scholarly journals Synthetic mesh placement - modality of choice in spontaneous intercostal pleural herniation: a case report

2021 ◽  
Vol 9 (1) ◽  
pp. 242
Author(s):  
Shashwat Vyas ◽  
Amit Goyal
Keyword(s):  
Primary Repair ◽  
Synthetic Mesh ◽  
Weight Lifting ◽  
Intercostal Space ◽  
Mesh Placement ◽  
Synthetic Materials ◽  
Lung Hernia ◽  
Chest X Ray ◽  
Monofilament Mesh ◽  
Spontaneous Herniation

Hernia is defined as protrusion of a viscus or its part from the wall covering it and in some rare cases due to increased intercostal space there is spontaneous herniation of pleura and lung also known as extrathoracic lung hernia. A 48 year gentleman was admitted in our centre for chest wall swelling which has developed spontaneously 1 year back, painless, with cough impulse, further investigations like chest x-ray revealed nothing , subsequently CT thorax showed intercostal pleural hernia. He underwent surgery which diagnosed it as a case of intercostal pleural hernia having defect between 8th and 9th rib. Subsequently primary repair of defect was done with placement of monofilament mesh over it and then approximation of intercostal space was done with monofilament suture placed over 8th and 9th ribs. Post operatively patient had no complications and no recurrence of hernia. Spontaneous pleural herniation is a usually caused by coughing, heavy weight lifting, weakness of thoracic muscles by smoking, obesity etc. Ideal management is to treat the aetiology along with repair of the defect to prevent recurrence. In the present case the hernia developed after a bout of cough due to increased intercostal space between 8th and 9th ribs and also due to obesity leading to weak musculature. Intercostal pleural hernia repair can be achieved by primary repair of defect but it is advisable to use synthetic materials such as knitted monofilament polypropylene (Marlex) mesh to provide addition support to prevent recurrence.  

scholarly journals Recent advances in pelvic floor repair

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 778 ◽  
Author(s):  
Emma Mironska ◽  
Christopher Chapple ◽  
Sheila MacNeil
Keyword(s):  
Pelvic Floor ◽  
Primary Repair ◽  
Treatment Options ◽  
Pelvic Organ ◽  
Synthetic Mesh ◽  
Social Consequences ◽  
Pelvic Floor Repair ◽  
Recent Advances ◽  
Current Guidance ◽  
Pop Repair

Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are conditions which result in significant physical, mental and social consequences for women worldwide. The high rates of recurrence reported with primary repair for POP led to the use of synthetic mesh to augment repairs in both primary and secondary cases following failed previous POP repair. The widely reported, unacceptably high rates of complications associated with the use of synthetic, transvaginal mesh in pelvic floor repair have severely limited the treatment options that surgeons can offer. This article summarises the recent advances in pelvic floor repair, such as improved quantification and modelling of the biomechanics of the pelvic floor and the developing technology within the field of tissue engineering for treatment of SUI/POP, including biomaterials and cell-based therapies. Finally, we will discuss the issues surrounding the commercial introduction of synthetic mesh for use within the pelvic floor and what lessons can be learned for the future as well as the current guidance surrounding treatment for SUI/POP.

scholarly journals Primary Closure of a Subtotal Sternal Cleft in a 7-Day-Old Neonate

2021 ◽  
pp. 60-63
Author(s):  
R. Sekelyk ◽  
D. Kozhokar ◽  
I. Yusifli ◽  
R. Tammo ◽  
I. Yemets
Keyword(s):  
Primary Repair ◽  
Incomplete Fusion ◽  
Direct Closure ◽  
Wall Defect ◽  
Sternal Cleft ◽  
Cardiac Compression ◽  
Rare Congenital Abnormality ◽  
Chest X Ray ◽  
Male Neonate ◽  
Significant Distance

Sternal cleft is a rare congenital abnormality that results from incomplete fusion of the two lateral mesodermal sternal bars. It is generally accepted that primary repair in the neonatal period is the best treatment option. However, significant distance between the sternal bars can be challenging because of cardiac compression. The aim. We report a case of a 7-day-old neonate with a subtotal sternal cleft successfully managed by direct closure. Material and methods. A full-term male neonate weighing 3 kg was referred to our clinic for evaluation of a chest wall defect. The chest X-ray and computed tomography were performed to evaluate the malformation. Results. Surgery was performed at the age of 7 days. Postoperative period was uneventful. The patient was discharged on the postoperative day 21. The first postoperative checkup after 3 months showed satisfactory cosmetic results and normal respiratory movements. Conclusion. Despite the significant diastasis between sternal bars, primary direct closure of the sternal cleft can be safely performed in neonates.

scholarly journals Laparoscopic Sacrocolpopexy Mesh Removal for Persistent Lumbosacral and Right-sided Gluteal Pain Possibly Caused by Nerve “entrapment”

2021 ◽  
Author(s):  
Li Yan ◽  
Lu Bin Liu ◽  
Cheng Zhi Zhao
Keyword(s):  
Scar Tissue ◽  
Synthetic Mesh ◽  
Nerve Entrapment ◽  
Sexual Life ◽  
Laparoscopic Sacrocolpopexy ◽  
Tissue Formation ◽  
Cure Rate ◽  
Mesh Removal ◽  
Mesh Placement ◽  
Gluteal Pain

Abstract Background: Laparoscopic sacrocolpopexy (LSC), which is an important procedure for vault prolapse, has the advantages of high cure rate, low recurrence rate and little impact on sexual life. Few nerve entrapment complications have been reported in the literature.Case presentation: A 48-year-old woman developed persistent lumbosacral and right-sided gluteal pain after the LSC. During diagnostic laparoscopy, we found that the fixation site deviated by approximately 1.5 cm from the middle of the sacral promontory, the anterior surface of the first sacral vertebra. Hence we removed most of the mesh carefully. S1 nerve “entrapment” caused by this deviation, accompanied by the tissue fibrosis and scar tissue formation, may have been the main cause of pain. The patient’s symptoms resolved after surgical intervention. Conclusions: Our case emphasizes that sacral nerve entrapment is a potential complication of retroperitonealized synthetic mesh placement during sacrocolpopexy. We hope that this report can serve as a reference for dealing with similar situations. For skilled laparoscopists, laparoscopic mesh removal is safe and feasible, but attention should be paid to avoid damage to vessels, ureters and other important organs.

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.

A Large Single-Center ‘Experience of Open Lateral Abdominal Wall Hernia Repairs

2016 ◽  
Vol 82 (7) ◽  
pp. 608-612 ◽  
Author(s):  
Puraj P. Patel ◽  
Jeremy A. Warren ◽  
Roozbeh Mansour ◽  
William S. Cobb ◽  
Alfredo M. Carbonell
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Lateral Wall ◽  
Synthetic Mesh ◽  
Mesh Placement ◽  
Lateral Abdominal Wall ◽  
Single Center Experience ◽  
European Hernia Society ◽  
Open Mesh Repair ◽  
Mesh Reconstruction

Lateral abdominal wall hernias may occur after a variety of procedures, including anterior spine exposure, urologic procedures, ostomy closures, or after trauma. Anatomically, these hernias are challenging and require a complete understanding of abdominal wall, interparietal and retroperitoneal, anatomy for successful repair. Mesh placement requires extensive dissection of often unfamiliar planes, and its fixation is difficult. We report our experience with open mesh repair of lateral abdominal wall hernias. A retrospective review of a prospectively maintained database was performed to identify patients with a classification of lateral abdominal wall hernia who underwent an open repair. A total of 61 patients underwent open lateral hernia repairs. Mean patient age was 58 years (range 25–78), with a mean body mass index of 32 kg/m2 (range 19.0–59.1). According to the European Hernia Society classification, defects were located subcostal (L1, 14 patients), flank (L2, 33 patients), iliac (L3, 11 patients), and lumber (L4, 3 patients). Mean defect size was 78.6 cm2, with a mean greatest single dimension of 9.2 cm (range 2–25 cm). Retromuscular or interparietal repair was performed in 50.8 per cent, preperitoneal in 41.0 per cent, intraperitoneal in 6.6 per cent, and onlay in 1.6 per cent. The rate of surgical site occurrence was 49.2 per cent, primarily seroma and surgical site infection rate was 13.1 per cent. With a mean follow-up of 15.4 months, seven patients (11.5%) have documented recurrence. Synthetic mesh reconstruction of lateral wall hernias is challenging. Our experience demonstrates the safety and success of repair using synthetic mesh primarily in the retromuscular, interparietal, or preperitoneal planes.

scholarly journals LEFT SUBCLAVIAN ARTERY RUPTURE DUE TO BLUNT THORACIC TRAUMA: A CASE REPORT

2017 ◽  
Vol 17 (2) ◽  
pp. 103-111
Author(s):  
Yopie Afriandi Habibie ◽  
Ign Wuryantoro
Keyword(s):  
Subclavian Artery ◽  
Thoracic Trauma ◽  
Left Subclavian Artery ◽  
Primary Repair ◽  
Median Sternotomy ◽  
Traumatic Rupture ◽  
Blunt Thoracic Trauma ◽  
X Ray ◽  
Massive Hemothorax ◽  
Chest X Ray

Abstrak. Trauma tumpul toraks memiliki insiden yang sangat tinggi pada populasi dewasa, 20 – 50 % dari kasus dapat mengakibatkan kematian. Cedera pada struktur pembuluh darah dari bagian dada atas, terutama pembuluh darah arteri subklavia kiri, sangat jarang ditemukan dan biasanya disertai dengan “hematotoraks massif”. Observasi ketat dari tanda- tanda vital dan foto toraks serial sangatlah penting. Kami paparkan sebuah kasus jarang dari seorang pasien yang mengalami cedera traumatik arteri subklavia kiri. Tidak ditemukan gambaran klinis dari hematoma di supra klavikula, pulsasi arteri radialis kiri tidak teraba, dan tidak ditemukan pelebaran dari mediastinum pada foto toraks. Tetapi didapatkan hematotoraks massif kiri. Dilakukan posterolateral torakotomi kiri, dijumpai sumber perdarahan dari bagian apex paru kiri, dicurigai terdapatnya robekan dari pembuluh darah arteri subklavia kiri. Tindakan dilanjutkan dengan insisi median sternotomy yang diperluas ke arah supraklavikula kiri, ditemukan rupture total dari arteri subklavia kiri dengan jarak 1,5 cm proksimal dari arkus aorta. Tindakan repair (perbaikan) arteri secara primer (end to end anastomosis) dilakukan dengan hasil baik. (JKS 2017; 2: 105-114)Kata kunci : Trauma tumpul toraks, hematotoraks massif, cedera arteri subklavia kiriAbstract. Blunt thoracic trauma highest incidence is in adult, 20% to 50 % of the trauma cause death. Injuries to the vascular structures of the thoracic outlet, especially left subclavian artery, are rare and typically accompanied by massive  hemorrhage. Close observation of vital sign and serial chest x-ray are very important. We describe an unusual presentation of a patient who suffered traumatic rupture of left subclavian artery. No clinical presentation of supraclavicular hematoma, unilateral absence of radial artery pulse and mediastinal widening in chest x-ray was found, but there is a massive hemothorax. Left posterolateral thoracotomy was performed, the source of bleeding was found in the apex of the lung, suspected a rupture of the left subclavian artery. The procedure continued with median sternotomy extended to left supraclavicular incision, a rupture was found in the left subclavian artery, 1,5 cm proximal to aortic arch. Primary repair was done with a good result. (JKS 2017; 2: 105-114)Key Words : Blunt thoracic trauma, massive hemothorax, left subclavian artery rupture

scholarly journals LEFT SUBCLAVIAN ARTERY RUPTURE DUE TO BLUNT THORACIC TRAUMA: A CASE REPORT

2018 ◽  
Vol 18 (2) ◽  
pp. 93-100
Author(s):  
Yopie Afriandi Habibie ◽  
Ign Wuryantoro
Keyword(s):  
Subclavian Artery ◽  
Thoracic Trauma ◽  
Left Subclavian Artery ◽  
Primary Repair ◽  
Median Sternotomy ◽  
Traumatic Rupture ◽  
Blunt Thoracic Trauma ◽  
X Ray ◽  
Massive Hemothorax ◽  
Chest X Ray

Abstract. Blunt thoracic trauma highest incidence is in adult, 20% to 50 % of the trauma cause death. Injuries to the vascular structures of the thoracic outlet, especially left subclavian artery, are rare and typically accompanied by massive  hemorrhage. Close observation of vital sign and serial chest x-ray are very important. We describe an unusual presentation of a patient who suffered traumatic rupture ofleft subclavian artery. No clinical presentation of supraclavicular hematoma, unilateral absence of radial artery pulse and mediastinal widening in chest x-ray was found, but there is a massive hemothorax. Left posterolateral thoracotomy was performed, the source of bleeding was found in the apex of the lung, suspected a rupture of the left subclavian artery. The procedure continued with median sternotomy extended to left supraclavicular incision, a rupture was found in the left subclavian artery, 1,5 cm proximal to aortic arch. Primary repair was done with a good result. Key Words : Blunt thoracic trauma, massive hemothorax, left subclavian artery rupture

Minimizing Retained Foreign Body in Hernia Repair Using a Novel Technique: Reinforced Biologic Augmented Repair (ReBAR)

2021 ◽  
Author(s):  
Paul Szotek
Keyword(s):  
Foreign Body ◽  
Hernia Repair ◽  
Care Delivery ◽  
Primary Repair ◽  
Synthetic Mesh ◽  
Patient Centered ◽  
Novel Technique ◽  
Retained Foreign Body ◽  
Centered Care

With the digital age in healthcare upon us, patients are more aware, educated, and concerned about their surgical options for hernia repair. As a result of exposure to the growing litigious environment surrounding synthetic mesh products, patients are demanding hernia repairs with minimal or no foreign body. In response to these pressures, we have developed a novel technique known as the Reinforced Biologic Augmented Repair (ReBAR) which incorporates the data-proven principles of (1) tissue defect closure and (2) primary repair reinforcement, while minimizing the amount of foreign body material exposure long-term. A cohort of 619 (1.2% recurrence) patients representing a variety of hernia types and using multiple methods underwent repair using the ReBAR technique:259 Robotic Inguinal (1.2%), 47 Open Inguinal (4.3%), 59 Robotic Ventral/Incisional (1.7%), 32 Stapled Retrorectus (0%), 54 Open Abdominal Wall Reconstructions (1.8%), and 48 Open Onlay Ventral/Incisional (2.0%) hernia repairs. Increasing consumer demand for alternatives to traditional synthetic mesh repairs has driven the development of the ReBAR technique. Outcomes to this point are equivalent or better using the ReBAR technique as compared to classical methodology, however further study will be required to determine if long-term outcomes are superior to traditional techniques. The easily adaptable ReBAR technique satisfies the patient-centered care goals of today’s healthcare and may drive enhanced overall value of hernia care delivery.

Long-Term Effectiveness of Strattice in the Laparoscopic Closure of Paraesophageal Hernias

2017 ◽  
Vol 24 (3) ◽  
pp. 259-263 ◽  
Author(s):  
Daniel Lomelin ◽  
Alicia Smith ◽  
Nathan Bills ◽  
Amareshewar Chiruvella ◽  
Christopher Crawford ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Primary Repair ◽  
Acellular Dermal Matrix ◽  
Synthetic Mesh ◽  
Barium Swallow ◽  
Symptom Improvement ◽  
Recurrence Rates ◽  
Dermal Matrix ◽  
Porcine Acellular Dermal Matrix

Prosthetic reinforcement reduces the recurrence rate of large paraesophageal hernias (PEH), but the use of synthetic or biosynthetic mesh in the repair remains controversial. PEH repair has reported recurrence rates of 12% to 42%, and primary repair of PEH by suture closure under tension is at high risk of disruption. Synthetic mesh use in large PEH repair has shown to reduce recurrence but can lead to problems including mesh erosion, ulceration, stricture, and dysphagia. The objective of this study was to examine the long-term safety and efficacy of Strattice biologic mesh, a porcine acellular dermal matrix, in crural reinforcement of laparoscopic large PEH repair. Thirty-five patients with symptomatic PEH (>5 cm) were consented to receive Strattice for PEH repair. Patients were seen in clinic preoperatively, at surgery, and 2 weeks, 6 months, and 12 months postoperatively. Patients were given a standard subjective reflux test at each visit and a 12-month barium swallow X-ray to test for recurrence. Hernia recurrence was documented in 14.3% of cases by the end of the 1-year follow-up. Symptoms improved in 75% to 100% of patients by 6 months, and 33% to 100% of patients were still reporting symptom improvement at 12 months. Strattice mesh in PEH repair results in similar outcomes to other absorbable meshes, and the recurrence rate is within the 12% to 42% range of recurrences reported in studies outside of our institution. The use of Strattice mesh in large PEH repair had results similar to other biomaterial meshes and successfully decreased patients’ symptom scores through surgical intervention.

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