Polypropylene meshes coated with a polysaccharide based bioadhesive for intra-abdominal mesh fixation in a rabbit model

Background

In this study, we evaluate a new bioadhesive for intra-abdominal onlay mesh fixation of a polypropylene–polyvinylchloride graft.

Methods

Three pieces of a commercially available polypropylene/polyvinylfluoride mesh, each 3 × 3 cm in size, and three pieces of the same mesh coated with a polysaccharide bioadhesive were fixated to the surface of the anterior abdominal wall of 30 New Zealand white rabbits. The fixation was performed either by using four transabdominal Prolene^® 4/0 sutures, four spiral tacks (Protack 5 mm Tyco), or cyanoacrylate glue (Glubran^® GEM, Viareggio, Italy). Each mesh position and the according kind of fixation were randomized before implantation. The animals were sacrificed 12 weeks postoperatively. After determining the extent of intra-abdominal adhesions, the meshes were excised en bloc with the anterior abdominal wall for tensile strength measurements and histological analysis.

Results

All meshes coated with the bioadhesive adhered to the intact peritoneum without extra fixation. Irrespective of the fixation technique coated meshes led to more and stronger adhesions. Mesh shrinkage by scarring was increased in coated meshes fixed with glue and low in uncoated meshes fixed with tacks. Testing the tensile strength, coated meshes fixed with transfascial sutures achieved the best results (16.14 ± 6.1 N), whereas coated meshes fixed with glue showed the lowest strength (10.39 ± 4.81 N). The foreign body reaction was considerably more distinctive using coated mesh. The mesh ingrowth was not influenced by this reaction.

Conclusions

All meshes coated with the new bioadhesive were self-adhesive in that way; they stayed in position when attached to the peritoneum. Although this may facilitate intra-operative mesh fixation, the bioadhesive displayed several disadvantages, such as stronger adhesions and an increased shrinkage of the implant. The tensile strength was not influenced by the use of the bioadhesive. At present, we see no major advantage for polysaccharide bioadhesive applied in this study.     

Effects of macroporous monofilament mesh on infection in a contaminated field

Background

The aim of this study was to evaluate whether the type of the mesh and proper surgical technique can influence the outcome of a tension-free hernia repair in a contaminated filed.

Materials and methods

This study was based on the model of bacterial peritonitis in rats induced with a mixture composed of Escherichia coli and Bacteroides fragilis. Two animals were used as a control group without induced peritonitis and 10 animals with mesh implanted inside of the peritoneal cavity. For the 20 animals in the studied group, bacterial fluid was applied into the abdominal cavity together with the mesh implantation. In 10 cases, the mesh was fixed flatly upon the surface of the peritoneum; in the other 10, the mesh was rolled and then fixed within the peritoneal cavity. After 5 weeks, the animals were operated on again, and the meshes, the peritoneal fluid and, if present, any granulomas were taken for bacterial cultivation.

Results

The results of the bacterial cultivation of the material from the control group (without mesh) and from the rats with flatly fixed mesh were almost completely negative (0/10 and 1/10, respectively). In 9 out of 10 rats that were exposed to the rolled mesh for 5 weeks, the colonisation of meshes with both B. fragilis and E. coli was found (p?Conclusions When properly fixed, flat mesh, even in a contaminated field, may allow for a proper mesh healing and does not influence the ability to cure bacterial peritonitis in an animal model. A bad surgical technique, such as inadequately positioned or rolled mesh, may cause persistent peritoneal bacteraemia.     

The effect of a chitosan coating on the adhesive potential and tensile strength of polypropylene meshes

Purpose

The polypropylene mesh used for the repair of abdominal wall hernia can cause intraabdominal adhesions. In this study, the effect of chitosan coating of the polypropylene meshes on the adhesion and tensile strength of the meshes was investigated.

Method

After coating polypropylene meshes with 2?% chitosan, 5?×?3 cm patches were prepared. Under general anesthesia, sterile laparotomy was performed in 96 Wistar albino female rats that were equally allocated to 6 groups. In the first group, only laparotomy was performed. In the second group, chitosan was applied to the peritoneal cavity, and the laparotomy was closed. In the third group, polypropylene (prolene) patches were used to close the abdomen; in the fourth group, polypropylene polyglecaprone 25 (ultrapro) mesh patches were used to close the abdomen. In the fifth and sixth groups, chitosan-coated versions of the meshes used in the third and fourth groups, respectively, were applied. All skin incisions were closed in all groups. On the 7th and 21st?days, eight randomly selected rats from each group were killed. The abdomen was opened, and the adhesions were evaluated using the diamond score. The tensile strength of the meshes was measured by an Instron 4301 device. The histopathological evaluation of the inflammatory response was performed according to the Ehrlich and Hunt classification.

Results

The adhesion score was comparable among mesh groups but higher when mesh groups were compared with the control and chitosan groups (p<0.001). The tensile strength of meshes did not differ among mesh groups. Histopathologically, meshes with or without chitosan were similar in terms of inflammatory findings.

Conclusions

The chitosan coating did not affect the adhesion potential, the tensile strength, or the inflammatory response of the polypropylene meshes.     

In Vivo Analysis of the Morphologic Characteristics of Synthetic Mesh to Resist MRSA Adherence

Background

Synthetic mesh has significantly reduced recurrence rates for ventral hernia repair; however, prosthetic mesh infections remain a significant complication. We hypothesized that unique mesh constructs might alter the ability of various synthetic meshes to clear bacterial contamination. To evaluate this, we studied commercially available synthetic meshes ability to clear a bacterial contamination with methicillin resistant Staphylococcus aureus infection.

Methods

Two hundred and eighty-three rats underwent hernia repair with one of nine synthetic materials. Control animals were closed, and the remainder was inoculated with either 10⁴ or 10⁶ methicillin-resistant S. aureus (MRSA). Animals were survived for 30?days without systemic antibiotics. At necropsy, the mesh was harvested and quantitative cultures and bacterial clearance assessed.

Results

All clean repairs remained sterile. Rates of bacterial clearance for 10⁴ repairs revealed that unprotected monofilament materials cleared significantly more bacteria than composite meshes and multifilament meshes (p?=?<0.01 and p?=?0.01, respectively). At higher levels of bacterial contamination (10⁶), all materials had a reduction in bacterial clearance, although monofilament materials had higher bacterial clearance compared to composite meshes (p?=?0.03).

Conclusions

Monofilament unprotected polypropylene and polyester mesh can clear a large percentage of MRSA contaminants. Multifilament, composite anti-adhesive barrier meshes, and laminar antimicrobial impregnated mesh are not able to clear bacterial contamination with MRSA. Unique properties of synthetic material should be considered when evaluating a prosthetic for high-risk incisional hernia repair.     

The use of sterilized mosquito nets for hernioplasty: a systematic review

Introduction

Hernia repair is among the most frequent surgeries performed. Surgeons prefer the tension-free mesh repair, but in large parts of the world, commercial meshes are unavailable or unaffordable. Consequently, surgeons have been experimenting with insertion of inexpensive non-commercial meshes, the most common being a non-impregnated, sterilized mosquito net.

Objective

To describe the results of inserting non-commercial meshes for hernioplastic surgery.

Methods

Systematic searches were performed in EMBASE, PubMed, and Cochrane databases, and articles were chosen based on predefined inclusion criteria.

Results

We found five original studies performed in humans, and one study was performed in goats using non-commercial meshes. A total of 577 non-commercial meshes have been inserted into humans, resulting in 35 patients (6.1?%) having short-term complications and one (0.17?%) recurrence. The majority of meshes inserted were mosquito nets. None of the short-term complications in any of the studies required reoperation.

Conclusions

There seems to be good short-term and long-term outcomes when using non-commercial meshes for open inguinal hernia repair. Operating using a non-commercial mesh is highly cost-effective. Using non-commercial meshes for hernioplastic surgery is therefore interesting??especially in a resource-limited setting.     

Differences in biomechanical stability using various fibrin glue compositions for mesh fixation in endoscopic inguinal hernia repair

Background

In hernia surgery, mesh fixation with fibrin glue instead of tacks and sutures can demonstrably reduce postoperative morbidity without increasing recurrence rates. In some cases there are significant differences in the biomechanical properties, depending on the functional structure of the meshes. Furthermore, there are various fibrin glue products on the market and these are used for mesh fixation. This study compared the fixation strength of fibrin glues in combination with various meshes.

Methods

Three different lightweight polypropylene meshes (TiMESH? light, ULTRAPRO?, Optilene^? LP) were tested. All meshes were fixed using 2?ml of each of the three different fibrin glues (TISSUCOL^?, QUIXIL^?, EVICEL^?) and tested for their biomechanical stability. The defect in the muscle tissue used was 45?mm for a mesh size of 10?×?15?cm. Measurements were conducted using a standardized stamp penetration test, while aiming not to use a fixation strength of less than 32?N.

Results

With TISSUCOL, the fixation of Optilene LP proved to be significantly better than that of TiMESH or ULTRAPRO (97.3 vs. 47.9 vs. 34.9?N, p?<?0.001). With EVICEL, it was possible to also achieve good tissue fixation for the ULTRAPRO mesh, while the results obtained for Optilene and TiMESH were relatively poorer [114.7 vs. 92.4?N (p?=?0.056), vs. 64.3?N (p?<?0.001)]. With QUIXIL, satisfactory results were obtained only for Optilene LP (43.6?N).

Conclusion

This study showed that there were significant differences in the fixation strength of different polypropylene meshes in combination with various fibrin glues. Experiments demonstrated that for each mesh there is an optimum combination with a particular fibrin glue with respect to the fixation strength. It must now be verified whether these results can be extrapolated to clinical practice.     

Gentamicin for prevention of intraoperative mesh contamination: demonstration of high bactericide effect (in vitro) and low systemic bioavailability (in vivo)

Introduction

Mesh infection is a severe complication after incisional hernia repair and occurs in 1–3 % of all open mesh implantations. For this reason, topical antimicrobial agent applied directly to the mesh is often used procedure. So far, however, this procedure lacks a scientific basis.

Materials and methods

Two different meshes (Parietex?, Covidien; Ultrapro?, Ethicon Johnson & Johnson) were incubated with increasing amounts of three different Staphylococcus aureus strains (ATCC 25923; Mu50; ST239) with or without gentamicin and growth ability were determined in vitro. To further address the question of the systemic impact of topic gentamicin, serum levels were analyzed 6 and 24 h after implantation of gentamicin-impregnated multifilament meshes in 19 patients.

Results

None of the gentamicin-impregnated meshes showed any bacterial growth in vitro. This effect was independent of the mesh type for all the tested S. aureus strains. In the clinical setting, serum gentamicin levels 6 h after implantation of the gentamicin-impregnated meshes were below the through-level (range 0.4–2.9 mg/l, mean 1.2 ± 0.7 mg/l). After 24 h the gentamicin serum levels in all patients had declined 90–65 % of the 6 h values.

Conclusion

Local application of gentamicin to meshes can completely prevent the growth of even gentamicin-resistant S. aureus strains in vitro. The systemic relevance of gentamicin in the clinical controls showed to be very low, without reaching therapeutic concentrations.     

Clinical efficacy of a trocar-guided mesh kit for repairing lateral defects

Introduction and hypothesis

The optimal surgery for lateral defects is not well defined. Our objective was to assess the effects of anterior trocar-guided transvaginal mesh repair versus anterior colporrhaphy in women with lateral defects.

Methods

This subanalysis from a randomized controlled trial of mesh kit versus anterior colporrhaphy assessed 99 patient diagnosed at baseline with lateral defects in the anterior vaginal wall. Thirty-nine patients underwent anterior colporrhaphy and 60 anterior trocar-guided transvaginal mesh surgery.

Results

One year after surgery, a persistent lateral defect was significantly more common after colporrhaphy compared with transvaginal mesh [11/32 (34.4 %) vs 1/42 (2.4 %), risk ratio (RR) 14.4, 95 % confidence interval (CI) 2.0–106.1; P?<?0.001)] However, there were no significant differences between treatment groups with regard to subjective symptoms as reflected by the overall Urogenital Distress Inventory scores, with mean difference from baseline 37.3?±?50.6 in the colporrhaphy group vs 39.0?±?45.8 in the mesh group (p?=?0.61).

Conclusions

Use of a transvaginal mesh kit increases the odds for anatomical correction of lateral defects compared with anterior colporrhaphy but does not necessarily improve lower urinary tract symptoms.     

Evaluation of a fully absorbable poly-4-hydroxybutyrate/absorbable barrier composite mesh in a porcine model of ventral hernia repair

Background

The objective of this study was to evaluate the mechanical and histological properties of a fully absorbable poly-4-hydroxybutyrate/absorbable barrier composite mesh (Phasix? ST) compared to partially absorbable (Ventralight? ST), fully absorbable (Phasix?), and biologically derived (Strattice?) meshes in a porcine model of ventral hernia repair.

Methods

Bilateral abdominal surgical defects were created in twenty-four Yucatan pigs, repaired with intraperitoneal (Phasix? ST, Ventralight? ST) or retromuscular (Phasix?, Strattice?) mesh, and evaluated at 12 and 24 weeks (n = 6 mesh/group/time point).

Results

Prior to implantation, Strattice? demonstrated significantly higher (p < 0.001) strength (636.6 ± 192.1 N) compared to Ventralight? ST (324.3 ± 37.1 N), Phasix? ST (206.9 ± 11.3 N), and Phasix? (200.6 ± 25.2 N). At 12 and 24 weeks, mesh/repair strength was significantly greater than NAW (p < 0.01 in all cases), and no significant changes in strength were observed for any meshes between 12 and 24 weeks (p > 0.05). Phasix? mesh/repair strength was significantly greater than Strattice? (p < 0.001) at 12 and 24 weeks, and Ventralight? ST mesh/repair strength was significantly greater than Phasix? ST mesh (p < 0.05) at 24 weeks. At 12 and 24 weeks, Phasix? ST and Ventralight? ST were associated with mild inflammation and minimal–mild fibrosis/neovascularization, with no significant differences between groups. At both time points, Phasix? was associated with minimal–mild inflammation/fibrosis and mild neovascularization. Strattice? was associated with minimal inflammation/fibrosis, with minimal neovascularization at 12 weeks, which increased to mild by 24 weeks. Strattice? exhibited significantly less neovascularization than Phasix? at 12 weeks and significantly greater inflammation at 24 weeks due to remodeling.

Conclusions

Phasix? ST demonstrated mechanical and histological properties comparable to partially absorbable (Ventralight? ST) and fully resorbable (Phasix?) meshes at 12 and 24 weeks in this model. Data also suggest that fully absorbable meshes with longer-term resorption profiles may provide improved mechanical and histological properties compared to biologically derived scaffolds.

     

Prospective histologic evaluation of intra-abdominal prosthetics four months after implantation in a rabbit model

Background

Placement of an intraperitoneal prosthetic is required for laparoscopic ventral hernia repair. The biocompatibility of these prosthetics determines the host’s inflammatory response, scar plate formation, tissue ingrowth, and subsequent mesh performance, including prosthetic compliance and prevention of hernia recurrence. We evaluated the host response to intraperitoneal placement of several prosthetics currently used in clinical practice.

Methods

A 4-cm × 4-cm piece of mesh was implanted on intact peritoneum in New Zealand white rabbits. The mesh types included expanded polytetrafluoroethylene (ePTFE) (DualMesh^®), ePTFE and polypropylene (Composix^®, heavyweight polypropylene), polypropylene and oxidized regenerated cellulose (Proceed^®, midweight polypropylene), and polypropylene (Marlex^®, heavyweight polypropylene). At four months, standard hematoxylin and eosin and Milligan’s trichrome stains of the mesh-tissue interaction were analyzed by three observers blinded to the mesh types. Each specimen was evaluated for scar plate formation, inflammatory response, and tissue ingrowth. Each of these three categories was graded on a standard scale of 1–4 (1 = normal tissue and 4 = severe inflammatory response). The scores were analyzed using Wilcoxon rank sum test with p < 0.05 as significant.

Results

Ten samples of each mesh type were evaluated. There was no difference in tissue incorporation between the groups. The mean scar plate formation was greater in the heavyweight polypropylene meshes than for DualMesh (p = 0.04). With Proceed, the reduction in scar plate formation compared with that for Composix and Marlex approached statistical significance (p = 0.07). The mean number of inflammatory cells was greater around the ePTFE when compared with the midweight polypropylene (p = 0.02) but equal to the other meshes.

Conclusions

The four prosthetic materials evaluated in this study demonstrate comparable host biocompatibility as evidenced by the tissue ingrowth. Scar plate formation around DualMesh was significantly less than that around Composix and Marlex. Interestingly, more inflammatory cells were noted surrounding the DualMesh which was equal to that of the heavyweight meshes. Proceed, a midweight polypropylene mesh, has the potential for improved patient tolerance compared to heavyweight polypropylene meshes based on its favorable histologic findings.     

Does Presoaking Synthetic Mesh in Antibiotic Solution Reduce Mesh Infections? An Experimental Study

Background

Prosthetic mesh infection is one of the most challenging complications after hernia repair. We evaluate the efficacy of soaking mesh in antibiotics to prevent prosthetic infection in an animal model of clean–contaminated ventral hernia repair (VHR).

Material and Methods

Rats underwent an acute VHR with one of four synthetic meshes (composite multifilament polyester (Parietex PCO), multifilament polyester (Parietex TET), composite monofilament polypropylene (Ventralight), or monofilament polypropylene (SoftMesh)). Prior to implantation, mesh was soaked in saline or 10 mg/ml of vancomycin for 15 min. Following implantation, meshes were contaminated with 10⁴ CFU of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Thirty days after implantation, mesh samples were cultured and evaluated under scanning electron microscope for biofilm formation.

Results

Presoaking meshes significantly improves bacterial clearance in composite meshes and multifilament polyester mesh. MRSA clearance was as follows for all meshes (saline-soaked vs. vanco-soaked): Parietex PCO (0 vs. 56 %, p?=?0.006), Parietex TET (0 vs. 50 %, p?=?0.01), Ventralight (20 vs. 78 %, p?=?0.012), and SoftMesh (70 vs. 80 %, p?=?0.6). MRSA biofilm formation was consistent with bacterial growth.

Conclusion

Presoaking multifilament and composite mesh in vancomycin solution reduces MRSA bacterial growth. Its implementation may reduce the risk of mesh infection in clean–contaminated cases, although further investigation with human trials should be performed.     

Mesh contraction: in vivo documentation of changes in apparent surface area utilizing meshes visible on magnetic resonance imaging in the rabbit abdominal wall model

Introduction and hypothesis

Our aim was to analyze the apparent contraction of meshes in vivo after abdominal wall reconstruction and evaluate histological and biomechanical properties after explantation.

Methods

Nine New Zealand female rabbits underwent repair of two full-thickness 25 × 30-mm midline defects in the upper and lower parts of the abdomen. These were primarily overlaid by 35 × 40-mm implants of a polyvinylidene fluoride (PVDF) DynaMesh (n?=?6) or polypropylene meshes Ultrapro (n?=?6) and Marlex (n?=?6). Edges of the meshes were secured with iron(II,III) oxide (Fe₃O₄)-loaded PVDF sutures. Magnetic resonance images (MRIs) were taken at days 2, 30 and 90 after implantation. The perimeter of the mesh was traced using a 3D spline curve. The apparent surface area or the area within the PVDF sutures was compared with the initial size using the one-sample t test. A two-way repeat analysis of variance (ANOVA) was used to compare the apparent surface area over time and between groups.

Results

PVDF meshes and sutures with Fe₃O₄ could be well visualized on MRI. DynaMesh and Marlex each had a 17 % decrease in apparent surface area by day 2 (p?<?0.001 and p?=?0.001), respectively, which persisted after day 90. Whereas there was a decrease in apparent surface area in Ultrapro, it did not reach significance until day 90 (p?=?0.01). Overall, the apparent surface area decreased 21 % in all meshes by day 90. No differences in histological or biomechanical properties were observed at day 90.

Conclusions

There was a reduction in the apparent surface area between implantation and day 2, indicating that most mesh deformation occurs prior to tissue in-growth.     

Intraperitoneal behaviour of a new composite mesh (Parietex™ Composite Ventral Patch) designed for umbilical or epigastric hernia repair

Introduction

The most common treatment option for ventral and umbilical hernias is the implant of a prosthetic mesh. This study compares the behaviour of a new mesh, Parietex? Composite Ventral Patch (Ptx), with two commercially available meshes, Ventralex? ST Hernia Patch and Proceed? Ventral Patch.

Materials and methods

The following meshes were tested in a umbilical-hernia repair model using 54 rabbits: Ventralex? ST Hernia Patch (Vent) (Bard Davol Inc., USA); Proceed? Ventral Patch (PVP) (Ethicon, USA) and Ptx (Covidien, Sofradim, France) (n = 18 each). At 3, 7 and 14 days postimplantation, peritoneal behaviour and adhesion formation were assessed by sequential laparoscopy. Adhesions were scored for consistency and quantified by image analysis. The animals were euthanized at 2 (n = 27) and 6 weeks (n = 27) postsurgery. Mesothelial cover of meshes and tissue ingrowth were determined by scanning and light microscopy.

Results

Seroma was observed in 1/18 Vent, 7/18 PVP and 4/18 Ptx, mainly between the implant and subcutaneous tissue. Firm omental adhesions between the mesh and parietal peritoneum were noted in 2/9 Vent, 6/9 PVP and 3/9 Ptx at 2 weeks and in 3/9 Vent, 5/9 PVP and 1/9 Ptx at 6 weeks. Three (out of 9) encapsulated PVP implants showed “tissue-integrated” adhesions affecting the intestinal loops. No differences between implants were detected in the surface area occupied by adhesions at 2 weeks, though at 6 weeks, percentages were significantly higher (p < 0.01; Mann–Whitney U test) for PVP compared to Ptx or Vent. At this time point, Ptx and Vent showed good host tissue incorporation and optimal mesothelialization.

Conclusions

The PVP implants showed greater adhesion formation than the other materials. Postimplantation behaviour was comparable for Ptx and Vent including scarce adhesion formation and optimal mesothelialization. Regarding tissue integration, Ptx showed greater long-term collagenization of the neoformed tissue.     

Evaluation of a knitted polytetrafluoroethylene mesh placed intraperitoneally in a New Zealand white rabbit model

Background

The intraperitoneal application of surgical mesh remains a controversial issue because of possible complications, especially adhesion and fistula formation. This study aimed to assess the potential of a knitted polytetrafluoroethylene (PTFE) mesh for intraabdominal implantation.

Methods

Twenty-eight 5?×?5?cm samples of knitted macroporous PTFE mesh and light-weight polypropylene mesh (LW-PP) were implanted intraperitoneally in 14 New Zealand white rabbits in a randomized manner and fixed using eight polypropylene stitches. After 90?days, the adhesion formation, adhesion score, shrinkage, strength of fixation to the abdominal wall, and histologic biocompatibility were assessed.

Results

No intraoperative or anesthesia-related complications or mesh infection were recorded. The average area covered by adhesions was 4.7?±?7.2% for the PTFE and 36.4?±?36.1% for the LW-PP. The median adhesion score was 0 for the PTFE and 8 for the LW-PP. Shrinkage was 36.9?±?12.9% for the PTFE mesh and 12.6?±?8.72% for the LW-PP. The mesh-to-abdominal wall fixation strength was almost the same for both materials (PTFE 3.6?±?1.9 vs. LW-PP 3.6?±?2.9). The inflammatory cell count was almost the same for the two groups, with no statistically significant difference. The width of the inner granuloma was equal (PTFE 10.5?±?0.9 vs. LW-PP 11.1?±?0.9). The outer granuloma was reduced significantly in the PTFE group (PTFE 23.0?±?2.1 vs. LW-PP 33.6?±?7.9). One of the animals in the PTFE group died on postoperative day 12 because of ileus. The reason was an adhesion of the small intestine to the polypropylene fixation stitch, which caused small intestine strangulation.

Conclusions

The knitted PTFE mesh induces fewer intraperitoneal adhesions of lower density than the light-weight polypropylene mesh. The strength of the knitted PTFE mesh fixation to the abdominal wall is comparable with that of the light-weight polypropylene mesh, but the shrinkage is greater. The biocompatibility of the knitted PTFE mesh is comparable with that of the light-weight polypropylene implant.     

A sodium hyaluronate carboxymethylcellulose bioresorbable membrane prevents postoperative small-bowel adhesive obstruction after distal gastrectomy

Purpose

It is predictable that since distal gastrectomy (DG) with Billroth I anastomosis involves no procedures caudal to transverse colon, the effects of the surgical wound are the main cause of adhesive obstruction. Thus, it is an appropriate operation to test the efficiency of a synthetic absorbable adhesion barrier (Seprafilm).

Methods

The subjects were 282 patients diagnosed with gastric cancer who underwent open DG with Billroth I anastomosis between 2001 and August, 2005. Seprafilm was not used in any patients operated on before April, 2003 (n = 169), but it was used in all patients operated on from May 2003 onward (n = 113). We retrospectively compared the incidences of adhesive obstruction in the Seprafilm group and the non-Seprafilm group.

Results

The cumulative incidence of adhesive obstruction was significantly lower in the Seprafilm group than in the non-Seprafilm group (P = 0.021). The respective incidences of adhesive obstruction 2 years after surgery were 0.9% and 6.5%. Multivariate analysis of the occurrence of adhesive obstruction revealed no significant differences in sex, age, body mass index, operation time, blood loss, or degree of lymph-node dissection; however, it revealed a significant difference in relation to the use of Seprafilm (P = 0.049).

Conclusion

In this series, Seprafilm reduced the incidence of adhesive obstruction after DG significantly; however, a prospective randomized study will be necessary to confirm this result.     

Five-year results of a randomized clinical trial comparing a polypropylene mesh with a poliglecaprone and polypropylene composite mesh for inguinal hernioplasty

Background

The aim of this study was to assess whether partially absorbable monofilament mesh could influence postoperative pain and recurrence after Lichtenstein hernioplasty over the long term.

Methods

Patients were randomized into two groups that were treated with lightweight (LW) or heavyweight (HW) mesh in 15 centers in Poland. A modified suture technique was used in the lightweight mesh group. Clinical examination was performed. A pain questionnaire was completed five?years after the surgery.

Results

Of the 392 patients who underwent surgery, 161 (90.81?%) of 177 in the HW group and 195 (90.69?%) of 215 in the LW group were examined according to protocol, a median of 62 (range 57–66) months after hernia repair. There was no difference in the recurrence rate (1.9?% LW vs. 0.6?% HW; P?=?0.493). There were 24 deaths in the follow-up period, but these had no connection to the surgery. The patients treated with LW mesh reported less pain in the early postoperative period. After five?years of follow-up, the intensity and the presence of pain did not differ between groups (5 patients in the LW and 4 patients in the HW group). Average pain, (VAS score), was also similar in the LW and HW group (2.25 vs. 2.4) at the fifth year postoperatively.

Conclusion

The use of partially absorbable mesh reduced postoperative pain during the short-term postoperative period. No difference in pain or recurrence rate was observed at 60?months.     

Partial removal of infected parietal meshes is a safe procedure

Introduction

Open tension-free hernioplasty using prosthetic meshes dramatically reduced recurrence rates after hernia or incisional hernia repair and has become the rule. Mesh infections (MI) are the major complication of prosthetic material. The aim of this study was to assess the efficacy of partial removal of mesh (PRM) therapy in the treatment of MI.

Materials and methods

From January 2000 to April 2010, from a prospective database, we retrospectively selected patients who underwent surgery for MI. We studied the epidemiological data (sex, age, obesity, diabetes, smoking), the operating time of the initial intervention, the presence of intestinal injuries during the first intervention, the average interval between initial surgical procedure and MI, the location of the hernia, the average size of the hernia, type of mesh used, the position of the mesh, type of surgery performed, the number through interventions required to achieve a cure, the cumulative duration of hospital stay and hernia recurrence rates.

Results

Twenty-five patients were supported for a MI in our institution. There were 9 women (36?%) and 16 men (64?%). The median age was 59?years (range 37–78). There were 4 inguinal hernias (16?%), 15 incisional hernias (60?%) and 6 multirecurrent incisional hernias (24?%). It was performed a PRM in 92?% of cases (n?=?23), a total excision of the prosthesis in 4?% of cases (n?=?1) and no removal of prosthesis in 4?% of cases (n?=?1). The average number of reoperations before healing was 1 (range 1–5). The mean cumulative duration of hospitalization until healing was 9.5?days (range 2–43). No visceral resection was performed.

Conclusion

PRM is feasible in most cases allowing first to spare the capital parietal patients and secondly to avoid major surgery. In case of failure, total removal of the mesh can be discussed.     

Modified laparoscopic extraperitoneal uterine suspension to anterior abdominal wall: the easier way to treat uterine prolapse

Introduction and hypothesis

To report the outcomes of modified laparoscopic extraperitoneal uterine suspension to anterior abdominal wall for uterine prolapse using mesh.

Methods

Twenty-two patients with uterovaginal prolapse, stage 2 or greater according to pelvic organ prolapse quantification (POP-Q), and with desire for uterine preservation, underwent modified laparoscopic extraperitoneal uterine suspension to the anterior abdominal wall bilaterally using mesh. The outcomes were measured by POP-Q and quality-of-life questionnaires. Intraoperative or postoperative complications were also observed.

Results

Patient age was 61.4?±?12?years, and parity was 3.3?±?1.8. After surgery, there was significant improvement in POP-Q measurements of Ba, Bp, and C (P?P?Conclusions Modified laparoscopic extraperitoneal uterine suspension to the anterior abdominal wall using mesh is a feasible and effective method for treating uterine prolapse and is easy to perform.     

Biomechanical effects of polyglecaprone fibers in a polypropylene mesh after abdominal and rectovaginal implantation in a rabbit

Introduction and hypothesis

To investigate the biomechanical effects of polyglecaprone fibers in lightweight meshes implanted into the vaginal and abdominal wall of parous rabbits.

Methods

New Zealand White rabbits (n?=?24) were implanted with polypropylene meshes (32?g/m²), with (Prolift plus M, n?=?12) or without (Prolift minus M, n?=?12) polyglecaprone fibers. Following implantation in the posterior vaginal and abdominal wall, local side effects were evaluated and explants underwent uniaxial tensiometry after 120 and 180?days.

Results

The vaginal extrusion rate was at least 50?%, coinciding with a minimum of 20?% of contraction. There were no measurable effects of the addition of polyglecaprone on tensiometric strength and compliance in abdominal explants.

Conclusions

The addition of polyglecaprone fibers did not compromise the biomechanical properties nor did it prevent vaginal extrusion and contraction. The latter as well as some other limitations preclude the rabbit vagina to be a suitable model for biomechanical testing.