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Song Z, Yang D, Hu Q, Wang Y, Zhang H, Dong W, Yang J, Gu Y. Reconstruction of Abdominal Wall Defect with Composite Scaffold of 3D Printed ADM/PLA in a Rat Model. Macromol Biosci 2023; 23:e2200521. [PMID: 36746773 DOI: 10.1002/mabi.202200521] [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: 11/29/2022] [Revised: 01/15/2023] [Indexed: 02/08/2023]
Abstract
Abdominal wall defects are a frequently occurring condition in surgical practice. The most important are material structure and biocompatibility. In this study, PLA mesh composited with a 3D printing of acellular dermal matrix (ADM) material is used to repair abdominal wall defects. The results show that the adhesion score of ADM/PLA composite scaffolds is smaller than PLA meshes. Immunohistochemical assessment reveals that the ADM/PLA composite scaffold can effectively reduce the inflammatory response at the contact surface between the meshes and the abdominal organs. And the ADM/PLA composite scaffold can effectively reduce the expression levels of the inflammation-related factors IL-6 and IL-10. In addition, the ADM/PLA composite scaffold repair is rich in the expression levels of tissue regeneration-related factors vascular endothelial growth factor and transforming growth factor β. Thus, ADM/PLA composite scaffolds can effectively reduce surrounding inflammation to effectively promote the repair of abdominal wall defects.
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Affiliation(s)
- Zhicheng Song
- General Surgery, Huadong Hospital Affiliated to Fudan University, 221 Yan 'an West Road, Jing 'an District, Shanghai, Shanghai, 200040, China
| | - Dongchao Yang
- General Surgery, Huadong Hospital Affiliated to Fudan University, 221 Yan 'an West Road, Jing 'an District, Shanghai, Shanghai, 200040, China
| | - Qingxi Hu
- Rapid Manufacturing Engineering Center, Shanghai University, 99 Shangda Road, Baoshan District, Shanghai, Shanghai, 200444, China
| | - Yiming Wang
- Administrative office, Tenth People's Hospital of Tongji University, 301 Yanchang Zhong Lu, Jing 'an District, Shanghai, Shanghai, 200072, China
| | - Haiguang Zhang
- Rapid Manufacturing Engineering Center, Shanghai University, 99 Shangda Road, Baoshan District, Shanghai, Shanghai, 200444, China
| | - Wenpei Dong
- General Surgery, Huadong Hospital Affiliated to Fudan University, 221 Yan 'an West Road, Jing 'an District, Shanghai, Shanghai, 200040, China
| | - Jianjun Yang
- General Surgery, Huadong Hospital Affiliated to Fudan University, 221 Yan 'an West Road, Jing 'an District, Shanghai, Shanghai, 200040, China
| | - Yan Gu
- General Surgery, Huadong Hospital Affiliated to Fudan University, 221 Yan 'an West Road, Jing 'an District, Shanghai, Shanghai, 200040, China
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Nedelcu M, Verhaeghe P, Skalli M, Champault G, Barrat C, Sebbag H, Reche F, Passebois L, Beyrne D, Gugenheim J, Berdah S, Bouayed A, Michel Fabre J, Nocca D. Multicenter prospective randomized study comparing the technique of using a bovine pericardium biological prosthesis reinforcement in parietal herniorrhaphy (Tutomesh TUTOGEN) with simple parietal herniorrhaphy, in a potentially contaminated setting. Wound Repair Regen 2016; 24:427-33. [DOI: 10.1111/wrr.12386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/19/2015] [Accepted: 11/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Marius Nedelcu
- Department of Digestive and General Surgery, University Hospital, Montpellier
| | - Pierre Verhaeghe
- Department of Digestive and General Surgery, University Hospital, Amiens Nord
| | - Mehdi Skalli
- Department of Digestive and General Surgery, University Hospital, Montpellier
| | - Gerard Champault
- Department of Digestive and General Surgery, University Hospital, Bondy
| | - Christophe Barrat
- Department of Digestive and General Surgery, University Hospital, Bondy
| | - Hugues Sebbag
- Department of Digestive and General Surgery, Community Hospital, Aix en Provence
| | - Fabian Reche
- Department of Digestive and General Surgery, University Hospital, Grenoble
| | - Laurent Passebois
- Department of Digestive and General Surgery, Community Hospital, Beziers
| | - Daniel Beyrne
- Department of Digestive and General Surgery, Community Hospital, Avignon
| | - Jean Gugenheim
- Department of Digestive and General Surgery, University Hospital, Nice
| | - Stephane Berdah
- Department of Digestive and General Surgery, Hopital Nord Marseille, Marseille
| | - Amine Bouayed
- Department of Digestive and General Surgery, Community Hospital, Salon de Provence, France
| | - Jean Michel Fabre
- Department of Digestive and General Surgery, University Hospital, Montpellier
| | - David Nocca
- Department of Digestive and General Surgery, University Hospital, Montpellier
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Figel NA, Ellis CN. Prosthetics for Parastomal Hernia Repair. SEMINARS IN COLON AND RECTAL SURGERY 2012. [DOI: 10.1053/j.scrs.2011.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Laparoscopic paracolostomy hernia repair: a retrospective case series at a tertiary care center. Surg Laparosc Endosc Percutan Tech 2011; 20:395-8. [PMID: 21150417 DOI: 10.1097/sle.0b013e3182009ae7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Paracolostomy hernias are one of the most common complications of stomas. Primary repair is associated with a high rate of recurrence. The choice is between mesh-reinforced repair of the defect and relocation of the stoma to another position. The laparoscopic approach seems attractive, as it is minimally invasive, requires shorter hospitalization, and the entry is through a noncontaminated part of the abdomen. STUDY DESIGN This study consists of a case series of 9 patients with paracolostomy hernia, of which 2 had recurrent hernias. All patients presenting with nonobstructed parastomal hernias at our clinic between October 2006 and October 2009 are included in this series. Two patients that presented with obstruction are not included. We describe our technique for this surgery using the laparoscopic approach and discuss the outcomes. RESULTS Nine patients with permanent colostomies in the left lumbar quadrant after abdominoperineal resection presented with parastomal hernias of varying durations and were subjected to laparoscopic repair. The average operating time was 112 minutes. All the patients were mobilized postoperatively and were discharged by 48 hours. None of the patients have reported any complication, including recurrence. CONCLUSIONS Laparoscopic repair of paracolostomy hernia using a technique involving intracorporeal suturing of defect followed by reinforcement by a tissue-separating mesh is safe and feasible.
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Smart NJ, Velineni R, Khan D, Daniels IR. Parastomal hernia repair outcomes in relation to stoma site with diisocyanate cross-linked acellular porcine dermal collagen mesh. Hernia 2011; 15:433-7. [PMID: 21279662 DOI: 10.1007/s10029-011-0791-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/09/2011] [Indexed: 12/31/2022]
Abstract
PURPOSE Biologic meshes are increasingly used in parastomal hernia repair. This study evaluates the efficacy and safety of diisocyanate cross-linked acellular porcine dermal collagen mesh for parastomal hernia repair, with particular reference to the relationship of the stoma site to the rectus sheath. METHODS Hernias were repaired via a lateral approach, with onlay placement of the biologic mesh. A retrospective case note review and analysis of clinical outcomes was performed. The relationship of the stoma to the rectus sheath was determined by abdominal computed tomography (CT) and intraoperative findings. RESULTS Over a 16-month period, 27 consecutive patients, median age 72 years, underwent parastomal hernia repair utilising onlay biologic mesh to reinforce the external oblique aponeurosis. There were 20 paracolostomy and seven paraileostomy hernias. Eleven stomas passed through the rectus sheath and 16 were lateral to it. Recurrences occurred in 3 of 11 stomas within and 12 of 16 stomas lateral to the rectus sheath (P = 0.022). The median time to recurrence was 10.1 months. The median follow up of patients without recurrence was 16.6 months (range 0.2-39.3). There was one perioperative death. One patient developed a superficial post-operative abscess that was managed conservatively, but there were no complications related to the biologic mesh and no mesh required removal. CONCLUSIONS For parastomal hernias within the rectus sheath, diisocyanate cross-linked porcine dermal collagen mesh onlay repair gives good results and is safe to use. Repair of a parastomal hernia where the stoma is lateral to the rectus sheath has a significantly higher risk of recurrence and is not recommended.
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Affiliation(s)
- N J Smart
- Exeter Colorectal Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
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Slater NJ, Hansson BME, Buyne OR, Hendriks T, Bleichrodt RP. Repair of parastomal hernias with biologic grafts: a systematic review. J Gastrointest Surg 2011; 15:1252-8. [PMID: 21360207 PMCID: PMC3116129 DOI: 10.1007/s11605-011-1435-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 01/26/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biologic grafts are increasingly used instead of synthetic mesh for parastomal hernia repair due to concerns of synthetic mesh-related complications. This systematic review was designed to evaluate the use of these collagen-based scaffolds for the repair of parastomal hernias. METHODS Studies were retrieved after searching the electronic databases MEDLINE, EMBASE and Cochrane CENTRAL. The search terms 'paracolostomy', 'paraileostomy', 'parastomal', 'colostomy', 'ileostomy', 'hernia', 'defect', 'closure', 'repair' and 'reconstruction' were used. Selection of studies and assessment of methodological quality were performed with a modified MINORS index. All reports on repair of parastomal hernias using a collagen-based biologic scaffold to reinforce or bridge the defect were included. Outcomes were recurrence rate, mortality and morbidity. RESULTS Four retrospective studies with a combined enrolment of 57 patients were included. Recurrence occurred in 15.7% (95% confidence interval [CI] 7.8-25.9) of patients and wound-related complications in 26.2% (95% CI 14.7-39.5). No mortality or graft infections were reported. CONCLUSIONS The use of reinforcing or bridging biologic grafts during parastomal hernia repair results in acceptable rates of recurrence and complications. However, given the similar rates of recurrence and complications achieved using synthetic mesh in this scenario, the evidence does not support use of biologic grafts.
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Affiliation(s)
- Nicholas Jonathan Slater
- Department of Surgery, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Szmulowicz UM, Hull TL. The Role of Biological Implants in the Repair and Prevention of Parastomal Hernia. SEMINARS IN COLON AND RECTAL SURGERY 2009. [DOI: 10.1053/j.scrs.2009.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lo Menzo E, Martinez JM, Spector SA, Iglesias A, Degennaro V, Cappellani A. Use of biologic mesh for a complicated paracolostomy hernia. Am J Surg 2008; 196:715-9. [PMID: 18954603 DOI: 10.1016/j.amjsurg.2008.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/02/2008] [Accepted: 07/02/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parastomal hernias are among the most frustrating and incapacitating complications of permanent colostomies. Because the traditional surgical options of primary repair with or without ostomy repositioning have led to disappointing results, the use of mesh is indicated, especially in the setting of multiple recurrences. METHODS After laparoscopic lyses of adhesions, the colostomy is pushed against the lateral abdominal wall, and a bovine pericardium graft is gently stretched and draped over the colostomy (the Sugarbaker technique). Transfascial sutures and tacks are placed along the perimeter of the mesh and around the colon to prevent small bowel herniation. RESULTS The patient developed a small seroma postoperatively, which resolved spontaneously. At his 17-month follow-up, the patient had no evidence of recurrence, he was pain free, and he was satisfied with his cosmetic results. CONCLUSION Although several studies indicate the feasibility and efficacy of synthetic permanent mesh repair, the concerns of mesh infection, erosion, and ostomy obstruction still persist. The authors suggest parietalizing the bowel and using a biologic mesh.
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Affiliation(s)
- Emanuele Lo Menzo
- Miami VA Healthcare System, University of Miami, Miller School of Medicine, Miami, FL, USA.
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