Management of Giant Ventral Hernia by Polypropylene Mesh and Host Tissue Barrier: Trial of Simplification

Management of contaminated large ventral hernias is still a challenge as a result of massive loss of muscular and fascial tissues in the abdominal wall, traditional contraindication to use of a prosthesis, and complicated perioperative management. This study aimed to provide a solution for this challenging dilemma using monofilament polypropylene mesh (Marlex; Bard) in the Sublay-Bridge fashion. Twenty-three consecutive patients with contaminated large ventral hernias from 2009 to 2011 were identified. Preoperatively, source of contamination at the surgical site was managed through oral antibiotics, wound débridement, and dressing change; the hernia content was reduced into the abdominal cavity gradually and an abdominal binder was applied. Marlex meshes in the Sublay-Bridge fashion were used in these patients. Demographic and perioperative data were collected. Fourteen males and nine females were included with a mean age of 52.5 ± 10.5 years and a mean body mass index of 25.2 ± 6.1 kg/m2. Twelve patients underwent ostomy takedown, which was the most common indication. Mean hernia size was 120.5 ± 18.5 cm2 and a mean mesh size was 380.0 ± 80.5 cm2. The mean operative time was 125.5 ± 35.5 minutes and the hospital stay was 10.0 ± 3.5 days. Twenty-three patients had a mean follow-up period of 12.5 ± 6.5 months. An iatrogenic bladder injury occurred because of severe prevesical adhesion attributed to previous prosthesis repair. There was no presentation of abdominal compartment syndrome. Four patients developed surgical site infection and managed with conservative therapy without mesh removal. Three patients had seromas and underwent aspiration guided by B-ultrasound. Three patients reported chronic foreign body sensation. No recurrence was followed up. Repair of contaminated large ventral hernia using a Marlex mesh in the Sublay-Bridge fashion is safe and efficient management. Perioperative management and operative technology play important roles in dealing with this problem.

Download Full-text

Prevention of adhesion formation with use of sodium hyaluronate–based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh—A randomized, controlled study

Surgery ◽

10.1016/s0039-6060(99)70267-9 ◽

1999 ◽

Vol 125 (2) ◽

pp. 211-216 ◽

Cited By ~ 85

Author(s):

Glen D. Hooker ◽

Brian M. Taylor ◽

David K. Driman

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Rat Model ◽

Polypropylene Mesh ◽

Ventral Hernia Repair ◽

Adhesion Formation ◽

Sodium Hyaluronate ◽

Controlled Study ◽

Bioresorbable Membrane ◽

Randomized Controlled

Download Full-text

Remodeling of Noncrosslinked Acellular Dermal Matrices in a Rabbit Model of Ventral Hernia Repair

European Surgical Research ◽

10.1159/000441721 ◽

2015 ◽

Vol 56 (1-2) ◽

pp. 32-48 ◽

Cited By ~ 1

Author(s):

Gemma Pascual ◽

Sandra Sotomayor ◽

Farah Adel ◽

Bárbara Pérez-Köhler ◽

Marta Rodríguez ◽

...

Keyword(s):

Tensile Strength ◽

Ventral Hernia ◽

Abdominal Wall Reconstruction ◽

Rabbit Model ◽

Host Tissue ◽

Tissue Response ◽

Significant Advance ◽

Macrophage Response ◽

Morphological Studies ◽

Porcine Dermal Collagen

Background: Bioprostheses represent a significant advance in the abdominal wall reconstruction since they become degraded until their complete elimination in the recipient organism. This study examines remodeling in the host of three noncrosslinked porcine dermal collagen biomeshes: Strattice™ (St; LifeCell Corp.), XCM Biologic® Tissue Matrix (XCM; Synthes CMF) and Protexa® (Pr; Deco Med S.R.L.). Methods: Partial ventral hernia defects created in New Zealand White rabbits were repaired using the biomeshes that were placed in an inlay, preperitoneal position. At 14 and 90 days after implantation, explants were assessed in terms of their host tissue incorporation by morphological studies, collagen gene/protein expression (quantitative real-time PCR/immunofluorescence), macrophage response (immunohistochemistry) and biomechanical strength. Results: There were no cases of mortality or infection. Among our macroscopic findings, the mesh detachment detected in one third of the Pr implants at 90 days was of note. The host tissue response to all the biomeshes was similar at both time points, with a tendency observed for their encapsulation. There were no appreciable signs of mesh degradation. The extent of host tissue infiltration and collagenization was greater for St and Pr than for XCM. Macrophages were observed in zones of inflammation and tissue infiltration inside the mesh. XCM showed a greater macrophage response at 90 days (p < 0.05). Improved tensile strength was observed for St (p < 0.05) over Pr and unrepaired defects. Conclusions:St showed the best behavior, featuring good collagenization and tensile strength while also inducing a minimal foreign body reaction.

Download Full-text