Infection and recurrence rates of the C-QUR V-Patch™ in ventral hernia repairs

PURPOSE

Ventral hernias are a common surgical issue and a myriad of surgical mesh designs has been developed for their treatment. Many of these new mesh designs have not been extensively tested and their complications rates are largely unknown. The C-QUR V-Patch Mesh^™ combines a unique knit construction polypropylene mesh with an omega-3 fatty acid coating. There has only previously been one reported study investigating this mesh.

METHODS

A multicentre cohort study, with a single surgeon, of 168 consecutive patients with ventral hernias underwent repair using a standardized open pre-peritoneal approach with the novel C-QUR V-Patch Mesh^™ between January 2013 and June 2015. A median follow-up of 37 months was completed to assess the patients for hernia infection and recurrence rates. Mesh infections were further classified into early and late infections for further subgroup analysis.

RESULTS

Infection and recurrence rates of the C-QUR V-Patch^® were compared with similar published results of alternate mesh designs. Surgical site infection rates were 7.7% and recurrence rates were 2.4%. The infection rate rose dramatically to 19.0% when the mesh was placed intra-peritoneally. The rate of mesh explantation was 2.4% and usually occurred between 4 and 12 months post-operatively. Smoking was the only factor that appeared to be associated with recurrence.

CONCLUSION

This series finds that recurrence rates associated with the novel C-QUR V-Patch Mesh^™ is acceptably low; however, infection rates appear to be higher when compared to comparable products for use in ventral hernia repairs.

Vesico-ureteral reflux in pediatric kidney transplants: clinical relevance to graft and patient outcome

From June 1985 to December 1998, 173 pediatric renal transplants were carried out in 170 patients at our center. From this pool, 73 patients (34 males and 39 females) with a follow-up of 48 months were examined. In all patients, ureteroneocystostomy was performed according to the Lich-Grégoire procedure. All patients were treated with cyclosporin A (CsA)-based immunosuppression, including prednisone and sometimes azathioprine (AZA). Six months after transplantation, voiding cystography (VCU) was performed in all patients and reflux was classified from Grade I to Grade IV. The patients were divided into two groups: those with reflux (Group A: 25 patients) and those without (Group B: 48 patients). Grade I reflux was found in four patients, Grade II in seven patients, Grade III in seven patients, and Grade IV in seven patients. All the patients with severe reflux (Grade IV) underwent a corrective surgical procedure. Both groups were examined for immunologic and non-immunologic risk factors and no significant differences were found. Analysis of patient and graft survival rates revealed no statistical differences (NS) between Groups A and B. Mean serum creatinine (mg/dL) was 1.06 +/- 0.28 and 1.12 +/- 0.41 at 4 yr in Groups A and B, respectively (NS). Mean calculated creatinine clearance (cCrC; ml/min) was 76.74 +/- 15.92 and 77.96 +/- 15.66 in Groups A and B, respectively (NS). The analysis was further extended by considering the grade of reflux (I to IV). Again, no significant differences in the above parameters emerged between the reflux sub-groups; only in the Grade IV sub-group was a slight decrease in cCrC detected, although this difference was not statistically significant when compared with the other sub-groups. In conclusion, vesico-ureteral reflux (VUR) does not seem to negatively affect graft function. However, as all severe reflux patients (Grade IV) were surgically corrected, no conclusions can be drawn with regard to the influence of Grade IV reflux on long-term graft function.