A randomised, multi-centre, prospective, double blind pilot-study to evaluate safety and efficacy of the non-absorbable Optilene Mesh Elastic versus the partly absorbable Ultrapro Mesh for incisional hernia repair

The Use of Inlay Bridge of the Posterior Fascia as Adjuvants to a Modified Rives-Stoppa Repair for Difficult Abdominal Wall Hernias

BACKGROUND

Major abdominal wall defects remain a highly morbid complication. Occasionally a fascial defect is encountered, that despite all surgical efforts, is unable to completely approximate at the midline. Here we describe our method and outcomes of using a bridging mesh when the posterior fascia was unable to be approximated during the repair of large postoperative ventral hernias using the modified Rives-Stoppa technique.

METHODS

A retrospective review was conducted looking at all the open abdominal wall hernia repairs between 2014 and 2020. The cohort of patients who had a bridge placed in addition to the traditional open modified Rives-Stoppa repair were used for this study.

RESULTS

Nineteen patients had a mesh inlay bridge placed in addition to a modified Rives-Stoppa repair with a sublay (retrorectus) Ultrapro mesh. For the inlay mesh 13 Symbotex composite meshes were placed and 6 Vicryl meshes used. The average surface area of the defect was 358.1 cm^2. The average length of hospitalization was 8.8 days with a range of 3-24 days. During the immediate postoperative course there were 6 minor complications. During the follow-up period there were 2 recurrences.

DISCUSSION

The use of inlay mesh bridge as an adjuvant to a modified Rives-Stoppa repair with a sublay ultrapro mesh is an effective technique for difficult abdominal wall repairs where the posterior fascia is unable to be approximated without tension.

How-we-do-it: the repair of postoperative ventral hernias after a Mercedes abdominal incision

PURPOSE

To describe the abdominal wall reconstruction technique with an Ultrapro mesh and outcome for the repair of postoperative ventral hernias after the use of a Mercedes incision during the initial abdominal operation.

METHOD

A retrospective review of all the patients undergoing elective postoperative ventral hernia repair between 2013 and 2019. The cohort of these patients that had an initial Mercedes incision was used for this study.

RESULTS

Fourteen patients met the criteria for this study. Thirteen of the patients were transplant patients (10 liver transplant and 3 combined pancreas and kidney transplant), and one patient was after a hepatectomy. Fifty-seven percent of these hernias were multiple defects. All the patients underwent the same repair of a modified Rives-Stoppa, transversus abdominis release, and a bilateral transverse plication. A partially absorbable Ultrapro mesh was used for all the patients, with two of the patients needing an additional Symbotex mesh in order to bridge a portion of the posterior fascia. There were 6 minor early postoperative complications (hematoma, superficial wound infection, and seroma) that did not require reoperation. Two patients were readmitted for observation of a wound hematoma, and two patients (14.2%) had recurrence during the follow-up period. The average length of hospitalization was 5.6 days.

CONCLUSION

This technique, with the use of an Ultrapro mesh, was found to be safe and effective for the repair of a postoperative ventral hernia due to an initial Mercedes incision.

A modification of Nissen fundoplication improves patients' outcome and may reduce procedure-related failure rate

BACKGROUND

Laparoscopic anti-reflux surgery has a failure rate of 10-20%. We aimed to investigate whether a modification of Nissen fundoplication (MNF) may improve patients' outcome and reduce failure rate.

MATERIALS & METHODS

We prospectively compared 40 consecutive patients with gastroesophageal reflux disease who underwent anti-reflux surgery: 20 Nissen fundoplication (NF) and 20 the MNF approach. Eight cases in the MNF group needed redo surgery. The MNF consisted in suturing the esophagus to the diaphragmatic crura on each side by means of 4 non-absorbable stitches and in fixing the upper stitch of the valve to diaphragm. In case of clearly weak crura, a reinforcement with Ultrapro mesh was used. All patients were assessed before and after surgery using validated symptoms and quality of life (GERD-HRQL) questionnaires, manometry and 24-h impedance-pH monitoring, endoscopy and barium-swallow.

RESULTS

Mortality and postoperative complications were nil. At a median follow-up of 36 months, no significant differences emerged between the MNF and NF group in terms of symptoms, GERD-HRQL scores, manometric findings, and impedance-pH features. Dysphagia was not reported by the MNF group, while it was quite common (20% vs.0%, p = ns) in the NF group. Anti-reflux surgery was successful in all patients in the MNF group, whereas two patients in the NF group presented a slipped wrap and one recurrent reflux; two of these cases required redo-surgery (10% vs. 0%, p = ns).

CONCLUSIONS

Our preliminary data demonstrated that the MNF is a safe and effective procedure. Further, it seems to reduce the failure rate associated to the surgical procedure.

In vitro analysis of biopolymer coating with glycidoxypropyltrimethoxysilane on hernia meshes

Certain coatings may improve the biocompatibility of hernia meshes. The coating with self-assembled monolayers, such as glycidoxypropyltrimethoxysilane (GOPS) can also improve the materials characteristics of implants. This approach was not yet explored in hernia meshes. It was the aim of this work to clarify if and how hernia meshes with their three-dimensional structure can be coated with GOPS and with which technique this coating can be best characterized. Commercially available meshes made from polypropylene (PP), polyester (PE), and expanded polytetrafluorethylene (ePTFE) have been coated with GOPS. The coatings were analyzed via X-ray photoelectron spectroscopy (XPS), confocal laser scanning microscopy (CLSM), and cell proliferation test (mouse fibroblasts). Cell viability and cytotoxicity were tested by MTT test. With the GOPS surface modification, the adherence of mouse fibroblasts on polyester meshes and the proliferation on ePTFE meshes were increased compared to noncoated meshes. Both XPS and CLSM are limited in their applicability and validity due to the three-dimensional mesh structure while CLSM was overall more suitable. In the MTT test, no negative effects of the GOPS coating on the cells were detected after 24 h. The present results show that GOPS coating of hernia meshes is feasible and effective. GOPS coating can be achieved in a fast and cost-efficient way. Further investigations are necessary with respect to coating quality and adverse effects before such a coating may be used in the clinical routine. In conclusion, GOPS is a promising material that warrants further research as coating of medical implants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1083-1090, 2017.

Inguinal hernia repair: can one identify the three main nerves of the region?

<sec><title>OBJECTIVE:</title><p> To identify the nerves in the groin during inguinal hernia repair by inguinotomy.</p></sec><sec><title>METHODS:</title><p> We conducted a prospective, sequenced, non-randomized study comprising 38 patients undergoing inguinal hernia repair with placement of polypropylene mesh.</p></sec><sec><title>RESULTS:</title><p> The male patients were 36 (94.7%), with a mean age and standard deviation of 43.1 ± 14.5, body mass index of 24.4 ± 2.8. Comorbidities were hypertension in two (5.2%), smoking in 12 (31.5%) and obesity in two (5.2%). The hernia was located only on the right in 21 (55.2%) patients, only on the left in 11 (28.9%), and was bilateral in six (15.7%) patients. Prior hernia repair was present in seven (18.4%) patients. The identification of the three nerves during operation was made in 20 (52.6%) patients, the ilioinguinal nerve and the iliohypogastric nerve were identified in 33 (86.8%), and the genital nerve branch of the genitofemoral nerve, in 20 (52.6%). Resection of at least one of the nerves was performed in seven (18.4%) cases, two iliohypogastric nerves and five ilioinguinal nerves. The average operating time was 70.8 ± 18.2 minutes. The hospital stay was 1.42 ± 1.18 days. Ten patients (26.3%) returned to physical activity around the first postoperative visit, and 37 (97.3%) in the last. The follow-up time was 95.6 ± 23.5 days. The inability to identify the ilioinguinal nerve was associated with previous repair (p = 0.035).</p></sec><sec><title>CONCLUSION:</title><p> The identification of the three nerves during inguinal hernia surgery has been described in more than half of the cases and prior repair interfered with the identification of ilioinguinal nerve.</p></sec>

Risk of infection and hernia recurrence for patients undergoing ventral hernia repair with non-absorbable or biological mesh during open bowel procedures

BACKGROUND

Ventral hernia repair (VHR) with mesh performed concurrently with colorectal surgery is presumably associated with significant risks of infection and recurrence. The purpose of this study is to evaluate the outcomes of patients undergoing VHR with non-absorbable mesh (NAM) or biological mesh (BM) at the same time as open colorectal surgery.

METHODS

A retrospective review of short- and long-term outcomes for 25 patients undergoing repair of VHR with NAM or BM at the same time as an open colorectal procedure from 1991 to 2007 was performed.

RESULTS

The mean age of the patients was 50.8 ± 12.7 years. Fifteen patients (60 %) underwent VHR with NAM versus 10 (40 %) with BM at the time of colorectal surgery. Mean follow-up after surgery was 32.9 ± 38.2 months. Overall wound infection, mesh infection and hernia recurrence rates were 44, 36 and 36 %, respectively. There was no difference between the NAM and BM mesh repair groups in terms of operative indications (p = 0.23) and operations performed (p = 0.47). Both groups had similar gender, ASA score, age, BMI, operating time, hernia recurrence rate, wound infection and follow-up.

CONCLUSIONS

Although a proportion of patients who undergo concomitant use of mesh for VHR during colorectal resection has reasonable outcomes, there is a high associated risk of wound and mesh infection. Thus, a judicious decision regarding the use of mesh for hernia repair needs to be made on a case-by-case basis for patients undergoing open bowel surgery at the same time.

A randomised, multi-centre, prospective, observer and patient blind study to evaluate a non-absorbable polypropylene mesh vs. a partly absorbable mesh in incisional hernia repair

BACKGROUND

The implantation of a polymer mesh is considered as the standard treatment for incisional hernia. It leads to lower recurrence rates compared to suture techniques without mesh implantation; however, there are also some drawbacks to mesh repair. The operation is more complex and peri-operative infectious complications are increased. Yet it is not clear to what extent a mesh implantation influences quality of life or leads to chronic pain or discomfort. The influence of the material, textile structure and size of the mesh remain unclear. The aim of this study was to evaluate if a non-absorbable, large pore-sized, lightweight polypropylene (PP) mesh leads to a better health outcome compared to a partly absorbable mesh.

METHODS/DESIGN

In this randomised, double-blinded study, 80 patients with incisional hernia after a median laparotomy received in sublay technique either a non-absorbable mesh (Optilene® Mesh Elastic) or a partly absorbable mesh (Ultrapro® Mesh). Primary endpoint was the physical health score from the SF-36 questionnaire 21 days post-operatively. Secondary variables were patients' daily activity score, pain score, wound assessment and post-surgical complications until 6 months post-operatively.

RESULTS

SF-36, daily activity and pain scores were similar in both groups after 21 days and 6 months, respectively. No hernia recurrence was observed during the observation period. Post-operative complication rates also showed no difference between the groups.

CONCLUSION

The implantation of a non-absorbable, large pore-sized, lightweight PP mesh for incisional hernia leads to similar patient-related outcome parameters, recurrence and complication rates as a partly absorbable mesh.