scholarly journals P049 SAFETY AND EFFICACY OF ABSORBABLE AND NON-ABSORBABLE FIXATION SYSTEMS FOR INTRAPERITONEAL MESH FIXATION: AN EXPERIMENTAL STUDY IN SWINE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Spyridon Kapoulas ◽  
Apostolos Papalois ◽  
Georgios Papadakis ◽  
Georgios Tsoulfas ◽  
Emmanouil Christoforidis ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Mesh Fixation ◽  
Peel Strength ◽  
Swine Model ◽  
Abdominal Wall Defects ◽  
Hernia Surgery ◽  
Safety And Efficacy ◽  
Mesh Placement ◽  
Intraperitoneal Mesh ◽  
Mesh Shrinkage

Abstract Aim Choice of the best fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of this study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation. Material and Methods Fourteen Landrace swine were utilized and the experiment included two stages. Initially, four pieces of polypropylene mesh with hydrogel barrier coating1 were fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. Each mesh was anchored with a different tack device between titanium2, steel3 or absorbable (4,5) fasteners. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy. The primary endpoint was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks. Results Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Steel tacks had higher peel strength when compared to titanium and absorbable fasteners. No significant differences were noted regarding the secondary endpoints. Conclusions Steel fasteners provided higher peel strength that the other devices in this swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.

scholarly journals P138 PREPERITONEAL ENDOSCOPIC GROIN HERNIA SURGERY - REASSESSMENT OF TOPOGRAPHIC ANATOMY AS A BASIS FOR STANDARDIZED DESCRIPTION OF SURGICAL STEPS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Marvin Heimke ◽  
Tilmann Heinze ◽  
Andreas Kuthe ◽  
Thilo Wedel ◽  
Christoph W Strey
Keyword(s):  
Abdominal Wall ◽  
Groin Hernia ◽  
Histological Study ◽  
Learning Curves ◽  
Surgical Approaches ◽  
Anatomical Landmarks ◽  
Hernia Surgery ◽  
Mesh Placement ◽  
Topographic Anatomy ◽  
Total Extraperitoneal

Abstract Aim Fascial groin anatomy remains a conundrum. In particular, a clear anatomical allocation of the correct extraperitoneal dissection planes and spaces in total extraperitoneal endoscopic hernia surgery (TEP) has not yet agreed upon. The differing anatomical concepts are reflected by the variability of surgical approaches, the considerably long learning curves and subsequent complications. Thus, the aim of this study was to reassess the topographic anatomy of the groin region providing a basis to standardize the surgical steps of TEP according to clearly defined anatomical landmarks. Material and Methods Video analysis of intraoperative surgical anatomy of groin hernia patients was correlated with the findings retrieved by macroscopic anatomical studies. The groin region of formalin fixed body donors was subjected to a stepwise dissection exposing the fascial system of the abdominal wall layer-by-layer and via different angles. Selected areas of interest were processed for histological study. Surgically relevant anatomical landmarks were defined and termed according to the most appropriate anatomical nomenclature. Results The essential surgical dissection steps during TEP could be related to specific anatomical landmarks extending within the extraperitoneal space of the ventral and dorsolateral abdominal wall. The definition of fascial structures and interfaces and the identification of structures at risk allowed the identification of correct dissection planes for mesh placement. Conclusions Our study helps to clarify the definition and nomenclature of anatomical key structures required for a standardized description of TEP in a simplified model. The data may contribute to reduce complications and improve surgical teaching and training.

scholarly journals Repair Methods in Parastomal Hernia Surgery

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Salih Tosun ◽  
Oktay Yener ◽  
Ihsan Metin Leblebici ◽  
Özgür Ekinci
Keyword(s):  
Abdominal Wall ◽  
Recurrence Rate ◽  
Mesh Repair ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
High Recurrence Rate ◽  
Suture Repair ◽  
Hernia Surgery ◽  
Promising Alternative ◽  
Mesh Placement

Background-Aim: Parastomal hernias (PSH) are incisional hernias that must be classified separately from the other abdominal wall hernias. The high recurrence rate of PSH is the most important problem after suture repair or relocation of the stoma; whereas open or laparoscopic mesh repair results in much lower recurrence rates. The aim of this study is to investigate PSH predisposing factors, surgical repair methods, postoperative complications and recurrence in surgery practice. Methods: Patient demographics, operation time before the first surgery, operation method, and the recurrence rate seen in patients who underwent PSH surgery in a 10-year time/ period (2008-2018) were investigated  from the patient records. Except for emergency cases, 2 years of disease-free time was set for PSH surgery in malignant cases to be sure that no malignancy was present in the time of operation.  Results: 14 PSHs were treated surgically using mesh repair in all cases.  There were 6 male and 8 female patients with a mean age of 71.7 years (range:45-84;median:78). Open sublay polypropylene mesh placement technique was performed in 12 patients and intraperitoneal composite mesh (using either keyhole or Sugarbaker techniques) was placed laparoscopically in 2 patients. Superficial wound infections were developed in 4 patients (28.5 %) and 2 patients developed recurrence (14.2%). Conclusion: There is no effective method defined for the surgery of PSH but the laparoscopic approach has been proposed as a promising alternative to open technique as it causes less abdominal wall trauma. Whether performed open or laparoscopic; mesh repair is the optimal standard for PSH surgery.

scholarly journals Recurrent petit traumatic hernia plasty: case report

2019 ◽  
Vol 6 (2) ◽  
pp. 593
Author(s):  
Gamaliel Vázquez Estudillo ◽  
Edwin Y. Ochoa Viveros ◽  
Amado Q. Nicasio Delgado ◽  
David Trejo Cervantes ◽  
Gerardo Rodarte Cajica ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Surgical Procedure ◽  
Humeral Fracture ◽  
Lumbar Hernia ◽  
Abdominal Wall Defects ◽  
Large Hospital ◽  
Mesh Placement ◽  
First Case ◽  
One Year ◽  
Lower Lumbar

Lumbar hernias are very infrequent posterior abdominal wall defects. They are usually located in the upper lumbar triangle and represent approximately 1.5-2% of all hernias of the abdominal wall. In fact, there are few cases described in the literature and most of the large hospital centers have published only 2 or 3 cases. This is a 34 year-old female, who suffered a car accident, in which bilateral femoral fracture and left humeral fracture, after recovery of said fractures has asymmetry of flanks with the appearance of volume increase in the left abdominal flank, computed tomography was performed evidencing left lower lumbar hernia (Petit's Hernia) so, it was protocolized for open lumbar hernia repair with placement of mesh by anterior approach, later one year later, it presented recurrent left lumbar hernia, therefore, a protocol and surgical procedure of open lumbar plasty was performed again with mesh placement by lumbotomy approach in 2016. After a year of the surgical procedure, a pelvic abdominal control CT scan was requested, where a proper prosthesis placement was observed without protruding tissues. This was the first case of recurrent post-traumatic Pettit hernia in this institution. There are few cases reported in the universal literature, the treatment was surgical when performing the diagnosis, either laparoscopically or openly with decision and according to the experience of the surgeon.

Management of Complex Abdominal Wall Defects Using Acellular Porcine Dermal Collagen

2010 ◽  
Vol 76 (1) ◽  
pp. 96-100 ◽  
Author(s):  
Luis Felipe Chavarriaga ◽  
Edward Lin ◽  
Albert Losken ◽  
Michael W. Cook ◽  
Louis O. Jeansonne ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Primary Repair ◽  
Abdominal Wall Reconstruction ◽  
Long Term Results ◽  
Wound Complications ◽  
Abdominal Wall Defects ◽  
Mesh Placement ◽  
Postoperative Wound ◽  
Porcine Dermal Collagen ◽  
Dermal Collagen

Multiple techniques have been used for the repair of complex abdominal wall defects after recurrent incisional hernias with varying rates of success. Primary repair has been associated with high recurrence rates, and prosthetic mesh placement is contraindicated in contaminated surgical fields. The development of biologic prostheses has changed the approach to these difficult problems. This study evaluates the management of complex abdominal wall defects using acellular porcine dermal collagen. Between August 2006 and May 2007, 18 patients underwent abdominal wall reconstruction for complex defects with acellular porcine dermal collagen (CollaMend™; Bard Inc., Warwick, RI). Patient demographics, preoperative risk factors, previous herniorrhaphy attempts, postoperative complications, recurrences, and long-term results were retrospectively reviewed. Records were reviewed at a mean follow up of 7.3 months; the recurrence rate was 44.4 per cent. A total of 38.9 per cent (seven of 18) developed a postoperative wound complications, including infection in 22.2 per cent (four of 18). All of the patients with infection required prosthesis removal as a result of encapsulation rather than incorporation of the biologic prosthesis. Acellular porcine dermal collagen has the potential for reconstruction of abdominal wall defects with postoperative wound occurrences comparable with other biologic materials. Encapsulation of the material was a major problem in cases with wound infection that required graft removal rather than local wound measures. Hernia recurrence and dehiscence of the graft were problems in noncompromised surgical fields.

Safety and efficacy of absorbable and non-absorbable fixation systems for intraperitoneal mesh fixation: an experimental study in swine

Hernia ◽  
2021 ◽  
Author(s):  
S. Kapoulas ◽  
A. Papalois ◽  
G. Papadakis ◽  
G. Tsoulfas ◽  
E. Christoforidis ◽  
...  
Keyword(s):  
Experimental Study ◽  
Mesh Fixation ◽  
Safety And Efficacy ◽  
Intraperitoneal Mesh

scholarly journals EP.TU.933Late enterocutaneous fistula formation after evisceration repair using intraperitoneal mesh

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jose Rodicio ◽  
Sandra Sanz ◽  
Tamara Vico ◽  
Sonia Amoza ◽  
Maria Moreno ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Potential Risk ◽  
Postoperative Period ◽  
Glycosylated Hemoglobin ◽  
Abdominal Wall Reconstruction ◽  
Transversus Abdominis ◽  
Fascial Closure ◽  
Fistula Formation ◽  
Mesh Placement ◽  
Intraperitoneal Mesh

Abstract Introduction Intraperitoneal meshes pose a potential risk of complications, either due to the material itself or the method of fixation. Enteric fistulas are a rare but serious complication following the repair of an abdominal wall reconstruction using an intraperitoneal prosthesis. Case report We present a 59-year-old male patient, who underwent surgery 5 years previously for urothelial carcinoma with radical cystoprostatectomy and a Bricker-type urinary diversion, without subsequent radiotherapy. He presented an evisceration in the postoperative period treated with an inlay placement of an intraperitoneal mesh, without fascial closure. During these five years the wound did not present any complications, and spontaneous intestinal drainage began through the laparotomy. The physical exploration showed a 2cm hole in the abdominal infraumbilical midline, a wall defect of 20x20cm contained by mesh, no parastomal hernia, BMI 31.2 kg/m2. Thoraco-abdominal CT studies were completed that ruled out other pathologies, nasal culture and optimization were performed with parenteral nutrition and glycosylated hemoglobin control to achieve values below 6. The reconstruction of the abdominal wall was done with posterior component separation with transversus abdominis release, double mesh placement a BioA and PVDF mesh, with a final bridge measuring 8x5cm. The postoperative period was prolonged by an ileus, with an admission period of two weeks. Discussion Intraperitoneal meshes, some of which are no longer commercially available, represent a potential risk of complication. As long as we can optimize the patient for surgery, we will improve the results. Retromuscular repair with large mesh and PVDF material gives us good results.

scholarly journals A comparative study of laparoscopic trans abdominal pre peritoneal ventral hernia repair versus open pre peritoneal ventral hernia repair

2019 ◽  
Vol 7 (1) ◽  
pp. 274
Author(s):  
Pravin N. Shingade ◽  
Anshu Rawat ◽  
Rizhin Sooraj
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Ventral Hernia ◽  
Umbilical Hernia ◽  
Ventral Hernia Repair ◽  
Open Repair ◽  
Hernia Surgery ◽  
Mesh Placement ◽  
Medical College ◽  
A Prospective Study

Background: Ventral hernias are defined as a protrusion of abdominal contents through the abdominal wall muscle. It can be categorised as spontaneous or acquired or by their location on the abdominal wall like epigastric hernia, umbilical hernia, para umbilical hernia etc. This original article reveals that laparoscopic trans abdominal pre peritoneal (TAPP) mesh placement for ventral hernia usually follows the current principle of hernia surgery and give better results from open pre peritoneal ventral hernia repair.Methods: A prospective study conducted in Dr. D. Y. Patil Medical College and Hospital, Pune for the period of 2017-2019 comparing laparoscopic TAPP vs. open preperitoneal ventral hernia repair. Total of 25 patients for laparoscopic TAPP repair and 25 patients for open preperitoneal repair were compared.Results: Total 50 cases were studies in which 25 for laparoscopic and 25 for open repair. Majority of patients were female than males. Incidence of para umbilical (56%) was found to be more. Intra operative, post-operative complications were found to be more in open repair than laparoscopic TAPP repair.Conclusions: Laparoscopic TAPP ventral hernia repair is safe with fewer complications. Therefore, offers successful treatment for ventral hernia repair with added benefits of laparoscopy such as better visualization and magnification of the hernia defects which are not clinically apparent and less chances of injury which is not possible by open technique. Laparoscopic TAPP ventral hernia repair gives equal results in terms of recurrence and less complications than open ventral hernia repair.

scholarly journals Prolene Hernia System, Ultrapro Hernia System and 3D patch devices in the treatment of inguinal, femoral, umbilical and small incisional hernias in outpatient surgery

2010 ◽  
Vol 57 (2) ◽  
pp. 49-54 ◽  
Author(s):  
D. Dabic ◽  
S. Cerovic ◽  
B. Azanjac ◽  
B. Maric ◽  
I. Kostic
Keyword(s):  
Abdominal Wall ◽  
Outpatient Surgery ◽  
Operating Time ◽  
Young Patients ◽  
Normal Activity ◽  
Abdominal Wall Defects ◽  
Hernia Surgery ◽  
Incisional Hernias ◽  
Prolene Hernia System ◽  
The Mean

Introduction: The employment of a diversity of prosthetic materials and several types of mesh different in construction is opening a new chapter in hernia surgery and tension-free techniques are becoming a 'golden standard' for repairing abdominal wall defects, whereas the conventional methods, i.e. the tension techniques are performed on young patients having small direct, indirect, or femoral hernias. Aim: The aim of this retrospective study is to present the results of using Prolene Hernia System (PHS), Ultrapro Hernia System (UHS) and 3D Patch (3DP) devices in the treatment of inguinal, femoral, umbilical and small incisional hernias in outpatient surgery. Material and methods: From January 2006 to January 2009, 70 patients were operated on for abdominal wall hernias (54 inguinal, 4 femoral, 8 umbilical and 4 small incisional hernias) using PHS, UHS and 3DP devices. All the patients underwent surgery under local infiltrative anaesthesia. All the surgical operations were performed by a single surgeon, 19 of them in the General Hospital and 51 in a private polyclinic. Results: The mean size of the hernia defect in the inguinal, femoral and umbilical hernias was 2.5cm (1- 4cm), while in the incisional hernias it was 4.5cm (3- 6cm). The mean operating time was 2.4hrs (2-6hrs). There were no requirement for urinary drains. The mean follow-up was 18 months (0-36 months). The incidence of infection, chronic pain and recurrence was 0%. Three of the patients had complications: seroma in one patient with an incisional hernia and hematoma in two patients after inguinal hernia repair. Conclusion: The employment of PHS, UHS and 3DP devices, which have not yet been widely accepted in our hospitals, has had outstanding results in outpatient surgery. In addition, the type of anaesthesia and the 3D mesh construction prepare the way for a short hospital stay, smooth recovery and a swift return to normal activity.

Is Muscular Atrophy a Contraindication in Laparoscopic Abdominal Wall Defect Repair? A Prospective Study

2012 ◽  
Vol 78 (2) ◽  
pp. 178-184 ◽  
Author(s):  
Alfredo Moreno-Egea ◽  
Maite Sanchez-Elduayen ◽  
Elena Parlorio De Andres ◽  
Andres Carrillo-Alcaraz
Keyword(s):  
Abdominal Wall ◽  
Muscular Atrophy ◽  
Abdominal Wall Defect ◽  
Laparoscopic Approach ◽  
Abdominal Muscle ◽  
Abdominal Wall Defects ◽  
Hernia Surgery ◽  
Prosthetic Reconstruction ◽  
Abdominal Perimeter ◽  
A Prospective Study

Laparoscopic surgery for abdominal wall hernias improves short-term results as compared with open hernia surgery. However, no evidence exists to recommend this approach for pseudohernias, which are abdominal wall defects postsurgery caused by denervation and muscular atrophy. The purpose of this study is to analyze whether the laparoscopic approach benefits patients with a pseudohernia. A prospective nonrandomized, single-center clinical study was conducted of 24 patients operated on for pseudohernia. This study was designed with the basic principle of one unit, one surgeon, one mesh, and two techniques (laparoscopic or open double prosthetic repair). The primary end point was assessment of the abdominal wall according to: 1) abdominal perimeter; 2) computed tomography scan; and 3) degree of satisfaction. The secondary end points were intraoperative parameters and comorbidity. Laparoscopy offered no benefits in patients with pseudohernias. Open surgery offered no significant differences in intra- and postoperative morbidity, but if the initial weakness improved with a decrease in abdominal perimeter and visceral content, then there was more than 90 per cent satisfaction ( P < 0.05). The laparoscopic approach does not improve the bulge caused by abdominal muscle atrophy. The option of a muscular and prosthetic reconstruction provides better clinical and cosmetic results.

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