mesh implantation
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2021 ◽  
Vol 22 (24) ◽  
pp. 13385
Author(s):  
Federica Marinaro ◽  
Joana M. Silva ◽  
Alexandre A. Barros ◽  
Ivo M. Aroso ◽  
Juan C. Gómez-Blanco ◽  
...  

Polypropylene (PP) mesh is well-known as a gold standard of all prosthetic materials of choice for the reinforcement of soft tissues in case of hernia, organ prolapse, and urinary incontinence. The adverse effects that follow surgical mesh implantation remain an unmet medical challenge. Herein, it is outlined a new approach to allow viability and adhesion of human menstrual blood-derived mesenchymal stromal cells (MenSCs) on PP surgical meshes. A multilayered fibrin coating, based on fibrinogen and thrombin from a commercial fibrin sealant, was optimized to guarantee a homogeneous and stratified film on PP mesh. MenSCs were seeded on the optimized fibrin-coated meshes and their adhesion, viability, phenotype, gene expression, and immunomodulatory capacity were fully evaluated. This coating guaranteed MenSC viability, adhesion and did not trigger any change in their stemness and inflammatory profile. Additionally, MenSCs seeded on fibrin-coated meshes significantly decreased CD4+ and CD8+ T cell proliferation, compared to in vitro stimulated lymphocytes (p < 0.0001). Hence, the proposed fibrin coating for PP surgical meshes may allow the local administration of stromal cells and the reduction of the exacerbated inflammatory response following mesh implantation surgery. Reproducible and easy to adapt to other cell types, this method undoubtedly requires a multidisciplinary and translational approach to be improved for future clinical uses.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Jurij Gorjanc ◽  
Raphael Edlinger ◽  
Magdalena Rosenkranz ◽  
Jörg Tschmelitsch

Abstract Aim The purpose of this study was to evaluate the rate of incisional hernias at the ostomy site after reversal of the ostomy. Material and Methods We used retrospectively compiled database of patients who had undergone ostomy formation and ist reversal. All patients had their surgery performed between Jan. 2011 and December 2019. Patients history, added by clinical examination and CT-scan were performed in order to identify the incidence of incisional hernias. Different variables, like gender, surgical site infection (SSI) and BMI were evaluated as possible risk factors for hernia occurrence. Results Among totally included 224 patients in the study, 190 of all patients had reversal after loop-ileostomy (85%) and 34 patients had reversal after loop-colostomy (15%). Among all stoma reversal patients, 12,8 % developed incisional hernia at the stoma reversal site (n = 28). The incisional hernia occurrence at the ostomy reversal site was present in 20,0% in patients with clinically relevant SSI and only in 9,4% in patients where SSI was absent (p = 0,03). There was no statistical significance in hernia occurrence between both genders and among patients with low, normal and high BMI in our cohort of patients. Conclusions Incisional hernia after ostomy reversal is a common late surgical complication. All measurements that reduce SSI at the reversal site are important for lower hernia incidence. Prophylactic mesh implantation at stoma reversal sites may be considered in these patients.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Björn Mück ◽  
Frank Heinzelamann ◽  
Robert Vogel ◽  
Peter Büchler

Abstract Aim Several meta-analyses indicated, that extraperitoneal mesh placement in the retromuscular or preperitoneal space shows advantages over intraperitoneal mesh placement. Previous surgical interventions which included extraperitoneal mesh placement were usually performed using open surgery. For several years now, our hospital has pursued to treat ventral hernias using a minimally invasive approach with extraperitoneal mesh placement. A Da Vinci X system has been available since the beginning of 2019. The aim of this analysis is to show the process of changing the operative procedure in ventral hernia repair over the period from 2016 to 2020. Material and Methods All hernia operations from 2016-2020 were evaluated using our hospitals information system. Every surgical intervention which included ventral hernia repair with the indication for mesh implantation was taken into the analysis. Results In 2016, the proportion of minimally invasive procedures was 36.67%. In all of these cases an intraperitoneal mesh was implanted in the abdominal cavity (laparoscopic IPOM operation). Open surgery was performed in 63.33%, out of which we implanted an intraperitoneal mesh in 23.68%, a retromuscular mesh in 73.68% and an onlay mesh in 2.63% of the cases. In 2020, the proportion of minimally invasive operations was already 87.5%, of which 83.33% were performed robotically assisted and 16.67% laparoscopically. In 94.29% of the minimally invasive operated patients an extraperitoneal mesh implantation was carried out, among which 75.76% were placed in the retromuscular and 24.24% in the preperitoneal position. Conclusions The majority of elective operations on ventral hernias can be performed in a minimally invasive technique with retromuscular mesh placement, using the robot.


Author(s):  
A. S. Lukianov ◽  
A. Yu. Titov ◽  
O. M. Biryukov ◽  
A. A. Mudrov ◽  
I. V. Kostarev

Aim. A methodological review on mesh implantation efficacy assessment in surgery for rectocele.Key points. Specialised quiz surveys are among the most appropriate methods to assess surgical intervention efficacy. The questionnaires that enable pre- and postsurgery rectocele grading include PFDI-20 (Pelvic Floor Distress Inventory), the colonic evacuation disorder scale and Cleveland Constipation Scoring System. These surveys determine the surgical intervention efficacy dynamically in conjunction with instrumental surgery assessment techniques.Conclusion. Clinical practice at the Ryzhikh National Medical Research Centre for Coloproctology combines the originally developed colonic evacuation disorder scale (2003) and PFDI-20. The combined scales allow for a comprehensive symptom assessment in patients with rectocele and other descending perineum syndrome manifestations prior to surgery, as well as symptom dynamics evaluation postoperatively, which, in link with defecography, enables a complete appraisal of the surgical effect.


Author(s):  
L. Jakobsson ◽  
A. Montgomery ◽  
J. Ingvar ◽  
A. Löfgren ◽  
F. Liedberg

Author(s):  
Mattia Dominoni ◽  
Barbara Gardella ◽  
Andrea Gritti ◽  
Arsenio Spinillo
Keyword(s):  

2020 ◽  
Vol 7 ◽  
Author(s):  
Sebastian Schaaf ◽  
Robert Schwab ◽  
Christoph Güsgen ◽  
Arnulf Willms

Introduction: Incisional hernia development after open abdomen therapy (OAT) remains a common complication in the long run. To demonstrate the feasibility, we describe our method of prophylactic onlay mesh implantation with definitive fascial closure after open abdomen therapy (PROMOAT). To display the feasibility of this concept, we evaluated the short-term outcome after absorbable and non-absorbable synthetic mesh implantation as prophylactic onlay.Material and Methods: Ten patients were prospectively enrolled, and prophylactic onlay mesh (long-term absorbable or non-absorbable) was implanted at the definitive fascial closure operation. The cohort was followed up with a special focus on incisional hernia development and complications.Results: OAT duration was 21.0 ± 12.6 days (95% CI: 16.9–25.1). Definitive fascial closure was achieved in all cases. No incisional hernias were present during a follow-up interval of 12.4 ± 10.8 months (range 1–30 months). Two seromas and one infected hematoma occurred. The outcome did not differ between mesh types.Conclusion: The prophylactic onlay mesh implantation of alloplastic, long-term absorbable, or non-absorbable meshes in OAT showed promising results and only a few complications that were of minor concern. Incisional hernias did not occur during follow-up. To validate the feasibility and safety of prophylactic onlay mesh implantation long-term data and large-scaled prospective trials are needed to give recommendations on prophylactic onlay mesh implantation after OAT.


2020 ◽  
pp. 039156032097489
Author(s):  
Ester Illiano ◽  
Vito Mancini ◽  
Francesco Trama ◽  
Larissa Maghlhàes Vasconcelos ◽  
Giuseppe Carrieri ◽  
...  

Introduction: Complications due to prosthetic surgery with mesh implantation may be misunderstood due to the insidious clinical presentation and inexperience of many surgeons if not adequately trained for the purpose. Case report: A 45-year-old female underwent a trans obturator tape procedure to correct severe stress urinary incontinence 3 months after surgery she developed urethral pain. The sling was partially removed, but the pain persisted. No residue sling was visualized by cystoscopies after surgery, and the pain was attributed to a psychiatric problem. She was treated with opioids, pregabalin without improvement of pain, until an extrusion of the sling into the urethra has been diagnosed by a careful urethrocystoscopy. Conclusion: It has been treated in our department by the removal of the residual sling, plus urethroplasty. The patient was followed up at 6 months with resolution of the painful symptoms.


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