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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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Abouzid A, Shetiwy M, Hossam A, Abd Elghaffar M. Abdominal wall reconstruction using Omental Flap with Mesh repair following resection of Aggressive Abdominal Wall Neoplasms. Oncol Res Treat 2022; 45:415-422. [PMID: 35537417 DOI: 10.1159/000524871] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Resection of large anterior abdominal wall tumors causes a large full-thickness abdominal wall defects, and the repair of these defects remains a challenging point. METHODS Between July 2016 and February 2021, we retrospectively reviewed the internal database registry of the Oncology Center, Mansoura University (OCMU) Egypt, for patients with large abdominal wall defects after abdominal wall tumors resection and repair with omental flaps and synthetic Polypropylene (PP) mesh. Thirty-two patients met the inclusion criteria. They were analyzed for demographics, operative data including defect size, mesh size, intrabdominal tumor extension and postoperative outcomes and complications. RESULTS Thirty-Two patients with abdominal wall neoplasm underwent local resection in our center and the defect was closed with omental flap and PP mesh. The mean operative time was 143.75 ± 30.77 mins. The mean size of the abdominal wall defect was 50.78 cm2 (range: 25 - 90 cm2). The meshes used in reconstruction had a mean size of 89.53 cm2 (range: 55 - 130 cm2). The median follow-up period of the patients was 13.5 months (range: 5-54 months). Post-operative complications included infection (n = 4 cases), seroma (n = 2 cases), hematoma (n =1 case) and abnormal sensation (n = 5 cases). Tumor recurrence was reported in two cases and no cases developed incisional hernia during the follow up period. CONCLUSION Immediate use of omental flap with synthetic (PP) mesh for reconstruction of abdominal wall defects is a feasible technique and has avoided the complications associated with the use of synthetic mesh alone.
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Affiliation(s)
- Amr Abouzid
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mosab Shetiwy
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Amr Hossam
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mohamed Abd Elghaffar
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
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Bass GA, Seamon MJ, Schwab CW. A surgeon's history of the omentum: From omens to patches to immunity. J Trauma Acute Care Surg 2021; 89:e161-e166. [PMID: 32925575 DOI: 10.1097/ta.0000000000002945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Gary Alan Bass
- From the Division of Traumatology, Emergency Surgery, and Surgical Critical Care, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Pascual G, Benito-Martínez S, Rodríguez M, Pérez-Köhler B, García-Moreno F, Bellón JM. Behaviour at the peritoneal interface of next-generation prosthetic materials for hernia repair. Surg Endosc 2021; 36:579-590. [PMID: 33507384 DOI: 10.1007/s00464-021-08320-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND When using a prosthetic material in hernia repair, the behaviour of the mesh at the peritoneal interface is especially important for implant success. Biomaterials developed for their intraperitoneal placement are known as composites and are made up of two different-structure materials, one is responsible for good integration within host tissue and the other is responsible to make contact with the viscera. This study examines the behaviour at the peritoneal level of two composites, the fully degradable Phasix-ST® and the partially degradable Symbotex®. A polypropylene mesh (Optilene®) served as control. METHODS Sequential laparoscopy from 3 to 90 days, in a preclinical model in the New Zealand white rabbit, allowed monitoring adhesion formation. Morphological studies were performed to analyse the neoperitoneum formed in the repair process. Total macrophages were identified by immunohistochemical labelling. To identify the different macrophage phenotypes, complementary DNAs were amplified by qRT-PCR using specific primers for M1 (TNF-α/CXCL9) and M2 (MRC1/IL-10) macrophages. RESULTS The percentage of firm and integrated adhesions remained very high in the control group over time. Both composites showed a significant decrease in adhesions at all study times and in qualitative terms were mainly loose. Significant differences were also observed from 7 days onwards between the two composites, increasing the values in Phasix over time. Neoperitoneum thickness for Phasix was significantly greater than those of the other meshes, showing mature and organized neoformed connective tissue. Immunohistochemically, a significantly higher percentage of macrophages was observed in Symbotex. mRNA expression levels for the M2 repair-type macrophages were highest for Phasix but significant differences only emerged for IL-10. CONCLUSIONS Fewer adhesions formed to the Symbotex than Phasix implants. Ninety days after implant, total macrophage counts were significantly higher for Symbotex, yet Phasix showed the greater expression of M2 markers related to the tissue repair process.
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Affiliation(s)
- Gemma Pascual
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain. .,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain. .,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain.
| | - Selma Benito-Martínez
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Marta Rodríguez
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Bárbara Pérez-Köhler
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Francisca García-Moreno
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Juan M Bellón
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
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Grulke S, Salciccia A, Arévalo Rodríguez JM, Sandersen C, Caudron I, Serteyn D, de la Rebière de Pouyade G. Mesh closure of epiploic foramen by ventral laparotomy in 17 horses with entrapment. Vet Rec 2020; 187:e43. [PMID: 32414910 DOI: 10.1136/vr.105684] [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: 08/16/2019] [Revised: 02/21/2020] [Accepted: 04/26/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Epiploic foramen entrapment (EFE) of small intestine is a severe cause of strangulating small intestinal obstruction (SSI) with long-term survival seeming lower than for other causes of SSI in horses. Different techniques via laparoscopy or laparotomy for epiploic foramen (EF) closure have been developed. METHODS This study describes a technique of peroperative mesh closure of the EF in clinical cases and their long-term follow up. RESULTS In the study period of 5.5 years, 36 horses were admitted to the clinic with EFE. Of these, 17 horses had peroperative mesh closure, with resection anastomosis in 4 cases and enterotomy in 4 other cases. Fifteen of these survived to discharge. Long-term follow-up (one to three years, median three years) was favourable in all 15 horses not showing recurrence of EFE nor other related signs of colic. Laparoscopic evaluation of the EF was performed in two cases and showed integration of the mesh. One horse was euthanased 3.5 years after mesh placement for an unrelated cause and the mesh was well adherent obliterating the EF. CONCLUSION Mesh closure of EF during emergency coeliotomy did not cause short-term complications even in horses with resection or enterotomy and may reduce the risk of recurrence of EFE in horses.
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Affiliation(s)
- Sigrid Grulke
- Department of Clinical Sciences (Companion Animals and Equids), Faculty of Veterinary Medicine, Equine Clinic, Liege University, Liege, Belgium .,FARAH Research Unit, Liege University, Liege, Belgium
| | - Alexandra Salciccia
- Department of Clinical Sciences (Companion Animals and Equids), Faculty of Veterinary Medicine, Equine Clinic, Liege University, Liege, Belgium.,FARAH Research Unit, Liege University, Liege, Belgium
| | - José Manuel Arévalo Rodríguez
- Department of Clinical Sciences (Companion Animals and Equids), Faculty of Veterinary Medicine, Equine Clinic, Liege University, Liege, Belgium
| | - Charlotte Sandersen
- Department of Clinical Sciences (Companion Animals and Equids), Faculty of Veterinary Medicine, Equine Clinic, Liege University, Liege, Belgium.,FARAH Research Unit, Liege University, Liege, Belgium
| | - Isabelle Caudron
- Department of Clinical Sciences (Companion Animals and Equids), Faculty of Veterinary Medicine, Equine Clinic, Liege University, Liege, Belgium
| | - Didier Serteyn
- Department of Clinical Sciences (Companion Animals and Equids), Faculty of Veterinary Medicine, Equine Clinic, Liege University, Liege, Belgium.,FARAH Research Unit, Liege University, Liege, Belgium
| | - Geoffroy de la Rebière de Pouyade
- Department of Clinical Sciences (Companion Animals and Equids), Faculty of Veterinary Medicine, Equine Clinic, Liege University, Liege, Belgium.,FARAH Research Unit, Liege University, Liege, Belgium
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Wang J, Wei H, Dong T. Efficacy and Safety of Preoperative Local Infiltration with Lidocaine vs. Levobupivacaine in Hernia Surgeries. INT J PHARMACOL 2019. [DOI: 10.3923/ijp.2019.428.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bermúdez AC, Galindo V. Cierre de un gran defecto de la pared torácica y abdominal usando omento y malla de polipropileno en un canino. REVISTA DE LA FACULTAD DE MEDICINA VETERINARIA Y DE ZOOTECNIA 2019. [DOI: 10.15446/rfmvz.v66n1.79403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Este reporte de caso describe la resección quirúrgica exitosa de un condroma de gran tamaño localizado en las dos últimas costillas y pared abdominal craneal izquierda de un canino, usando una malla de polipropileno, omento y avance del diafragma. Se discute la técnica quirúrgica y los materiales utilizados en el procedimiento, así como la evolución posquirúrgica del paciente.
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The outcome of A. Double mesh intraperitoneal repair for complex ventral hernia: A retrospective cohort study. Int J Surg 2018; 53:129-136. [PMID: 29581046 DOI: 10.1016/j.ijsu.2018.03.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/09/2018] [Accepted: 03/15/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Complex ventral hernia is a challenging surgical entity, commonly attended with huge defect, loss of domain and possible soft tissue infection. It is difficult to repair, especially with multiple recurrences. Numerous methods of repair have been described with no evidence-based data available to prefer one method over the other. The purpose of this study is to determine the long-term outcome of the proposed new modification of intraperitoneal mesh repair procedure in complex ventral hernia. MATERIALS AND METHODS This is a single-center retrospective analysis utilizing the prospectively-maintained dataset in our institution during the study period between January 2003 and June 2017. Patients who fit the inclusion criteria of having a complex ventral hernia, whether de-novo or recurrent and were subjected to A. Double Mesh Intraperitoneal Repair (ADMIR) procedure were included in the study. Patients were followed up till recurrence or lost to follow through a period ranging from 6 to 174 months (mean: 142.96 ± SE: 11.91). RESULTS Forty-nine cases were included in this study (38 females and 11 males) with a female to male ratio of 3.5:1. The age range was from 28 to 81 years (mean 49 ± 12.4). BMI range from 25 to 42 (mean 33.6 ± 5.42). The ratio between the hernia sac volume and abdominal cavity volume was more than 20% in 12 patients (24.5%), who were subjected to preoperative progressive pneumoperitoneum (PPP) for an average period of two weeks. Hernias were recurrent in 28 cases (57%) and associated comorbidities were observed in 29 patients (63%). Postoperative complications occurred in 19 patients (38.7%), among them only 2 patients developed recurrence (4%) after a mean follow up period of 142 months. Five patients were lost to follow and were included in the Kaplan and Meier survival analysis. CONCLUSIONS ADMIR procedure is successful for the repair of complex ventral hernias as it is applicable to all sites of ventral hernias. The mesh is tension free hidden within the abdomen allowing for early mobilization and the complications rate is acceptable with low recurrence rate.
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Ünek T, Sökmen S, Egeli T, Avkan Oğuz V, Ellidokuz H, Obuz F. The results of expanded-polytetrafluoroethylene mesh repair in difficult abdominal wall defects. Asian J Surg 2018; 42:131-143. [PMID: 29398241 DOI: 10.1016/j.asjsur.2017.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/10/2017] [Accepted: 12/26/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The repair of difficult abdominal wall defects (AWDs) continues to be a crucial and demanding issue for surgeons. This study aimed to present the risk factors and the long-term results of usage of an expanded-polytetrafluoroethylene (e-PTFE) synthetic mesh for the AWR of difficult abdominal wall defects. METHODS This study included 156 adult patients who underwent difficult AWR with e-PTFE mesh for incisional hernia, ventral hernia, and created AWDs of various etiopathologies. The association between the risk factors and the postoperative complications of AWR was analyzed, and overall long-term outcomes of e-PTFE repair were assessed. RESULTS The median follow-up duration was 119.1 (ranging from 2 to 206) months. In 70 (44.8%) patients, there were major co-morbidities. A surgical site infection developed in 17 (10.9%) patients. Of these, only 2 (1.3%) patients had e-PTFE mesh infection. Seven (4.4%) patients experienced recurrence. Recalcitrant seroma formation occurred in 8 (36.3%) patients. CONCLUSION E-PTFE synthetic mesh usage for difficult abdominal wall hernias can help the hernia surgeon obtain safe and durable long-term results of sound repair.
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Affiliation(s)
- Tarkan Ünek
- Department of Surgery, Dokuz Eylul University Medical Faculty, Balcova, Izmir, Turkey.
| | - Selman Sökmen
- Department of Surgery, Dokuz Eylul University Medical Faculty, Balcova, Izmir, Turkey.
| | - Tufan Egeli
- Department of Surgery, Dokuz Eylul University Medical Faculty, Balcova, Izmir, Turkey
| | - Vildan Avkan Oğuz
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylul University Medical Faculty, Balcova, Izmir, Turkey
| | - Hülya Ellidokuz
- Institute of Oncology, Department of Preventive Oncology, Dokuz Eylul University Medical Faculty, Balcova, Izmir, Turkey
| | - Funda Obuz
- Department of Radiodiagnostic, Dokuz Eylul University Medical Faculty, Balcova, Izmir, Turkey
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Gandini M, Giusto G, Caramello V, Comino F, Rosso A. Single-port laparoscopic incisional hernia repair in a horse. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M. Gandini
- Department of Veterinary Sciences; University of Turin; Grugliasco Italy
| | - G. Giusto
- Department of Veterinary Sciences; University of Turin; Grugliasco Italy
| | - V. Caramello
- Department of Veterinary Sciences; University of Turin; Grugliasco Italy
| | - F. Comino
- Department of Veterinary Sciences; University of Turin; Grugliasco Italy
| | - A. Rosso
- Department of Veterinary Sciences; University of Turin; Grugliasco Italy
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Bridging with reduced overlap: fixation and peritoneal grip can prevent slippage of DIS class A meshes. Hernia 2017; 21:455-467. [DOI: 10.1007/s10029-017-1583-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
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12
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Polypropylene-based composite mesh versus standard polypropylene mesh in the reconstruction of complicated large abdominal wall hernias: a prospective randomized study. Hernia 2016; 20:691-700. [PMID: 27507403 DOI: 10.1007/s10029-016-1526-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 07/29/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare polypropylene mesh positioned onlay supported by omentum and/or peritoneum versus inlay implantation of polypropylene-based composite mesh in patients with complicated wide-defect ventral hernias. METHODS This was a prospective randomized study carried out on 60 patients presenting with complicated large ventral hernia in the period from January 2012 to January 2016 in the department of Gastrointestinal Surgery unit and Surgical Emergency of the Main Alexandria University Hospital, Egypt. Large hernia had an abdominal wall defect that could not be closed. Patients were divided into two groups of 30 patients according to the type of mesh used to deal with the large abdominal wall defect. RESULTS The study included 38 women (63.3 %) and 22 men (37.7 %); their mean age was 46.5 years (range, 25-70). Complicated incisional hernia was the commonest presentation (56.7 %).The operative and mesh fixation times were longer in the polypropylene group. Seven wound infections and two recurrences were encountered in the propylene group. Mean follow-up was 28.7 months (2-48 months). CONCLUSIONS Composite mesh provided, in one session, satisfactory results in patients with complicated large ventral hernia. The procedure is safe and effective in lowering operative time with a trend of low wound complication and recurrence rates.
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