Comparative analysis of autodermal graft and polypropylene mesh use in large incisional hernia defects reconstruction

Background. Large defects of the abdominal wall caused by incisional hernia still represent a challenging problem in plastic, reconstructive, and abdominal surgery. For their successful tension-free repair a proper selection of reconstructive material is essential. In the last decades, the use of synthetic meshes was dominant while biological autodermal grafts were rarely used. The aim of the study was to comparatively analyse efficacy and safety of autodermal graft and polypropylene mesh in surgical treatment of large abdominal wall defects. Methods. This prospective comparative clinical study enroled 40 patients surgically treated for large incisional hernia repair in a 10-year period. The patients were divided into two equal groups consisting of 20 subjects and treated either by biological autodermal graft or by synthetic polypropylene mesh. The surgical techniques of reconstruction, duration of surgery, the occurrence of early, minor, and major (severe) and delyed complications and hospital stay were analyzed. The average follow-up took 2 years. Results. Statistically significant differences in demographic characteristics of patients and in size of defects were not found. The surgical technique of reconstruction with an autodermal graft was more complicated. The duration of surgery in patients treated with autodermal grafts was significantly longer. There was no statistically significant difference regarding occurrence of early, minor postoperative complications and hospital stay in our study. Two severe complications were registered in the synthetic mesh group: intestinal obstruction and enterocutaneous fistula. The recurrence rate was 10% in the autodermal graft group and 15% in the group with a synthetic mesh. Conclusion. Tension-free repair of large incisional hernia with autodermal grafts was unjustly neglected despite the fact that it is safe and effective. It can be applied in all cases where synthetic mesh are not indicated (presence of infection, immunodeficient patients, after radiotherapy). They are especially important in war surgery and in lack of funds when commercial grafts cannot be purchased.

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How safe is the use of prosthetic materials in the repair of abdominal-wall defects in malnourished subjects?

Open Medicine ◽

10.2478/s11536-009-0029-2 ◽

2009 ◽

Vol 4 (3) ◽

pp. 331-336 ◽

Cited By ~ 1

Author(s):

Mehmet Karahan ◽

Hakan Kulacoglu ◽

Duray Seker ◽

Zafer Ergul ◽

Aysel Kiziltay ◽

...

Keyword(s):

Wound Healing ◽

Abdominal Wall ◽

Polypropylene Mesh ◽

Histopathological Examination ◽

Abdominal Wall Defect ◽

Infectious Complications ◽

Abdominal Wall Defects ◽

Tissue Samples ◽

Significant Difference ◽

Histopathological Studies

AbstractIncisional hernias and abdominal-wall defects consume large amounts of healthcare resources. Use of mesh is effective in treatment of these disorders and can decrease the rate of recurrence. This experimental study focused on the safety of mesh use in the setting of malnutrition, a condition that impairs wound healing. Rats were divided into two groups: normally fed and food-restricted. An abdominal-wall defect, 2 by 2 cm, was covered with polypropylene mesh, 2.5 by 2.5 cm. After sacrifice of the rats at the 21st and 60th days, tissue samples were sent for tensiometric and histopathological studies. No significant difference in infectious complications was observed between the two groups. Tensiometry revealed no significant differences between the groups. On histopathological examination, the only difference noted was in the vascularization scores of normally fed rats. For malnourished subjects that survived after surgery, the use of polypropylene mesh appeared safe in the closure of abdominal-wall defects, with no increase in infection rate and satisfactory wound healing.

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Initial experience of double-layer tension free reconstruction of abdominal wall defects with porcine acellular dermal collagen implant and polypropylene mesh

International Journal of Surgery ◽

10.1016/j.ijsu.2011.07.279 ◽

2011 ◽

Vol 9 (7) ◽

pp. 552

Author(s):

Faisal M. Shaikh ◽

Eamon G. Kavanagh ◽

Pierce A. Grace

Keyword(s):

Abdominal Wall ◽

Double Layer ◽

Polypropylene Mesh ◽

Abdominal Wall Defects ◽

Initial Experience ◽

Tension Free ◽

Collagen Implant ◽

Dermal Collagen ◽

Acellular Dermal

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Initial experience of double-layer tension free reconstruction of abdominal wall defects with porcine acellular dermal collagen implant and polypropylene mesh

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-011-0776-3 ◽

2011 ◽

Vol 181 (2) ◽

pp. 205-209 ◽

Cited By ~ 8

Author(s):

F. M. Shaikh ◽

T. E. Kennedy ◽

E. G. Kavanagh ◽

P. A. Grace

Keyword(s):

Abdominal Wall ◽

Double Layer ◽

Polypropylene Mesh ◽

Abdominal Wall Defects ◽

Initial Experience ◽

Tension Free ◽

Collagen Implant ◽

Dermal Collagen ◽

Acellular Dermal

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A Comparative Study Between Laparoscopic Versus Open Incisional Hernia Repair

BIRDEM Medical Journal ◽

10.3329/birdem.v5i3.28535 ◽

2016 ◽

pp. 29-33

Author(s):

Md Noor A Alam ◽

Md Rajibul Haque Talukder ◽

Md Roushan Iqbal ◽

Raihan Anwar ◽

Humayun Kabir Chowdhury

Keyword(s):

Incisional Hernia ◽

Hospital Stay ◽

Laparoscopic Repair ◽

Open Repair ◽

Laparoscopic Group ◽

Incisional Hernia Repair ◽

Synthetic Mesh ◽

Open Procedure ◽

Significant Difference ◽

One Year

Aims: This study aims to compare between laparoscopic and open incisional hernia repair.Methods and Materials: The study was conducted in different tertiary hospitals of Dhaka between January 2011 to December 2012 and in 96 patients with incisional hernia. Among them, 68 patients underwent open repair and 28 underwent laparoscopic repair. Both procedures usually consisted of applying a synthetic mesh overlapping the defect. They were followed up for one year to observe the clinical outcome.Results: Mean operative time was shorter in laparoscopic group in comparison to open procedure and mean post operative hospital stay was less than 3 days in laparoscopic group and above 7 days in open group. In the laparoscopic group return to normal activities/work after surgery was less than 2 weeks but after open procedure it was more than 3 weeks. Analgesics requirement was also lower in the laparoscopic group. Post operative complications were observed in 33.82% (23) patients in open hernioplasty group and in 7.14% (2) patients in laparoscopic group which showed significant difference (p<0.05). There was no recurrence in the laparoscopic group during one year follow-up.Conclusion: Data suggest laparoscopic repair is superior to open repair because of less complications, relapses and short hospital stay but long term follow up is required.Birdem Med J 2015; 5(1) Supplement: 29-33

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Large Incisional Hernia Repair: Abdominal Wall Component Separation & Transversus Abdominis Release

Journal of Surgical Sciences ◽

10.3329/jss.v24i1.52215 ◽

2020 ◽

Vol 24 (1) ◽

pp. 32-37

Author(s):

AHM Shamsul Alam

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Abdominal Wall ◽

Incisional Hernia Repair ◽

Component Separation ◽

Transversus Abdominis ◽

Transversus Abdominis Release ◽

Large Incisional Hernia

Abstract not available Journal of Surgical Sciences (2020) Vol. 24 (1) : 32-37

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P011 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: A CASE-CONTROL SERIES

British Journal of Surgery ◽

10.1093/bjs/znab395.010 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Claudio Birolini ◽

Eduardo Tanaka ◽

Jocielle Miranda ◽

Abel Murakami ◽

Edivaldo Utiyama

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Tissue Response ◽

Abdominal Wall Defects ◽

Chronic Infections ◽

Control Series ◽

Elective Setting ◽

Abdominal Operations ◽

Low Incidence

Abstract Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods A prospective clinical trial started in 2016 and designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and a longer operative and anesthesia time. At 30-days, surgical site occurrences were observed in 18 (47.4%) AI vs. 17 (44.7%) CC; surgical site infection occurred in 4 (10.4%) AI vs. 6 (15.8%) CC, and a higher number of procedural interventions were required in the CC group, 15.8% AI vs. 28.9% CC. At 6-months follow-up, no chronic infections or hernia recurrences were observed in both groups. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

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Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.8.1.759.1 ◽

2021 ◽

Vol 8 (1) ◽

pp. 37-42

Author(s):

Hasan Ghandhari ◽

◽

Ebrahim Ameri ◽

Mohsen Motalebi ◽

Mohamad-Mahdi Azizi ◽

...

Keyword(s):

Retrospective Study ◽

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Obese Group ◽

Obese Patients ◽

Number Of Patients ◽

Significant Difference ◽

Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

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Evaluation of healing prosthetic materials polyester mesh resorbable film and collagen elastin matrix /polypropylene used in rabbits abdominal wall defects

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502009000600010 ◽

2009 ◽

Vol 24 (6) ◽

pp. 476-483 ◽

Cited By ~ 9

Author(s):

Danielle Duck Schulz ◽

Nicolau Gregori Czeczko ◽

Osvado Malafaia ◽

Gustavo Justo Schulz ◽

Leticia Elizabeth A. Czeczko ◽

...

Keyword(s):

Abdominal Wall ◽

Adhesion Formation ◽

Collagen Type I ◽

Abdominal Wall Defects ◽

Type I ◽

Polyester Mesh ◽

Collagen Formation ◽

Collagen Iii ◽

Microscopic Evaluation ◽

Significant Difference

PURPOSE: To compare polyester with absorbable layer prosthesis with collagen-elastin/polypropylene prosthesis in the repair of abdominal wall defects. METHODS: The 16 studied rabbits were divided in groups A and B (euthanized on the 30th and 60th days, after the implant of the mesh). The animals underwent laparotomy and received a 2cm wall "defect" on each side of the Alba linea. The repair was made with the suture of a polyester mesh with absorbable film on the left side of the Alba Linea and with collagen-elastin/polypropylene mesh on the right side. Adherences were classified according to Nair Score and microscopic evaluation observing types I and III collagen formation and other immunohistochemical analyses. RESULTS: There were no significant differences in adhesion formation. The collagen type I showed higher deposition in polyester with absorbable layer. In group B, the difference between the meshes was significant, with higher collagen III deposition in polyester with absorbable layer (60º P.O.). About the metalloproteinases, the presence of MMP -1 and MMP-8 were about the same; the expression of MMP-13 increased near to the 60th day. CONCLUSIONS: There is no significant difference between the two meshes in adhesion formation and immunohystochemical evaluation. The polyester mesh resorbable film presented a higher deposition of collagen.

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Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model

Hernia ◽

10.1007/s10029-020-02140-7 ◽

2020 ◽

Vol 24 (6) ◽

pp. 1317-1324

Author(s):

Y. Yurtkap ◽

F. P. J. den Hartog ◽

W. van Weteringen ◽

J. Jeekel ◽

G. J. Kleinrensink ◽

...

Keyword(s):

Incisional Hernia ◽

Abdominal Wall ◽

Suture Material ◽

Abdominal Pressure ◽

Postoperative Phase ◽

Burst Abdomen ◽

Linea Alba ◽

Custom Made ◽

Suture Tension ◽

Significant Difference

Abstract Purpose After closure of laparotomies, sutures may pull through tissue due to too high intra-abdominal pressure or suture tension, resulting in burst abdomen and incisional hernia. The objective of this study was to measure the suture tension in small and large bites with a new suture material. Methods Closure of the linea alba was performed with small bites (i.e., 5 mm between two consecutive stitches and 5 mm distance from the incision) and large bites (i.e., 10 mm × 10 mm) with Duramesh™ size 0 (2 mm) and PDS II 2-0 in 24 experiments on six porcine abdominal walls. The abdominal wall was fixated on an artificial computer-controlled insufflatable abdomen, known as the ‘AbdoMan’. A custom-made suture tension sensor was placed in the middle of the incision. Results The suture tension was significantly lower with the small bites technique and Duramesh™ when compared with large bites (small bites 0.12 N (IQR 0.07–0.19) vs. large bites 0.57 N (IQR 0.23–0.92), p < 0.025). This significant difference was also found in favour of the small bites with PDS II 2-0 (p < 0.038). No macroscopic tissue failure was seen during or after the experiments. Conclusion Closure of the abdominal wall with the small bites technique and Duramesh™ was more efficient in dividing suture tension across the incision when compared to large bites. However, suture tension compared to a conventional suture material was not significantly different, contradicting an advantage of the new suture material in the prevention of burst abdomen and incisional hernia during the acute, postoperative phase.

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