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Kocgozlu L, Mutschler A, Tallet L, Calligaro C, Knopf-Marques H, Lebaudy E, Mathieu E, Rabineau M, Gribova V, Senger B, Vrana NE, Lavalle P. Cationic homopolypeptides: A versatile tool to design multifunctional antimicrobial nanocoatings. Mater Today Bio 2024; 28:101168. [PMID: 39221202 PMCID: PMC11364137 DOI: 10.1016/j.mtbio.2024.101168] [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: 03/26/2024] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 09/04/2024] Open
Abstract
Postoperative infections are the most common complications faced by surgeons after implant surgery. To address this issue, an emerging and promising approach is to develop antimicrobial coatings using antibiotic substitutes. We investigated the use of polycationic homopolypeptides in a layer-by-layer coating combined with hyaluronic acid (HA) to produce an effective antimicrobial shield. The three peptide-based polycations used to make the coatings, poly(l-arginine) (PAR), poly(l-lysine), and poly(l-ornithine), provided an efficient antibacterial barrier by a contact-killing mechanism against Gram-positive, Gram-negative, and antibiotic-resistant bacteria. Moreover, this activity was higher for homopolypeptides containing 30 amino-acid residues per polycation chain, emphasizing the impact of the polycation chain length and its mobility in the coatings to deploy its contact-killing antimicrobial properties. However, the PAR-containing coating emerged as the best candidate among the three selected polycations, as it promoted cell adhesion and epithelial monolayer formation. It also stimulated nitric oxide production in endothelial cells, thereby facilitating angiogenesis and subsequent tissue regeneration. More interestingly, bacteria did not develop a resistance to PAR and (PAR/HA) also inhibited the proliferation of eukaryotic pathogens, such as yeasts. Furthermore, in vivo investigations on a (PAR/HA)-coated hernia mesh implanted on a rabbit model confirmed that the coating had antibacterial properties without causing chronic inflammation. These impressive synergistic activities highlight the strong potential of PAR/HA coatings as a key tool in combating bacteria, including those resistant to conventional antibiotics and associated to medical devices.
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Affiliation(s)
- Leyla Kocgozlu
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Angela Mutschler
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Lorène Tallet
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | | | - Helena Knopf-Marques
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Eloïse Lebaudy
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Eric Mathieu
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Morgane Rabineau
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Varvara Gribova
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Bernard Senger
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | | | - Philippe Lavalle
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
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Jia L, Zhao H, Liu J. Meta-analysis of postoperative incision infection risk factors in colorectal cancer surgery. Front Surg 2024; 11:1415357. [PMID: 39193402 PMCID: PMC11347452 DOI: 10.3389/fsurg.2024.1415357] [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: 04/10/2024] [Accepted: 07/09/2024] [Indexed: 08/29/2024] Open
Abstract
Objective To evaluate the risk factors for postoperative incision infection in colorectal cancer, this meta-analysis aimed to identify key variables impacting infection incidence following colorectal cancer surgery. Methods Utilizing a meta-analytical approach, studies published from January 2015 to December 2022 were systematically collected and analyzed through the assessment of factors like body mass index, diabetes, albumin levels, malnutrition, and surgical duration. Results The meta-analysis of eleven high-quality studies revealed that elevated BMI, diabetes, low albumin levels, malnutrition, and extended surgical duration were associated with increased infection risk, while laparoscopic procedures showed potential for risk reduction. Conclusions This study underscores the significance of preoperative risk assessment and management in mitigating postoperative incision infections in colorectal cancer patients. The findings present actionable insights for clinicians to enhance patient prognoses and overall quality of life.
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Affiliation(s)
- Li Jia
- Department of Infection Control, People's Hospital of Dayi County, Chengdu, Sichuan Province, China
| | - Huacai Zhao
- Department of Urology, People's Hospital of Dayi County, Chengdu, Sichuan Province, China
| | - Jia Liu
- Department of Infection Control, Chengdu Fifth People’s Hospital, Chengdu, Sichuan Province, China
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Jiang X, Sun R, Huang W, Yao J. Prospective comparison of two surgical approaches for incarcerated and strangulated inguinal hernia: preperitoneal hernioplasty through the lower abdominal median incision and laparoscope (TAPP). Updates Surg 2024:10.1007/s13304-024-01944-x. [PMID: 39014056 DOI: 10.1007/s13304-024-01944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
The optimal surgical approach of incarcerated and strangulated inguinal hernia is controversial. Retrospective studies showed that surgical approaches through lower abdominal median incision or laparoscopic are superior to the oblique inguinal incision, respectively. Whether transabdominal laparoscopic approach is superior to the lower abdominal median incision approach needs prospective research.Prospective comparative study of patients with incarcerated and strangulated groin hernia admitted to Jinshan hospital for emergency surgery from January 2018 to June 2022. They were divided into two groups according to different surgical approach. The open preperitoneal repair group (OPR) was operated through the lower abdominal median incision. Laparoscopic preperitoneal repair group (TAPP) was completed under transabdominal laparoscope. The perioperative complications and long-term results of the two groups were compared and analyzed. Eighty-two patients met the inclusion criteria, 40 in OPR group and 42 in TAPP group. Baseline data of the two groups were comparable. Thirteen cases (15.9%) of the two groups underwent intestinal resection and anastomosis. Seventy cases (90.2%) underwent the 1st stage mesh repair, including 5 cases of preperitoneal hernioplasty after intestinal resection. The average operation time of TAPP group was 13 min longer (60.7 ± 13.7 min vs 47.8 ± 19.8 min P < 0.001), and the visual analogue scale pain score at 24 h after operation was lower (3.5 ± 1.2 vs 4.4 ± 1.7 P = 0.019) than that of OPR group. There was 1 case of bladder injury (2.5%) in OPR group and 1 case of inferior abdominal artery injury (2.4%) in TAPP group. There was no difference in the rate of the 1st stage hernioplasty between the two groups. In OPR group, 2 cases (5%) extended the incision for more than 2 cm, while in TAPP group, 1 case (2.4%) converted to laparotomy. The time of hospital stay (3.2 ± 1.8 d vs 4.3 ± 2.7 d, P = 0.036) and return to normal activities (7.9 ± 2.7 d vs 11.0 ± 4.4 d, P < 0.001) were shorter in TAPP group. The rate of total postoperative complications including chronic pain, surgical-site infection, seroma, hernia recurrence and so on was 11.9% in TAPP group, which was not significantly different from 25% in OPR group (P = 0.212). There were no cases of mesh related infection and death within 30 days in both groups.TAPP is safe and feasible for the operation of acute incarcerated inguinal hernia. TAPP had better comfort and faster recovery over open preperitoneal repair for the appropriate patients with incarcerated/strangulated inguinal hernia, which can reduce acute pain, shorten hospital stay and return to normal activities earlier.
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Affiliation(s)
- Xiaoming Jiang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
| | - Rongxun Sun
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Wenhai Huang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Junliang Yao
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
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Yu T, Fang Z, Zhou Y, Liu C. Formation of an appendiceal fistula following tension-free inguinal hernia repair: A case report. Asian J Surg 2024:S1015-9584(24)01381-2. [PMID: 38991932 DOI: 10.1016/j.asjsur.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/04/2024] [Indexed: 07/13/2024] Open
Affiliation(s)
- Tianqi Yu
- Department of General Surgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhihao Fang
- Department of General Surgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yongxu Zhou
- Department of General Surgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chang Liu
- Department of General Surgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
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Hsieh TY, Lin HY, Huang KH. Non-mesh inguinal hernia repair with early resumption of peritoneal dialysis in patients on continuous ambulatory peritoneal dialysis. Hernia 2024; 28:615-620. [PMID: 38374213 DOI: 10.1007/s10029-024-02960-x] [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: 10/17/2023] [Accepted: 01/05/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Inguinal hernia is a common complication of peritoneal dialysis (PD). Although tension-free mesh repair is a leading option for inguinal hernia repair, concerns over serious mesh-related complications may indicate a role for non-mesh inguinal hernia repair. In addition, there is no consensus on the perioperative dialysis regimen. Early resumption of PD may avoid the additional risks associated with hemodialysis. We report on the outcomes of non-mesh inguinal hernia repair in patients on continuous ambulatory PD (CAPD) and provide a perioperative dialysis protocol that aims to guide early resumption of PD. METHODS Between May 2019 and September 2023, thirty CAPD patients with 43 inguinal hernias who underwent non-mesh inguinal hernia repair were retrospectively analyzed. Data on the patient characteristics, perioperative dialysis regimen, perioperative features, complications, and hernia recurrence were collected and assessed. RESULTS Thirty patients with a total of 43 inguinal hernia repairs were included in this study. The median age was 53 years. 23 patients were male and 7 were female. Non-mesh inguinal repair was performed for all patients. PD was resumed at a median of 2 days after the surgery. Five patients received interim hemodialysis. There were no postoperative surgical or uremic complications and no recurrence after a median follow-up of 31.5 months. CONCLUSION Our study demonstrates the effectiveness and safety of non-mesh repair with early resumption of PD in patients on CAPD. Interim HD is unnecessary in selected patients. Choosing the optimal perioperative dialysis regimen is essential to managing inguinal hernias in CAPD patients.
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Affiliation(s)
- Tsung-Yi Hsieh
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Ying Lin
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
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Zarbaliyev E, Turhan N, Dündar F, Sevmiş M, Çelik S, Çağlikülekçi M. The Relationship Between Small Peritoneal Flap Defects and Postoperative Seroma in TAPP Repair of Inguinal Hernias. Surg Laparosc Endosc Percutan Tech 2023; 33:493-498. [PMID: 37796240 DOI: 10.1097/sle.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Total abdominal preperitoneal (TAPP) is one of the most frequently used surgical treatment methods in the treatment of inguinal hernia (IH). One of the most common early postoperative complications after hernia repair is seroma/hematoma. In this study, we aimed to study the role of unclosed peritoneal flap defects on the development of postoperative seroma. MATERIAL AND METHODS The study was performed retrospectively in 2 university hospitals. All patients over the age of 18 years who underwent laparoscopic TAPP surgery in Istanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital General Surgery Clinic and Van Yüzüncü Yıl University Faculty of Medicine General Surgery Clinic between January 1, 2018, and December 31, 2021, were included. Patients were divided into those with peritoneal defects (group 1) and those without (group 2). Whether there was a peritoneal defect or not was compiled from video recordings. In addition, risk factors affecting the development of seroma were determined. RESULTS A total of 250 patients, 16 (6.4%) women and 234 (93.6%) men, were included in the study. There were bilateral hernias in 35 (14%) patients, and a total of 320 hernias were analyzed in the study. It was determined that an American Society of Anaesthesiologists (ASA) III score increased the risk of seroma 15.97 fold (P<0.001, 95% CI, 4.94 to 51.56), direct hernia type increased risk 7.1 fold (P<0.03, 95% CI, 1.204 to 42.422), hernia descending into scrotum increased risk 22.48 fold (P<0.001, 95% CI, 6.66 to 75.84) and closure of the peritoneal flap completely without leaving any defect increased the risk of seroma 8.67 fold (P<0.001, 95% CI, 3.254 to 23.115). CONCLUSIONS The presence or leaving of small-diameter defects on the peritoneal flap may reduce seroma development without increasing the risk of complications. Prospective randomized studies are required to reach definitive conclusions.
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Affiliation(s)
- Elbrus Zarbaliyev
- Department of General Surgery, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyil University
| | - Nihan Turhan
- Department of General Surgery, Martyr Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, İstanbul
| | - Faruk Dündar
- Department of General Surgery, Faculty of Medicine, Van Yüzüncü Yil University, Van, Turkey
| | - Murat Sevmiş
- Department of General Surgery, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyil University
| | - Sebahattain Çelik
- Department of General Surgery, Faculty of Medicine, Van Yüzüncü Yil University, Van, Turkey
| | - Mehmet Çağlikülekçi
- Department of General Surgery, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyil University
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Goullieux M, Abo-Alhassan F, Vieira-Da-Silva R, Lauranne P, Guiraud A, Ortega-Deballon P. Primary Ventral Hernia Repair and the Risk of Postoperative Small Bowel Obstruction: Intra Versus Extraperitoneal Mesh. J Clin Med 2023; 12:5341. [PMID: 37629383 PMCID: PMC10455485 DOI: 10.3390/jcm12165341] [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: 06/13/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE The aim of this study was to compare the likelihood of bowel obstruction according to the placement of the mesh (either intraperitoneal or extraperitoneal) in ventral hernia repairs. MATERIALS AND METHODS Patients were divided into two groups, an intraperitoneal (IP) group (mesh placed by laparoscopy or with an open approach) and an extraperitoneal (EP) group, all operated on in the Digestive Surgery Department at the Dijon University Hospital. The primary outcome was the occurrence of an episode of bowel obstruction requiring hospitalization and confirmed by abdominal CT scan. RESULTS Between March 2008 and July 2021, 318 patients were included, with 99 patients in the EP group (71 meshes placed preperitoneally and 28 placed retromuscularly) and 219 patients in the IP group (175 patients operated on laparoscopically versus 44 patients by direct approach). Three patients presented an episode of acute intestinal obstruction, with no difference between the two groups (p = 0.245), although all bowel obstructions occurred in the IP group and with the laparoscopic approach (1.7% of patients operated on by laparoscopy). The occlusive events occurred at 1 month, 2 years, and 3 years. There was no difference in terms of recurrence or postoperative chronic pain. There were more seroma and mesh infections in the EP group (p < 0.05). Two patients operated on by laparoscopy had undetected bowel injuries, prompting emergent surgery for peritonitis. CONCLUSIONS No statistically significant difference was found in terms of bowel obstruction between the intraperitoneal and the extraperitoneal position, but all cases of obstruction happened in the intraperitoneal mesh group. Visceral lesions remain a major complication of the laparoscopic approach that should not be neglected.
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Affiliation(s)
| | - Fawaz Abo-Alhassan
- Department of Digestive Surgery, University Hospital of Dijon, 14 Rue Paul Gaffarel, 21000 Dijon, France
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Philipp M, Leuchter M, Lorenz R, Grambow E, Schafmayer C, Wiessner R. Quality of Life after Desarda Technique for Inguinal Hernia Repair-A Comparative Retrospective Multicenter Study of 120 Patients. J Clin Med 2023; 12:jcm12031001. [PMID: 36769652 PMCID: PMC9917682 DOI: 10.3390/jcm12031001] [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: 12/02/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Inguinal hernia repair, according to Desarda, is a pure tissue surgical technique using external oblique fascia to reinforce the posterior wall of the inguinal canal. This has provided an impetus for the rethinking of guideline adherence toward minimally invasive and mesh-based surgery of inguinal hernia. In this study, a retrospective analysis of this technique was conducted in two German hospitals. Between 6/2013 and 12/2020, 120 operations were performed. Analysis included patient characteristics, duration of operation, length of hospital stay, and perioperative complications. Data were used to achieve a matched-pair analysis comparing Desarda to laparoscopic transabdominal preperitoneal (TAPP) hernia repair. Propensity scores were calculated based on five preoperative variables, including sex, age, American Society of Anesthesiology classification, localization, and width of the inguinal hernia in order to achieve comparability. Additionally, we assessed pain level and quality of life (QoL) 12 months postoperatively. The focus of our study was a comparison of QoL to a reference population and TAPP cohort. The study population consisted of 106 male and 14 female patients, and the median age was 37.5 years. The median operation time was 50 min, and the median length of hospital stay was 2 days. At a follow-up of 17 months, the median recurrence rate was 0.8%, and two cases of chronic postoperative pain were recorded. Postoperative QoL does not significantly differ between Desarda and TAPP. In contrast, Desarda patients had a significantly higher QoL compared with the reference population. In summary, Desarda's procedure is a good option as a pure tissue method for inguinal hernia repair.
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Affiliation(s)
- Mark Philipp
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Correspondence:
| | - Matthias Leuchter
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Institute for Implant Technology and Biomaterials-IIB E.V, Associated Institute of the University of Rostock, 18119 Warnemuende, Germany
| | - Ralph Lorenz
- 3+ Chirurgen, Berlin-Spandau, 13581 Berlin, Germany
| | - Eberhard Grambow
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany
| | - Clemens Schafmayer
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany
| | - Reiko Wiessner
- Department of General and Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, 18311 Ribnitz-Damgarten, Germany
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Soon CY, Siow SL. Mesh erosion into skin following laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. BMJ Case Rep 2023; 16:e254011. [PMID: 36596626 DOI: 10.1136/bcr-2022-254011] [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] [Indexed: 01/05/2023] Open
Abstract
With increasing utilisation of meshes in inguinal hernia repair, reports of mesh-related complications are emerging, particularly late visceral complications, with mesh migration and erosion into the small bowel, bladder and colon reported after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. We present a case of spontaneous mesh migration through the superficial inguinal ring with skin erosion following TEP inguinal hernia repair, the first published report in the literature to our knowledge. This case highlights the difficulty in diagnosis due to the long latent period of hernia repair and the onset of erosion. A high index of suspicion is required when diagnosing any patient who presents with an unexplained groin abscess following ipsilateral TEP repair. CT scan should be performed early for diagnosis and assessment. Removal of the migrated portion of the mesh, antibiotic therapy and secondary wound closure are strategies for the successful treatment of this complication.
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Affiliation(s)
- Chen Ying Soon
- Department of General Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Sze Li Siow
- Department of General Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia
- Taylor's University School of Medicine, Subang Jaya, Selangor Darul Ehsan, Malaysia
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
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Techapongsatorn S, Tansawet A, Pattanaprateep O, Attia J, Mckay GJ, Thakkinstian A. Cost-effectiveness analysis of mesh fixation techniques for laparoscopic and open inguinal hernia surgeries. BMC Health Serv Res 2022; 22:1125. [PMID: 36068521 PMCID: PMC9450344 DOI: 10.1186/s12913-022-08491-4] [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: 03/19/2022] [Accepted: 08/26/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose This study reports economic evaluation of mesh fixation in open and laparoscopic hernia repair from a prospective real-world cohort study, using cost-effectiveness analysis (CEA) and cost-utility analysis (CUA). Methods A prospective real-world cohort study was conducted in two university-based hospitals in Thailand from November 2018 to 2019. Patient data on hernia features, operative approaches, clinical outcomes, associated cost data, and quality of life were collected. Models were used to determine each group’s treatment effect, potential outcome means, and average treatment effects. An incremental cost-effectiveness ratio was used to evaluate the incremental risk of hernia recurrences. Results The 261 patients in this study were divided into six groups: laparoscopic with tack (LT, n = 47), glue (LG, n = 26), and self-gripping mesh (LSG, n = 30), and open with suture (OS, n = 117), glue (OG, n = 18), and self-gripping mesh (OSG, n = 23). Hernia recurrence was most common in LSG. The mean utility score was highest in OG and OSG (both 0.99). Treatment costs were generally higher for laparoscopic than open procedures. The cost-effectiveness plane for utility and hernia recurrence identified LSG as least cost effective. Cost-effectiveness acceptability curves identified OG as having the highest probability of being cost effective at willingness to pay levels between $0 and $3,300, followed by OSG. Conclusion Given the similarity of hernia recurrence among all major procedures, the cost of surgery may impact the decision. According to our findings, open hernia repair with adhesive or self-gripping mesh appears most cost-effective. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08491-4.
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Affiliation(s)
- Suphakarn Techapongsatorn
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Amarit Tansawet
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - John Attia
- School of Medicine and Public Health, and Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
| | - Gareth J Mckay
- Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Cao C, Shi X, Jin W, Luan F. Clinical Data Analysis for Treatment of Adult Inguinal Hernia by TAPP or TEP. Front Surg 2022; 9:900843. [PMID: 35669248 PMCID: PMC9163490 DOI: 10.3389/fsurg.2022.900843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair are the primary surgical methods for the treatment of adult inguinal hernia, but it remains necessary to consider which one to choose in clinical practice. Our study seeks to compare the efficacy of laparoscopic TAPP and laparoscopic TEP in the treatment of adult inguinal hernia and to explore which surgical method is a better choice. Methods A retrospective analysis of 686 adult patients with inguinal hernia admitted to our hospital from the period January 2016 to December 2020 was conducted. According to different surgical methods, they were divided into two groups: a TAPP group (n = 361) and a TEP group (n = 325). These two groups of patients were statistically analyzed, and the operation time, postoperative pain, postoperative hospital stay length, postoperative complications, and recurrence rate were compared between them. Results There were no significant differences in postoperative hospital stay, complications, and the recurrence rate between the two groups (p > 0.05). The duration of operation in the TEP group was significantly shorter than that in the TAPP group, and the difference was statistically significant (p < 0.001); in terms of postoperative pain, the TEP group fared better than the TAPP group, and the difference was statistically significant (p < 0.001). Conclusion TAPP and TEP are safe and effective surgical methods in the treatment of adult inguinal hernia. However, compared with TAPP, TEP can significantly shorten the operative time, reduce intraoperative trauma, and limit postoperative pain in the treatment of adult inguinal hernia. Furthermore, it does not increase the rate of complications or recurrence, so it is worth popularizing.
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Affiliation(s)
| | | | | | - Fengming Luan
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Xie TH, Wang Q, Ha SN, Cheng SJ, Niu Z, Ren XX, Sun Q, Jin XS. Mesh plug erosion into the small intestine after inguinal hernia repair: A case report. World J Clin Cases 2022; 10:3944-3950. [PMID: 35647162 PMCID: PMC9100743 DOI: 10.12998/wjcc.v10.i12.3944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/23/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mesh plug (MP) erosion into the intra-abdominal organs is a rare but serious long-term complication after inguinal hernia repair (IHR), and may lead to aggravation of symptoms if not treated promptly. It is difficult to diagnose MP erosion as there are no obvious specific clinical manifestations, and surgery is often needed for confirmation. In recent years, with the increased understanding of postoperative complications, MP eroding into the intra-abdominal organs has been a cause for concern among surgeons.
CASE SUMMARY A 50-year-old man was referred to the Department of General Surgery with the complaint of abdominal pain in the right lower quadrant for 2 d. He had a surgical history of right open IHR and partial thyroidectomy performed 20 years and 15 years ago, respectively. Computed tomography revealed a circinate high-density image with short segmental thickening of the ileum stuck to the abdominal wall, and no evidence of recurrent inguinal hernia. Laparoscopic abdominal exploration confirmed adhesion of the middle segmental portion of the ileal loop to the right inguinal abdominal wall; the rest of the small intestine was normal. Further exploration revealed migration of the polypropylene MP into the intraperitoneal cavity and formation of granulation tissue around the plug, which eroded the ileum. Partial resection of the ileum, including the MP and end-to-side anastomosis with an anastomat, was performed.
CONCLUSION Surgeons should aim to improve their ability to predict patients at high risk for MP erosion after IHR.
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Affiliation(s)
- Tian-Hao Xie
- Department of General Surgery, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
| | - Qiang Wang
- Department of General Surgery, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
| | - Si-Ning Ha
- Department of General Surgery, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
| | - Shu-Jie Cheng
- Department of General Surgery, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
| | - Zheng Niu
- Department of General Surgery, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
| | - Xiang-Xiang Ren
- Department of General Surgery, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
| | - Qian Sun
- Department of General Surgery, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
| | - Xiao-Shi Jin
- Department of General Surgery, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
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Avoiding migration at open mesh plug inguinal hernioplasty. Heliyon 2022; 8:e09320. [PMID: 35540936 PMCID: PMC9079702 DOI: 10.1016/j.heliyon.2022.e09320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/09/2022] [Accepted: 04/20/2022] [Indexed: 12/05/2022] Open
Abstract
The open repair of groin hernias is often augmented with prosthetic biomaterials (mesh) as this favours a lower recurrence rate. The use of such prostheses may be associated with various complications including migration the frequency of which is unclear. A 29-year review of this complication after mesh plug hernioplasty is undertaken and technical advice described to avoid this. Open Mesh plug inguinal hernia repair needs to be performed methodically.
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14
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Dumitrescu D, Serban D, Comandasu M, Dumitrescu V. Peritoneal Pocket Hernia—Avoidable Complication Following TAPP with Meticulous Closure Technique of Peritoneal Flaps. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02767-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Intraperitoneal versus extraperitoneal mesh in minimally invasive ventral hernia repair: a systematic review and meta-analysis. Hernia 2021; 26:533-541. [PMID: 34800188 DOI: 10.1007/s10029-021-02530-5] [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: 07/26/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The ideal location for mesh placement in minimally invasive ventral hernia repair (VHR) is still up for debate. We undertook a systematic review and meta-analysis (SRMA) to evaluate the outcomes of patients who received intraperitoneal mesh versus those that received extraperitoneal mesh in minimally invasive VHR. METHODS We searched PubMed, EMBASE, Cochrane, and Scopus from inception to May 3, 2021. We selected studies comparing intraperitoneal mesh versus extraperitoneal mesh placement in minimally invasive VHR. A meta-analysis was done for the outcomes of surgical site infection (SSI), seroma, hematoma, readmission, and recurrence. A subgroup analysis was conducted for a subset of studies comparing patients who have undergone intraperitoneal onlay mesh (IPOM) versus extended totally extraperitoneal approach (e-TEP). RESULTS A total of 11 studies (2320 patients) were identified. We found no statistically significant difference between patients who received intraperitoneal versus extraperitoneal mesh for outcomes of SSI, seroma, hematoma, readmission, and recurrence [(RR 1.60, 95% CI 0.60-4.27), (RR 1.39, 95% CI 0.68-2.81), (RR 1.29, 95% CI 0.45-3.72), (RR 1.40, 95% CI 0.69-2.86), and (RR 1.22, 95% CI 0.22-6.63), respectively]. The subgroup analysis had findings similar to the overall analysis. CONCLUSION Based on short-term results, extraperitoneal mesh does not appear to be superior to intraperitoneal mesh in minimally invasive ventral hernia repair. The choice of mesh location should be based on the current evidence, surgeon, and center experience as well as individualized to each patient.
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16
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Kohno S, Hasegawa T, Aoki H, Ogawa M, Yoshida K, Yanaga K, Ikegami T. Analysis of risk factors for surgical site infection and postoperative recurrence following inguinal and femoral hernia surgery in adults. Asian J Surg 2021; 45:1001-1006. [PMID: 34598841 DOI: 10.1016/j.asjsur.2021.08.019] [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: 06/22/2021] [Revised: 07/31/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the causes of complications following surgery for inguinal and femoral hernia, using surgical site infection (SSI) and recurrence rate as indicators of outcomes to consider appropriate treatments. METHODS We retrospectively assessed the medical histories of 1,098 patients with adult inguinal and femoral hernias who underwent herniorrhaphy between July 2010 and March 2019. Using SSI and recurrence rate as indicators of outcomes, we statistically assessed the influence of preoperative and operative conditions on surgical outcomes. RESULTS The occurrence of postoperative SSI was significantly more frequent in patients who experienced a long surgical duration, excessive blood loss, and incarceration; underwent emergency surgery and bowel resection; and in whom no mesh sheet insertion was performed. There was no correlation between mesh use and SSI in cases that did not require emergency incarceration repair. For cases involving hernia incarceration, the use of a mesh sheet was avoided to prevent potential infection, which could explain the high incidence of SSI in cases where mesh was not used. The hernia may have recurred due to technical issues during the procedure, as well as failure to ligate the hernia sac. CONCLUSIONS Selecting the appropriate surgical method for hernia repair may reduce the incidence of SSI. If manual reduction of inguinal hernias is not possible, an appropriate surgical procedure should be determined based on laparoscopic findings in facilities where laparoscopic hernia surgeries are frequently performed. Moreover, in cases without infection and bowel resection, mesh use may be beneficial. Recurrence can be prevented by ligating the hernia sac during surgery and solving relevant technical problems.
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Affiliation(s)
- Shuzo Kohno
- Department of Surgery, The Jikei University Katsushika Medical Center, 125-8061, Tokyo, Japan.
| | - Takuo Hasegawa
- Department of Surgery, The Jikei University Katsushika Medical Center, 125-8061, Tokyo, Japan
| | - Hiroaki Aoki
- Department of Surgery, The Jikei University Katsushika Medical Center, 125-8061, Tokyo, Japan
| | - Masaichi Ogawa
- Department of Surgery, The Jikei University Katsushika Medical Center, 125-8061, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Surgery, The Jikei University Katsushika Medical Center, 125-8061, Tokyo, Japan
| | - Katsuhiko Yanaga
- International University of Health and Welfare, 814-0001, Fukuoka, Japan
| | - Toru Ikegami
- Department of Surgery, The Jikei University School of Medicine, 105-8461, Tokyo, Japan
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17
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Haddad A, Yahia DBH, Chaker Y, Maghrebi H, Daghfous A, Kacem MJ. Intraperitoneal migrating mesh plug wrongfully taken for right colon cancer: A case report. Int J Surg Case Rep 2021; 84:106088. [PMID: 34186460 PMCID: PMC8254107 DOI: 10.1016/j.ijscr.2021.106088] [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: 04/08/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The use of mesh has become nowadays a standard for hernia repairs. It allows a tension-free hernioplasty and has shown that it is an effective way to prevent recurrences. But complications have been described. Intraperitoneal migration of mesh plug is an uncommon complication. CASE REPORT In this paper we report a case of a 57 year old male who has been operated on 12 years ago, he had a mesh plug repair for a ventral incisional hernia. The mesh migrated into the abdominal cavity and it was wrongfully taken for a locally advanced right colon cancer. Colonoscopy was done and biopsies were taken, but the results were not conclusive. He was operated on. We found the mesh that had migrated and eroded the hepatic flexure. There was a granulation tissue that also included some of the small intestine. There was also an abscess in the abdominal wall. He had an en-bloc resection of a part of the abdominal wall, small intestine and right colon. CONCLUSION Mesh hernioplasty is a frequent, simple and effective procedure with a low recurrence rate but it can be associated to serious complications such as mesh migration.
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Affiliation(s)
- A Haddad
- Surgery department A, Rabta Hospital, Rue Jbel Lakhdar, La Rabta Jebbari 1007, Tunis, Tunisia; The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - D Bel Haj Yahia
- Surgery department A, Rabta Hospital, Rue Jbel Lakhdar, La Rabta Jebbari 1007, Tunis, Tunisia; The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Y Chaker
- Surgery department A, Rabta Hospital, Rue Jbel Lakhdar, La Rabta Jebbari 1007, Tunis, Tunisia; The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - H Maghrebi
- Surgery department A, Rabta Hospital, Rue Jbel Lakhdar, La Rabta Jebbari 1007, Tunis, Tunisia; The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - A Daghfous
- Surgery department A, Rabta Hospital, Rue Jbel Lakhdar, La Rabta Jebbari 1007, Tunis, Tunisia; The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - M J Kacem
- Surgery department A, Rabta Hospital, Rue Jbel Lakhdar, La Rabta Jebbari 1007, Tunis, Tunisia; The Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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18
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Li Y, Qin C, Yan L, Tong C, Qiu J, Zhao Y, Xiao Y, Wang X. Urogenital fascia anatomy study in the inguinal region of 10 formalin-fixed cadavers: new understanding for laparoscopic inguinal hernia repair. BMC Surg 2021; 21:295. [PMID: 34140024 PMCID: PMC8212528 DOI: 10.1186/s12893-021-01287-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/31/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To investigate the urogenital fascia (UGF) anatomy in the inguinal region, to provide anatomical guidance for laparoscopic inguinal hernia repair (LIHR). Methods The anatomy was performed on 10 formalin-fixed cadavers. The peritoneum and its deeper fascial tissues were carefully dissected. Results The UGF’s bilateral superficial layer extended and ended in front of the abdominal aorta. At the posterior axillary line, the superficial layer medially reversed, with extension represented the UGF's deep layer. The UGF's bilateral deep layer medially extended beside the vertebral body and then continued with the transversalis fascia. The ureters, genital vessels, and superior hypogastric plexus moved between both layers. The vas deferens and spermatic vessels, ensheathed by both layers, moved through the deep inguinal ring. From the deep inguinal ring to the midline, the superficial layer extended to the urinary bladder’s posterior wall, whereas the deep layer extended to its anterior wall. Both layers ensheathed the urinary bladder and extended along the medial umbilical ligament to the umbilicus and in the sacral promontory, extended along the sacrum, forming the presacral fascia. The superficial layer formed the rectosacral fascia at S4 sacral vertebra, and the deep layer extended to the pelvic diaphragm, terminating at the levator ani muscle. Conclusion The UGF ensheaths the kidneys, ureters, vas deferens, genital vessels, superior hypogastric plexus, seminal vesicles, prostate, and urinary bladder. This knowledge of the UGF’s anatomy in the inguinal region will help find correct LIHR targets and reduce bleeding and other complications.
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Affiliation(s)
- Yi Li
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China
| | - Changfu Qin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - Likun Yan
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China.
| | - Cong Tong
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China
| | - Jian Qiu
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China
| | - Yamin Zhao
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China
| | - Yang Xiao
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China
| | - Xiaoqiang Wang
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China
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19
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Intestinal erosion rate following transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) inguinal hernia repair: does the surgical approach matter? Author's reply. Hernia 2021; 25:1391-1392. [PMID: 33934265 DOI: 10.1007/s10029-021-02418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
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20
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Zou Z, Zhu Y, Wang F, Cao J, Liu Y, Yang H, Wang M. Preperitoneal herniation as a complication of tansabdominal preperitoneal patch plasty: a report of two cases. BMC Surg 2021; 21:227. [PMID: 33933041 PMCID: PMC8088710 DOI: 10.1186/s12893-021-01225-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preperitoneal herniation is a rare complication after transabdominal preperitoneal patch plasty (TAPP) and may be caused by inadequate peritoneal closure. We herein report two cases of postoperative small bowel obstruction due to preperitoneal herniation through a disrupted peritoneum. CASE PRESENTATION Two men in their 70s were admitted to our center because of small bowel obstruction after TAPP. After examinations and unsuccessful conservative treatment, emergency laparoscopic exploration was performed. Preperitoneal herniation through the disrupted peritoneum was found. The herniated small bowel was reduced and the peritoneum was properly reclosed. The patients recovered and were discharged with normal bowel function. CONCLUSIONS Inadequate peritoneal closure may cause preperitoneal herniation and lead to postoperative small bowel obstruction and even death. Hernia surgeons can avoid this complication by improving their suture technique and paying attention to the procedure details.
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Affiliation(s)
- Zhenyu Zou
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Yilin Zhu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Fan Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Jinxin Cao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Yuchen Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Huiqi Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Minggang Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
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21
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Comment to: intestinal erosions following inguinal hernia repair-a systematic review. Author's reply. Hernia 2021; 25:1395-1396. [PMID: 33856563 DOI: 10.1007/s10029-021-02384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
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22
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Bui NH, Jørgensen LN, Jensen KK. Laparoscopic intraperitoneal versus enhanced-view totally extraperitoneal retromuscular mesh repair for ventral hernia: a retrospective cohort study. Surg Endosc 2021; 36:1500-1506. [PMID: 33723968 DOI: 10.1007/s00464-021-08436-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/05/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic enhanced-view totally extraperitoneal retromuscular repair (eTEP-RM) was recently introduced as a new technique for ventral hernia repair. The aim of the current study was to examine the outcomes of laparoscopic eTEP-RM compared with laparoscopic IPOM for patients with primary ventral and incisional hernia. METHODS This was a retrospective cohort study of patients undergoing laparoscopic ventral hernia repair at a single University Hospital from June 2017 to November 2020. Medical charts of all patients subjected to IPOM and eTEP-RM were evaluated to identify patient- and procedure related variables, as well as postoperative 30-day outcomes. RESULTS A total of 72 patients were included in the study, 43 and 29 of whom underwent IPOM and eTEP-RM repair, respectively. Patient demographics showed no differences in terms of gender, age, smoking and comorbidity. The median age was 57 years and body mass index 30.5 kg/m2. The rate of patients with incisional hernia was higher in the IPOM group (39.5% vs. 20.7%, p = 0.154). There was no difference in horizontal and vertical hernia size defect. The duration of surgery was significantly shorter for IPOM (mean 82.4 vs. 103.4 min, p = 0.010), whereas the length of stay was significantly longer after IPOM (median 1 days vs. 0 days (p < 0.001). The rate of patients requiring postoperative transversus abdominis plane (TAP) block or epidural analgesia was significantly higher after IPOM (33% vs. 0%, p = 0.002). A subgroup analysis on patients undergoing primary ventral hernia showed similar results. CONCLUSION The study found laparoscopic eTEP-RM safe and effective compared to traditional laparoscopic IPOM. The patients undergoing eTEP-RM had significantly reduced need for additional analgesic treatment and length of stay.
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Affiliation(s)
- Nam H Bui
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Nielsine Nielsens Vej 41A, 2400, Copenhagen NV, Denmark
| | - Lars N Jørgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Nielsine Nielsens Vej 41A, 2400, Copenhagen NV, Denmark
| | - Kristian K Jensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Nielsine Nielsens Vej 41A, 2400, Copenhagen NV, Denmark.
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23
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Hernia Mesh Migration into Urinary Bladder a Cause of Recurrent Stones: A Case Report. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02321-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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D'Amore L, Bambi L, Negro P, Gossetti F. Comment to: intestinal erosions following inguinal hernia repair: a systematic review. Hernia 2021; 25:1393-1394. [PMID: 33481095 DOI: 10.1007/s10029-020-02367-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/31/2020] [Indexed: 11/26/2022]
Affiliation(s)
- L D'Amore
- Abdominal Wall Unit, Department of Surgery "P.Stefanini", Sapienza University of Rome, Rome, Italy.
| | - L Bambi
- Abdominal Wall Unit, Department of Surgery "P.Stefanini", Sapienza University of Rome, Rome, Italy
| | - P Negro
- Abdominal Wall Unit, Department of Surgery "P.Stefanini", Sapienza University of Rome, Rome, Italy
| | - F Gossetti
- Abdominal Wall Unit, Department of Surgery "P.Stefanini", Sapienza University of Rome, Rome, Italy
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25
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Apostolou K, Schizas D. Intestinal erosion rate following transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) inguinal hernia repair: does the surgical approach matter? Hernia 2021; 25:1389-1390. [PMID: 33428010 DOI: 10.1007/s10029-020-02356-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Affiliation(s)
- K Apostolou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 Str., Goudi, 11527, Athens, Greece.
| | - D Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 Str., Goudi, 11527, Athens, Greece
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Koliakos N, Papaconstantinou D, Nastos C, Kirkilesis G, Bompetsi G, Bakopoulos A, Ntomi V, Pikoulis E. Intestinal erosions following inguinal hernia repair: a systematic review. Hernia 2020; 25:1137-1145. [DOI: 10.1007/s10029-020-02324-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/19/2020] [Indexed: 12/12/2022]
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27
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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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A new semiresorbable mesh for primary inguinal repair: a preliminary observational study on quality of life and safety. Hernia 2020; 24:1019-1031. [PMID: 32767180 DOI: 10.1007/s10029-020-02276-6] [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: 01/13/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND A currently unsolved problem of open inguinal hernia repair (IHR) is chronic postoperative inguinal pain (CPIP), which affects 10-12% of patients after IHR. In the present paper, we explored the results of a newly designed partially absorbable mesh made of polypropylene and polylactic acid (HybridMesh®) for open hernia repair and its impact on postoperative safety, efficacy, comfort and pain. METHODS A prospective multicentric pilot trial was conducted in third-referral centers across Italy (n = 5). Inclusion criteria were unilateral primary inguinal hernia in patients of both genders and BMI < 30 kg/m2. All patients were submitted to elective Lichtenstein mesh hernia repair under local anesthesia with HybridMesh. Primary outcome measure was the evaluation of Carolina Comfort Scale and modifications at 2 years after surgery and its correlation with surgical variables; secondary outcomes were postoperative early and late morbidity, recurrence and postoperative early quality of life. RESULTS Between 2015 and 2016, 125 (5 female) patients were operated, 2-year follow-up rate was 100%. The surgical site occurrence rate was 28% without the need of procedural interventions. Twenty-four months after surgery, no case of severe CPIP was recorded and altered global CCS score was present in 16 patients (13.0%). At univariate analysis, CCS score was negatively affected by fixation with sutures (OR 3.949; 95% CI 1.334-13.300), with no effect shown on multivariate analysis. Alterations in pain and movement limitations domains of CCS were observed in 9.7% of patients, at univariate analysis; they occurred more frequently when the mesh was sutured (OR 4.437; 95% CI 1.387-17.025) and in patients suffering from SSO (ecchymosis: OR 3.269; 95% CI 1.032-10.405); however, no effect was shown on multivariate analysis. Two recurrences (1.6%) were identified within the first postoperative year. CONCLUSIONS The results of this study support the safety, efficacy and good tolerability of HybridMesh as a device to treat primary unilateral inguinal hernia during open anterior approach. Further studies are needed to clarify its role in comparison to currently available devices at longer follow-ups.
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Patel M, Shenoy C, Nagarajan G, Chandiramani V. Mesh migration into the sigmoid colon after total extraperitoneal hernioplasty - Report of a case and review of the literature. J Minim Access Surg 2020; 16:411-414. [PMID: 32978354 PMCID: PMC7597895 DOI: 10.4103/jmas.jmas_122_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Over the past three decades, the practice laparoscopic inguinal hernioplasty has gained momentum. Mesh migration after laparoscopic inguinal hernia repair is an uncommon mesh-related delayed complication which is more common after transabdominal preperitoneal repair as compared to total extraperitoneal (TEP) repair. We report the first case of mesh migration into the sigmoid colon after TEP presenting 10 years after surgery. A 72-year-old male presented with left iliac fossa pain and diffuse lump. His computed tomogram scan showed sigmoid colon adherent to internal oblique at the site of hernia repair with a collection containing air specks and calcification. A colonoscopy revealed mesh within the sigmoid colon. He had to undergo a sigmoidectomy with Hartmann's surgery for the same. Here, we discuss the implicated pathophysiology, management and prevention of mesh migration after laparoscopic inguinal hernioplasty with literature review.
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Affiliation(s)
- Maitreyi Patel
- Department of Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Chetan Shenoy
- Department of Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Ganesh Nagarajan
- Department of Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Vinod Chandiramani
- Department of Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Jezupovs A. Surgical disaster following hernia mesh infection and erroneous treatment strategy: A case report. Int J Surg Case Rep 2020; 70:68-74. [PMID: 32413771 PMCID: PMC7226637 DOI: 10.1016/j.ijscr.2020.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/26/2020] [Accepted: 04/10/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Arnolds Jezupovs
- Clinic of Surgical Infections, Riga East University Hospital, Riga, Latvia; Faculty of Medicine, University of Latvia, Riga, Latvia.
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D'Amore L, Ceci F, Bruzzone P, Negro P, Gossetti F. Comment on: Mesh erosion into the urinary bladder, rare condition but important to know. Hernia 2019; 24:1403-1404. [PMID: 31773548 DOI: 10.1007/s10029-019-02081-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/03/2019] [Indexed: 12/24/2022]
Affiliation(s)
- L D'Amore
- Abdominal Wall Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy.
| | - F Ceci
- Abdominal Wall Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - P Bruzzone
- Abdominal Wall Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - P Negro
- Abdominal Wall Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - F Gossetti
- Abdominal Wall Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
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Costa A, Adamo S, Gossetti F, D'Amore L, Ceci F, Negro P, Bruzzone P. Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application? MATERIALS 2019; 12:ma12152375. [PMID: 31349716 PMCID: PMC6695954 DOI: 10.3390/ma12152375] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 12/11/2022]
Abstract
Millions of abdominal wall repair procedures are performed each year for primary and incisional hernias both in the European Union and in the United States with extremely high costs. Synthetic meshes approved for augmenting abdominal wall repair provide adequate mechanical support but have significant drawbacks (seroma formation, adhesion to viscera, stiffness of abdominal wall, and infection). Biologic scaffolds (i.e., derived from naturally occurring materials) represent an alternative to synthetic surgical meshes and are less sensitive to infection. Among biologic scaffolds, extracellular matrix scaffolds promote stem/progenitor cell recruitment in models of tissue remodeling and, in the specific application of abdominal wall repair, have enough mechanical strength to support the repair. However, many concerns remain about the use of these scaffolds in the clinic due to their higher cost of production compared with synthetic meshes, despite having the same recurrence rate. The present review aims to highlight the pros and cons of using biologic scaffolds as surgical devices for abdominal wall repair and present possible improvements to widen their use in clinical practice.
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Affiliation(s)
- Alessandra Costa
- Sezione di Istologia ed Embriologia Medica, Dipartimento SAIMLAL, Sapienza Università di Roma, Via A. Scarpa 16, 00161 Rome, Italy
| | - Sergio Adamo
- Sezione di Istologia ed Embriologia Medica, Dipartimento SAIMLAL, Sapienza Università di Roma, Via A. Scarpa 16, 00161 Rome, Italy
| | - Francesco Gossetti
- Dipartimento Assistenziale Integrato Cardio Toraco-Vascolare, Chirurgia e Trapianti d'Organo, Azienda Ospedaliera Universitaria Policlinico Umberto I. Dipartimento Universitario Chirurgia Generale e Specialistica "Paride Stefanini", Sapienza Università di Roma, Viale del Policlinico 155, 00161 Rome, Italy
| | - Linda D'Amore
- Dipartimento Assistenziale Integrato Cardio Toraco-Vascolare, Chirurgia e Trapianti d'Organo, Azienda Ospedaliera Universitaria Policlinico Umberto I. Dipartimento Universitario Chirurgia Generale e Specialistica "Paride Stefanini", Sapienza Università di Roma, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesca Ceci
- Dipartimento Assistenziale Integrato Cardio Toraco-Vascolare, Chirurgia e Trapianti d'Organo, Azienda Ospedaliera Universitaria Policlinico Umberto I. Dipartimento Universitario Chirurgia Generale e Specialistica "Paride Stefanini", Sapienza Università di Roma, Viale del Policlinico 155, 00161 Rome, Italy
| | - Paolo Negro
- Dipartimento Assistenziale Integrato Cardio Toraco-Vascolare, Chirurgia e Trapianti d'Organo, Azienda Ospedaliera Universitaria Policlinico Umberto I. Dipartimento Universitario Chirurgia Generale e Specialistica "Paride Stefanini", Sapienza Università di Roma, Viale del Policlinico 155, 00161 Rome, Italy
| | - Paolo Bruzzone
- Dipartimento Assistenziale Integrato Cardio Toraco-Vascolare, Chirurgia e Trapianti d'Organo, Azienda Ospedaliera Universitaria Policlinico Umberto I. Dipartimento Universitario Chirurgia Generale e Specialistica "Paride Stefanini", Sapienza Università di Roma, Viale del Policlinico 155, 00161 Rome, Italy.
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Cunningham H, Huerta S. Mesh migration following abdominal hernia repair: author's reply. Hernia 2019; 24:223-224. [PMID: 31134440 DOI: 10.1007/s10029-019-01981-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
Affiliation(s)
- H Cunningham
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - S Huerta
- University of Texas Southwestern Medical Center, Dallas, TX, USA. .,VA North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX, 75216, USA.
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Comment to: Mesh migration following abdominal hernia repair: a comprehensive review. Hernia 2019; 24:221-222. [PMID: 31104186 DOI: 10.1007/s10029-019-01977-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
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