不同材质补片固定大鼠膈肌后的炎症反应、粘连及补片皱缩情况对比研究

背景与目的：食管裂孔疝是外科常见病症,临床上多采用补片以无张力修补的方式进行治疗。食管裂孔疝的补片修补中补片的选择及其应用效果方面的实验数据仍相对缺乏。因此,本研究通过在大鼠食道裂孔处膈肌组织上分别固定聚丙烯补片和复合补片,比较两种材质补片对周围组织的影响,以及自身皱缩情况,为临床食管裂孔疝补片的选择提供参考。方法：雄性SD大鼠在分离胃部与肝脏相连接组织显露胃食道裂孔后,分别用单丝缝线将轻量聚丙烯补片（聚丙烯补片组）或复合补片（复合补片组）固定于食道裂孔处膈肌组织,或不进行补片固定（假手术组）。分别在术后7、15、30 d时记录每组每只大鼠的体质量和饮食量。观察30 d后处死大鼠,分析补片皱缩程度、粘连强度以及膈肌组织的病理学变化。结果：各组大鼠手术前后的体质量及每天进食量均无明显的变化（均P>0.05）。复合补片组膈肌组织与补片的粘连范围及粘连程度分值均明显低于聚丙烯补片组（均P<0.05）;两组补片均出现皱缩,但复合补片组术后补片面积明显大于聚丙烯补片组,皱缩率明显低于聚丙烯补片组（均P<0.05）;与假手术组比较,聚丙烯补片组和复合补片组膈肌组织出现局部肌纤维萎...     

Shrinkage evaluation of heavyweight and lightweight polypropylene meshes in inguinal hernia repair: a randomized controlled trial

Background  

One of the current complications in inguinal repair is shrinkage following the use of mesh. The selected mesh material, heavyweight (HWM) mesh or lightweight (LWM) mesh, is associated with the frequency of shrinkage. The aim of this study was to investigate shrinkage of these two types of mesh in a controlled trial of male inguinal hernia repair.     

Biomechanical properties of lightweight versus heavyweight meshes for laparoscopic inguinal hernia repair and their impact on recurrence rates

Background  Laparoscopic inguinal hernia repair can be performed using light- or heavyweight meshes. Apart from the size of the mesh, its friction coefficient (μ₀) and flexural stiffness are of crucial importance to avoidance of hernia recurrence. Methods  In the current biomechanical study, tensile tests were performed to determine the ultimate tensile strength and modulus of elasticity of six lightweight meshes and six heavyweight meshes for laparoscopic inguinal hernia repair. To determine their friction coefficient (μ₀), the meshes were placed between a resected peritoneum and groin muscles during an autopsy. Meshes measuring 15 × 10 cm in size then were used in a hernia model with an opening size of 1.5, 3, or 5 cm. Results  The ultimate tensile strength and modulus of elasticity were significantly lower in the lightweight mesh group than in the heavyweight mesh group. The mean friction coefficient (μ₀) of the meshes was 0.4. Given an opening of 1.5 cm, all meshes remained adequately stable. At opening sizes of 3 and 5 cm, the lightweight meshes flexed on the average by 3.16 ± 0.4 mm and 10.40 ± 2.5 mm, respectively. Heavyweight meshes, on the other hand, were significantly less flexible. Their mean flexure was, respectively, 0.34 ± 0.2 mm and 3.97 ± 0.7 mm (p < 0.001). Conclusion  Stable meshes are characterized by a small degree of flexure and do not slide into the gap even when subjected to repetitive loads. Therefore, in terms of hernia recurrence, meshes with greater flexural stiffness or well-fixed lightweight meshes that adequately overlap the hernia defect can be used for laparoscopic treatment of large inguinal hernias.     

Experimental study of inflammatory response and collagen morphometry with different types of meshes

Purpose

To compare an inflammation score and collagen morphometry after incisional hernia repair with four different meshes at two time points.

Methods

Four types of mesh were used to repair an abdominal wall incisional defect in Wistar rats: high-density polypropylene (HW/PP); low-density polypropylene (LW/PP); polypropylene mesh encapsulated with polydioxanone coated with oxidized cellulose (PP/CE); and expanded polytetrafluoroethylene (ePTFE). An inflammation score based on histological analysis and collagen morphometry was performed after 7 and 28 days after operation (POD).

Results

Compared to LW/PP group at 7 POD, HW/PP group had lower (p = 0.014) and PP/CE group had higher inflammation scores (p = 0.001). At 28 POD, higher scores were seen in all the other groups compared to the LW/PP group (HW/PP, p = 0.046; PP/CE, p < 0.001; ePTFE, p = 0.027). Comparing groups individually at 7 and 28 PODs, all demonstrated lower inflammation score values at 28 POD (HW/PP, p < 0.001; LW/PP, p < 0.001; PP/CE, p = 0.002; ePTFE, p = 0.001). At 7 POD, higher amounts of collagen were detected in ePTFE compared to HW/PP (p < 0.001) and LW/PP (p = 0.004) and in PPCE group compared to HW/PP (p = 0.022). At 28 POD, no statistically significant difference was found. Comparing groups individually at 7 and 28 PODs, HW/PP and LW/PP showed larger amounts of collagen at the 28th POD, without any statistically significant differences for the PP/CE and ePTFE groups.

Conclusions

Inflammation scores decreased in all groups at 28 POD. Collagen deposition was higher for non-composite meshes at 28 POD.

     

The comparison of heavyweight mesh and lightweight mesh in an incisional animal model

Purpose  

An incisional hernia may occur through the incision area following a surgical operation, through the trocar opening and even through drainage exit points. Various synthetic surgical meshes have recently been used for the surgical repair of incisional hernias. In this study, we analysed the burst strength forces of heavyweight mesh and lightweight mesh in an incisional animal model.     

轻型补片与传统补片在腹股沟疝修补术中有效性和安全性的荟萃分析

目的系统评价轻量型补片与传统补片在腹股沟疝修补术中的有效性和安全性。 方法计算机检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库、中国科技期刊全文数据库、中国期刊全文数据库。全面收集比较轻量型补片与传统补片在腹股沟疝修有效性和安全性的随机对照试验（randomized controlled trials,RCTs）,2名评价者独立评价纳入文献的方法学质量,用RevMan 5.3软件进行统计分析。 结果共纳入19篇RCTs,Meta分析结果显示,轻量型补片组与传统传统补片组患者在复发率方面比较,差异无统计学意义[RR=0.82,95% CI（0.56～1.19）,P=0.30];在慢性疼痛[RR=0.68,95% CI（0.57～0.81）,P<0.000 1]、异物感[RR=0.67,95% CI（0.56～0.81）,P<0.000 1]及其并发症[RR=0.63,95% CI（0.51～0.77）,P<0.000 1]方面比较,差异均有统计学意义。 结论轻量型补片与传统传统补片在无张力疝修补术中的复发率方面相似,而轻量型补片减轻慢性疼痛、异物感及并发症发生方面优于传统补片。     

Characterization of heavyweight and lightweight polypropylene prosthetic mesh explants from a single patient

Although polypropylene has been used as a hernia repair material for nearly 50 years, very little science has been applied to studying the body's effect on this material. It is possible that oxidation of mesh occurs as a result of the chemical structure of polypropylene and the physiological conditions to which it is subjected; this leads to embrittlement of the material, impaired abdominal movement, and chronic pain. It is also possible that lightweight polypropylene meshes undergo less oxidation due to a reduced inflammatory reaction. The objective of this study was to characterize explanted hernia meshes using techniques such as scanning electron microscopy, differential scanning calorimetry, thermogravimetric analysis, and compliance testing to determine whether the mesh density of polypropylene affects the oxidative degradation of the material. The hypothesis was that heavyweight polypropylene would incite a more intense inflammatory response than lightweight polypropylene and thus undergo greater oxidative degradation. Overall, the results support this theory.     

重量型补片与轻量型补片应用于腹股沟疝修补术的Meta分析

目的评价重量型补片与轻量型补片应用于腹股沟疝无张力修补对患者恢复的影响。方法检索PubMed、EMBase、Springer及Cochrane图书馆,结合查找到文献中的参考文献,检索时间从2000年1月至2010年9月,选择有关重量型补片与轻量型补片应用于腹股沟疝修补术的临床对照研究,由两位作者分别对研究质量进行评估,并提取有关资料,主要包括术后复发、血肿与血清肿、异物感,感染及疼痛的情况,采用RevMan5.0软件进行Meta分析。结果共纳入21项临床对照研究,其中16项为前赡性随机对照临床研究,包括5389例,其中重量型补片组2861例,轻量型补片组2528例。对纳入研究进行整体分析显示,轻量型补片组术后异物感发生率明显少于重量型补片组（p〈0.05）,优势比（Odds ratio）及95%可信区间为1.90（1.48,2.43）,轻量型补片组术后慢性疼痛（12个月或更长）的发生率明显少于重量型补片组（p〈0.05）,OR及95%可信区间为1.39（1.10,1.75）;两组患者在术后的复发、血肿（血清肿）、感染及早期疼痛的发生率无显著差异（p〉0.05）。结论使用轻量型补片进行腹股沟疝无张力修补术,能减少术后的异物感及慢性疼痛,对术后的复发、血肿（血清肿）、感染及早期疼痛无明显影响。     

Three-year results of randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty

Purpose

The aim of the present randomised study was to find out whether usage of lightweight mesh in inguinal hernia repair, compared with heavyweight mesh, results in decreased incidence of chronic groin pain and foreign body feeling, as well as to evaluate the risk factors for chronic pain development and hernia recurrences.

Methods

The patients were randomised into the heavyweight mesh (HW) group and lightweight mesh (LW) group. A tension-free mesh repair using the Lichtenstein technique was performed on all patients. Pain scores during different activities were measured on visual analogue scale. All patients underwent a clinical examination for any evidence of hernia recurrence.

Results

Of the patients, 17.2?% in the HW group and 29.3?% in the LW group reported that they experienced pain at 3-year follow-up (P?=?0.1323). Pain was most often reported during physical activity. The median VAS score of all studied activities was 30.5 in the HW group and 30.0 in the LW group. There were more patients in the HW group than in the LW group who stated that they could feel the mesh in the groin (27.6 vs. 20.7?%, P?=?0.3967). Among all patients, 42.9?% who had severe pain preoperatively also reported pain during different activities and 19.6?% of the patients who did not have severe pain preoperatively reported pain during different activities (P?=?0.0481). At 3-year follow-up, there was 1 hernia recurrence in the HW group and 1 hernia recurrence in the LW group.

Conclusions

Our study shows that compared with HW mesh, LW mesh has no advantage in reducing chronic groin pain and foreign body feeling at the operation site after inguinal hernioplasty at 3-year follow-up. Severe preoperative pain was correlated with the development of chronic pain. There was no difference between the two study groups in the recurrence rates.     

Prospective, randomized, controlled trial comparing lightweight versus heavyweight mesh in chronic pain incidence after TEP repair of bilateral inguinal hernia

Background  

This prospective, clinical, randomized, controlled study was performed to define the incidence of chronic pain after total extraperitoneal (TEP) repair with a light-weighted mesh compared with heavyweight mesh in patients with bilateral inguinal hernias.     

Prospective randomized clinical trial comparing lightweight mesh and heavyweight polypropylene mesh in endoscopic totally extraperitoneal groin hernia repair

Background  

The purported advantage of lightweight large-pore meshes is improved biocompatibility that translates into lesser postoperative pain and earlier rehabilitation. However, there are concerns of increased hernia recurrence rate. We undertook a prospective randomized clinical trial to compare early and late outcome measures with the use of a lightweight (Ultrapro) mesh and heavyweight (Prolene) mesh in endoscopic totally extraperitoneal (TEP) groin hernia repair.     

Randomized clinical trial comparing lightweight or heavyweight mesh for mesh plug repair of primary inguinal hernia

Background

The aim of this study was to assess whether the application of a lightweight mesh for mesh plug repair (MPR) for primary inguinal hernia could reduce chronic pain or other symptoms associated with the insertion of the prosthesis.

Methods

Patients over 20 years of age with a unilateral primary inguinal hernia were eligible to participate in the study. The patients were randomly assigned to a lightweight mesh (LWM) or a heavyweight mesh (HWM) group. All the operations were performed under local anesthesia. The operative details, including the hernia type and the nerves that were identified, and the postoperative complications were recorded. All follow-up and outcome measures were obtained based on a physical examination and a questionnaire regarding pain and other symptoms at 1 week, 1, 3, 6, and 12 months after the surgery in a double-blinded manner.

Results

The use of LWM significantly reduced foreign body sensation after 12 months to one-third of the incidence reported for the use of HWM (5.8 vs. 17.9 %; P = 0.013), while no significant differences were found in pain parameters, including the use of pain relief medications, between the groups throughout the study period.

Conclusion

This study indicated that the use of LWM in the MPR decreases the incidence of foreign body sensation at 1 year after surgery for primary inguinal hernia. LWM may be preferable to MPR, similar to results described previously for Lichtenstein repair.     

Adhesion prevention in ventral hernia repair: an experimental study comparing three lightweight porous meshes recommended for intraperitoneal use

Hernia - In ventral hernia repair, when prosthetic material is placed intraperitoneally, it may lead to an inflammatory reaction resulting in adhesions between the mesh and abdominal viscera....     

Early and late postoperative inflammatory and collagen deposition responses in three different meshes: an experimental study in rats

Purpose

Although meshes reduce abdominal hernia recurrence, they increase the risk of inflammatory complications. This study aimed to compare the early and late postoperative inflammation and collagen deposition responses induced by three meshes.

Methods

Rats were allocated into three groups. In group I, a polypropylene (PP) mesh was implanted in the abdominal wall. In groups II and III, PP + polyglactin (PP + PG) and PP + titanium (PP + TI) meshes were employed, respectively. On the seventh (7th) postoperative day, collagen deposition and inflammation were evaluated, and immunohistochemistry was performed on abdominal wall biopsies. These data were compared with those obtained on the fortieth (40th) postoperative day in a previous study.

Results

The early inflammatory responses were the same in all groups. With time, it decreased in group I (p = 0.047) and increased in group II (p = 0.003). Group I exhibited early elevated VEGF (p < 0.001), COX2 (p < 0.001), and collagen (p = 0.023) levels, and group II exhibited the most severe inflammatory tissue response. On the 40th postoperative day, the VEGF (p < 0.001) and collagen (p < 0.005) were reduced as compared with the 7th postoperative day in all groups.

Conclusions

Belatedly, the inflammatory reaction decreased in PP mesh group and increased in PP + PG mesh group. The PP mesh induced early great elevations in VEGF, COX2 and collagen levels, whereas the PP + PG mesh caused severe tissue inflammation with small elevation in these levels. PP + TI mesh induced inflammatory response levels between the others. In conclusion, the inflammatory response depends on the mesh density and also the mesh material with clinical implications.