1
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Siebert M, Lhomme C, Carbonnelle E, Trésallet C, Kolakowska A, Jaureguy F. Microbiological epidemiology and antibiotic susceptibility of infected meshes after prosthetic abdominal wall repair. J Visc Surg 2023; 160:85-89. [PMID: 36935232 DOI: 10.1016/j.jviscsurg.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Infectious complications of parietal mesh after prosthetic abdominal wall repair are rare. Their management is complex. Furthermore, the emergence of bacterial resistance, the presence of a foreign material, the need to continue an extended antibiotic therapy, and the choice of an appropriate treatment are crucial. The objective of this study is to access the microbiological epidemiology of infected parietal meshes in order to optimize the empirical antibiotic therapy. METHODS Between January 2016 and December 2021, a monocentric and retrospective study was performed in patients hospitalized for infected parietal meshes at Avicenne hospital, in Paris area. Clinical and microbiological data such as antibiotic susceptibility were collected. RESULTS Twenty-six patients with infected parietal meshes have been hospitalized during this period. Meshes were in preaponevrotic positions (n=10; 38%), retromuscular (n=6; 23%) and intraperitoneal (n=10; 38%). Among the 22 (84.6%) documented cases of infections, 17 (77.3%) were polymicrobial. A total of 54 bacteria were isolated, 48 of which had an antibiogram available. The most frequently isolated bacteria were: Enterobacterales (n=19), Enterococcus spp. (n=11) and Staphylococcus aureus (n=6), whereas anaerobes were poorly isolated (n=3). Concerning these isolated bacteria, amoxicillin-clavulanic acid, metronidazole-associated cefotaxime, piperacillin-tazobactam and meropenem were susceptible in 45.5%, 68.2%, 63.6%, 77.2%, of cases, respectively. CONCLUSION This work highlights that infections of abdominal parietal meshes may be polymicrobial and the association amoxicillin-clavulanic acid cannot be used as a probabilist antibiotic therapy because of the high resistance rate in isolated bacteria. The association piperacillin-tazobactam appears to be a more adapted empirical treatment to preserve carbapenems, a broad-spectrum antibiotic class.
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Affiliation(s)
- M Siebert
- Digestive, bariatric and endocrine surgery unit, hôpital Avicenne, AP-HP, Bobigny, France.
| | - C Lhomme
- Digestive, bariatric and endocrine surgery unit, hôpital Avicenne, AP-HP, Bobigny, France
| | - E Carbonnelle
- Clinical microbiology department, groupe hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - C Trésallet
- Digestive, bariatric and endocrine surgery unit, hôpital Avicenne, AP-HP, Bobigny, France
| | - A Kolakowska
- Infectious and tropical diseases unit, groupe hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - F Jaureguy
- Clinical microbiology department, groupe hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France; Infection antimicrobials modelling evolution (IAME), UMR 1137, université Paris 13, Sorbonne Paris Cité, France
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2
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Repair Technique of Indirect Inguinal Hernia Without Mesh Concomitant with Radical Retropubic Prostatectomy: a Report of Three Cases. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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3
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Favourable outcomes after Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Non-Complex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-Analysis. Ann Surg 2022; 276:55-65. [PMID: 35185120 DOI: 10.1097/sla.0000000000005422] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. SUMMARY BACKGROUND DATA Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For non-complex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. METHODS Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. RESULTS Ninety-three studies representing 12440 patients undergoing retro-rectus repair were included. Pooled hernia recurrence was estimated at 3.2% (95%CI: 2.2-4.2%, n = 11049) after minimally 12 months and 4.1%, (95%CI: 2.9-5.5%, n = 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2-6.4%, n = 4891) and 5.5% (95%CI: 4.4-6.8%, n = 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair (OR: 0.27, 95%CI: 0.15-0.51, p < 0.001) and equal recurrence rates compared to intraperitoneal onlay (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, p = 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03-3.14, p = 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7-2.3%, n = 849) and SSI (1.5%, 95%CI: 0.8-2.8%, n = 982), albeit based on non-randomized studies. CONCLUSIONS Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except surgical site infection. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.
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Ng K, Goddard K. Extremely Late-Onset Deep Infection Post-inguinal Hernia Repair After Panendoscopy. Cureus 2022; 14:e22169. [PMID: 35308762 PMCID: PMC8923242 DOI: 10.7759/cureus.22169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/03/2022] Open
Abstract
Mesh infection after hernia repair is a well-known complication, which can have morbid consequences. This report presents a case of a gentleman with mesh infection many years after initial surgery, potentially from bacterial translocation post-colonoscopy, and describes his successful treatment. This case emphasizes the need to consider mesh infection regardless of time from surgery to presentation.
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Quiroga-Centeno AC, Quiroga-Centeno CA, Guerrero-Macías S, Navas-Quintero O, Gómez-Ochoa SA. Systematic review and meta-analysis of risk factors for Mesh infection following Abdominal Wall Hernia Repair Surgery. Am J Surg 2021; 224:239-246. [PMID: 34969506 DOI: 10.1016/j.amjsurg.2021.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical Mesh Infection (SMI) after Abdominal Wall Hernia Repair (AWHR) represents a catastrophic complication. We performed a systematic review and meta-analysis to analyze the risk factors for SMI in the context of AWHR. METHODS PubMed, Embase, Scielo, and LILACS were searched without language or time restrictions from inception until June 2021. Articles evaluating the association between demographic, clinical, laboratory and surgical characteristics with SMI in AWHR were included. RESULTS 23 studies were evaluated, comprising a total of 118,790 patients (98% males; mean age 56.5 years) with a mesh infection pooled prevalence of 4%. Significant risk factors for SMI were type 2 diabetes mellitus, obesity, smoking history, steroids use, ASA III/IV, laparotomy vs laparoscopy, emergency surgery, duration of surgery and onlay mesh position vs sublay. The quality of evidence was regarded as very low-moderate. CONCLUSION Several factors, highlighting sociodemographic characteristics, comorbidities, and the clinical scenario, may increase the risk of developing mesh infections in AWHR. The recognition and mitigation of these may significantly reduce mesh infection rates in this context.
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Affiliation(s)
| | | | | | | | - Sergio Alejandro Gómez-Ochoa
- Member Grupo de Investigación en Cirugía y Especialidades Quirúrgicas (GRICES-UIS), Universidad Industrial de Santander, Bucaramanga, Colombia; Research Division, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
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Mesh Migration into the Neobladder and Ileum with Complicated Fistula Formation following Incisional Hernia Repair. Case Rep Surg 2021; 2021:5683621. [PMID: 34733565 PMCID: PMC8560301 DOI: 10.1155/2021/5683621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/05/2021] [Indexed: 12/21/2022] Open
Abstract
Background Tension-free repair using mesh has become the standard treatment for abdominal wall incisional hernias. However, its postoperative complications reportedly include mesh infection, adhesions, and fistula formation in other organs. Here, we report an extremely rare case of mesh migration into the neobladder and ileum with entero-neobladder and neobladder-cutaneous fistulas. Case Presentation. An 80-year-old male who had undergone radical cystectomy 5 years ago and abdominal wall incisional hernia repair 3 years ago presented with fever and abdominal pain. Computed tomography (CT) scan revealed mesh migration into the neobladder and ileum. He was treated conservatively with antibiotics for a month but did not show improvement; hence, he was transferred to our hospital. He was diagnosed with mesh migration into the neobladder and ileum with complicated fistula formation. He underwent mesh removal, partial neobladder resection, and partial small bowel resection. He developed superficial incisional surgical site infection, which improved with drainage and antibiotics, and he was discharged 40 days after the surgery. Conclusions We reported a rare case of mesh migration into the neobladder and ileum with fistula formation. Successful conservative treatment cannot be expected for this condition because mesh migration into the intestinal tract causes infection and fistula formation. Hernia repair requires careful placement of the mesh such that it does not come into contact with the intestinal tract. Early surgical intervention is important if migration into the intestinal tract is observed.
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7
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Parker BK, Manning S. Postprocedural Gastrointestinal Emergencies. Emerg Med Clin North Am 2021; 39:781-794. [PMID: 34600637 DOI: 10.1016/j.emc.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Postprocedural complications encompass a wide array of conditions that vary in acuity, symptoms, index procedure, and treatment. Continued advancements in diagnostic and therapeutic procedures have led to a significant shift of procedures to the ambulatory setting. This trend is of particular interest to the emergency physician, as patients who develop complications often present to an emergency department for evaluation and treatment. Here the authors examine a high-yield collection of procedures, both ambulatory and inpatient, notable for their frequent utilization and unique complication profiles including common laparoscopic surgical procedures, bariatric surgery, endoscopic procedures, interventional radiology procedures, and hernia repairs with implantable mesh.
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Affiliation(s)
- Brian K Parker
- Department of Emergency Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7736, San Antonio, TX 78229, USA
| | - Sara Manning
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue
- FOB 3rd Floor, Indianapolis, IN 46202, USA.
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Van den Dop LM, Sneiders D, Kleinrensink GJ, Jeekel HJ, Lange JF, Timmermans L. Infectious Complication in Relation to the Prophylactic Mesh Position: The PRIMA Trial Revisited. J Am Coll Surg 2021; 232:738-745. [PMID: 33601004 DOI: 10.1016/j.jamcollsurg.2021.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prophylactic mesh reinforcement has proven to reduce the incidence of incisional hernia (IH). Fear of infectious complications may withhold the widespread implementation of prophylactic mesh reinforcement, particularly in the onlay position. STUDY DESIGN Patients scheduled for elective midline surgery were randomly assigned to a suture closure group, onlay mesh group, or sublay mesh group. The incidence, treatment, and outcomes of patients with infectious complications were assessed through examining the adverse event forms. Data were collected prospectively for 2 years after the index procedure. RESULTS Overall, infectious complications occurred in 14/107 (13.3%) patients in the suture group and in 52/373 (13.9%) patients with prophylactic mesh reinforcement (p = 0.821). Infectious complications occurred in 17.6% of the onlay group and 10.3% of the sublay group (p = 0.042). Excluding anastomotic leakage as a cause, these incidences were 16% (onlay) and 9.7% (sublay), p = 0.073. The mesh could remain in-situ in 40/52 (77%) patients with an infectious complication. The 2-year IH incidence after onlay mesh reinforcement was 10 in 33 (30.3%) with infectious complications and 15 in 140 (9.7%) without infectious complications (p = 0.003). This difference was not statistically significant for the sublay group. CONCLUSIONS Prophylactic mesh placement was not associated with increased incidence, severity, or need for invasive treatment of infectious complications compared with suture closure. Patients with onlay mesh reinforcement and an infectious complication had a significantly higher risk of developing an incisional hernia, compared with those in the sublay group.
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Affiliation(s)
| | - Dimitri Sneiders
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Gert-Jan Kleinrensink
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hans J Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Department of Surgery, IJsselland ziekenhuis, Capelle aan den Ijssel, The Netherlands
| | - Lucas Timmermans
- Department of Surgery, Department of Maasstad ziekenhuis, Rotterdam, The Netherlands
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Warren JA, Love M, Cobb WS, Beffa LR, Couto FJ, Hancock B, Morrow D, Ewing JA, Carbonell AM. Factors affecting salvage rate of infected prosthetic mesh. Am J Surg 2020; 220:751-756. [DOI: 10.1016/j.amjsurg.2020.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 02/06/2023]
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10
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Kraft CT, Molina BJ, Skoracki RJ. Polypropylene Mesh Complications in the Sublay Position After Abdominally Based Breast Reconstruction: Les complications des treillis de polypropylène en sous-couche après une reconstruction mammaire par voie abdominale. Plast Surg (Oakv) 2020; 29:16-20. [PMID: 33614536 DOI: 10.1177/2292550320936683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Abdominal wall morbidity after microsurgical breast reconstruction is an important consideration for patients and surgeons. Previous studies are limited by multiple mesh locations or types. In this study, we evaluate specifically subfascial polypropylene mesh placement to determine a more definitive complication rate and basis for objective comparison. Methods A retrospective review was performed for patients undergoing microsurgical breast reconstruction at our institution by 3 surgeons from 2015 to 2018. All patients with sublay placement of polypropylene mesh were included. Patient demographics, medical comorbidities, type of reconstruction, and postoperative abdominal wall complications were recorded. Results A total of 114 flaps were performed on 81 patients who met the inclusion criteria. Of these, 48 were deep inferior epigastric artery (DIEP) flaps (42%), 43 were MS-2 TRAM flaps (37.8%), 20 were muscle sparing (MS-1) transverse rectus abdominus muscle (TRAM) flaps (17.5%), and 3 were free TRAM flaps (2.6%). Average follow-up was 392 days (range: 29-1191). Average body mass index was 30.7. No patients developed hernias. Two patients (2.5%) complained of post-operative bulges, neither of which required operative treatment. Two patients experienced superficial abdominal wall infection, one of which required admission and intravenous antibiotics. Ten patients (12.3%) had abdominal incision dehiscence, 3 of which required operative intervention. There were no cases of mesh exposure, contamination, or removal. Conclusion Polypropylene mesh is safe and effective, with subfascial placement resulting in low morbidity and low rates of bulge/hernia formation after microsurgical breast reconstruction. Consideration should be given to using polypropylene mesh for fascial repairs after microsurgical breast reconstruction, particularly in high-risk populations.
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Affiliation(s)
- Casey T Kraft
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bianca J Molina
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Roman J Skoracki
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
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11
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Yang F. Use of Polypropylene Mesh in the Management of a Contaminated Large Ventral Hernia: A Contraindication or a Solution? Am Surg 2020. [DOI: 10.1177/000313481307901224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Management of contaminated large ventral hernias is still a challenge as a result of massive loss of muscular and fascial tissues in the abdominal wall, traditional contraindication to use of a prosthesis, and complicated perioperative management. This study aimed to provide a solution for this challenging dilemma using monofilament polypropylene mesh (Marlex; Bard) in the Sublay-Bridge fashion. Twenty-three consecutive patients with contaminated large ventral hernias from 2009 to 2011 were identified. Preoperatively, source of contamination at the surgical site was managed through oral antibiotics, wound débridement, and dressing change; the hernia content was reduced into the abdominal cavity gradually and an abdominal binder was applied. Marlex meshes in the Sublay-Bridge fashion were used in these patients. Demographic and perioperative data were collected. Fourteen males and nine females were included with a mean age of 52.5 ± 10.5 years and a mean body mass index of 25.2 ± 6.1 kg/m2. Twelve patients underwent ostomy takedown, which was the most common indication. Mean hernia size was 120.5 ± 18.5 cm2 and a mean mesh size was 380.0 ± 80.5 cm2. The mean operative time was 125.5 ± 35.5 minutes and the hospital stay was 10.0 ± 3.5 days. Twenty-three patients had a mean follow-up period of 12.5 ± 6.5 months. An iatrogenic bladder injury occurred because of severe prevesical adhesion attributed to previous prosthesis repair. There was no presentation of abdominal compartment syndrome. Four patients developed surgical site infection and managed with conservative therapy without mesh removal. Three patients had seromas and underwent aspiration guided by B-ultrasound. Three patients reported chronic foreign body sensation. No recurrence was followed up. Repair of contaminated large ventral hernia using a Marlex mesh in the Sublay-Bridge fashion is safe and efficient management. Perioperative management and operative technology play important roles in dealing with this problem.
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Affiliation(s)
- Fei Yang
- Department of General Surgery, 1st Affiliated Hospital of PLA General Hospital, HaiDian District, Beijing, China
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12
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Usefulness of sonication procedure in mesh infection diagnosis associated with hernia repair. Hernia 2020; 24:845-847. [PMID: 31989327 DOI: 10.1007/s10029-019-02118-0] [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: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of prosthetic meshes is a common practice in hernia repair surgery. However, infection can appear as an important complication where antibiotic selection must be directed by the etiology of the infection. In recent years, sonication has appeared as an important tool for the diagnosis of many biomaterial-associated infections. Here, we evaluated our experience with this methodology for the diagnosis of mesh infection. METHODS We retrospectively reviewed the microbiological records between 2015 and 2019 looking for sonicated meshes in the microbiology laboratory. All samples were processed according to the sonication protocol described by Esteban J et al. (J Clin Microbiol. 2008 Feb; 46 (2): 488-92). RESULTS 26 samples were processed during the study period. 21 of them gave a positive result for culture (11 polymicrobial and 10 monomicrobial ones). Staphylococcus aureus and Candida albicans were the commonest monomicrobial isolates (4 cases each). There were five cases of mixed gut microbiota. The median (interquartile range) UFC count was > 100,000 (50,000- > 100,000) CFU/mL. CONCLUSION Sonication is a useful technique for the diagnosis of mesh infection.
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Pauli E, Siegal S, Morrell D, Orenstein S. Mesh salvage following deep surgical site infection. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_47_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kohler A, Lavanchy JL, Lenoir U, Kurmann A, Candinas D, Beldi G. Effectiveness of Prophylactic Intraperitoneal Mesh Implantation for Prevention of Incisional Hernia in Patients Undergoing Open Abdominal Surgery: A Randomized Clinical Trial. JAMA Surg 2019; 154:109-115. [PMID: 30476940 DOI: 10.1001/jamasurg.2018.4221] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Incisional hernia is a frequent complication after open abdominal surgery. Prophylactic mesh implantation in the onlay or sublay position requires dissection of the abdominal wall, potentially leading to wound-associated complications. Objective To compare the incidence of incisional hernia among patients after prophylactic intraperitoneal mesh implantation with that among patients after standard abdominal closure. Design, Setting, and Participants An open-label randomized clinical trial was performed in 169 patients undergoing elective open abdominal surgery from January 1, 2011, to February 29, 2014. Follow-up examinations were performed 1 year and 3 years after surgery. The study was conducted at Bern University Hospital, Bern, Switzerland, a referral center that offers the whole spectrum of abdominal surgical interventions. Patients with 2 or more of the following risk factors were included: overweight or obesity, diagnosis of neoplastic disease, male sex, or history of previous laparotomy. Patients were randomly assigned to prophylactic intraperitoneal mesh implantation or standard abdominal closure. Data were analyzed in August 2017. Interventions Intraperitoneal implantation of a polypropylene-polyvinylidene fluoride mesh with circumferential fixation. Main Outcomes and Measures The primary end point was the incidence of incisional hernia 3 years after surgery. Secondary end points included mesh-related complications. Results After the exclusion of 19 patients, 150 patients (81 in the control group and 69 in the mesh group; mean [SD] age, 64.2 [11.1] years; 102 [68.0%] male) were studied. The cumulative incidence of incisional hernia was significantly lower in the mesh group compared with the control group (5 of 69 [7.2%] vs 15 of 81 [18.5%], log-rank test P = .03). Abdominal pain was observed in significantly more patients in the mesh group compared with the control group at 6 weeks (34 of 52 [65%] vs 26 of 59 [44%], P = .04) but not at 12 and 36 months postoperatively. No difference in surgical site infections was observed, but time to complete wound healing of surgical site infection was significantly longer in patients with mesh implantation (median [interquartile range], 8 [6-24] weeks compared with 5 [1-9] weeks; P = .03). Trunk extension was significantly decreased after mesh implantation compared with the control group (mean [SD], 1.73 [0.97] cm vs 2.40 [1.23] cm, P = .009). Conclusions and Relevance In patients at elevated risk for incisional hernia, prophylactic intraperitoneal mesh implantation reduces the incidence of hernia formation but with increased early postoperative pain and prolonged wound healing of surgical site infection. Trial Registration ClinicalTrials.gov Identifier: NCT01203553.
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Affiliation(s)
- Andreas Kohler
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joel L Lavanchy
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ursina Lenoir
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita Kurmann
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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15
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Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP. Nat Rev Urol 2019; 16:675-689. [PMID: 31548731 DOI: 10.1038/s41585-019-0230-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 01/03/2023]
Abstract
Vaginal meshes used in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have produced highly variable outcomes, causing life-changing complications in some patients while providing others with effective, minimally invasive treatments. The risk:benefit ratio when using vaginal meshes is a complex issue in which a combination of several factors, including the inherent incompatibility of the mesh material with some applications in pelvic reconstructive surgeries and the lack of appropriate regulatory approval processes at the time of the premarket clearance of these products, have contributed to the occurrence of complications caused by vaginal mesh. Surgical mesh used in hernia repair has evolved over many years, from metal implants to knitted polymer meshes that were adopted for use in the pelvic floor for treatment of POP and SUI. The evolution of the material and textile properties of the surgical mesh was guided by clinical feedback from hernia repair procedures, which were also being modified to obtain the best outcomes with use of the mesh. Current evidence shows how surgical mesh fails biomechanically when used in the pelvic floor and materials with improved performance can be developed using modern material processing and tissue engineering techniques.
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Boukovalas S, Sisk G, Selber JC. Erratum: Addendum: Abdominal Wall Reconstruction: An Integrated Approach. Semin Plast Surg 2019; 32:199-202. [PMID: 31329738 DOI: 10.1055/s-0038-1673696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
[This corrects the article DOI: 10.1055/s-0038-1667062.].
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Affiliation(s)
- Stefanos Boukovalas
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Geoffrey Sisk
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jesse C Selber
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
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A Comparison of Open and Laparoscopic Techniques in Incisional Hernia Surgery: A Single-center Experience. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2019. [DOI: 10.21673/anadoluklin.453962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Shubinets V, Carney MJ, Colen DL, Mirzabeigi MN, Weissler JM, Lanni MA, Braslow BM, Fischer JP, Kovach SJ. Management of Infected Mesh After Abdominal Hernia Repair: Systematic Review and Single-Institution Experience. Ann Plast Surg 2018; 80:145-153. [PMID: 28671890 DOI: 10.1097/sap.0000000000001189] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mesh infection after abdominal hernia repair is a devastating complication that affects general and plastic surgeons alike. The purpose of this study was 3-fold: (1) to determine current evidence for treatment of infected abdominal wall mesh via systematic review of literature, (2) to analyze our single-institution experience with treatment of infected mesh patients, and (3) to establish a framework for how to approach this complex clinical problem. METHODS Literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, followed by single-institution retrospective analysis of infected mesh patients. RESULTS A total of 3565 abstracts and 92 full-text articles were reviewed. For qualitative and quantitative assessment, articles were subdivided on the basis of treatment approach: "conservative management," "excision of mesh with primary closure," "single-stage reconstruction," "immediate staged repair," and "repair in contaminated field." Evidence for each treatment approach is presented. At our institution, most patients (40/43) were treated by excision of infected mesh and single-stage reconstruction with biologic mesh. When the mesh was placed in a retrorectus or underlay fashion, 21.4% rate of hernia recurrence was achieved. Bridged repairs were highly prone to recurrence (88.9%; P = 0.001), but the bridging biologic mesh seemed to maintain domain and potentially contribute to a more effective repair in the future. Of the patients who underwent additional ("secondary") repairs after recurrence, 75% were eventually able to achieve "hernia-free" state. CONCLUSIONS This study reviews the literature and our single-institution experience regarding treatment of infected abdominal wall mesh. Framework is developed for how to approach this complex clinical problem.
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Prophylactic Intraperitoneal Onlay Mesh Reinforcement Reduces the Risk of Incisional Hernia, Two-Year Results of a Randomized Clinical Trial. World J Surg 2018; 42:1687-1694. [PMID: 29159603 DOI: 10.1007/s00268-017-4363-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Incisional hernias still are a major concern after laparotomy and are causing substantial morbidity. This study examines the feasibility, safety and incisional hernia rate of the use of a prophylactic intraperitoneal onlay mesh stripe (IPOM) to prevent incisional hernia following midline laparotomy. METHODS This prospective, randomized controlled trial randomly allocated patients undergoing median laparotomy either to mass closure of the abdominal wall with a PDS-loop running suture reinforced by an intraperitoneal composite mesh stripe (Group A) or to the same procedure without the additional mesh stripe (Group B). Primary endpoint was the incidence of incisional hernias at 2 years following midline laparotomy. Secondary endpoints are were the feasibility, the safety of the mesh stripe implantation including postoperative pain, and the incidence of incisional hernias at 5 years. RESULTS A total of 267 patients were included in this study. Follow-up data 2 years after surgery was available from 210 patients (Group A = 107; Group B = 103). An incisional hernia was diagnosed in 18/107 (17%) patients in Group A and in 40/103 (39%) patients in Group B (p < 0.001). A surgical operation due to an incisional hernia was conducted for 12/107 (11%) patients in Group A and for 24/103 (23%) patients in Group B (p = 0.039). In both groups, minor and major complications as well as postoperative pain are reported with no statistically significant difference between the groups, even in contaminated situations. CONCLUSIONS This first randomized clinical trial indicates that the placement of a non-absorbable IPOM-stripe with prophylactic intention may significantly reduce the risk for a midline incisional hernia. TRIAL REGISTRATION Ref. NCT01003067 (clinicaltrials.gov).
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Affiliation(s)
- Hamid Reza Zahiri
- Anne Arundel Medical Center, Department of Surgery, Division of Minimally Invasive Surgery, Annapolis, Maryland
| | - Igor Belyansky
- Anne Arundel Medical Center, Department of Surgery, Division of Minimally Invasive Surgery, Annapolis, Maryland
| | - Adrian Park
- Anne Arundel Medical Center, Department of Surgery, Division of Minimally Invasive Surgery, Annapolis, Maryland.
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23
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Prevention and Treatment Strategies for Mesh Infection in Abdominal Wall Reconstruction. Plast Reconstr Surg 2018; 142:149S-155S. [DOI: 10.1097/prs.0000000000004871] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Ismaeil DA. Mesh repair of paraumblical hernia, outcome of 58 cases. Ann Med Surg (Lond) 2018; 30:28-31. [PMID: 29946456 PMCID: PMC6016320 DOI: 10.1016/j.amsu.2018.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/20/2018] [Accepted: 04/09/2018] [Indexed: 11/15/2022] Open
Abstract
Background According to the literature, defects in para-umbilical hernias up to 2 cm in diameter could be sutured primarily. For defects larger than 2 cm in dimeters, mesh repair is recommended. The aim of this study is to evaluate the outcome of para-umbilical hernia repair with proline mesh regardless of its size. Methods In this retrospective study, patients with para-umbilical hernia, who were managed by onlay mesh placement were presented, and followed for 1–6 years. Several variables were studied including patients' socio-demographic data, post-operative complications, morbidity and mortality. Results The series includes 58 patients, the age ranged from 18 to 85 years with median age of 44 years and inter-quartile range of 13.5 years. Mean body mass index was (30.9 ± 4.2). From 49 female patients; 43 (87.8%) were multipara. Forty seven cases (81%) presented for the first time, and 11 cases (19%) had recurrent hernias. Twenty patients (34.5%) had hernia defect ≤2 cm, while 38 patients (65.5%) had hernia size >2 cm. Superficial surgical site infection was found in 6 patients (10.34%). Seroma was found in one female patient (1.72%). One patient (1.72%) had recurrent hernia after 19 months. Conclusion Mesh onlay repair by open surgery can be applied to all sizes of para umbilical hernias, it has low recurrence rate and the rates of morbidity and recurrence are comparable with international standard. Defect in para-umbilical hernias up to 2 cm in diameter may be sutured primarily. For defects larger than 2 cm, mesh repair is recommended. A retrospective study of 58 paraumblical hernias that were treated with onlay mesh. The aim of this study is to confirm the outcome of para-umbilical hernia repair with proline mesh regardless of its size.
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Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair. Hernia 2018; 22:773-779. [DOI: 10.1007/s10029-018-1785-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
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26
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Guillaume O, Pérez-Tanoira R, Fortelny R, Redl H, Moriarty TF, Richards RG, Eglin D, Petter Puchner A. Infections associated with mesh repairs of abdominal wall hernias: Are antimicrobial biomaterials the longed-for solution? Biomaterials 2018; 167:15-31. [PMID: 29554478 DOI: 10.1016/j.biomaterials.2018.03.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 12/30/2022]
Abstract
The incidence of mesh-related infection after abdominal wall hernia repair is low, generally between 1 and 4%; however, worldwide, this corresponds to tens of thousands of difficult cases to treat annually. Adopting best practices in prevention is one of the keys to reduce the incidence of mesh-related infection. Once the infection is established, however, only a limited number of options are available that provides an efficient and successful treatment outcome. Over the past few years, there has been a tremendous amount of research dedicated to the functionalization of prosthetic meshes with antimicrobial properties, with some receiving regulatory approval and are currently available for clinical use. In this context, it is important to review the clinical importance of mesh infection, its risk factors, prophylaxis and pathogenicity. In addition, we give an overview of the main functionalization approaches that have been applied on meshes to confer anti-bacterial protection, the respective benefits and limitations, and finally some relevant future directions.
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Affiliation(s)
- O Guillaume
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland.
| | - R Pérez-Tanoira
- Division of Infectious Diseases, IIS-Fundación Jiménez Díaz, Madrid, Spain; Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Finland
| | - R Fortelny
- Department of General, Visceral and Oncologic Surgery, Wilhelminen Hospital, Montleartstrasse 37, 1160, Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria; Sigmund Freud University, Medical Faculty, Kelsenstraße 2, A-1030, Vienna, Austria
| | - H Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Donaueschingenstrasse 13, A-1200, Vienna, Austria
| | - T F Moriarty
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - R G Richards
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - D Eglin
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - A Petter Puchner
- Department of General, Visceral and Oncologic Surgery, Wilhelminen Hospital, Montleartstrasse 37, 1160, Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria
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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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Degovtsov EN, Kolyadko PV. [Diagnosis and treatment of seroma after anterior abdominal wall hernia repair by using of mesh implant]. Khirurgiia (Mosk) 2018:99-102. [PMID: 29376967 DOI: 10.17116/hirurgia2018199-102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- E N Degovtsov
- Omsk State Medical University of the Ministry of Health of Russia, Omsk, Russia
| | - P V Kolyadko
- Nizhnevartovsk District Clinical Hospital, Nizhnevartovsk, Russia
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Abouelnasr K, Hamed M, Lashen S, El-Adl M, Eltaysh R, Tagawa M. Enhancement of abdominal wall defect repair using allogenic platelet-rich plasma with commercial polyester/cotton fabric (Damour) in a canine model. J Vet Med Sci 2017; 79:1301-1309. [PMID: 28603214 PMCID: PMC5559380 DOI: 10.1292/jvms.17-0139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Platelet-rich plasma (PRP) has an important role in musculoskeletal surgery; however, it has been underutilized for accelerating the healing of abdominal wall defects in veterinary practice. Therefore, the aim of this study was
to evaluate the use of commercial polyester/cotton fabric (Damour) as a new composite mesh for the repair of experimentally induced abdominal wall defects in canine models, and to investigate the possible role of PRP for improving
such repair and reducing allied complications. For this purpose, abdominal wall defects were created in 24 healthy mongrel dogs and then repaired with mesh alone (control group) or mesh and allogenic PRP (PRP group). Dogs were
euthanized after 2 or 4 months for gross examination of implantation site, detection of adhesion score and hernia recurrence. Moreover, tissue samples were collected for histological and gene expression analyses for
neovascularization, collagen formation and tissue incorporation. Hernia recurrence was not recorded in PRP-treated dogs that also displayed significantly more neovascularization and less severe adhesion to the underlings (1.08 ±
0.51) in comparison to control group (2.08 ± 0.99). Histological and molecular evaluation confirmed the gross findings that collagen deposition, new vessel formation, and overexpression of angiogenic and myofibroplastic genes
(COL1α1, COL3α1, VEGF and TGFβ1) were observed more frequently in the PRP group, at both time points. In conclusion, we found that addition of allogenic PRP to
Damour mesh enhanced neovessel formation, and increased tissue deposition and incorporation, with subsequent reduction of peritoneal adhesion and recurrence rate.
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Affiliation(s)
- Khaled Abouelnasr
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed Hamed
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Aswan University, Aswan 81528, Egypt
| | - Samah Lashen
- Department of Cytology and Histology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed El-Adl
- Department of Biochemistry and Chemistry of Nutrition, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Rasha Eltaysh
- Department of Pharmacology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Michihito Tagawa
- Veterinary Medical Center, Department of Clinical Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Inada, Obihiro, Hokkaido 080-8555, Japan
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Outcomes of Posterior Component Separation With Transversus Abdominis Muscle Release and Synthetic Mesh Sublay Reinforcement. Ann Surg 2017; 264:226-32. [PMID: 26910200 DOI: 10.1097/sla.0000000000001673] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of transversus abdominis muscle release (TAR) with retrorectus synthetic mesh reinforcement in a large series of complex hernia patients. BACKGROUND Posterior component separation via TAR during abdominal wall reconstruction (AWR) continues to gain popularity. Although our early experience with TAR has been promising, long-term outcomes have not been reported. METHODS From December 2006 to December 2014, consecutive patients undergoing open AWR utilizing TAR were identified in our prospectively maintained database and reviewed retrospectively. Main outcome measures included demographics, perioperative details, wound complications, and recurrences. RESULTS During the study period, 428 consecutive TAR procedures were analyzed. Mean age was 58, with mean body mass index 34.4 kg/m (range 20-65). Major comorbidities included diabetes (21%), chronic obstructive pulmonary disease (12%), and immunosuppression (3%). Mean hernia defect area was 606 cm (range 180-1280) and average mesh size was 1220 cm (range 600-4500). The majority of cases (66%) were clean, 26% were clean-contaminated, and 8% were contaminated. Eighty (18.7%) surgical-site events occurred, of which 39 (9.1%) were surgical-site infections. Three patients required mesh debridement; however, no instances of mesh explantation occurred. Of the 347 (81%) patients with at least 1-year follow-up (mean 31.5 mo), there were 13 (3.7%) recurrences. CONCLUSIONS Complex AWR represents a formidable surgical challenge. In this large series, we demonstrated that posterior component separation via TAR with wide synthetic mesh sublay provides a very durable repair with low morbidity, even in comorbid patients with large defects. We strongly advocate TAR as a robust addition to the armamentarium of reconstructive surgeons.
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Nobaek S, Rogmark P, Petersson U. Negative Pressure Wound Therapy for Treatment of Mesh Infection After Abdominal Surgery: Long-Term Results and Patient-Reported Outcome. Scand J Surg 2017; 106:285-293. [PMID: 28385111 DOI: 10.1177/1457496917690966] [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: 11/16/2022]
Abstract
BACKGROUND AND AIMS Treatment of synthetic mesh infections has previously often resulted in mesh explantation. Negative pressure wound therapy has been used in these situations with encouraging results. The aims of this study were to evaluate wound healing, mesh preservation, and patient-reported outcome after negative pressure wound therapy of mesh infections. MATERIAL AND METHODS Medical records of patients treated with negative pressure wound therapy for mesh infection and age-matched mesh-operated controls without postoperative complications were scrutinized in a retrospective study. An abdominal wall complaints questionnaire was used to evaluate patient-reported outcome. RESULTS Of 722 mesh operations performed 2005-2012, negative pressure wound therapy was used for treating postoperative mesh infections in 48 patients. A total of 48 age-matched controls were recruited from patients without wound complications. No differences were found between groups regarding preoperative characteristics. The following peroperative characteristics were significantly more frequent in the negative pressure wound therapy group: emergency operation, dirty/infected surgical field, surgical techniques other than laparoscopic intraperitoneal onlay mesh repair, implantation of more than one mesh, larger mesh size, longer duration of surgery, and mesh not completely covered with anterior rectus fascia. The entire mesh was salvaged in 92%, while four meshes were partly excised. Wounds healed in 88% after a median of 110 (range 3-649) days. In total, 85% in the negative pressure wound therapy group and 75% in the control group answered the questionnaire. There were no significant differences regarding pain, other abdominal wall symptoms, and satisfaction with the final result in favor of the controls. CONCLUSION No mesh had to be explanted and wound healing was achieved in the majority of patients when negative pressure wound therapy was used for treatment of mesh infections. However, time to healing was long, and numerous procedures were sometimes needed. Positive long-term outcome was more frequently reported among controls.
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Affiliation(s)
- S Nobaek
- 1 School of Medical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Rogmark
- 2 Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.,3 Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden
| | - U Petersson
- 2 Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.,3 Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden
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Kummerow Broman K, Huang LC, Faqih A, Phillips SE, Baucom RB, Pierce RA, Holzman MD, Sharp KW, Poulose BK. Hidden Morbidity of Ventral Hernia Repair with Mesh: As Concerning as Common Bile Duct Injury? J Am Coll Surg 2017; 224:35-42. [DOI: 10.1016/j.jamcollsurg.2016.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 02/04/2023]
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Song Z, Ma Y, Xia G, Wang Y, Kapadia W, Sun Z, Wu W, Gu H, Cui W, Huang X. In vitro and in vivo combined antibacterial effect of levofloxacin/silver co-loaded electrospun fibrous membranes. J Mater Chem B 2017; 5:7632-7643. [PMID: 32264238 DOI: 10.1039/c7tb01243h] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The Lev@MSN@Ag–PLLA fibers provided an advanced synergistic antibacterial nanoplatform of low dosage for the treatment of drug-resistant bacterial infections.
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Affiliation(s)
- Ziliang Song
- Department of General Surgery
- Sixth People's Hospital Affiliated Shanghai Jiao Tong University
- Shanghai
- P. R. China
| | - Yongjie Ma
- School of Biomedical Engineering and Med-X Research Institute
- Shanghai Jiao Tong University
- Shanghai
- P. R. China
| | - Guanggai Xia
- Department of General Surgery
- Sixth People's Hospital Affiliated Shanghai Jiao Tong University
- Shanghai
- P. R. China
| | - Yao Wang
- School of Biomedical Engineering and Med-X Research Institute
- Shanghai Jiao Tong University
- Shanghai
- P. R. China
| | - Wasim Kapadia
- Department of Orthopedics
- The First Affiliated Hospital of Soochow University
- Orthopedic Institute
- Soochow University
- Suzhou
| | - Zhiyong Sun
- Department of Orthopedics
- The First Affiliated Hospital of Soochow University
- Orthopedic Institute
- Soochow University
- Suzhou
| | - Wei Wu
- Department of Orthopedics
- The First Affiliated Hospital of Soochow University
- Orthopedic Institute
- Soochow University
- Suzhou
| | - Hongchen Gu
- School of Biomedical Engineering and Med-X Research Institute
- Shanghai Jiao Tong University
- Shanghai
- P. R. China
| | - Wenguo Cui
- Department of Orthopedics
- The First Affiliated Hospital of Soochow University
- Orthopedic Institute
- Soochow University
- Suzhou
| | - Xinyu Huang
- Department of General Surgery
- Sixth People's Hospital Affiliated Shanghai Jiao Tong University
- Shanghai
- P. R. China
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Garvey PB, Giordano SA, Baumann DP, Liu J, Butler CE. Long-Term Outcomes after Abdominal Wall Reconstruction with Acellular Dermal Matrix. J Am Coll Surg 2016; 224:341-350. [PMID: 27993696 DOI: 10.1016/j.jamcollsurg.2016.11.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/04/2016] [Accepted: 11/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Long-term outcomes data for hernia recurrence rates after abdominal wall reconstruction (AWR) with acellular dermal matrix (ADM) are lacking. The aim of this study was to assess the long-term durability of AWR using ADM. STUDY DESIGN We studied patients who underwent AWR with ADM at a single center in 2005 to 2015 with a minimum follow-up of 36 months. Hernia recurrence was the primary end point and surgical site occurrence (SSO) was a secondary end point. The recurrence-free survival curves were estimated by Kaplan-Meier product limit method. Univariate and multivariable Cox proportional hazards regression models and logistic regression models were used to evaluate the associations of risk factors at surgery with subsequent risks for hernia recurrence and SSO, respectively. RESULTS A total of 512 patients underwent AWR with ADM. After excluding those with follow-up less than 36 months, 191 patients were included, with a median follow-up of 52.9 months (range 36 to 104 months). Twenty-six of 191 patients had a hernia recurrence documented in the study. The cumulative recurrence rates were 11.5% at 3 years and 14.6% by 5 years. Factors significantly predictive of hernia recurrence developing included bridged repair, wound skin dehiscence, use of human cadaveric ADM, and coronary disease; component separation was protective. In a subset analysis excluding bridged repairs and human cadaveric ADM patients, cumulative hernia recurrence rates were 6.4% by 3 years and 8.3% by 5 years. The crude rate of SSO was 25.1% (48 of 191). Factors significantly predictive of the incidence of SSO included at least 1 comorbidity, BMI ≥30 kg/m2, and defect width >15 cm. CONCLUSIONS Use of ADM for AWR was associated with 11.5% and 14.6% hernia recurrence rates at 3- and 5-years follow-up, respectively. Avoiding bridged repairs and human cadaveric ADM can improve long-term AWR outcomes using ADM.
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Affiliation(s)
- Patrick B Garvey
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Salvatore A Giordano
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Donald P Baumann
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jun Liu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Bueno-Lledó J, Torregrosa-Gallud A, Carreño-Saénz O, García-Pastor P, Carbonell-Tatay F, Bonafé-Diana S, Iserte-Hernández J. Partial versus complete removal of the infected mesh after abdominal wall hernia repair. Am J Surg 2016; 214:47-52. [PMID: 27939024 DOI: 10.1016/j.amjsurg.2016.10.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND To compare the results with complete mesh removal (CMR) versus partial mesh removal (PMR) in the treatment of mesh infection after abdominal wall hernia repair (AWHR). METHODS Retrospective review of all patients who underwent surgery for mesh infection between January 2004 and May 2014 at a tertiary center. RESULTS Of 3470 cases of AWHR, we reported 66 cases (1.9%) of mesh infection, and 48 repairs (72.7%) required mesh explantation. CMR was achieved on 38 occasions, while PMR was undertaken ten times. We observed more postoperative complications in CMR than PMR group (p = 0.04). Three patients with intestinal fistula were reoperated in postoperative period after a difficult mesh removal; one of them died due to multiple organ failure. The overall recurrence rate after explantation was 47.9%: recurrence was more frequent in CMR group (p = 0.001), although persistent or new mesh infection was observed more frequently with PMR (p = 0.001). CONCLUSIONS Although PMR has less postoperative morbidity, shorter duration of hospitalization and lower rate of recurrence than CMR, prosthetic infection persists in up to 50% of cases.
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Affiliation(s)
- José Bueno-Lledó
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Valencia, Spain.
| | - Antonio Torregrosa-Gallud
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Valencia, Spain
| | - Omar Carreño-Saénz
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Valencia, Spain
| | - Providencia García-Pastor
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Valencia, Spain
| | - Fernando Carbonell-Tatay
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Valencia, Spain
| | - Santiago Bonafé-Diana
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Valencia, Spain
| | - José Iserte-Hernández
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Valencia, Spain
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Chen J, Howell C, Haller CA, Patel MS, Ayala P, Moravec KA, Dai E, Liu L, Sotiri I, Aizenberg M, Aizenberg J, Chaikof EL. An immobilized liquid interface prevents device associated bacterial infection in vivo. Biomaterials 2016; 113:80-92. [PMID: 27810644 DOI: 10.1016/j.biomaterials.2016.09.028] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 09/20/2016] [Accepted: 09/30/2016] [Indexed: 12/16/2022]
Abstract
Virtually all biomaterials are susceptible to biofilm formation and, as a consequence, device-associated infection. The concept of an immobilized liquid surface, termed slippery liquid-infused porous surfaces (SLIPS), represents a new framework for creating a stable, dynamic, omniphobic surface that displays ultralow adhesion and limits bacterial biofilm formation. A widely used biomaterial in clinical care, expanded polytetrafluoroethylene (ePTFE), infused with various perfluorocarbon liquids generated SLIPS surfaces that exhibited a 99% reduction in S. aureus adhesion with preservation of macrophage viability, phagocytosis, and bactericidal function. Notably, SLIPS modification of ePTFE prevents device infection after S. aureus challenge in vivo, while eliciting a significantly attenuated innate immune response. SLIPS-modified implants also decrease macrophage inflammatory cytokine expression in vitro, which likely contributed to the presence of a thinner fibrous capsule in the absence of bacterial challenge. SLIPS is an easily implementable technology that provides a promising approach to substantially reduce the risk of device infection and associated patient morbidity, as well as health care costs.
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Affiliation(s)
- Jiaxuan Chen
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States; Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, United States
| | - Caitlin Howell
- Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, United States; John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, United States
| | - Carolyn A Haller
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States; Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, United States
| | - Madhukar S Patel
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States; Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, United States; Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States
| | - Perla Ayala
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States; Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, United States
| | - Katherine A Moravec
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Erbin Dai
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Liying Liu
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Irini Sotiri
- Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, United States; John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, United States
| | - Michael Aizenberg
- Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, United States
| | - Joanna Aizenberg
- Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, United States; John A. Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, United States; Department of Chemistry and Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, United States; Kavli Institute for Bionano Science and Technology, Harvard University, 29 Oxford Street, Cambridge, MA 02138, United States.
| | - Elliot L Chaikof
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States; Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, United States; Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, United States.
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Kalaba S, Gerhard E, Winder JS, Pauli EM, Haluck RS, Yang J. Design Strategies and Applications of Biomaterials and Devices for Hernia Repair. Bioact Mater 2016; 1:2-17. [PMID: 28349130 PMCID: PMC5365083 DOI: 10.1016/j.bioactmat.2016.05.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/10/2016] [Accepted: 05/20/2016] [Indexed: 12/17/2022] Open
Abstract
Hernia repair is one of the most commonly performed surgical procedures worldwide, with a multi-billion dollar global market. Implant design remains a critical challenge for the successful repair and prevention of recurrent hernias, and despite significant progress, there is no ideal mesh for every surgery. This review summarizes the evolution of prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias. Next, the major milestones in implant design are discussed. Commonly encountered complications and strategies to minimize these adverse effects are described, followed by a thorough description of the implant characteristics necessary for successful repair. Finally, available implants are categorized and their advantages and limitations elucidated, including non-absorbable and absorbable (synthetic and biologically derived) prostheses, composite prostheses, and coated prostheses. This review not only summarizes the state of the art in hernia repair, but also suggests future research directions toward improved hernia repair utilizing novel materials and fabrication methods.
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Affiliation(s)
- Surge Kalaba
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Ethan Gerhard
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Joshua S. Winder
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Eric M. Pauli
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Randy S. Haluck
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Jian Yang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
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Tatar C, Tüzün İS, Karşıdağ T, Kızılkaya MC, Yılmaz E. Prosthetic Mesh Repair for Incarcerated Inguinal Hernia. Balkan Med J 2016; 33:434-40. [PMID: 27606140 DOI: 10.5152/balkanmedj.2016.150137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 08/17/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Incarcerated inguinal hernia is a commonly encountered urgent surgical condition, and tension-free repair is a well-established method for the treatment of non-complicated cases. However, due to the risk of prosthetic material-related infections, the use of mesh in the repair of strangulated or incarcerated hernia has often been subject to debate. Recent studies have demonstrated that biomaterials represent suitable materials for performing urgent hernia repair. Certain studies recommend mesh repair only for cases where no bowel resection is required; other studies, however, recommend mesh repair for patients requiring bowel resection as well. AIM The aim of this study was to compare the outcomes of different surgical techniques performed for strangulated hernia, and to evaluate the effect of mesh use on postoperative complications. STUDY DESIGN Retrospective cross-sectional study. METHODS This retrospective study was performed with 151 patients who had been admitted to our hospital's emergency department to undergo surgery for a diagnosis of incarcerated inguinal hernia. The patients were divided into two groups based on the applied surgical technique. Group 1 consisted of 112 patients treated with mesh-based repair techniques, while Group 2 consisted of 39 patients treated with tissue repair techniques. Patients in Group 1 were further divided into two sub-groups: one consisting of patients undergoing bowel resection (Group 3), and the other consisting of patients not undergoing bowel resection (Group 4). RESULTS In Group 1, it was observed that eight (7.14%) of the patients had wound infections, while two (1.78%) had hematomas, four (3.57%) had seromas, and one (0.89%) had relapse. In Group 2, one (2.56%) of the patients had a wound infection, while three (7.69%) had hematomas, one (2.56%) had seroma, and none had relapses. There were no statistically significant differences between the two groups with respect to wound infection, seroma, hematoma, or relapse (p>0.05). In Group 3, it was observed that one (6.7%) of the patients had wound infections, while one (6.7%) had a hematoma, one patient (6.7%) had seroma, and none had relapses. In Group 4, seven (7.2%) of the patients had wound infections, while one (1%) had a hematoma, three (3%) had seromas, and one (1%) had a relapse. There were no significant differences between the two groups with respect to wound infection, seroma, hematoma, or relapse (p>0.05). CONCLUSION In urgent groin hernia repair surgeries, polypropylene mesh can be safely used even in the patients undergoing bowel resection.
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Affiliation(s)
- Cihad Tatar
- Department of General Surgery, Besni State Hospital, Adıyaman, Turkey
| | - İshak Sefa Tüzün
- Department of General Surgery, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Tamer Karşıdağ
- Department of General Surgery, Ataşehir Memorial Hospital, İstanbul, Turkey
| | | | - Erdem Yılmaz
- Department of General Surgery, Çekirge State Hospital, Bursa, Turkey
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Fayezizadeh M, Majumder A, Belyansky I, Novitsky YW. Outcomes of Retromuscular Porcine Biologic Mesh Repairs Using Transversus Abdominis Release Reconstruction. J Am Coll Surg 2016; 223:461-8. [PMID: 27349683 DOI: 10.1016/j.jamcollsurg.2016.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Optimal mesh reinforcement and operative technique for major abdominal wall reconstructions (AWR) remain debatable. Posterior component separation via transversus abdominis release (TAR) allows for wide sublay mesh reinforcement with durable reconstruction, and has been gaining popularity in recent years. Although biologic mesh has been associated with mixed results, outcomes of AWR with bioprosthetics have not been well elucidated to date. We evaluated our outcomes of TAR reconstructions with retromuscular porcine biologic mesh reinforcement. STUDY DESIGN Consecutive patients undergoing AWR using TAR with biologic mesh sublay reinforcement were identified in our prospective databases and analyzed. We characterized patient demographics and perioperative details. Main outcomes measures included wound complications and hernia recurrence. RESULTS Between 2007 and 2014, seventy-seven patients (mean age 56 years, mean BMI 35 kg/m(2)) underwent AWR using TAR with biologic mesh. Mean hernia size was 306 ± 128 cm(2) with mean width of 14.3 ± 3.3 cm. The vast majority of patients had grade 3 hernias (92%) and more than half had a history of wound infection (55%). There were 22 (28.6%) surgical site infections consisting of 14 deep, 7 superficial, and 1 organ-space surgical site infections. There were no incidences of chronic mesh infection or explantation. In patients with at least 12 months follow-up (mean duration 28.2 months), there were 8 (12.5%) recurrences. CONCLUSIONS Complex hernias repaired with TAR and retromuscular porcine biologic mesh reinforcement are associated with a low rate of serious perioperative wound/mesh complications. Additionally, our approach resulted in a fairly low rate of hernia recurrences in this complex cohort of patients. We believe that the TAR approach and retromuscular mesh placement can be beneficial when biologic mesh reinforcement is chosen during complex and/or contaminated abdominal wall reconstructions.
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Affiliation(s)
- Mojtaba Fayezizadeh
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Arnab Majumder
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Igor Belyansky
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD
| | - Yuri W Novitsky
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH.
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Kuckelman JP, Barron MR, Blair K, Martin MJ. The routine use of prosthetic mesh in austere environments: dogma vs data. Am J Surg 2016; 211:958-62. [PMID: 27002955 DOI: 10.1016/j.amjsurg.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 11/19/2022]
Affiliation(s)
- John P Kuckelman
- Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, 9040-A Fitzsimmons Avenue, Tacoma, Washington 98431, USA
| | - Morgan R Barron
- Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, 9040-A Fitzsimmons Avenue, Tacoma, Washington 98431, USA
| | - Kelly Blair
- Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, 9040-A Fitzsimmons Avenue, Tacoma, Washington 98431, USA
| | - Matthew J Martin
- Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, 9040-A Fitzsimmons Avenue, Tacoma, Washington 98431, USA.
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Rastegarpour A, Cheung M, Vardhan M, Ibrahim MM, Butler CE, Levinson H. Surgical mesh for ventral incisional hernia repairs: Understanding mesh design. Plast Surg (Oakv) 2016; 24:41-50. [PMID: 27054138 DOI: 10.4172/plastic-surgery.1000955] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years.
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Affiliation(s)
- Ali Rastegarpour
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
| | - Michael Cheung
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
| | - Madhurima Vardhan
- Department of Biomedical Engineering, Duke University, Pratt School of Engineering, Durham, North Carolina
| | - Mohamed M Ibrahim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
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Rastegarpour A, Cheung M, Vardhan M, Ibrahim MM, Butler CE, Levinson H. Surgical mesh for ventral incisional hernia repairs: Understanding mesh design. Plast Surg (Oakv) 2016. [DOI: 10.1177/229255031602400110] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years.
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Affiliation(s)
- Ali Rastegarpour
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael Cheung
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Madhurima Vardhan
- Department of Biomedical Engineering, Duke University, Pratt School of Engineering, Durham, North Carolina
| | - Mohamed M Ibrahim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Pérez-Köhler B, Bayon Y, Bellón JM. Mesh Infection and Hernia Repair: A Review. Surg Infect (Larchmt) 2015; 17:124-37. [PMID: 26654576 DOI: 10.1089/sur.2015.078] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The use of a prosthetic mesh to repair a tissue defect may produce a series of post-operative complications, among which infection is the most feared and one of the most devastating. When occurring, bacterial adherence and biofilm formation on the mesh surface affect the implant's tissue integration and host tissue regeneration, making preventive measures to control prosthetic infection a major goal of prosthetic mesh improvement. METHODS This article reviews the literature on the infection of prosthetic meshes used in hernia repair to describe the in vitro and in vivo models used to examine bacterial adherence and biofilm formation on the surface of different biomaterials. Also discussed are the prophylactic measures used to control implant infection ranging from meshes soaked in antibiotics to mesh coatings that release antimicrobial agents in a controlled manner. RESULTS Prosthetic architecture has a direct effect on bacterial adherence and biofilm formation. Absorbable synthetic materials are more prone to bacterial colonization than non-absorbable materials. The reported behavior of collagen biomeshes, also called xenografts, in a contaminated environment has been contradictory, and their use in this setting needs further clinical investigation. New prophylactic mesh designs include surface modifications with an anti-adhesive substance or pre-treatment with antibacterial agents or metal coatings. CONCLUSIONS The use of polymer coatings that slowly release non-antibiotic drugs seems to be a good strategy to prevent implant contamination and reduce the onset of resistant bacterial strains. Even though the prophylactic designs described in this review are mainly focused on hernia repair meshes, these strategies can be extrapolated to other implantable devices, regardless of their design, shape or dimension.
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Affiliation(s)
- Bárbara Pérez-Köhler
- 1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .,2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Yves Bayon
- 3 Covidien - Sofradim Production , Trévoux, France
| | - Juan Manuel Bellón
- 1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .,2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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Kathju S, Nistico L, Melton-Kreft R, Lasko LA, Stoodley P. Direct demonstration of bacterial biofilms on prosthetic mesh after ventral herniorrhaphy. Surg Infect (Larchmt) 2015; 16:45-53. [PMID: 25761080 DOI: 10.1089/sur.2014.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Prosthetic mesh is employed routinely in the treatment of ventral and parastomal hernias, but its use can lead to major complications, including infection, extrusion, and fistula. Bacterial biofilms have been posited to play a role in mesh-related infection, but although bacteria have been noted to form biofilms on mesh surfaces in vitro, they have never been visualized directly in biofilms on mesh recovered from patients experiencing infectious complications. METHODS Five patients who developed complications after ventral hernia repair with prosthetic mesh were operated on again. Explanted mesh was examined for biofilm with confocal laser scanning microscopy (CLSM) and fluorescence in situ hybridization (FISH). In two cases, a novel molecular assay (the Ibis T5000) was used to characterize the biofilm-forming bacteria. RESULTS The CLSM examination demonstrated adherent biofilms on mesh surfaces in all five patients. Biofilms also were noted on investing fibrous tissue. The FISH study was able to discriminate between bacterial species in polymicrobial biofilms. In two patients the Ibis T5000 detected more species of constituent biofilm bacteria than did standard culture. Removal of the mesh and reconstruction with autologous tissues or biologic materials resolved the presenting complaints in all cases. CONCLUSION Bacterial biofilms should be considered an important contributor to the pathology and complications associated with prosthetic mesh implanted in the abdominal wall. If biofilms are present, complete removal of the mesh and repair of the resulting defect without alloplastic materials is an effective intervention.
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Affiliation(s)
- Sandeep Kathju
- 1 Department of Plastic Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
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Gossedge G, Vallance A, Jayne D. Diverse applications for near infra-red intraoperative imaging. Colorectal Dis 2015; 17 Suppl 3:7-11. [PMID: 26394736 DOI: 10.1111/codi.13023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Near infra-red angiography using Indocyanine Green (ICG) has increasingly used as a tool for intraoperative diagnostics. AIMS The aim of this review is to explore the applications of ICG fluorescence angiography with particular emphasis on general surgical applications. MATERIALS AND METHODS A literature review was conducted to identify and summarise the diverse range of applications of ICG fluorescence. RESULTS ICG fluorescence angiography is increasingly used in a number of general surgical applications, including identification of colorectal liver metastases, assessment of skin flap perfusion, diagnosis of peritoneal endometriosis, ureteric identification, and localisation of colonic pathology. DISCUSSION ICG fluorescence angiography has clinical application in many areas as a tool for guiding surgical resection. CONCLUSION With the technological developments in near infra-red imaging it is likely that ICG fluorescence will play an increasing role in many routine surgical procedures.
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Affiliation(s)
- G Gossedge
- Section of Translational Anaesthesia and Surgical Sciences, Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, Leeds, UK
| | - A Vallance
- Section of Translational Anaesthesia and Surgical Sciences, Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, Leeds, UK
| | - D Jayne
- Section of Translational Anaesthesia and Surgical Sciences, Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, Leeds, UK
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Hanna M, Dissanaike S. Mesh ingrowth with concomitant bacterial infection resulting in inability to explant: a failure of mesh salvage. Hernia 2014; 19:339-44. [DOI: 10.1007/s10029-014-1330-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 11/30/2014] [Indexed: 11/25/2022]
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Fortelny RH, Petter-Puchner AH, Redl H, May C, Pospischil W, Glaser K. Assessment of Pain and Quality of Life in Lichtenstein Hernia Repair Using a New Monofilament PTFE Mesh: Comparison of Suture vs. Fibrin-Sealant Mesh Fixation. Front Surg 2014; 1:45. [PMID: 25593969 PMCID: PMC4286975 DOI: 10.3389/fsurg.2014.00045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/10/2014] [Indexed: 11/13/2022] Open
Abstract
Background: Inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become the gold standard in open inguinal hernia repair. Despite the low recurrence rates, pain and discomfort remain a problem for a large number of patients. The aim of this study was to compare suture fixation vs. fibrin sealing by using a new monofilament PTFE mesh, i.e., the Infinit® mesh by W. L. Gore & Associates. Methods: This study was designed as a controlled prospective single-center two-cohort study. A total of 38 patients were enrolled and operated in Lichtenstein technique either standard suture mesh fixation or fibrin-sealant mesh fixation were used as described in the TIMELI trial. Primary outcome parameters were postoperative complications with the new mesh (i.e., seroma, infection), pain, and quality of life evaluated by the VAS and the SF-36 questionnaire. Secondary outcome was recurrence assessed by ultrasound and physical examination. Follow-up time was 1 year. Results: Significantly, less postoperative pain was reported in the fibrin-sealant group compared to the suture group at 6 weeks (P = 0.035), 6 months (P = 0.023), and 1 year (P = 0.011) postoperatively. Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay were seen in the fibrin-sealant group. Conclusion: Fibrin-sealant mesh fixation in Lichtenstein hernioplasty effectively reduces acute and chronic postoperative pain. Monofilament, macro-porous, knitted PTFE meshes seem to be a practicable alternative to commonly used polypropylene meshes in open inguinal hernia repair.
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Affiliation(s)
- René H Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital , Vienna , Austria ; Paracelsus Private Medical University , Salzburg , Austria
| | - Alexander H Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration , Vienna , Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration , Vienna , Austria
| | - Christopher May
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital , Vienna , Austria
| | | | - Karl Glaser
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital , Vienna , Austria
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Placement of a non-cross-linked porcine-derived acellular dermal matrix during preperitoneal laparoscopic inguinal hernia repair. Int Surg 2014; 98:133-9. [PMID: 23701148 DOI: 10.9738/cc176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This retrospective chart review evaluated outcomes following laparoscopic inguinal herniorrhaphies with non-cross-linked intact porcine-derived acellular dermal matrix (PADM) by one surgeon in a community teaching facility hospital. Mesh was sutured and/or tacked in the preperitoneal space. Postoperative visits were scheduled at 2 weeks, 3 months, and 6 months, and then at 6-month intervals up to 2 years. PADM was placed in 14 male patients (mean age, 41.1 years). Seven patients had bilateral hernias. One patient required intraoperative conversion to open herniorrhaphy based on diagnostic laparoscopy findings. PADM sizes were 6 × 10 to 12 × 16 cm; mean operative time was 102 minutes. All patients were discharged on the day of surgery and resumed full activity. This treatment approach was effective, with no recurrence or complications during a median follow-up period of 18 months (range, 13-25 months).
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Bury K, Smietański M, Justyna B, Gumiela P, Smietańska AI, Owczuk R, Naumiuk L, Samet A, Paradziej-Łukowicz J. Effects of macroporous monofilament mesh on infection in a contaminated field. Langenbecks Arch Surg 2014; 399:873-7. [PMID: 25168297 PMCID: PMC4165876 DOI: 10.1007/s00423-014-1225-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/09/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was to evaluate whether the type of the mesh and proper surgical technique can influence the outcome of a tension-free hernia repair in a contaminated filed. MATERIALS AND METHODS This study was based on the model of bacterial peritonitis in rats induced with a mixture composed of Escherichia coli and Bacteroides fragilis. Two animals were used as a control group without induced peritonitis and 10 animals with mesh implanted inside of the peritoneal cavity. For the 20 animals in the studied group, bacterial fluid was applied into the abdominal cavity together with the mesh implantation. In 10 cases, the mesh was fixed flatly upon the surface of the peritoneum; in the other 10, the mesh was rolled and then fixed within the peritoneal cavity. After 5 weeks, the animals were operated on again, and the meshes, the peritoneal fluid and, if present, any granulomas were taken for bacterial cultivation. RESULTS The results of the bacterial cultivation of the material from the control group (without mesh) and from the rats with flatly fixed mesh were almost completely negative (0/10 and 1/10, respectively). In 9 out of 10 rats that were exposed to the rolled mesh for 5 weeks, the colonisation of meshes with both B. fragilis and E. coli was found (p < 0.0198). CONCLUSIONS When properly fixed, flat mesh, even in a contaminated field, may allow for a proper mesh healing and does not influence the ability to cure bacterial peritonitis in an animal model. A bad surgical technique, such as inadequately positioned or rolled mesh, may cause persistent peritoneal bacteraemia.
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Affiliation(s)
- Kamil Bury
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland,
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Hutan M, Bartko C, Majesky I, Prochotsky A, Sekac J, Skultety J. Reconstruction option of abdominal wounds with large tissue defects. BMC Surg 2014; 14:50. [PMID: 25103782 PMCID: PMC4127081 DOI: 10.1186/1471-2482-14-50] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 07/30/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Abdominal wall defects result from trauma, abdominal wall tumors, necrotizing infections or complications of previous abdominal surgeries. Apart from cosmetics, abdominal wall defects have strong negative functional impact on the patients.Many different techniques exist for abdominal wall repair. Most problematic and troublesome are defects, where major part of abdominal wall had to be resected and tissue for transfer or reconstruction is absent. CASE PRESENTATION Authors of the article present operative technique, in which reconstruction of abdominal wall was managed by composite polypropylene mesh with absorbable collagen film, creation of granulation tissue with use of NPWT (negative pressure wound therapy), and subsequent split skin grafting.Three patients with massive abdominal wall defect were successfully managed and abdominal wall reconstruction was performed by mentioned technique. Functional and cosmetic effect is acceptable and patients have good postoperative quality of life. CONCLUSIONS Patients with giant abdominal defects can benefit from described technique. It serves as the only option, with which abdominal wall is fully reconstructed without need for the secondary intervention.
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Affiliation(s)
- Martin Hutan
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
| | - Christian Bartko
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
| | - Ivan Majesky
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
| | - Augustin Prochotsky
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
| | - Jaroslav Sekac
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
| | - Jan Skultety
- II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia
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