in 460 cases of meshes excised for complications after hernia repair. Patterns of percentage growth and time lapses at 50th and 95th percentiles were used to compare groups of different hernia type, age, gender and reason for excision. RESULTS The 50th and 95th case percentiles in the dataset were at 3.75 and 15.0 years between mesh implantation and excision. For hernia types, the longest time lapses were for groin hernias (4.0 and 16.11 years at 50th and 95th percentiles). The shortest were for umbilical hernias (2.16 and 9.68 years). Males had later excisions than females (4.11 and 16.1 vs. 2.47 and 9.79 years). Younger patients (< 45 y.o.) had later excisions than older patients (4.12 and 17.68 vs. 3.37 and 10.0 years). Out of all subgroups, the longest time lapses were for groin hernias in younger males (4.77 and 18.89 years) and for mesh erosion into organs (4.67 and 17.0 years). CONCLUSIONS Follow-up of more than 15 years is needed to fully assess complications after mesh hernia repair. Especially longer periods are needed to detect mesh erosion into organs and complications in younger males. Presently, short observations and lack of reporting standard in the literature prohibit accurate assessment of complication risks. We propose to use cumulative incidence for standardized risk reporting (y% risk at x years). This will show time-dependent patterns and allow comparisons between different techniques and studies of variable duration. Standardization will also help to predict long-term risks beyond shorter (practical) follow-ups and facilitate real-time monitoring during surveillance.
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Affiliation(s)
| | - J Morrison
- Chatham Kent Health Alliance, Chatham, Ontario, Canada
| | - V Oprea
- Military Hospital of Cluj, Cluj-Napoca, Romania, Romania
| | | | - A Koch
- Day Surgery and Hernia Center, Cottbus, Germany
| | - R Lorenz
- , Hernia Center 3+CHIRURGEN, Berlin, Germany
| | - R Bendavid
- Department of Surgery, Shouldice Hospital, Thornhill, University of Toronto, Toronto, ON, Canada
| | - V Iakovlev
- Department of Laboratory Medicine, St. Michael's Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
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23
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Yasukawa D, Aisu Y, Hori T. Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults. World J Gastrointest Surg 2020; 12:307-325. [PMID: 32821340 PMCID: PMC7407845 DOI: 10.4240/wjgs.v12.i7.307] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.
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Affiliation(s)
- Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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Re-do surgery after prosthetic abdominal wall repair: intraoperative findings of mesh-related complications. Hernia 2020; 25:435-440. [PMID: 32495044 DOI: 10.1007/s10029-020-02225-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mesh repair is one of the most popular technique for the treatment of abdominal wall hernias, resulting in lower recurrence rates. However, it is associated with a high risk of mesh-related complications. The aim of the present study is to assess the impact of biomaterials on the intra-abdominal organs, in terms of adhesions and visceral complications, in a series of patients undergoing re-do surgery at our abdominal wall unit. MATERIALS AND METHODS We reviewed the clinical records of 301 patients who undergone laparotomy between June 2008 and May 2018, selecting 67 patients with one or more previous prosthetic abdominal wall repair (AWR). RESULTS The average number of previous repairs was 1.6 with a mean time interval of 66 months from the last repair. Clinical presentation included hernia recurrence (69%), mesh infection (26%), infection and recurrence (10%), and fistula (1%). Adhesions were intraoperatively observed in all patients, except for eight cases. Mesh was completely removed in 43 patients, partially in four. Postoperative complications were observed in 39% of cases, including wound dehiscence, hematoma, seroma, and mesh infection. CONCLUSIONS Long-term implant results in abdominal wall repair and are not completely known, and literature is still lacking on this topic. Re-do surgery for subsequent pathological events may represent a way to increase our knowledge.
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The influence of mesh removal during laparoscopic repair of recurrent ventral hernias on the long-term outcome. Wideochir Inne Tech Maloinwazyjne 2019; 14:366-373. [PMID: 31534565 PMCID: PMC6748057 DOI: 10.5114/wiitm.2019.85350] [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: 04/16/2019] [Accepted: 05/06/2019] [Indexed: 01/29/2023] Open
Abstract
Introduction Recurrent hernias can be treated by laparoscopy without the need for mesh removal. However, shrinkage of the mesh following recurrence affects most of the patients, and leaving a partially floating and rigid foreign body could be discussed. Aim To compare the outcomes of patients regarding the removal of previous mesh during laparoscopic repair of recurrent abdominal wall hernias. Material and methods Patients who underwent laparoscopic repair for recurrent ventral hernias between August 2012 and March 2015 were included in the study. The patients with complete removal of the mesh were included in the MR group and the patients with partial removal or without removal of the previous mesh were included in the non-MR group. Patient characteristics and demographics, previous hernia repair, defect size, mesh size, operative time, mean hospital stay, complications, recurrences, numeric pain rating scale (NRS), early termination of analgesics and prolonged use of analgesics were compared. Results A total of 112 patients with a mean age of 53.2 and mean body mass index of 31.1 kg/m2 underwent laparoscopic repair. There were 47 patients in the MR group and 54 patients in the non-MR group. Operative time was shorter in the non-MR group (p < 0.05), whereas symptomatic seroma and NRS scores on postoperative day 10 and at the 6th week were higher in comparison with the MR group (p < 0.05). Conclusions Mesh removal during laparoscopic repair of recurrent ventral hernias has an association with the reduction of pain and symptomatic seroma. However, further prospective comparative studies are required to verify this view.
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Mesh erosion into urinary bladder, rare condition but important to know. Hernia 2019; 23:709-716. [PMID: 31073962 DOI: 10.1007/s10029-019-01966-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although rare, mesh migration or erosion into viscera has been reported as case report, and most of the cases involved with the urinary bladder. With the increasing use of prosthetic mesh in hernia repair, this severe complication would increase in the future; thus, we feel that it is necessary to analyze the clinical patterns of mesh erosion into the urinary bladder, and to discuss the prevention and treatment of this severe complication. METHOD In the present study, we made a thorough identification of all published reports on mesh migration or erosion into the urinary bladder, and the data were summarized, analysed, and discussed. RESULTS A total of 23 cases of mesh erosion into urinary bladder were reported since 1994. Among them, two cases were from incisional hernia repairs, and 21 cases were following inguinal hernia repairs. The most frequently reported procedures were TAPP, followed by TEP. The duration from initial hernia repair to the onset of mesh erosion into bladder varied greatly (3 months-20 years), and most of cases occurred in 1-5 years after the initial hernia repair (10/23, 43.5%), while a certain number of cases occurred 10 years after hernia repair (6/23, 26.1%). Most of these cases were treated with mesh removal via a open procedure (12/22, 54.5%), and in 7 cases (7/22, 31.8%), the partial cystectomy was performed as well as mesh removal. Laparoscopic or robotic treatment procedures were performed in three cases. CONCLUSION Mesh erosion into the urinary bladder can occur after both open and laparoscopic inguinal hernia repairs in a wide range of duration. This complication most frequently happened following laparoscopic inguinal hernia repair. It was usually treated with partial or complete mesh removal, with or without partial cystectomy. A registry system is necessary for monitoring this complication.
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Fadaee N, Mazer L, Sharma R, Capati I, Balzer B, Towfigh S. Clinical Value of Hernia Mesh Pathology Evaluation. J Am Coll Surg 2019; 228:776-781. [DOI: 10.1016/j.jamcollsurg.2019.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
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