[How to choose a mesh for the treatment of incisional hernias?]

Reconstruction with antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty for pediatric chest wall reconstruction: A 10-case series

INTRODUCTION

Chest wall reconstruction in children after large resection of tumors may be performed with rigid or soft materials. Cementoplasty is commonly used with the "Sandwich" method i.e. gore-tex meshes surrounding both faces of the cement.

HYPOTHESIS

Is antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty an interesting alternative to the double-side "sandwich" method for chest wall reconstruction?

MATERIAL AND METHODS

Consecutive patients who were treated from 2011 to 2023 in our hospital were included.

RESULTS

Among the ten children treated with a median 5.6 years follow-up, there were no surgical complications related to the reconstruction, loss of function, infections, post operative complications (versus 22.7% in meta-analysis encompassing the 50 rigid reconstructions reported worldwide) nor scoliosis (versus 25%). Three patients have an asymmetric chest wall appearance.

DISCUSSION

"Tartine" cementoplasty is a simple, low-cost technique for pediatric chest wall reconstruction. It is well tolerated and checks key demands for chest wall reconstructions.

LEVEL OF EVIDENCE

IV; retrospective case series.

Xenograft biologic mesh in parietal and general surgery: Technical assessment and review of clinical effectiveness and safety data

STUDY AIM

To describe the main technical characteristics of biologic prostheses used for parietal reinforcement and to present the state of the art on their risk/benefit ratio.

METHODS

We conducted a technical analysis of manufacturer specifications of the biologic prostheses that are currently available in France accompanied by a literature review by selecting meta-analyses and systematic reviews, randomized controlled trials and publications of health technology rating agencies.

RESULTS

Biological implants for parietal reinforcement are mainly intended for use in a contaminated environment where the use of synthetic prostheses is contra-indicated. We identified fourteen systematic reviews and meta-analyses and one randomized controlled trial. Six ongoing clinical trials were identified as well as two clinical trials that had been interrupted. In the current state of knowledge, there are no high-level evidence data on the therapeutic contribution of biologic prostheses that allow prioritization of the various biologic prostheses according to their characteristics or their different manufacturing processes.

CONCLUSION

Pending the results of current randomized controlled trials to validate the indications and an eventual specific reimbursement, indications for the use of biologic parietal reinforcement prostheses seems to be limited to rare clinical situations and only after collegial discussion.

Visceral mesh modified with cyclodextrin for the local sustained delivery of ropivacaine

The aim of the study was to develop a polyester visceral implant modified with a cyclodextrin polymer for the local and prolonged delivery of ropivacaine to reduce post operatory pain. Therefore, we applied a coating of an inguinal mesh with a crosslinked polymer of hydroxypropyl-β-cyclodextrin (HPβCD) whose specific host-guest complex forming properties were expected to improve the adsorption capacity of the implant toward anesthetic, and then to release it within a sustained period. The modification reaction of the textile with cyclodextrin was explored through the study of the influence of the pad/dry/cure process parameters and the resulting implant (PET-CD) was characterized by solid state NMR and SEM. Besides, the inclusion complex between ropivacaine and CD was studied by NMR and capillary electrophoresis in PBS medium. Finally, ropivacaine sorption test showed that a maximum of 30 mg/g of ropivacaine could be adsorbed on the functionalized samples. In dynamic batch tests in PBS at pH 7.4, the release could be observed up to 6h. The cytocompatibility of the PET-CD loaded with ropivacaine was also studied and reached 65% cell vitality after 6 days.

A review of available prosthetic material for abdominal wall repair

Abdominal wall incisional and inguinal hernia repair can call for utilization of implants or prostheses as an alternative to simple suture techniques. The various implants can be synthetic, biologic or mixed: their physicochemical properties condition the mechanical results and the long-term outcome of the repair. The increasing number of available materials allows the surgeon to choose between a wide variety depending on the indication, the site of implantation, the surgical approach and whether the operative field is contaminated or not. With regard to evidence-based medicine, while several synthetic implants have been shown to be superior in efficacy to simple suture, other studies are underway to develop the indications for bioprostheses, in particular in contaminated fields. This review of the literature summarizes the current knowledge on synthetic and biologic implants (physicochemical characteristics, forms, indications).

The influence of porosity on the integration histology of two polypropylene meshes for the treatment of abdominal wall defects in dogs

Two types of monofilament polypropylene mesh with different pore sizes, mass densities and burst strengths were used to repair two identical paired full-thickness abdominal wall defects in ten dogs, in order to compare their integration histology 90 days after implantation. On one side a standard mesh, Prolene (Ethicon), was sutured to the borders of the defect, while on the other a new ultralightweight macroporous mesh, Mpathy mesh, was used. There was a significantly greater densitometric proportion of mature (type I) collagen (58.38%) for Mpathy mesh compared to Prolene (34.05%, P=0.01). Although Prolene has 3.6 times the burst strength of Mpathy mesh, the implanted tissue strength was marginally greater for Mpathy mesh. We conclude that Mpathy mesh gives a surgical repair that is at least as strong as that provided by Prolene, along with a higher concentration of mature collagen and less fibrosis (P=0.07), in this canine histology model.

Anatomical pitfalls in the technique for total extra peritoneal laparoscopic repair for inguinal hernias

PURPOSE

The totally extraperitoneal laparoscopic approach for the treatment of inguinal hernia is a well-recognized technique with proven efficacy, low failure rate, and reduced post-operative pain. This laparoscopic technique is reputed to be a more difficult procedure to learn and practice than a laparoscopic trans-abdomino-pre-peritoneal procedure: we hope this is because many surgeons don't well know extra-peritoneal anatomy of groin. So we proposed a "step by step" anatomical analysis, with pitfalls to avoid, of a totally extraperitoneal laparoscopic approach for treatment of inguinal hernia.

METHODS

Our experience with totally extraperitoneal laparoscopic inguinal hernia repair with regard to the morphology of the inguinal-femoral region concerns 23 cadaver dissection and more than 400 surgical procedures, now permits clarification of a surgical technique that has hitherto not been well known.

CONCLUSION

Photographic representations of surgical views are displayed, and detailed descriptions applicable to anatomical structures are presented.