1
|
Shiroud Heidari B, Dodda JM, El-Khordagui LK, Focarete ML, Maroti P, Toth L, Pacilio S, El-Habashy SE, Boateng J, Catanzano O, Sahai N, Mou L, Zheng M. Emerging materials and technologies for advancing bioresorbable surgical meshes. Acta Biomater 2024; 184:1-21. [PMID: 38879102 DOI: 10.1016/j.actbio.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/22/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
Surgical meshes play a significant role in the treatment of various medical conditions, such as hernias, pelvic floor issues, guided bone regeneration, and wound healing. To date, commercial surgical meshes are typically made of non-absorbable synthetic polymers, notably polypropylene and polytetrafluoroethylene, which are associated with postoperative complications, such as infections. Biological meshes, based on native tissues, have been employed to overcome such complications, though mechanical strength has been a main disadvantage. The right balance in mechanical and biological performances has been achieved by the advent of bioresorbable meshes. Despite improvements, recurrence of clinical complications associated with surgical meshes raises significant concerns regarding the technical adequacy of current materials and designs, pointing to a crucial need for further development. To this end, current research focuses on the design of meshes capable of biomimicking native tissue and facilitating the healing process without post-operative complications. Researchers are actively investigating advanced bioresorbable materials, both synthetic polymers and natural biopolymers, while also exploring the performance of therapeutic agents, surface modification methods and advanced manufacturing technologies such as 4D printing. This review seeks to evaluate emerging biomaterials and technologies for enhancing the performance and clinical applicability of the next-generation surgical meshes. STATEMENT OF SIGNIFICANCE: In the ever-transforming landscape of regenerative medicine, the embracing of engineered bioabsorbable surgical meshes stands as a key milestone in addressing persistent challenges and complications associated with existing treatments. The urgency to move beyond conventional non-absorbable meshes, fraught with post-surgery complications, emphasises the necessity of using advanced biomaterials for engineered tissue regeneration. This review critically examines the growing field of absorbable surgical meshes, considering their potential to transform clinical practice. By strategically combining mechanical strength with bioresorbable characteristics, these innovative meshes hold the promise of mitigating complications and improving patient outcomes across diverse medical applications. As we navigate the complexities of modern medicine, this exploration of engineered absorbable meshes emerges as a promising approach, offering an overall perspective on biomaterials, technologies, and strategies adopted to redefine the future of surgical meshes.
Collapse
Affiliation(s)
- Behzad Shiroud Heidari
- Centre for Orthopaedic Research, Medical School, The University of Western Australia, Nedlands, WA, Australia
| | - Jagan Mohan Dodda
- New Technologies - Research Centre (NTC), University of West Bohemia, Univerzitní 8, 301 00 Pilsen, Czech Republic.
| | | | - Maria Letizia Focarete
- Department of Chemistry "Giacomo Ciamician" and INSTM UdR of Bologna, University of Bologna, Italy. Health Sciences & Technologies (HST) CIRI, University of Bologna, Via Tolara di Sopra 41/E, 40064 Ozzano Emilia, Italy
| | - Peter Maroti
- University of Pecs, Medical School, 3D Printing and Visualization Centre, Hungary, University of Pecs, Medical Skills Education and Innovation Centre, Hungary
| | - Luca Toth
- University of Pecs, Medical School, Institute for Translational Medicine, Hungary, University of Pecs, Medical School, Department of Neurosurgery, Hungary
| | - Serafina Pacilio
- Department of Chemistry "Giacomo Ciamician" and INSTM UdR of Bologna, University of Bologna, Italy. Health Sciences & Technologies (HST) CIRI, University of Bologna, Via Tolara di Sopra 41/E, 40064 Ozzano Emilia, Italy; Department of Biomedical and Neuromotor Sciences DIBINEM, Alma Mater Studiorum-University of Bologna, Italy
| | - Salma E El-Habashy
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Egypt
| | - Joshua Boateng
- Faculty of Engineering and Science, University of Greenwich, Medway Campus, UK
| | - Ovidio Catanzano
- Institute for Polymers, Composites and Biomaterials (IPCB-CNR), Via Campi Flegrei 34, 80078 Pozzuoli, NA, Italy
| | - Nitin Sahai
- University of Pecs, Medical School, 3D Printing and Visualization Centre, Hungary, University of Pecs, Medical Skills Education and Innovation Centre, Hungary; Department of Biomedical Engineering, North Eastern Hill University, Meghalaya, India
| | - Lingjun Mou
- WA Liver and Kidney Transplant Department, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Medical School, The University of Western Australia, Nedlands, WA, Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| |
Collapse
|
2
|
da Costa CS, Jorge SDF, Figueiredo MA, Neves DR, Chagas MA. Use of rainbow trout skin treated with glutaraldehyde as a mesh for abdominal hernioplasty in rats. Acta Cir Bras 2024; 39:e393024. [PMID: 39046040 PMCID: PMC11262756 DOI: 10.1590/acb393024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/04/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE To test the use of rainbow trout skin as a surgical mesh in abdominal hernioplasties in rats. METHODS The experiment involved 20 Wistar rats receiving implants of trout skin processed for disinfection in 0.5% glutaraldehyde and preserved in 100% glycerin. The animals were divided into four groups, divided at 7, 15, 30, and 90 days postoperatively. Clinical and infrared thermography evaluations were performed, and after euthanasia, assessments of adhesion formations and sample collection for histological evaluation were conducted. RESULTS The implant was observed to be intact, ensuring the integrity of the abdominal wall, support for the viscera, and normal mobility for the rats for up to 90 days. Low rates of clinical alterations were observed, with an intense inflammatory reaction up to day 7, chronic inflammation and the onset of angiogenesis at day 15, and a low inflammatory reaction with collagenous infiltrate and fibrosis at day 30. At day 90, the implants showed a collagenous and fibrotic infiltrate with a minimal inflammatory infiltrate. CONCLUSIONS The surgical mesh of trout skin performed well, making it a potential alternative for surgical procedures in muscle aponeurotic corrections in the abdominal wall.
Collapse
Affiliation(s)
- Carolina Seabra da Costa
- Universidade Federal Fluminense – Programa de Pós-graduação em Medicina Veterinária Clínica e Reprodução Animal – Niterói (RJ), Brazil
| | - Siria da Fonseca Jorge
- Centro Universitário Serra dos Órgãos – Curso de Graduação em Medicina Veterinária – Teresópolis (RJ), Brazil
| | - Marcelo Abidu Figueiredo
- Universidade Federal Fluminense – Programa de Pós-graduação em Medicina Veterinária Clínica e Reprodução Animal – Niterói (RJ), Brazil
| | - Danielle Rangel Neves
- Centro Universitário Serra dos Órgãos – Curso de Graduação em Medicina Veterinária – Teresópolis (RJ), Brazil
| | - Maurício Alves Chagas
- Universidade Federal Fluminense – Programa de Pós-graduação em Medicina Veterinária Clínica e Reprodução Animal – Niterói (RJ), Brazil
| |
Collapse
|
3
|
Flechas Becerra C, Barrios Silva LV, Ahmed E, Bear JC, Feng Z, Chau DY, Parker SG, Halligan S, Lythgoe MF, Stuckey DJ, Patrick PS. X-Ray Visible Protein Scaffolds by Bulk Iodination. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2306246. [PMID: 38145968 PMCID: PMC10933627 DOI: 10.1002/advs.202306246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/18/2023] [Indexed: 12/27/2023]
Abstract
Protein-based biomaterial use is expanding within medicine, together with the demand to visualize their placement and behavior in vivo. However, current medical imaging techniques struggle to differentiate between protein-based implants and surrounding tissue. Here a fast, simple, and translational solution for tracking transplanted protein-based scaffolds is presented using X-ray CT-facilitating long-term, non-invasive, and high-resolution imaging. X-ray visible scaffolds are engineered by selectively iodinating tyrosine residues under mild conditions using readily available reagents. To illustrate translatability, a clinically approved hernia repair mesh (based on decellularized porcine dermis) is labeled, preserving morphological and mechanical properties. In a mouse model of mesh implantation, implants retain marked X-ray contrast up to 3 months, together with an unchanged degradation rate and inflammatory response. The technique's compatibility is demonstrated with a range of therapeutically relevant protein formats including bovine, porcine, and jellyfish collagen, as well as silk sutures, enabling a wide range of surgical and regenerative medicine uses. This solution tackles the challenge of visualizing implanted protein-based biomaterials, which conventional imaging methods fail to differentiate from endogenous tissue. This will address previously unanswered questions regarding the accuracy of implantation, degradation rate, migration, and structural integrity, thereby accelerating optimization and safe translation of therapeutic biomaterials.
Collapse
Affiliation(s)
- Carlos Flechas Becerra
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| | - Lady V. Barrios Silva
- Division of Biomaterials and Tissue EngineeringEastman Dental InstituteUniversity College LondonRoyal Free HospitalRowland Hill StreetLondonNW3 2PFUK
| | - Ebtehal Ahmed
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| | - Joseph C. Bear
- School of Life SciencePharmacy & ChemistryKingston UniversityPenrhyn RoadKingston upon ThamesKT1 2EEUK
| | - Zhiping Feng
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| | - David Y.S. Chau
- Division of Biomaterials and Tissue EngineeringEastman Dental InstituteUniversity College LondonRoyal Free HospitalRowland Hill StreetLondonNW3 2PFUK
| | - Samuel G. Parker
- Centre for Medical Imaging, Division of MedicineUniversity College London UCLCharles Bell House, 43–45 Foley StreetLondonW1W 7TSUK
| | - Steve Halligan
- Centre for Medical Imaging, Division of MedicineUniversity College London UCLCharles Bell House, 43–45 Foley StreetLondonW1W 7TSUK
| | - Mark F. Lythgoe
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| | - Daniel J. Stuckey
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| | - P. Stephen Patrick
- Centre for Advanced Biomedical ImagingDivision of MedicineUniversity College LondonPaul O'Gorman Building, 72 Huntley StreetLondonWC1E 6DDUK
| |
Collapse
|
4
|
Narita M, Moriyoshi K, Yamaoka R, Hata H. The "Plug folding" may be a pathogenesis in chronic postoperative inguinal pain following mesh plug repair. Asian J Surg 2023; 46:5770-5772. [PMID: 37673739 DOI: 10.1016/j.asjsur.2023.08.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- Masato Narita
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
| | - Koki Moriyoshi
- Department of Diagnostic Pathology, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Ryoya Yamaoka
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Hiroaki Hata
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| |
Collapse
|
5
|
Schmitz SM, Helmedag MJ, Kroh A, Heise D, Klinge U, Lambertz A, Hornef MW, Neumann UP, Eickhoff RM. Choice of Polymer, but Not Mesh Structure Variation, Reduces the Risk of Bacterial Infection with Staphylococcus aureus In Vivo. Biomedicines 2023; 11:2083. [PMID: 37509722 PMCID: PMC10377515 DOI: 10.3390/biomedicines11072083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Synthetic mesh material is of great importance for surgical incisional hernia repair. The physical and biochemical characteristics of the mesh influence mechanical stability and the foreign body tissue reaction. The influence on bacterial infections, however, remains ill-defined. The aim of the present study was to evaluate the influence of a modified mesh structure with variation in filament linking on the occurrence of bacterial infection that is indicated by the occurrence of CD68+, CD4+, and CD8+ cells in two different materials. METHODS A total of 56 male Sprague Dawley rats received a surgical mesh implant in a subcutaneous abdominal position. The mesh of two different polymers (polypropylene (PP) and polyvinylidenfluoride (PVDF)) and two different structures (standard structure and bold structure with higher filament linking) were compared. During the implantation, the meshes were infected with Staphylococcus (S.) aureus. After 7 and 21 days, meshes were explanted, and the early and late tissue responses to infection were histologically evaluated. RESULTS Overall, the inflammatory tissue response was higher at 7 days when compared to 21 days. At 7 days, PP meshes of the standard structure (PP-S) showed the strongest inflammatory tissue response in comparison to all the other groups. At 21 days, no statistically significant difference between different meshes was detected. CD8+ cytotoxic T cells showed a significant difference at 21 days but not at 7 days. PP meshes of both structures showed a higher infiltration of CD8+ T cells than PVDF meshes. CD4+ T helper cells differed at 7 days but not at 21 days, and PVDF meshes in a bold structure showed the highest CD4+ T cell count. The number of CD68+ macrophages was also significantly higher in PP meshes in a standard structure when compared to PVDF meshes at 21 days. CONCLUSION The inflammatory tissue response to S. aureus infection appears to be highest during the early period after mesh implantation. PP meshes showed a higher inflammatory response than PVDF meshes. The mesh material appears to be more important for the risk of infection than the variation in filament linking.
Collapse
Affiliation(s)
- Sophia M Schmitz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Marius J Helmedag
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Daniel Heise
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Uwe Klinge
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Mathias W Hornef
- Department of Medical Microbiology, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Ulf P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Roman M Eickhoff
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| |
Collapse
|
6
|
Lu X, Harman M, Todd Heniford B, Augenstein V, McIver B, Bridges W. Analyzing material changes consistent with degradation of explanted polymeric hernia mesh related to clinical characteristics. Surg Endosc 2022; 36:5121-5135. [PMID: 35257210 PMCID: PMC10851311 DOI: 10.1007/s00464-021-08882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/16/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Proposed mechanisms that potentially contribute to polypropylene mesh degradation after in vivo exposure include oxidizing species and mechanical strains induced by normal healing, tissue integration, muscle contraction, and the immediate and chronic inflammatory responses. METHODS This study explores these potential degradation mechanisms using 63 mesh implants retrieved from patients after a median implantation time of 24 months following hernia repair surgery (mesh explants) and analysis of multivariate associations between the material changes and clinical characteristics. Specifically, polypropylene mesh degradation was characterized in terms of material changes in surface oxidation, crystallinity and mechanical properties, and clinical characteristics included mesh placement location, medical history and mesh selection. RESULTS Compared to pristine control samples, subsets of mesh explants had evidence of surface oxidation, altered crystallinity, or changed mechanical properties. Using multivariate statistical approach to control for clinical characteristics, infection was a significant factor affecting changes in mesh stiffness and mesh class was a significant factor affecting polypropylene crystallinity changes. CONCLUSIONS Highly variable in vivo conditions expose mesh to mechanisms that alter clinical outcomes and potentially contribute to mesh degradation. These PP mesh explants after 0.5 to 13 years in vivo had measurable changes in surface chemistry, crystallinity and mechanical properties, with significant trends associated with factors of mesh placement, mesh class, and infection.
Collapse
Affiliation(s)
- Xinyue Lu
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Melinda Harman
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA.
| | - B Todd Heniford
- Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Vedra Augenstein
- Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Brittney McIver
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - William Bridges
- Department of Mathematical Sciences, Clemson University, Clemson, SC, 29634, USA
| |
Collapse
|
7
|
Mlodinow AS, Yerneni K, Hasse ME, Cruikshank T, Kuzycz MJ, Ellis MF. Evaluation of a Novel Absorbable Mesh in a Porcine Model of Abdominal Wall Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3529. [PMID: 34881139 PMCID: PMC8647887 DOI: 10.1097/gox.0000000000003529] [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] [Received: 11/09/2020] [Accepted: 02/14/2021] [Indexed: 11/26/2022]
Abstract
Bioabsorbable meshes have seen increasing clinical use to reinforce soft tissue, and exist on a spectrum of strength loss versus absorption: several retain their strength for months, but remain in situ for years. Others lose strength fully by 6 weeks. An intermediate profile, with some strength for 3 -4 months, but consistent absorption in less than a year, may be an optimal balance of near-term support and long-term safety. In this large animal study, we evaluate such a mesh (DuraSorb, SIA), assessing its utility in a porcine model of abdominal wall repair. METHODS Two full-thickness defects were created in the abdominal walls of nine Yucatan swine via midline approach and repaired preperitoneally with either DuraSorb or long-lasting control mesh (TIGR, Novus Scientific). At 30 days, 3 months, and 1 year, the implantations were assessed by clinical pathology, post-necropsy histopathology, and burst strength testing. RESULTS No device-associated complications were found in vivo, at necropsy, or histologically. DuraSorb was well-integrated and vascularized by 30 days. DuraSorb demonstrated minimal/mild inflammation and fibroplasia, and lower inflammatory scores when compared with TIGR at all time points (P < 0.05). Burst strength of the repair sites was higher than adjacent abdominal wall at all time points (P < 0.05). CONCLUSIONS DuraSorb provided durable long-term support, minimal inflammation, and consistent absorption in this porcine model of abdominal wall repair, as compared to a long-term control. Clinical data is needed, but these results suggest that this mesh provides adequate structural support while potentially reducing long-term device reactions.
Collapse
Affiliation(s)
- Alexei S. Mlodinow
- From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
- Surgical Innovation Associates, Inc., Chicago, Ill
| | - Ketan Yerneni
- From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
- Surgical Innovation Associates, Inc., Chicago, Ill
| | | | | | | | - Marco F. Ellis
- From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
- Department of Surgery, University of Illinois Chicago, Chicago, Ill
| |
Collapse
|
8
|
Long-term Comparison of Recurrence Rates Between Different Lightweight and Heavyweight Meshes in Open Anterior Mesh Inguinal Hernia Repair: A Nationwide Population-based Register Study. Ann Surg 2021; 273:365-372. [PMID: 30720504 DOI: 10.1097/sla.0000000000003219] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the reoperation rate for recurrence of different lightweight to heavyweight meshes after an open anterior mesh (OAM) inguinal hernia repair. SUMMARY BACKGROUND DATA Lightweight meshes have shown benefits compared with heavyweight meshes in terms of accelerated recovery after surgery with less postoperative pain. The use of such meshes may, however, be associated with an increase in hernia recurrence. Studies of large cohorts with long-term follow-up regarding recurrence are lacking. METHODS All OAM groin hernia repairs registered in The Swedish Hernia Register between January 1, 2005 and December 31, 2013 were eligible. Follow-up time was until June 30, 2016. Four groups of meshes were included: polypropylene (PP) heavyweight meshes >50 g/m2 (HWM), regular lightweight PP meshes <50 g/m2 (regular LWM-PP), lightweight PP mesh with absorbable poliglecaprone-25(LWM-PP/PGC), or polyglactin-910(LWM-PP/PG). Primary endpoint was reoperation for recurrence. RESULTS 76,495 OAM inguinal hernia repairs in male patients were included for statistical analysis. 1676 repairs were reoperated for recurrence. Multivariate analysis demonstrated no significant difference of risk for recurrence between HWM and regular LWM-PP (HR 1.12, P = 0.13). LWM-PP/PGC (HR 1.42, P < 0.001) and LWM-PP/PG (HR 2.05, P < 0.001) resulted in a significant increased risk compared with HWM. Larger hernia defects, direct hernias, and recurrent hernias were associated with an increased risk of reoperation for recurrence. CONCLUSIONS Although lightweight meshes with partially absorbable component resulted in an increased risk of recurrence, there was no difference between regular LWM-PP and HWM. Considering that regular LWM-PP has less associated side effects there are no benefits of using HWM in OAM inguinal hernia repair.
Collapse
|
9
|
Lambrecht M, Tollens T. Successful conservative treatment of a poly-4-hydroxybutyrate mesh infection: A case report. Ann Med Surg (Lond) 2021; 63:102162. [PMID: 33664948 PMCID: PMC7905175 DOI: 10.1016/j.amsu.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 10/27/2022] Open
Abstract
Introduction and importance An infection of an abdominal wall prosthesis can be a real disaster for the patient. A conservative treatment might be an option if biological or slowly resorbable synthetic meshes were used. However, adequate research of their use in contaminated and dirty wounds lacks. Case presentation Herein we report the case of a 69-year-old patient with a heavily infected poly-4-hydroxybutyrate mesh that was successfully treated conservatively. Clinical discussion Despite promising results of poly-4-hydroxybutyrate meshes, their use remains controversial and studies in contaminated wounds are scarce. Conclusion Our case report shows the potential benefits of a poly-4-hydroxybutyrate mesh in a very high-risk patient with active infection.
Collapse
Affiliation(s)
- Maarten Lambrecht
- Department of General Surgery, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Tim Tollens
- Head of Department of Abdominal Surgery, Imelda VZW, Imeldalaan 9, 2820, Bonheiden, Belgium
| |
Collapse
|
10
|
Pascual G, Benito-Martínez S, Rodríguez M, Pérez-Köhler B, García-Moreno F, Bellón JM. Behaviour at the peritoneal interface of next-generation prosthetic materials for hernia repair. Surg Endosc 2021; 36:579-590. [PMID: 33507384 DOI: 10.1007/s00464-021-08320-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND When using a prosthetic material in hernia repair, the behaviour of the mesh at the peritoneal interface is especially important for implant success. Biomaterials developed for their intraperitoneal placement are known as composites and are made up of two different-structure materials, one is responsible for good integration within host tissue and the other is responsible to make contact with the viscera. This study examines the behaviour at the peritoneal level of two composites, the fully degradable Phasix-ST® and the partially degradable Symbotex®. A polypropylene mesh (Optilene®) served as control. METHODS Sequential laparoscopy from 3 to 90 days, in a preclinical model in the New Zealand white rabbit, allowed monitoring adhesion formation. Morphological studies were performed to analyse the neoperitoneum formed in the repair process. Total macrophages were identified by immunohistochemical labelling. To identify the different macrophage phenotypes, complementary DNAs were amplified by qRT-PCR using specific primers for M1 (TNF-α/CXCL9) and M2 (MRC1/IL-10) macrophages. RESULTS The percentage of firm and integrated adhesions remained very high in the control group over time. Both composites showed a significant decrease in adhesions at all study times and in qualitative terms were mainly loose. Significant differences were also observed from 7 days onwards between the two composites, increasing the values in Phasix over time. Neoperitoneum thickness for Phasix was significantly greater than those of the other meshes, showing mature and organized neoformed connective tissue. Immunohistochemically, a significantly higher percentage of macrophages was observed in Symbotex. mRNA expression levels for the M2 repair-type macrophages were highest for Phasix but significant differences only emerged for IL-10. CONCLUSIONS Fewer adhesions formed to the Symbotex than Phasix implants. Ninety days after implant, total macrophage counts were significantly higher for Symbotex, yet Phasix showed the greater expression of M2 markers related to the tissue repair process.
Collapse
Affiliation(s)
- Gemma Pascual
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain. .,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain. .,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain.
| | - Selma Benito-Martínez
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Marta Rodríguez
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Bárbara Pérez-Köhler
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Francisca García-Moreno
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Juan M Bellón
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain.,Networking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| |
Collapse
|
11
|
Eickhoff RM, Kroh A, Eickhoff S, Heise D, Helmedag MJ, Tolba RH, Klinge U, Neumann UP, Klink CD, Lambertz A. A peritoneal defect covered by intraperitoneal mesh prosthesis effects an increased and distinctive foreign body reaction in a minipig model. J Biomater Appl 2020; 35:732-739. [PMID: 33331198 DOI: 10.1177/0885328220963918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of incisional hernia is with up to 30% one of the frequent long-term complication after laparotomy. After establishing minimal invasive operations, the laparoscopic intraperitoneal onlay mesh technique (lap. IPOM) was first described in 1993. Little is known about the foreign body reaction of IPOM-meshes, which covered a defect of the parietal peritoneum. This is becoming more important, since IPOM procedure with peritoneal-sac resection and hernia port closing (IPOM plus) is more frequently used. METHODS In 18 female minipigs, two out of three Polyvinylidene-fluoride (PVDF) -meshes (I: standard IPOM; II: IPOM with modified structure [bigger pores]; III: IPOM with the same structure as IPOM II + degradable hydrogel-coating) were placed in a laparoscopic IPOM procedure. Before mesh placement, a 2x2cm peritoneal defect was created. After 30 days, animals were euthanized, adhesions were evaluated by re-laparoscopy and mesh samples were explanted for histological and immunohistochemichal investigations. RESULTS All animals recovered after implantation and had no complications during the follow-up period. Analysing foreign body reaction, the IPOM II mesh had a significant smaller inner granuloma, compared to the other meshes (IPOM II: 8.4 µm ± 1.3 vs. IPOM I 9.1 µm ± 1.3, p < 0.001). The degradable hydrogel coating does not prevent adhesions measured by Diamond score (p = 0.46). A peritoneal defect covered by a standard or modified IPOM mesh was a significant factor for increasing foreign body granuloma, the amount of CD3+ lymphocytes, CD68+ macrophages and decrease of pore size. CONCLUSION A peritoneal defect covered by IPOM prostheses leads to an increased foreign body reaction compared to intact peritoneum. Whenever feasible, a peritoneal defect should be closed accurately before placing an IPOM-mesh to avoid an excessive foreign body reaction and therefore inferior biomaterial properties of the prosthesis.
Collapse
Affiliation(s)
- Roman Marius Eickhoff
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Simon Eickhoff
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Germany and Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Germany
| | - Daniel Heise
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marius Julian Helmedag
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Rene H Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Uwe Klinge
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian Daniel Klink
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| |
Collapse
|
12
|
Marinaro F, Casado JG, Blázquez R, Brun MV, Marcos R, Santos M, Duque FJ, López E, Álvarez V, Usón A, Sánchez-Margallo FM. Laparoscopy for the Treatment of Congenital Hernia: Use of Surgical Meshes and Mesenchymal Stem Cells in a Clinically Relevant Animal Model. Front Pharmacol 2020; 11:01332. [PMID: 33101010 PMCID: PMC7546355 DOI: 10.3389/fphar.2020.01332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022] Open
Abstract
More than a century has passed since the first surgical mesh for hernia repair was developed, and, to date, this is still the most widely used method despite the great number of complications it poses. The purpose of this study was to combine stem cell therapy and laparoscopy for the treatment of congenital hernia in a swine animal model. Porcine bone marrow-derived mesenchymal stem cells (MSCs) were seeded on polypropylene surgical meshes using a fibrin sealant solution as a vehicle. Meshes with (cell group) or without (control group) MSCs were implanted through laparoscopy in Large White pigs with congenital abdominal hernia after the approximation of hernia borders (implantation day). A successive laparoscopic biopsy of the mesh and its surrounding tissues was performed a week after implantation, and surgical meshes were excised a month after implantation. Ultrasonography was used to measure hernia sizes. Flow cytometry, histological, and gene expression analyses of the biopsy and necropsy samples were performed. The fibrin sealant solution was easy to prepare and preserved the viability of MSCs in the surgical meshes. Ultrasonography demonstrated a significant reduction in hernia size 1 week after implantation in the cell group relative to that on the day of implantation (p < 0.05). Flow cytometry of the mesh-infiltrated cells showed a non-significant increase of M2 macrophages when the cell group was compared with the control group 1 week after implantation. A significant decrease in the gene expression of VEGF and a significant increase in TNF expression were determined in the cell group 1 month after implantation compared with gene expressions in the control group (p < 0.05). Here, we propose an easy and feasible method to combine stem cell therapy and minimally invasive surgical techniques for hernia repair. In this study, stem cell therapy did not show a great immunomodulatory or regenerative effect in overcoming hernia-related complications. However, our clinically relevant animal model with congenital hernia closely resembles the clinical human condition. Further studies should be focused on this valuable animal model to evaluate stem cell therapies in hernia surgery.
Collapse
Affiliation(s)
- Federica Marinaro
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Javier G Casado
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.,CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Rebeca Blázquez
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.,CIBER de Enfermedades Cardiovasculares, Madrid, Spain
| | - Mauricio Veloso Brun
- Department of Small Animal Clinics, Center of Rural Science, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Ricardo Marcos
- Laboratory of Histology and Embryology, Department of Microscopy, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Marta Santos
- Laboratory of Histology and Embryology, Department of Microscopy, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Francisco Javier Duque
- Animal Medicine Department, Faculty of Veterinary Medicine, University of Extremadura, Cáceres, Spain
| | - Esther López
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Verónica Álvarez
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Alejandra Usón
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Francisco Miguel Sánchez-Margallo
- CIBER de Enfermedades Cardiovasculares, Madrid, Spain.,Scientific Direction, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| |
Collapse
|
13
|
Grumezescu AM, Stoica AE, Dima-Bălcescu MȘ, Chircov C, Gharbia S, Baltă C, Roșu M, Herman H, Holban AM, Ficai A, Vasile BS, Andronescu E, Chifiriuc MC, Hermenean A. Electrospun Polyethylene Terephthalate Nanofibers Loaded with Silver Nanoparticles: Novel Approach in Anti-Infective Therapy. J Clin Med 2019; 8:E1039. [PMID: 31315266 PMCID: PMC6679131 DOI: 10.3390/jcm8071039] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/04/2019] [Accepted: 07/07/2019] [Indexed: 12/29/2022] Open
Abstract
Polyethylene terephthalate (PET) is a major pollutant polymer, due to its wide use in food packaging and fiber production industries worldwide. Currently, there is great interest for recycling the huge amount of PET-based materials, derived especially from the food and textile industries. In this study, we applied the electrospinning technique to obtain nanostructured fibrillary membranes based on PET materials. Subsequently, the recycled PET networks were decorated with silver nanoparticles through the chemical reduction method for antimicrobial applications. After the characterization of the materials in terms of crystallinity, chemical bonding, and morphology, the effect against Gram-positive and Gram-negative bacteria, as well as fungal strains, was investigated. Furthermore, in vitro and in vivo biocompatibility tests were performed in order to open up potential biomedical applications, such as wound dressings or implant coatings. Silver-decorated fibers showed lower cytotoxicity and inflammatory effects and increased antibiofilm activity, thus highlighting the potential of these systems for antimicrobial purposes.
Collapse
Affiliation(s)
- Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 050094 Bucharest, Romania
- ICUB, Research Institute of Bucharest University, University of Bucharest, 030018 Bucharest, Romania
| | - Alexandra Elena Stoica
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | | | - Cristina Chircov
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Sami Gharbia
- Institute of Life Sciences, Vasile Goldis Western University of Arad, 310414 Arad, Romania
| | - Cornel Baltă
- Institute of Life Sciences, Vasile Goldis Western University of Arad, 310414 Arad, Romania
| | - Marcel Roșu
- Institute of Life Sciences, Vasile Goldis Western University of Arad, 310414 Arad, Romania
| | - Hildegard Herman
- Institute of Life Sciences, Vasile Goldis Western University of Arad, 310414 Arad, Romania
| | - Alina Maria Holban
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Microbiology Immunology Department, Faculty of Biology, University of Bucharest, 050107 Bucharest, Romania
| | - Anton Ficai
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Bogdan Stefan Vasile
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Ecaterina Andronescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania.
| | - Mariana Carmen Chifiriuc
- ICUB, Research Institute of Bucharest University, University of Bucharest, 030018 Bucharest, Romania
| | - Anca Hermenean
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Faculty of Medicine, Vasile Goldis Western University of Arad, 310045 Arad, Romania
| |
Collapse
|
14
|
Eickhoff RM, Bolle T, Kossel K, Heise D, Kroh A, Lambertz A, Blaeser A, Gries T, Jockenhoevel S, Neumann UP, Klink CD. Improved biocompatibility of profiled sutures through lower macrophages adhesion. J Biomed Mater Res B Appl Biomater 2018; 107:1772-1778. [PMID: 30452123 DOI: 10.1002/jbm.b.34269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/12/2018] [Accepted: 09/30/2018] [Indexed: 12/21/2022]
Abstract
The biocompatibility of a textile implant is determined by various parameters, such as material composition and surface chemistry. However, little is known about the influence of geometry of sutures on biocompatibility. To elucidate this factor we focused on geometry-modification resulting in ultrafine polyethylene terephthalate (UFPET) suture and a snowflake like shaped polyvenylidenfluorid (PVDF) suture. Forty-eight rats were divided into two observation periods. In each rat 3 out of 4 sutures (profiled UFPET, snowflake-like profiled PVDF, reference Prolene and Mersilene suture) were randomly placed into the subcutaneous tissue. Rats were euthanized after 7 and 21 days and samples were explanted. Foreign body granuloma was measured and expression of CD68, TUNEL, Ki-67 and Collagen I/III ratio were determined. The profiled (snowflake) suture showed a significantly smaller FBG in comparison to standard sutures (p < 0.001). Both modified sutures showed a significant lower tissue remodeling by Ki-67 and TUNEL expression (p < 0.03). Furthermore, profiled sutures caused a lower inflammatory reaction expressed in a significant lower amount of CD68 positive macrophages after 21 days (p < 0.001). Modifications of suture geometry alter the foreign body granuloma and the inflammatory reaction. Therefore, profiled sutures might be a promising approach to improve biocompatibility of textile mesh prosthesis. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1772-1778, 2019.
Collapse
Affiliation(s)
- Roman M Eickhoff
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Tim Bolle
- Institut fuer Textiltechnik of RWTH Aachen University, Aachen, Germany
| | - Klas Kossel
- Institut fuer Textiltechnik of RWTH Aachen University, Aachen, Germany
| | - Daniel Heise
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Blaeser
- Institut fuer Textiltechnik of RWTH Aachen University, Aachen, Germany
| | - Thomas Gries
- Institut fuer Textiltechnik of RWTH Aachen University, Aachen, Germany
| | - Stefan Jockenhoevel
- Department of Biohybrid and Medical Textiles (BioTex) at AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Ulf P Neumann
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian D Klink
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| |
Collapse
|
15
|
Melkemichel M, Bringman S, Widhe B. Lower recurrence rate with heavyweight mesh compared to lightweight mesh in laparoscopic totally extra-peritoneal (TEP) repair of groin hernia: a nationwide population-based register study. Hernia 2018; 22:989-997. [PMID: 30168009 PMCID: PMC6245119 DOI: 10.1007/s10029-018-1809-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/18/2018] [Indexed: 12/03/2022]
Abstract
Purpose Lightweight meshes (LWM) have shown benefits compared to heavyweight meshes (HWM) in terms of less postoperative pain and stiffness in open inguinal hernia repair. It appears to have similar advantages also in TEP, but concerns exist if it may be associated with higher recurrence rates. The aim of the study was to compare reoperation rate for recurrence of LWM to HWM in laparoscopic totally extra-peritoneal (TEP) repair. Methods All groin hernias operated on with TEP between 1 January 2005 and 31 December 2013 at surgical units participating in The Swedish Hernia Register were eligible. Data included clinically important hernia variables. Primary endpoint was reoperation for recurrence. Median follow-up time was 6.1 years (0–11.5) with minimum 2.5 years postoperatively. Results In total, 13,839 repairs were included for statistical analysis and 491 were re-operated for recurrence. Multivariate analysis demonstrated significantly increased risk of reoperation for recurrence in LWM 4.0% (HR 1.56, P < 0.001) compared to HWM 3.2%. This was most evident in direct hernias (HR 1.75, P < 0.001) and in hernia repairs with a defect > 3 cm (HR 1.54, P < 0.021). The risk of recurrence with use of LWM in indirect hernias and in hernia repairs with a defect < 1.5 cm was more comparable to HWM. Conclusions Lightweight meshes were associated with an increased risk of reoperation for recurrence compared to HWM. While direct hernias and larger hernia defects may benefit from HWM to avoid increased recurrence rates, LWM is recommended to be used in indirect and smaller hernia defects in TEP repair.
Collapse
Affiliation(s)
- M Melkemichel
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. .,Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden.
| | - S Bringman
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.,Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden
| | - B Widhe
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.,Department of Surgery, Södertälje Hospital, 152 86, Södertälje, Sweden
| |
Collapse
|
16
|
|
17
|
Luz S, Rechner J, Widmann B, Zollinger T, De Lorenzi D. [Lower right abdominal pain and anal bleeding : A rare cause for nonspecific complaints]. Chirurg 2017; 89:306-309. [PMID: 29038821 DOI: 10.1007/s00104-017-0534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Luz
- Department für Chirurgie, Spital Grabs, Spitalstraße 44, 9472, Grabs, Schweiz.
| | - J Rechner
- Department für Chirurgie, Spital Altstätten, Altstätten, Schweiz
| | - B Widmann
- Klinik für Allgemein‑, Viszeral‑, Endokrin- und Transplantationschirurgie, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - T Zollinger
- Institut für Pathologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - D De Lorenzi
- Department für Chirurgie, Spital Grabs, Spitalstraße 44, 9472, Grabs, Schweiz
| |
Collapse
|
18
|
Berger D. Evidence-Based Hernia Treatment in Adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 113:150-7; quiz 158. [PMID: 26987468 DOI: 10.3238/arztebl.2016.0150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 01/19/2016] [Accepted: 01/19/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Inguinal hernia repair is the most common general surgical procedure in industrialized countries, with a frequency of about 200 operations per 100 000 persons per year. Suture- and mesh-based techniques can be used, and the procedure can be either open or minimally invasive. METHODS This review is based on a selective search of the literature, with interpretation of the published findings according to the principles of evidence-based medicine. RESULTS Inguinal hernia is diagnosed by physical examination. Surgery is not necessarily indicated for a primary, asymptomatic inguinal hernia in a male patient, but all inguinal hernias in women should be operated on. For hernias in women, and for all bilateral hernias, a laparoscopic or endoscopic procedure is preferable to an open procedure. Primary unilateral hernias in men can be treated either by open surgery or by laparoscopy/endoscopy. Patients treated by laparoscopy/endoscopy develop chronic pain less often than those treated by open surgery. A mesh-based repair is generally recommended; this seems reasonable in view of the pathogenesis of the condition, which involves an abnormality of the extracellular matrix. CONCLUSION The choice of procedure has been addressed by international guidelines based on high-level evidence. Surgeons should deviate from their recommendations only in exceptional cases and for special reasons. Guideline conformity implies that hernia surgeons must master both open and endoscopic/laparoscopic techniques.
Collapse
Affiliation(s)
- Dieter Berger
- Clinic of Abdominal, Thoracic and Pediatric Surgery, Klinikum Mittelbaden/Balg, Baden-Baden
| |
Collapse
|
19
|
Vats M, Pandey D, Saha S, Talwar N, Saurabh G, Andley M, Kumar A. Assessment of systemic inflammatory response after total extraperitoneal repair and Lichtenstein repair for inguinal hernia. Hernia 2016; 21:65-71. [PMID: 27838831 DOI: 10.1007/s10029-016-1543-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 11/06/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study was assessment of the systemic inflammatory response (SIR) intensity by measuring the blood serum levels of high sensitivity C-reactive protein (hsCRP), Interleukin-6 (IL-6) and Total Leukocyte Counts of patients. The estimations were done before and after the patient underwent either open Lichtenstein or endoscopic TEP inguinal hernia repair. This is a prospective observational type of study. METHODS Sixty patients with a diagnosis of unilateral uncomplicated inguinal hernia were included in the study. Patients were divided into two groups. In the first group, endoscopic total extraperitoneal repair (TEP) was done, while the other group underwent Lichtenstein repair. The patient selection was random. Serum markers for SIR were measured prior to and 24 h post-surgery. RESULTS Total extraperitoneal repair (TEP) and open Lichtenstein inguinal hernia repair both cause a significant Systemic Inflammatory Response in the body. The rise in serum markers for SIR post-surgery was statistically significant in both the groups. The rise in serum hsCRP and IL-6 concentrations was observed to be equivocal among the two groups. Statistically significant difference was observed in serum TLC rise: Lichtenstein repair group having a higher value. CONCLUSION Both, open and endoscopic surgical techniques incite a systemic inflammatory response in the body. However, it cannot be conclusively stated that TEP is associated with lesser SIR compared to the Lichtenstein repair on the basis of this study.
Collapse
Affiliation(s)
- M Vats
- Department of Surgery, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani Hospital, C-702, Panchsheel Apartments, Plot No. 24, Sector 4, Dwarka, New Delhi, Delhi, 110078, India.
| | - D Pandey
- Department of Surgery, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani Hospital, C-604, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, Delhi, 110001, India
| | - S Saha
- Department of Surgery, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani Hospital, C-604, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, Delhi, 110001, India
| | - N Talwar
- Department of Surgery, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani Hospital, C-604, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, Delhi, 110001, India
| | - G Saurabh
- Department of Surgery, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani Hospital, C-604, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, Delhi, 110001, India
| | - M Andley
- Department of Surgery, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani Hospital, C-604, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, Delhi, 110001, India
| | - A Kumar
- Department of Surgery, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani Hospital, C-604, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, Delhi, 110001, India
| |
Collapse
|
20
|
Lanier ST, Fligor JE, Miller KR, Dumanian GA. Reliable complex abdominal wall hernia repairs with a narrow, well-fixed retrorectus polypropylene mesh: A review of over 100 consecutive cases. Surgery 2016; 160:1508-1516. [PMID: 27545993 DOI: 10.1016/j.surg.2016.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/13/2016] [Accepted: 07/01/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Our objective was to determine outcomes for complex ventral hernia repairs in a large cohort of patients utilizing an operative construct employing retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution. No consensus exists on the optimal technique for repair of complex ventral hernias. Current trends emphasize large meshes with wide overlaps and minimal suture fixation, though reported complications and recurrence remain problematic. METHODS A retrospective review was performed for all patients undergoing ventral hernia repair with retrorectus placement of midweight, uncoated, soft polypropylene mesh by a single surgeon (GAD) between the years of 2010 and 2015. Patient characteristics, operative history, operative data, and postoperative course were reviewed. RESULTS A total of 101 patients with a mean age of 56 years and a mean body mass index of 29 m/kg2 (range 18-51 m/kg2) underwent hernia repair. Patients had a median of 3 prior abdominal operations (range 0-9), with 44 patients presenting with recurrent hernias. A total of 42 patients were Ventral Hernia Working Group grade 1, 40 grade 2, 17 grade 3, and 2 grade 4. There were no recurrences at a mean follow-up of almost 400 days for the 93 patients with long-term follow-up. The surgical site occurrence rate was 7.9% (3 surgical site infections, 2 seromas, 2 hematomas, and 4 instances of delayed wound healing in 8 patients). One patient required reoperation for hematoma drainage; 5 patients required readmission within 30 days. CONCLUSION An operative construct employing a retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution can achieve significantly better outcomes across a spectrum of Ventral Hernia Working Group grade, risk-stratified patients compared to rates reported in the literature for current strategies that employ wide meshes with minimal fixation.
Collapse
Affiliation(s)
- Steven T Lanier
- Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jennifer E Fligor
- Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kyle R Miller
- Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregory A Dumanian
- Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| |
Collapse
|
21
|
|
22
|
Brown BN, Mani D, Nolfi AL, Liang R, Abramowitch SD, Moalli PA. Characterization of the host inflammatory response following implantation of prolapse mesh in rhesus macaque. Am J Obstet Gynecol 2015; 213:668.e1-10. [PMID: 26259906 PMCID: PMC4631685 DOI: 10.1016/j.ajog.2015.08.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/21/2015] [Accepted: 08/02/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We sought to determine the predominant cell type (macrophage, T lymphocyte, B lymphocyte, mast cell) within the area of implantation of the prototypical polypropylene mesh, Gynemesh PS (Ethicon, Somerville, NJ); and to determine the phenotypic profile (M1 proinflammatory, M2 antiinflammatory) of the macrophage response to 3 different polypropylene meshes: Gynemesh PS (Ethicon), and 2 lower-weight, higher-porosity meshes, UltraPro (Ethicon) and Restorelle (Coloplast, Humblebaek, Denmark). STUDY DESIGN Sacrocolpopexy was performed following hysterectomy in rhesus macaques. Sham-operated animals served as controls. At 12 weeks postsurgery, the vagina-mesh complex was excised and the host inflammatory response was evaluated. Hematoxylin and eosin was used to perform routine histomorphologic evaluation. Identification of leukocyte (CD45(+)) subsets was performed by immunolabeling for CD68 (macrophage), CD3 (T lymphocyte), CD20 (B lymphocyte), and CD117 (mast cell). M1 and M2 macrophage subsets were identified using immunolabeling (CD86(+) and CD206(+), respectively), and further evaluation was performed using enzyme-linked immunosorbent assay for 2 M1 (tumor necrosis factor-alpha and interleukin [IL]-12) and 2 M2 (IL-4 and IL-10) cytokines. RESULTS Histomorphologic evaluation showed a dense cellular response surrounding each mesh fiber. CD45(+) leukocytes accounted for 21.4 ± 5.4% of total cells within the perimesh area captured in a ×20 field, with macrophages as the predominant leukocyte subset (10.5 ± 3.9% of total cells) followed by T lymphocytes (7.3 ± 1.7%), B lymphocytes (3.0 ± 1.2%), and mast cells (0.2 ± 0.2%). The response was observed to be more diffuse with increasing distance from the fiber surface. Few leukocytes of any type were observed in sham-operated animals. Immunolabeling revealed polarization of the macrophage response toward the M1 phenotype in all mesh groups. However, the ratio of M2:M1 macrophages was increased in the fiber area in UltraPro (P = .033) and Restorelle (P = .016) compared to Gynemesh PS. In addition, a shift toward increased expression of the antiinflammatory cytokine IL-10 was observed in Restorelle as compared to Gynemesh PS (P = .011). CONCLUSION The host response to mesh consists predominantly of activated, proinflammatory M1 macrophages at 12 weeks postsurgery. However, this response is attenuated with implantation of lighter-weight, higher-porosity mesh. While additional work is required to establish causal relationships, these results suggest a link among the host inflammatory response, mesh textile properties, and clinical outcomes in the repair of pelvic organ prolapse.
Collapse
Affiliation(s)
- Bryan N Brown
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Deepa Mani
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Alexis L Nolfi
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Rui Liang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA
| | - Steven D Abramowitch
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Pamela A Moalli
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA.
| |
Collapse
|
23
|
|
24
|
Standard polypropylene mesh vs lightweight mesh for Lichtenstein repair of primary inguinal hernia: a randomized controlled trial. Int J Surg 2014; 12:1380-4. [PMID: 25448661 DOI: 10.1016/j.ijsu.2014.10.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/13/2014] [Accepted: 10/25/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of the present clinical study was to compare early and late outcomes after inguinal hernia repair with the heavyweight mesh (HW) and lightweight mesh (LW) during a 3 year follow-up period. METHODS 226 patients were randomized into LW and HW mesh groups, both of which underwent unilateral primary inguinal hernia repair via the Lichtenstein technique. Wound complications (infection, hematoma, seroma), hernia recurrence, pain and feeling of foreign body in inguinal area were determined in patients. Pain was measured by visual analogue scale. RESULTS No statistical difference has been found between LW and HW groups by wound complication (P = 0.80). One case of hernia recurrence has been mentioned in both groups one year after hernioplasty. But there was no detectable difference between the two groups. No significant difference has been found between LW and HW groups by frequency of chronic pain 7 days, 1 and 3 months, 1, 2, and 3 years after surgery. As for the feeling of foreign body in groin it is similar in both groups after 1 and 3 months. Level of feeling of foreign body was significantly lower in LW group 1, 2, and 3 years after surgery, than in HW group (P = 0.03, P = 0.02, P = 0.02, respectively). CONCLUSION Our research shows no significant difference in wound complications, hernia recurrence and chronic pain after Lichtenstein hernioplasty, by using of LW and HW meshes. The usage of the LW mesh was associated with less feeling of foreign body than that of the HW mesh, what can be considered as prevalence of LW mesh hernioplasty.
Collapse
|
25
|
Vogels RRM, van Barneveld KWY, Bosmans JWAM, Beets G, Gijbels MJJ, Schreinemacher MHF, Bouvy ND. Long-term evaluation of adhesion formation and foreign body response to three new meshes. Surg Endosc 2014; 29:2251-9. [DOI: 10.1007/s00464-014-3936-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/03/2014] [Indexed: 02/03/2023]
|
26
|
Abstract
The frequency of chronic pain after hernia repair is currently much higher than the recurrence rate. For inguinal hernias it has been shown that mesh-based techniques are comparable to mesh-free techniques concerning chronic pain. Risk factors could be clearly identified for inguinal hernia repair and include open repair, meshes with small pores, mesh fixation with sutures or tacks, pre-existing pain and severe pain during the early postoperative period. The last two risk factors are also important for incisional hernias. For laparoscopic incisional hernia repair, the width (> 10 cm) of the gap seems to correlate with chronic pain. The diagnostic measures are restricted to the identification of a segmental problem in terms of nerve entrapment which can be blocked by local anesthesia or definite neurectomy. In some cases of chronic pain after inguinal hernia repair removal of the mesh will be advisable. After incisional hernia repair a segmental involvement is rarely seen. Localized pain may be induced by stay sutures which can be removed. Mesh removal is, however, a complex procedure especially after open repair resulting in hernia recurrence and therefore represents a salvage technique. The prophylaxis of chronic pain is therefore of utmost importance as is the identification of patients at risk which is now possible. These patients for example with inguinal hernias should be treated laparoscopically with an adequate technique including meshes with big pores and without fixation or fixation with glue only.
Collapse
Affiliation(s)
- D Berger
- Klinik für Viszeral-, Thorax- und Kinderchirurgie, Stadtklinik, Frankenstr. 70, 76532, Baden-Baden, Deutschland,
| |
Collapse
|
27
|
Sandor M, Scott N, Edwards M, Qi S, De Deyne PG. In vitro and in vivo characterization of a fully resorbable and composite surgical mesh. J BIOACT COMPAT POL 2014. [DOI: 10.1177/0883911513520382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Fully resorbable and composite synthetic meshes are intended to provide advantages over nonabsorbable synthetic meshes, such as minimization of visceral adhesions and improved biocompatibility, but the inflammatory response to these materials has not previously been fully characterized. We compared resorbable and composite synthetic meshes using in vitro characterization and evaluated the host response in a nonhuman primate acute abdominal wall defect. After a 2-week in vitro incubation, resorbable synthetic mesh mechanical strength decreased to 0.12 ± 0.09 N (0.25% of initial strength), which preceded acidification and a fractured morphology at 1 month. The composite synthetic mesh strength decreased to 10.0 ± 3.2 N (41.1% of initial strength), coincident with morphological changes. In vivo, resorbable synthetic mesh elicited an intense yet transient foreign-body response, with macrophages and myofibroblasts persisting through 3 months of implantation. At 6 months, resorbable synthetic mesh was undetectable and the mesh–host tissue interface strength (14.7 ± 7.9 N) was equivalent to that of primary repair (21.4 ± 4.9 N). The composite synthetic mesh elicited a significant foreign-body response following 1 month of implantation. By 3 months, the composite synthetic mesh resorbable films had fully degraded, with foreign-body reaction localized to polypropylene fibers. By 6 months, macrophages had surrounded these polypropylene fibers, with a myofibroblast-positive capsule encircling a macrophage-rich layer. Resorbable and composite synthetic meshes may ultimately not be the most ideal biomaterials in situations where the biological response is expected to lead to a regeneration of host soft tissues.
Collapse
Affiliation(s)
| | | | | | - Shijie Qi
- Hôpital Notre-Dame, Department of Surgery, University of Montreal, Montreal, QC, Canada
| | | |
Collapse
|
28
|
Abstract
Secondary ventral hernia or incisional hernia occurs in at least 20 % of cases after laparotomy and most patients are symptomatic. The pathogenesis of incisional hernia is believed to be based on a defect in collagen synthesis indicating the necessity of covering the whole original incision with a non-resorbable, macroporous mesh. These meshes can be used on top of the fascia (onlay), in a retromuscular fashion (sublay) or intraperitoneally (IPOM). The IPOM technique is the preferred procedure during laparoscopic repair of ventral hernias. The clear advantage of the laparoscopic approach is the dramatically reduced rate of wound complications, especially infections. Major defects of the abdominal wall require plastic reconstruction with the component separation technique in both anterior and posterior approaches. The component separation technique must be combined with retromuscular mesh augmentation enabling a recurrence rate of less than 10 % and an acceptable morbidity to be achieved.
Collapse
|