1
|
Stolz MP, Chambers JG, Mahalati K. Formation of Biologic Plug and Patch Mesh for Use in Perforated Femoral Hernia. Am Surg 2023; 89:6307-6308. [PMID: 36823132 DOI: 10.1177/00031348231157911] [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: 02/25/2023]
Abstract
Incarcerated inguinal hernias with contamination frequently lead to an open inguinal hernia primary repair. If no contamination is present, a tension-free repair with mesh is a good option. In this case, we encountered an incarcerated femoral hernia with perforation of the small bowel. We will describe and demonstrate via video how to incorporate a tension-free repair with mesh in a contaminated field with formation of a plug and patch made from biologic mesh.
Collapse
Affiliation(s)
- Michael P Stolz
- General Surgery, Northeast Georgia Medical Center Health System, Gainesville, GA, USA
| | | | | |
Collapse
|
2
|
Zhang K, Zhu L. Transversalis fascia suture reinforcement may facilitate the performance of electrospun P(LLA-CL) nanoscale fibrinogen mesh in inguinal hernia repair: a prospective single-center cohort study. Sci Rep 2023; 13:12132. [PMID: 37495644 PMCID: PMC10372066 DOI: 10.1038/s41598-023-39391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/25/2023] [Indexed: 07/28/2023] Open
Abstract
The aim of this study was to evaluate a new electrospun P(LLA-CL) nanoscale fibrinogen mesh performance in real-world clinical practice. A prospective, single-center evaluation of Lichtenstein inguinal hernia repair using electrospun P(LLA-CL) nanoscale fibrinogen mesh in elderly patients with comorbid diseases was conducted between 2020 and 2022. A suture reinforcement of transversalis fascia was applied before mesh implantation. Hernia recurrence, pain score and overall complication rate were measured. A total of 52 inguinal hernias in 48 patients were included. The age of patients ranged from 33 to 95 years, with a median of 78 years. Comorbid conditions included cardiopulmonary disease, organ dysfunction, anticoagulant use, diabetes and smoking. By optimizing the physical condition perioperatively, all patients finished treatment successfully. Four cases recurred secondary to direct hernias or combined hernias and were diagnosed in the first 24 case cohort during follow-up. With surgical procedural modification involving strengthening the posterior inguinal floor by reef-up suturing of the transversalis fascia and the inferior edge of mesh slit to accommodate the spermatic cord, no further recurrence was diagnosed. Postoperative pain was mild and the pain score decreased three months after surgery compared to 1 week after surgery (p = 0.0099). No severe complications occurred, while seroma occurred in six cases. Electrospun P(LLA-CL) nanoscale fibrinogen mesh is safe and effective in repairing inguinal hernias in elderly patients with comorbid disease. A strengthening of the transversalis fascia by suturing may enhance the performance of this mesh.
Collapse
Affiliation(s)
- Kewei Zhang
- Department of General Surgery, Shanghai Tongren Hospital, JiaoTong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China
| | - Leiming Zhu
- Department of General Surgery, Shanghai Tongren Hospital, JiaoTong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China.
| |
Collapse
|
3
|
Randomized and Comparative Clinical Trial of Bovine Mesh Versus Polypropylene Mesh in the Repair of Inguinal Hernias. Surg Laparosc Endosc Percutan Tech 2021; 30:26-29. [PMID: 31876883 DOI: 10.1097/sle.0000000000000744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The type of mesh (synthetic vs. biological) play integral roles in the recovery and long-term outcomes of patients undergoing hernia repair. The aim of this study was to determine whether a biological mesh from bovine pericardium is equivalent to a standard polypropylene mesh in an open inguinal hernia repair using the Lichtenstein technique. MATERIALS AND METHODS A prospective, randomized, double-blinded, single-center trial was conducted to evaluate the safety and efficacy of a biological mesh compared with a commonly used polypropylene mesh using Lichtenstein's inguinal hernia repair in a 6-month study. Patients were evaluated for recurrence and complications by a blinded surgeon at 1 day, 1 week, 1 month, 3 months, and 6 months after surgery. RESULTS A total of 132 patients were randomized into experimental group receiving the bovine mesh (n=66) and control group receiving the standard polypropylene mesh (n=66). No recurrences were diagnosed in both arms within 6-month follow-up. Patients in the experimental group reported markedly less groin pain during the 3-month postoperative assessment period compared with the control group. There were no statistically significant differences in other complications, such as incision inflammation, physical limitation, testicular problems, and foreign body sensation, between the 2 groups. CONCLUSIONS Biological mesh is safe and effective in repairing inguinal hernia, with comparable intraoperative and early postoperative morbidity to the synthetic mesh.
Collapse
|
4
|
Samson DJ, Gachabayov M, Latifi R. Biologic Mesh in Surgery: A Comprehensive Review and Meta-Analysis of Selected Outcomes in 51 Studies and 6079 Patients. World J Surg 2021; 45:3524-3540. [PMID: 33416939 DOI: 10.1007/s00268-020-05887-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND In recent decades, biologic mesh (BM) has become an important adjunct to surgical practice. Recent evidence-based clinical applications of BM include but are not limited to: reconstruction of abdominal wall defects; breast reconstruction; face, head and neck surgery; periodontal surgery; other hernia repairs (diaphragmatic, hiatal/paraesophageal, inguinal and perineal); hand surgery; and shoulder arthroplasty. Prior systematic reviews of BM in complex abdominal wall hernia repair had several shortcomings that our comprehensive review seeks to address, including exclusion of laparoscopic repair, assessment of risk of bias, use of an acceptable meta-analytic method and review of risk factors identified in multivariable regression analyses. MATERIALS AND METHODS We sought articles of BM for open ventral hernia repair reporting on early complications, late complications or recurrences and included minimum of 50. We used the quality in prognostic studies risk of bias assessment tool. Random effects meta-analysis was applied. RESULTS This comprehensive review selected 62 articles from 51 studies that included 6,079 patients. Meta-analytic pooling found that early complications are present in about 50%, surgical site occurrences (SSOs) in 37%, surgical site infections (SSIs) in 18%, reoperation in 7%, readmission in 20% and mortality in 3%. Meta-analytic estimates of late outcomes included overall complications (42%), SSOs (40%) and SSIs (22%). Specific SSOs included seroma (14%), hematoma (4%), abscess (10%), necrosis (5%), dehiscence (8%) and fistula formation (5%). Reoperation occurred in about 17%, mesh explantation in 9% and recurrence in 36%. CONCLUSION Estimates of nearly all outcomes from individual studies were highly heterogeneous and sensitivity analyses and meta-regressions generally failed to explain this heterogeneity. Recurrence is the only outcome for which there are consistent findings for risk factors. Bridge placement of BM is associated with higher risk of recurrence. Prior hernia repair, history of reintervention and history of mesh removal were also risk factors for increased recurrence.
Collapse
Affiliation(s)
- David J Samson
- Department of Surgery, Westchester Medical Center, 100 Woods Road, Taylor Pavilion, Suite D-353, Valhalla, NY, 10595, USA
| | - Mahir Gachabayov
- Department of Surgery, New York Medical College, School of Medicine, Valhalla, NY, 10595, USA
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, 100 Woods Road, Taylor Pavilion, Suite D-353, Valhalla, NY, 10595, USA. .,Department of Surgery, New York Medical College, School of Medicine, Valhalla, NY, 10595, USA.
| |
Collapse
|
5
|
Li B, Zhang X, Man Y, Xie J, Hu W, Huang H, Wang Y, Ma H. Lichtenstein inguinal hernia repairs with porcine small intestine submucosa: a 5- year follow-up. a prospective randomized controlled study. Regen Biomater 2021; 8:rbaa055. [PMID: 33732500 PMCID: PMC7947568 DOI: 10.1093/rb/rbaa055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/10/2020] [Accepted: 11/25/2020] [Indexed: 01/06/2023] Open
Abstract
Porcine small intestine submucosa (SIS) biologic patch has been used in inguinal hernia repair. However, there are little data available to assess the long-term effect after repair. This study aimed to explore the long-term effect of SIS patch in open inguinal hernia repair. Sevent-six patients with unilateral inguinal hernia were treated with Lichtenstein tension-free hernia repair using SIS patch (Beijing Datsing Bio-Tech Co., Ltd.) and Surgisis patch (COOK, USA) in Tianjin Union Medical Center and China-Japan Friendship Hospital. In the trial, the long-term efficacy of the treatment group and the control group were compared. A total of 66 patients in both groups received long-term follow-up (> 5 years) after surgery, with a follow-up rate of 86.8%. During the follow-up period, there was one case of recurrence, one case of chronic pain in the control group. There was no statistically significant difference (P > 0.05) in terms of recurrence, chronic pain, foreign body sensation and infection between the two groups of patients. After long-term observations, it has been found that the porcine small intestinal submucosa (SIS) biological patch is safe and effective for inguinal hernia Lichtenstein repair, and has a low recurrence rate and complication rate.
Collapse
Affiliation(s)
- Baoshan Li
- Department of Hernia and Abdominal Wall Surgery, Tianjin Union Medical Center, 190, jieyuan Road, HongqiaoDistrict, Tianjin 300121, China
| | - Xin Zhang
- Department of Hernia and Abdominal Wall Surgery, Tianjin Union Medical Center, 190, jieyuan Road, HongqiaoDistrict, Tianjin 300121, China
| | - Yi Man
- Department of Hernia and Abdominal Wall Surgery, Tianjin Union Medical Center, 190, jieyuan Road, HongqiaoDistrict, Tianjin 300121, China
| | - Jiadong Xie
- Department of Hernia and Abdominal Wall Surgery, Tianjin Union Medical Center, 190, jieyuan Road, HongqiaoDistrict, Tianjin 300121, China
| | - Wei Hu
- Department of Hernia and Abdominal Wall Surgery, Tianjin Union Medical Center, 190, jieyuan Road, HongqiaoDistrict, Tianjin 300121, China
| | - Huang Huang
- Department of Hernia and Abdominal Wall Surgery, Tianjin Union Medical Center, 190, jieyuan Road, HongqiaoDistrict, Tianjin 300121, China
| | - Yinlong Wang
- Department of Hernia and Abdominal Wall Surgery, Tianjin Union Medical Center, 190, jieyuan Road, HongqiaoDistrict, Tianjin 300121, China
| | - Hongguang Ma
- Department of General Surgery, China-Japan Friendship Hospital, Sakura Garden East Street, Chaoyang District, Beijing 100029, China
| |
Collapse
|
6
|
Decellularization and In Vivo Recellularization of Abdominal Porcine Fascial Tissue. Tissue Eng Regen Med 2020; 18:369-376. [PMID: 33230802 DOI: 10.1007/s13770-020-00314-z] [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: 08/11/2020] [Revised: 09/11/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Tissue decellularization has evolved as a promising approach for tissue engineering applications. METHODS In this study, we harvested fascial tissue from porcine anterior abdominal wall and the samples were decellularized with a combination of agents such as Triton X-100, trypsin and DNAase. Afterwards, we evaluated cell removal by histological analysis and DNA quantification. Mechanical functionality was evaluated by applying a range of hydrostatic pressures. A sample of decellularized fascia was transplanted into a rabbit and after 15 days a biopsy of this tissue was examined; the animal was observed during 6 months after surgery. RESULTS The extracellular matrix was retained with a complete decellularization as evidenced by histologic examination. The DNA content was significantly reduced. The scaffold preserved its tensile mechanical properties. The graft was incorporated into a full thickness defect made in the rabbit abdominal wall. This tissue was infiltrated by granulation and inflammatory cells and the histologic structure was preserved 15 days after surgery. The animal did not develop hernias, infections or other complications, after a 6-months of follow up. CONCLUSIONS The protocol of decellularization of fascial tissue employed in this study proved to be efficient. The mechanical test demonstrated that the samples were not damaged and maintained its physical characteristics; clinical evolution of the rabbit, recipient of the decellularized fascia, demonstrated that the graft was effective as a replacement of native tissue.In conclusion, a biological scaffold derived from porcine fascial tissue may be a suitable candidate for tissue engineering applications.
Collapse
|
7
|
Porcine Small Intestinal Submucosa Mesh to Treat Inguinal Hernia in Young Adults Using Laparoscopic Inguinal Hernia Repair: A Retrospective Controlled Study. Surg Laparosc Endosc Percutan Tech 2020; 30:367-370. [PMID: 32366749 DOI: 10.1097/sle.0000000000000806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The authors evaluated the effects and clinical value of small intestinal submucosa (SIS) mesh to treat inguinal hernia in young adults by the laparoscopic method. METHODS The clinical data of 357 cases with inguinal hernia using SIS mesh in our hospital were analyzed retrospectively from June 2014 to June 2018. All cases were divided into 2 groups according to the surgical method. Operation time, hospital stay, cost, postoperative complications, and complications during follow-up were analyzed. RESULTS Of the 357 patients, 202 (56.6%) underwent Lichtenstein repair and 155 (43.4%) underwent transabdominal preperitoneal (TAPP) repair. Operation time and hospital costs of the Lichtenstein group were significantly lower compared with the TAPP group (P<0.05). The incidence of seroma in the Lichtenstein group was lower than that in the TAPP group at 1 week, 1 month, and 3 months postoperatively with significant differences (P<0.05). Perioperative pain scores in the Lichtenstein group were higher than the TAPP group (P<0.05). No statistical difference was observed for hospital stay between 2 groups (P>0.05). In the Lichtenstein group, 1 case recurred during the follow-up period (0.5%). No intestinal obstruction or intestinal fistula occurred in any patient during the follow-up period. CONCLUSION The effect of SIS mesh was positive whether the patient underwent a Lichtenstein or TAPP method. Seroma was more common in the TAPP method that may cause lower postoperative pain. Therefore, we recommend individualized treatment.
Collapse
|
8
|
Ruiz-Jasbon F, Ticehurst K, Ahonen J, Norrby J, Falk P, Ivarsson ML. Results at 3-year follow-up of totally extraperitoneal (TEP) hernia surgery with long-term resorbable mesh. Hernia 2020; 24:669-676. [PMID: 31925599 PMCID: PMC7210225 DOI: 10.1007/s10029-019-02116-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Synthetic non-resorbable mesh is almost standard in hernia surgery. However, several studies have showed negative effects of permanent implants such as chronic inflammation and complications involving different organs bordering the mesh. Such complications can raise the risk of chronic post-operative pain (CPP). Recently promising results regarding CPP have been published in patients with Lateral Inguinal Hernia (LIH) using a slowly resorbable mesh in Lichtenstein technique. For this reason the aim of the present study was to find the effect of a slowly resorbable implant on the long-term rate of hernia recurrence and chronic post-operative pain in patients with LIH repaired with TEP procedure. METHODS Prospective pilot study of TEP repair using TIGR® Matrix Surgical Mesh in 35 primary LIH. At 3-year follow-up the Visual Analogue Scale (VAS) and the Inguinal Pain Questionnaire were employed to assess pain. Recurrence was determined by ultrasound and clinical examination. RESULTS All patients completed the pain questionnaires but one patient did not attend the planned clinical examination for the 3-year follow-up. No patients had CPP, as defined in the World Guidelines for Groin Hernia Management. Almost all patients had lower VAS score in any activity 3 years following surgery in comparison to the preoperative period. Three patients (8.8%) suffered symptomatic recurrence during the 3-year follow-up. CONCLUSION TEP repair in patients with LIH using a synthetic long-term resorbable mesh was found to be encouraging respecting chronic post-operative pain at 3-year follow-up but at the cost of an increased risk of recurrence.
Collapse
Affiliation(s)
- F Ruiz-Jasbon
- Department of Surgery, Halland's Hospital, Kungsbacka, Sweden. .,Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
| | - K Ticehurst
- Department of Surgery, Halland's Hospital, Kungsbacka, Sweden
| | - J Ahonen
- Department of Surgery, Halland's Hospital, Kungsbacka, Sweden
| | - J Norrby
- Department of Surgery, Halland's Hospital, Kungsbacka, Sweden.,Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - P Falk
- Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - M-L Ivarsson
- Department of Surgery, Institute of Clinical Science, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| |
Collapse
|
9
|
|
10
|
Li S, Xiao H, Yang L, Hua L, Qiu Z, Hu X, Ping D, Zheng K, He H, Tang J. Electrospun P(LLA-CL) Nanoscale Fibrinogen Patch vs Porcine Small Intestine Submucosa Graft Repair of Inguinal Hernia in Adults: A Randomized, Single-Blind, Controlled, Multicenter, Noninferiority Trial. J Am Coll Surg 2019; 229:541-551.e1. [DOI: 10.1016/j.jamcollsurg.2019.08.1446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022]
|
11
|
Sun L, Chen J, Shen Y. Randomized Controlled Trial Of Lichtenstein Repair Of Indirect Inguinal Hernias With Two Biologic Meshes From Porcine Small Intestine Submucosa. Ther Clin Risk Manag 2019; 15:1277-1282. [PMID: 31802878 PMCID: PMC6827516 DOI: 10.2147/tcrm.s208185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/13/2019] [Indexed: 12/03/2022] Open
Abstract
Background Biologic mesh is a newly developed material for hernia repairs which has been successfully used in clinical practices. This study aims to evaluate the clinical efficacy between patients undergoing a Lichtenstein’s hernioplasty with a new biologic mesh derived from porcine small intestine submucosal (SIS) extracellular matrix versus a standard SIS mesh. Methods A prospective, randomized, double-blinded, multi-center trial was conducted in a 6-month study. Lichtenstein hernioplasty was performed using the new SIS mesh (Beijing Biosis Healing Biotechnology) or the standard SIS mesh (Biodesign Surgisis, Cook Biotech). The postoperative follow-up examinations were carried out at during hospitalization, 1st week, 1st, 3rd, and 6th month after surgery. The primary outcome was the excellent and good rate of recovery. Secondary outcomes included recurrence rate, complications, and patient-centered outcomes. Results A total of 194 patients were randomized into experimental group receiving the new SIS mesh (n=97) and control group receiving the standard SIS mesh (n=97). The excellent and good rate of rehabilitation in the experimental group was 98.97%, while it was 100.00% in the control group (P>0.05). One patient had a recurrence in the experimental group, while there was no recurrence in the control group (P>0.05). Other clinical outcomes, including the length of operation or hospitalization, foreign body sensation in the inguinal area, incision healing, infection, postoperative chronic pain, postoperative allergy, hydrocele, and orchitis, were similar between the two groups. Conclusion Lichtenstein hernioplasty using the SIS mesh was safe and effective, and the new SIS mesh tested in this study had comparable safety and efficacy to the wildly used SIS mesh.
Collapse
Affiliation(s)
- Li Sun
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, People's Republic of China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, People's Republic of China
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, People's Republic of China
| |
Collapse
|
12
|
Ravo B, Falasco G. Pure tissue inguinal hernia repair with the use of biological mesh: a 10-year follows up. A prospective study. Hernia 2019; 24:121-126. [PMID: 31111323 DOI: 10.1007/s10029-019-01976-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/11/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The long-term results for inguinal hernia repair (IH) with the use of biological mesh (BM) are not known. A prospective study was started in 2003-2004 to evaluate the results of pure tissue (IH) repair with the use of biological mesh with a 10-year follow-up. METHODS From March 2003 to December 2004, all patients with IH who presented to the office, including incarcerated and recurrent IH, not excluding any, underwent pure tissue IH repair reinforced with a BM. During this period, 101 patients (87/male, 14/female) underwent 104 IH repair with a continuous suture of transversalis to transversalis fascia repair reinforced with BM of porcine intestinal submucosal origin (Surgisis, Cook) and were followed up for 10 years. RESULTS There were 104 IH, 90 electives (86%), 2 incarcerated (1.9%), and 12 recurrent (11%). Follow-up was scheduled at 1 week, 1 month, 1 year, 3 years, 7 years and 10 years., in 100%, 100%, 99%, 93%, 89% and 85% of the patients, respectively. Recurrence was observed in 2/104 (1.9%): one recurrence at 1 week in a patient with bilateral IH and one at 7 years. The mean recovery time was 1.2 days (range 1-5 days). Mortality was 0(0%). COMPLICATIONS six hematic infiltration to the scrotum and one to the vulva, all resolved spontaneously; wound infection 0(0%); urinary retention 11/104 (10.5%); inguinal scrotal hypoesthesia 7/104(6.7%), improved after 4-6months; asymptomatic fever of 39°C, 2/104 patients (1.9%), responded to a single dose of 4 mg betamethasone. No long-term inguinal pain complaint was found except for one patient with a recurrent IH. CONCLUSIONS The use of BM to reinforce a pure tissue IH repair is safe and effective. The recurrence rate is comparable to short- and long-term synthetic mesh IH repair with less complications and pain than the use of synthetic mesh as reported in the literature.
Collapse
Affiliation(s)
- B Ravo
- Università Campus Bio-Medico, Via Álvaro del Portillo 21, 00128, Rome, Italy. .,Rome American Hospital, Via Emilio Longoni 69, 00155, Rome, Italy.
| | - Giuliano Falasco
- Università Campus Bio-Medico, Via Álvaro del Portillo 21, 00128, Rome, Italy.,Department of Emergency, San Camillo Forlanini Hospital, Rome, Italy.,Rome American Hospital, Via Emilio Longoni 69, 00155, Rome, Italy
| |
Collapse
|
13
|
Mongelli F, Ferrario di Tor Vajana A, FitzGerald M, Cafarotti S, Lucchelli M, Proietti F, Di Giuseppe M, La Regina D. Open and Laparoscopic Inguinal Hernia Surgery: A Cost Analysis. J Laparoendosc Adv Surg Tech A 2019; 29:608-613. [PMID: 30807244 DOI: 10.1089/lap.2018.0805] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: In the treatment of inguinal hernias, there is little hard evidence concerning the economic reimbursement in the diagnosis-related group (DRG) era. Factors that affect whether a hospital may earn or lose financially depending on open or laparoscopic approach is still underexplored. The aim of this study was to provide a reliable analysis of in-hospital costs and reimbursements in inguinal hernia surgery. Methods: This retrospective study analyzed the 1-year experience in inguinal hernia repair in patients undergoing open Lichtenstein (OL), laparoscopic totally extraperitoneal unilateral (UTEP), or bilateral (BTEP) hernia repair. Demographics, results, costs, and DRG-based reimbursements were recorded and analyzed. Results: During the study period, 39 patients underwent OL, 82 patients UTEP, and 16 patients BTEP. The average total cost amounted to 4126 EUR in OL, 5134 EUR in UTEP, and 7082 EUR in BTEP groups (P < .001). The hospital reimbursement amounted to 5486 EUR, 5252 EUR, and 6555 EUR in the OL, UTEP, and BTEP groups, respectively (P < .001). Finally, the mean hospital earnings were 1360 EUR, 118 EUR, and -527 EUR for each patient in OL, UTEP, and BTEP, respectively (P < .001). Conclusions: In-hospital costs were higher in UTEP and BTEP as compared with OL. The DRG-based reimbursement provided adequate compensation for patients with unilateral inguinal hernia, whereas hospital earnings were profitable in OL group only, and led an overall financial loss in the BTEP group. Surgeons should be conscious that clinical advantages of the laparoscopic approach are not adequately compensated for, from an economic point of view.
Collapse
Affiliation(s)
- Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | | | - Maurice FitzGerald
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Massimo Lucchelli
- Department of Medical Controlling, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Francesco Proietti
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Matteo Di Giuseppe
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| |
Collapse
|
14
|
Seefeldt CS, Meyer JS, Knievel J, Rieger A, Geißen R, Lefering R, Heiss MM. BIOLAP: biological versus synthetic mesh in laparo-endoscopic inguinal hernia repair: study protocol for a randomized, multicenter, self-controlled clinical trial. Trials 2019; 20:55. [PMID: 30651127 PMCID: PMC6335692 DOI: 10.1186/s13063-018-3122-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 12/10/2018] [Indexed: 12/19/2022] Open
Abstract
Background Inguinal hernia repair is one of the most common surgical operations globally; more than 20 million groin herniae are repaired annually worldwide. Recurrence after an inguinal hernia operation is a considerable clinical problem. Another remaining problem after hernia surgery is the occurrence of chronic pain. Up to now, the use of synthetic meshes is the standard procedure, but there is increasing evidence that biological meshes could be advantageous concerning the occurrence of chronic pain due to different postoperative remodeling, without the disadvantages of a life-long implant. We hypothesize that the use of a biological mesh reduces postoperative pain without being inferior in terms of recurrence rate compared with a synthetic mesh. Methods/design The trial compares possible the advantages of biological matrices to synthetic meshes in laparo-endoscopic inguinal hernia repair. Four hundred and ninety-six patients with primary bilateral inguinal herniae in 20 German hernia centers will be enrolled. Biological mesh is used for one of the bilateral herniae, the other side will be operated on with a synthetic mesh. Randomization will preset which side is repaired with which material and trial participants will not be informed about the location of each mesh type. The primary endpoints will be intensity of postoperative local pain and the incidence of recurrent hernia after 2 years. Discussion There is no reasonably sized trial that assesses the use of biological meshes in laparo-endoscopic inguinal hernia repair. Our self-controlled trial design allows a direct comparison of the two meshes with very few confounding factors as well as minimizing the exclusion criteria. As we compare CE-certified medical devices in their designated indication the medical risk is not different compared to routine clinical care. Due to the common nature of bilateral inguinal hernia, a high recruitment rate is achievable. Because guidelines for hernia repair have stressed the need for reliable data on the already frequent use of biological meshes, we can expect our trial to have a direct implication on hernia-repair standards. Trial registration German Clinical Trials Register, ID: DRKS00010178. Registered on 16.June.2016. BIOLAP underwent full external peer review as part of the funding process with the German Research Foundation. Electronic supplementary material The online version of this article (10.1186/s13063-018-3122-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- C S Seefeldt
- Department of Visceral, Vascular and Transplant Surgery/Chair of Surgery of the University of Witten-Herdecke, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Straße. 200, 51109, Köln, Germany
| | - J S Meyer
- Department of Visceral, Vascular and Transplant Surgery/Chair of Surgery of the University of Witten-Herdecke, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Straße. 200, 51109, Köln, Germany
| | - J Knievel
- Institut für Forschung in der Operativen Medizin der Universität Witten/Herdecke, Ostmerheimer Straße 200, Haus 38, 51109, Köln, Germany
| | - A Rieger
- Department of Visceral, Vascular and Transplant Surgery/Chair of Surgery of the University of Witten-Herdecke, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Straße. 200, 51109, Köln, Germany.,Chirurgische Klinik, St. Elisabeth Hospital Köln, Former Krankenhaus Merheim, Kliniken der Stadt Köln, Werthmannstr. 1, 50935, Köln, Germany
| | - R Geißen
- Zentrum für klinische Studien der Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - R Lefering
- Institut für Forschung in der Operativen Medizin der Universität Witten/Herdecke, Ostmerheimer Straße 200, Haus 38, 51109, Köln, Germany
| | - M M Heiss
- Department of Visceral, Vascular and Transplant Surgery/Chair of Surgery of the University of Witten-Herdecke, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Straße. 200, 51109, Köln, Germany.
| |
Collapse
|
15
|
Sasse KC, Lambin JH, Gevorkian J, Elliott C, Afshar R, Gardner A, Mehta A, Lambin R, Peraza L. Long-term clinical, radiological, and histological follow-up after complex ventral incisional hernia repair using urinary bladder matrix graft reinforcement: a retrospective cohort study. Hernia 2018; 22:899-907. [PMID: 30276560 PMCID: PMC6245125 DOI: 10.1007/s10029-018-1830-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/14/2018] [Indexed: 12/21/2022]
Abstract
Background Complex ventral incisional hernia repair represents a challenging clinical condition in which biologically derived graft reinforcement is often utilized, but little long-term data inform that decision. Urinary bladder matrix (UBM) has shown effectiveness in diverse clinical settings as durable reinforcement graft material, but it has not been studied over a long term in ventral incisional hernia repair. This study evaluates the clinical, radiographic, and histological outcome of complex incisional hernia repair using UBM reinforcement with 12–70 months of follow-up. Methods A single-arm, retrospective observational study of all ventral incisional hernia repairs utilizing UBM reinforcement over a 6-year time frame by a single surgeon was performed. Patients were assessed in long-term follow-up clinically and with the Carolina Comfort Scale. A subset of patients was assessed with abdominal wall ultrasound or CT scan. Three patients had abdominal wall fascial biopsies years after the incisional hernia repair with UBM graft, and the histology is analyzed. Results 64 patients underwent repair of complex incisional hernias with UBM graft reinforcement by a single surgeon. 42 patients had concomitant procedures including large or small bowel resection, excision of infected mesh, evacuation of abscess or hematoma, cholecystectomy, or panniculectomy with abdominoplasty. 16 patients had ostomies at the time of repair. Median follow-up time is 36 months, with a range of 12–70 months. Nine patients (14%) have required surgical repair of a recurrent hernia, and a tenth patient has a recurrence that is managed non-surgically, for a total recurrence rate of 15.6% over the entire time frame. Median time to recurrence was 32 months, and a Kaplan–Meier freedom from recurrence curve is depicted. 28 patients have undergone ultrasound or CT assessments of the abdominal wall which demonstrate radiographic fascial integrity 12–70 months after repair. Three patients have been re-explored for unrelated reasons in the years following ventral incisional hernia repair with UBM, and full thickness fascial biopsies demonstrate a robust remodeling response histologically similar to native myofascial tissue. No patients have developed graft infection, fistulization to the graft, or required graft explantation. Carolina Comfort Scale assessment of 45 patients 3 years after the repair averaged 16 out of a possible 115. Conclusion In 64 patients undergoing complex ventral incisional hernia repair with UBM reinforcement, all have experienced successful resolution of complex clinical conditions and 15.6% of these repairs have recurred at a median follow-up of 3 years. Three full-thickness biopsies of the repaired fascia years later shed light on a promising remodeling response which may signal strength and durability comparable to native fascia.
Collapse
Affiliation(s)
- K C Sasse
- University of Nevada School of Medicine, 75 Pringle Way, Suite 804, Reno, NV, 89502, USA.
| | - J-H Lambin
- University of Nevada School of Medicine, 75 Pringle Way, Suite 804, Reno, NV, 89502, USA
| | - J Gevorkian
- University of Nevada School of Medicine, 75 Pringle Way, Suite 804, Reno, NV, 89502, USA
| | - C Elliott
- University of Nevada School of Medicine, 75 Pringle Way, Suite 804, Reno, NV, 89502, USA
| | - R Afshar
- University of Nevada School of Medicine, 75 Pringle Way, Suite 804, Reno, NV, 89502, USA
| | - A Gardner
- University of Nevada School of Medicine, 75 Pringle Way, Suite 804, Reno, NV, 89502, USA
| | - A Mehta
- University of Nevada School of Medicine, 75 Pringle Way, Suite 804, Reno, NV, 89502, USA
| | - R Lambin
- University of Nevada School of Medicine, 75 Pringle Way, Suite 804, Reno, NV, 89502, USA
| | - L Peraza
- University of Nevada School of Medicine, 75 Pringle Way, Suite 804, Reno, NV, 89502, USA
| |
Collapse
|
16
|
Öberg S, Andresen K, Rosenberg J. Absorbable Meshes in Inguinal Hernia Surgery: A Systematic Review and Meta-Analysis. Surg Innov 2017; 24:289-298. [PMID: 28492358 DOI: 10.1177/1553350617697849] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Absorbable meshes used in inguinal hernia repair are believed to result in less chronic pain than permanent meshes, but concerns remain whether absorbable meshes result in an increased risk of recurrence. The aim of this study was to present an overview of the advantages and limitations of fully absorbable meshes for the repair of inguinal hernias, focusing mainly on postoperative pain and recurrence. METHODS This systematic review with meta-analyses is based on searches in PubMed, Embase, Cochrane, and Psychinfo. Included study designs were case series, cohort studies, randomized controlled trials (RCTs), and non-RCTs. Studies had to include adult patients undergoing an inguinal hernia repair with a fully absorbable mesh. RESULTS The meta-analyses showed no difference in recurrence rates (median 18 months follow-up) and chronic pain rates (1 year follow-up) between absorbable- and permanent meshes. Crude chronic pain rates for the RCTs were 2.1% for the absorbable meshes and 7.6% for the permanent meshes. For the absorbable meshes, medial hernias were more susceptible for recurrence compared with lateral hernias ( P < .0005). None of the studies reported allergic reactions or other serious adverse events related to the absorbable mesh. CONCLUSIONS Patients with an absorbable mesh seem to have less chronic pain following inguinal hernia surgery compared with permanent meshes, without increased risk of recurrence.
Collapse
Affiliation(s)
- Stina Öberg
- 1 Center for perioperative optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark
| | - Kristoffer Andresen
- 1 Center for perioperative optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark
| | - Jacob Rosenberg
- 1 Center for perioperative optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark
| |
Collapse
|
17
|
Sainfort A, Denis Hallouard I, Hartmann D, Aulagner G, Francois Y, Tiffet O, Barabino G, Nuiry O, Armoiry X. Xenograft biologic mesh in parietal and general surgery: Technical assessment and review of clinical effectiveness and safety data. J Visc Surg 2016; 153:403-417. [PMID: 27618702 DOI: 10.1016/j.jviscsurg.2016.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
Collapse
Affiliation(s)
- A Sainfort
- Pharmacie, hospices civils de Lyon, 69500 Bron, France.
| | - I Denis Hallouard
- Pharmacie des dispositifs médicaux, centre hospitalo-universitaire de Saint-Étienne, 42055 Saint-Étienne, France
| | - D Hartmann
- Équipe I2B - « Interactions biologiques et biomatériaux », UCBL1/ISPB, faculté de pharmacie, UMR CNRS 5510/MATEIS, 69373 Lyon, France
| | - G Aulagner
- Pharmacie, hospices civils de Lyon, 69500 Bron, France; Équipe I2B - « Interactions biologiques et biomatériaux », UCBL1/ISPB, faculté de pharmacie, UMR CNRS 5510/MATEIS, 69373 Lyon, France
| | - Y Francois
- Service de chirurgie générale, hospices civils de Lyon, 69495 Pierre-Benite, France
| | - O Tiffet
- Service de chirurgie, centre hospitalo-universitaire de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France
| | - G Barabino
- Service de chirurgie, centre hospitalo-universitaire de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France
| | - O Nuiry
- Pharmacie des dispositifs médicaux, centre hospitalo-universitaire de Saint-Étienne, 42055 Saint-Étienne, France
| | - X Armoiry
- Délégation à la recherche clinique et à l'innovation, cellule innovation/UMR-CNRS 5510/MATEIS, hospices civils de Lyon, 69500 Bron, France
| |
Collapse
|
18
|
Molegraaf M, Lange J, Wijsmuller A. Uniformity of Chronic Pain Assessment after Inguinal Hernia Repair: A Critical Review of the Literature. Eur Surg Res 2016; 58:1-19. [PMID: 27577699 DOI: 10.1159/000448706] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 07/26/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic postoperative inguinal pain (CPIP) is the most common long-term complication of inguinal hernia repair. As such procedures are routinely performed, CPIP can be considered a significant burden to global health care. Therefore, adequate preventative measures relevant to surgical practice are investigated. However, as no gold standard research approach is currently available, study and outcome measures differ between studies. The current review aims to provide a qualitative analysis of the literature to seek out if outcomes of CPIP are valid and comparable, facilitating recommendations on the best approach to preventing CPIP. METHODS A systematic review of recent studies investigating CPIP was performed, comprising studies published in 2007-2015. Study designs were analyzed regarding the CPIP definitions applied, the use of validated instruments, the availability of a baseline score, and the existence of a minimal follow-up of 12 months. RESULTS Eighty eligible studies were included. In 48 studies, 22 different definitions of CPIP were identified, of which the definition provided by the International Association for the Study of Pain was applied most often. Of the studies included, 53 (66%) used 33 different validated instruments to quantify CPIP. There were 32 studies (40%) that assessed both pain intensity (PI) and quality of life (QOL) with validated tools, 41% and 4% had a validated assessment of only PI or QOL, respectively, and 15% lacked a validated assessment. The visual analog scale and the Short Form 36 (SF36) were most commonly used for measuring PI (73%) and QOL (19%). Assessment of CPIP was unclear in 15% of the studies included. A baseline score was assessed in 45% of the studies, and 75% had a follow-up of at least 12 months. CONCLUSION The current literature addressing CPIP after inguinal hernia repair has a variable degree of quality and lacks uniformity in outcome measures. Proper comparison of the study results to provide conclusive recommendations for preventive measures against CPIP therefore remains difficult. These findings reaffirm the need for a uniform and validated assessment with uniform reporting of outcomes to improve the burden that CPIP poses to a significant surgical patient population.
Collapse
Affiliation(s)
- Marijke Molegraaf
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | |
Collapse
|
19
|
Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair. Hernia 2016; 20:399-404. [DOI: 10.1007/s10029-016-1465-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
|
20
|
Köckerling F, Alam NN, Narang SK, Daniels IR, Smart NJ. Biological Meshes for Inguinal Hernia Repair - Review of the Literature. Front Surg 2015; 2:48. [PMID: 26442279 PMCID: PMC4569804 DOI: 10.3389/fsurg.2015.00048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/01/2015] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Biological meshes are a potential alternative to the synthetic meshes to avoid complications and are used in a contaminated field for incarcerated inguinal hernias. The clinical experiences gained with biological meshes for repair of inguinal hernias are presented in this review. MATERIALS AND METHODS In a literature search of the Medline database using the key word "Biological mesh," 2,277 citations were found. There remained 14 studies in which biological meshes had been used to repair inguinal hernias. RESULTS In prospective randomized trials, the use of polypropylene vs. biological meshes was compared in open inguinal hernia repair. There was no difference in the recurrence rate, but differences were observed in the postsurgical pain incidence in favor of the biological mesh. In the remaining retrospective studies, the recurrence rates were also acceptable. The biological mesh was used successfully in a potentially contaminated setting. CONCLUSION Inguinal hernias can be repaired with biological meshes with reasonable recurrence rate, also as an alternative in a potentially contaminated field.
Collapse
Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery, Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | - Nasra N. Alam
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - Sunil K. Narang
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - Ian R. Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - Neil J. Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK
| |
Collapse
|
21
|
Nie X, Xiao D, Wang W, Song Z, Yang Z, Chen Y, Gu Y. Comparison of Porcine Small Intestinal Submucosa versus Polypropylene in Open Inguinal Hernia Repair: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0135073. [PMID: 26252895 PMCID: PMC4529205 DOI: 10.1371/journal.pone.0135073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/17/2015] [Indexed: 01/28/2023] Open
Abstract
Background A systematic review and meta-analysis was performed in randomized controlled trials (RCTs) to compare porcine small intestinal submucosa (SIS) with polypropylene in open inguinal hernia repair. Method Electronic databases MEDLINE, Embase, and the Cochrane Library were used to compare patient outcomes for the two groups via meta-analysis. Result A total of 3 randomized controlled trials encompassing 200 patients were included in the meta-analysis. There was no significant difference in recurrence (P = 0.16), hematomas (P = 0.06), postoperative pain within 30 days (P = 0.45), or postoperative pain after 1 year (P = 0.12) between the 2 groups. The incidence of discomfort was significantly lower (P = 0.0006) in the SIS group. However, the SIS group experienced a significantly higher incidence of seroma (P = 0.03). Conclusions Compared to polypropylene, using SIS in open inguinal hernia repair is associated with a lower incidence of discomfort and a higher incidence of seroma. However, well-designed larger RCT studies with a longer follow-up period are needed to confirm these findings.
Collapse
Affiliation(s)
- Xin Nie
- Department of General Surgery, Shanghai Ninth Hospital affiliated to Shanghai JiaoTong University School of Medicine, and Hernia and Abdominal Wall Surgery Center of Shanghai JiaoTong University, Shanghai, China
| | - Dongdong Xiao
- Department of Urology Surgery, Shanghai Ninth Hospital affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wenyue Wang
- Department of General Surgery, Shanghai Ninth Hospital affiliated to Shanghai JiaoTong University School of Medicine, and Hernia and Abdominal Wall Surgery Center of Shanghai JiaoTong University, Shanghai, China
| | - Zhicheng Song
- Department of General Surgery, Shanghai Ninth Hospital affiliated to Shanghai JiaoTong University School of Medicine, and Hernia and Abdominal Wall Surgery Center of Shanghai JiaoTong University, Shanghai, China
| | - Zhi Yang
- Department of General Surgery, Shanghai Ninth Hospital affiliated to Shanghai JiaoTong University School of Medicine, and Hernia and Abdominal Wall Surgery Center of Shanghai JiaoTong University, Shanghai, China
| | - Yuanwen Chen
- Department of General Surgery, Shanghai Ninth Hospital affiliated to Shanghai JiaoTong University School of Medicine, and Hernia and Abdominal Wall Surgery Center of Shanghai JiaoTong University, Shanghai, China
| | - Yan Gu
- Department of General Surgery, Shanghai Ninth Hospital affiliated to Shanghai JiaoTong University School of Medicine, and Hernia and Abdominal Wall Surgery Center of Shanghai JiaoTong University, Shanghai, China
- * E-mail:
| |
Collapse
|
22
|
Fang Z, Ren F, Zhou J, Tian J. Biologic mesh versus synthetic mesh in open inguinal hernia repair: system review and meta-analysis. ANZ J Surg 2015; 85:910-6. [PMID: 26183816 DOI: 10.1111/ans.13234] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Biologic meshes are mostly used for abdominal wall reinforcement in infected fields, but no consensus has been reached on its use for inguinal hernia repairing. The purpose of this study was to compare biologic mesh with synthetic mesh in open inguinal herniorrhaphy. METHODS A systematic literature review and meta-analysis was undertaken to identify studies comparing the outcomes of biologic mesh and synthetic mesh in open inguinal hernia repair. Published studies were identified by the databases PubMed, EMBASE and the Cochrane Library. RESULTS A total of 382 patients in five randomized controlled trials were reviewed (179 patients in biologic mesh group; 203 patients in synthetic mesh group). The two groups did not significantly differ in chronic groin pain (P = 0.06) or recurrence (P = 0.38). The incidence of seroma trended higher in biologic mesh group (P = 0.03). Operating time was significantly longer with biologic mesh (P = 0.03). There was no significant difference in hematomas (P = 0.23) between the two groups. CONCLUSIONS From the data of this study, biologic mesh had no superiority to synthetic mesh in open inguinal hernia repair with similar recurrence rates and incidence of chronic groin pain, but higher rate of seroma and longer operating time. However, this mesh still needs to be assessed in a large, multicentre, well-designed randomized controlled trial.
Collapse
Affiliation(s)
- Zhixue Fang
- Department of Geriatrics Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feng Ren
- Department of Geriatrics Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianping Zhou
- Department of Geriatrics Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiao Tian
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
23
|
Scientific surgery. Br J Surg 2014. [DOI: 10.1002/bjs.9610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|