Biomechanical analyses of overlap and mesh dislocation in an incisional hernia model in vitro

BACKGROUND: Incisional hernia repair is one of the most common surgical complications. Despite the introduction of mesh techniques of repair, recurrences are still prevalent. The aim of the current study was to evaluate the dependence of mesh dislocation on defect size, facial overlap, mesh-position, and orientation of the mesh in cases of anisotropic stretchability. METHODS: An in vitro incisional hernia model was used, which consisted of a pressure chamber, an elastic silicone pad representing the peritoneal sac, and a silicone mat with bovine muscle tissue representing the abdominal wall. Intrinsic pressure (up to 200 mm Hg) was generated within the pressure chamber by continuous inflation with CO(2). A slit-like or flap-like defect was created in the silicone mat to simulate small or large hernia defects, respectively. The implanted mesh was arranged in both onlay and sublay configurations. A large pore polypropylene mesh with significant anisotropic stretchability was investigated, whereas overlaps of 2, 3, and 4 cm were applied. RESULTS: Despite the application of pressures up to 200 mm Hg, no mesh ruptures occurred. In the slit-like defect model, the minimal overlap required to prevent dislocation at 200 mm Hg was 3 cm using the sublay technique provided that the mesh was positioned with its most stretchable axis parallel to the largest slit dehiscence. Perpendicular rotation of the mesh resulted in dislocation at 160 mm Hg, despite using an overlap of 3 cm. Mesh reinforcement showed less stability in both the onlay position and the flap-like defect. CONCLUSION: An overlap of 3 cm is sufficient to prevent early mesh dislocation. Meshes with anisotropic stretchability should be orientated with the most stretchable axis in the direction of least overlap.     

Experimental study of Composix mesh for ventral hernia

We aimed to compare conventional single-layer mesh and composite mesh in terms of the degree of tissue repair on the abdominal wall side of the mesh and the degree of mechanical adhesion to the intestine and to confirm the stability of composite mesh. We used a single-layer polypropylene (PP) mesh and a two-layer Composix mesh (E/X type) consisting of a PP mesh and an expanded polytetrafluoroethylene mesh. Twenty rats were divided into two groups. Three months after mesh placement, histopathologically, ingrowth of granulation tissue into the mesh on the abdominal wall side was prominent without mesh shrinkage or shift in either group. In the PP mesh group, 50% of the rats had firm adhesions between the mesh and the intestine, whereas the Composix mesh group had no adhesions to the intestine. Unlike conventional PP mesh, Composix mesh prevented adhesions to the intestine on the peritoneal side without impairing tissue union with the visceral peritoneum, suggesting its usefulness in clinical onlay mesh repair for ventral defects.     

不同补片放置层次治疗外科手术切口疝的疗效

目的对不同补片放置层次（肌后修补术与腹腔内修补术）治疗外科手术切口疝的疗效及并发症发生情况进行比较。 方法回顾分析2015年1月至2018年1月,江苏省宜兴市人民医院普外科收治的切口疝72例患者的临床资料,其中采用腹腔内修补术35例（腹腔组）,肌后修补术37例（肌后组）,观察2组手术基本情况（手术时间、术后住院时间、住院总费用、术中出血量）、并发症（肠管损伤、肠梗阻、肠瘘、切口感染、切口脂肪液化）;术后第1天、第3天疼痛视觉模拟评分（VAS）及随访1年的复发情况。 结果腹腔组手术时间、术后住院时间均较肌后组短,而腹腔组术中出血量低于肌后组,但腹腔组住院总费用高于肌后组,差异有统计学意义（P<0.05）;腹腔组肠管损伤、肠梗阻、切口感染及切口脂肪液化等发生率低于肌后组,腹腔组见1例（2.86%）肠瘘并发症,肌后组未有肠瘘并发症出现,2组组间差异无统计学意义（P>0.05）;2组患者术后第1天、术后第3天VAS评分比较,差异无统计学意义（P>0.05）;随访1年后腹腔组复发0例,肌后组在术后7个月时有2例（5.71%）复发,2组复发率无统计学意义（P>0.05）。 结论两种术式不同补片放置层次方法治疗切口疝均有效,但腹腔内修补术治疗效果更佳,安全性高。     

Parastomale Hernienversorgung mit prothetischer Netzplastik

After stoma formation, parastomal hernia develops in 30–50% of patients, with one-third of these require operative correction. Recurrence rates are very high after suture repair of parastomal hernias or relocation of the stoma. Open or laparoscopic mesh repairs have resulted in much lower recurrence rates. Long-term follow-up of the various techniques for parastomal hernia repair is lacking, as are randomized trials. A prophylactic prosthetic mesh placed in a sublay position at the index operation has reduced the rate of parastomal hernia in randomized trials. A prophylactic mesh in an onlay position, a sublay position, and an intraperitoneal onlay position has also been associated with low herniation rates in non-randomized studies. Although several questions within this field still have to be answered, it seems obvious that use of a mesh represents a suitable measure for the prevention of parastomal hernia as well as parastomal hernia repair.     

生物补片在合并造口旁疝的肠造口还纳术中的应用

目的探讨生物补片在合并造口旁疝的肠造口还纳术中的应用价值。 方法回顾分析2017年5月10日至2019年9月30日中山大学附属第六医院,应用生物补片（SIS）在合并造口旁疝的肠造口还纳术中进行一期修补的22例患者的临床资料,观察造口部位切口疝（SSIH）的发生率及术后疼痛、血清肿、补片感染等并发症发生率。 结果所有手术均顺利完成,Onlay修补16例,Sublay修补6例。仅1例（4.5%）出现SSIH（Onlay修补）,术后疼痛以轻-中度为主,1周内基本回复正常,无血清肿、补片感染病例。Onlay与Sublay修补在SSIH发生率和其他并发症发生率方面差异无统计学意义。 结论应用生物补片在合并造口旁疝的肠造口还纳手术中加强筋膜缺损,在不明显增加手术并发症的情况下能显著降低SSIH的发生率,是一安全、有效的方法。     

Laparoscopic ventral hernia meshplasty with "double-breasted" fascial closure of hernial defect: a new technique

BACKGROUND: Absence of recurrence, seroma, and pain eludes the laparoscopic surgeon managing ventral and incisional hernias. Multifactorial etiology (i.e., obesity, comorbidity, and dyscollagenemia) is a challenge. Surgeons have risen to this challenge by providing laparoscopic ventral hernia repair (LVHR). Stability of mesh in a standard LVHR is attributed to Pascal's Principle (PP). PP, based upon concentration of forces at the point of least resistance, has been classically applied in hydraulic jacks to move large masses. Application of PP in LVHR is thus misplaced where the hernial defect becomes a point of concentration of intra-abdominal forces. This makes the mesh inherently unstable. For a stable mesh aided by PP, benefits of defect closure needed to be explored. METHODS: Between January 2000 and December 2004, 30 nonsmoker patients with incisional, primary ventral, and recurrent ventral hernias were operated on. Laparoscopic closure of the defect augmented with intraperitoneal onlay mesh (IPOM), as done in standard LVHR, was preformed. RESULTS: Thirty patients with 34 defects of a mean "closed defect" length of 5.7 cm (range, 3-10) were operated on. Mean operative time was 90 minutes (range, 75-110). There were no conversions, visceral injury, postoperative visible bulge, or seroma. No painkiller except Paracetamol was required. There was no recurrence in a mean follow-up of 58 months (range, 26-84). Restored abdominal contour was achieved by all the patients. CONCLUSION: Closure of hernial defect augmented with IPOM is a safe, patient friendly, and scientific way of doing LVHR.     

The surgical treatment of the parastomal hernia using prolene mesh

Parastomal herniation is a frequent complication in enterostomy. The therapeutic strategy consists in three approaches: local fascial repair, relocation of the stoma, local repair of the parietal defect using nonabsorbable meshes. In our clinic between 1997-2002 we used monofilament meshes placed in sublay position at four patients with parastomal herniation. At three patients we used midline laparotomy placing the mesh round the colostomy on preperitoneal space, after preparing the hernia sack. The size of the mesh goes beyond the parastomal parietal defect with 3-5 cm. At the fourth patient we placed the mesh round the preperitoneal segment of the colon using a combined intraperitoneal and parastomal procedure, the size of the mesh going beyond parastomal parietal defect in this case too with 3-5 cm. The immediately and delayed results was favorable. CONCLUSIONS: The parastomal herniation's surgical repair applying prolen mesh can be a therapeutic alternative with good results.     

Mechanical failure of a lightweight polypropylene mesh

We report the case of a 41-year-old male who underwent repair of a recurrent midline abdominal incisional hernia with components separation. The hernia defect was repaired with a 30 cm × 30 cm underlay biological (Strattice) mesh used to partially bridge a small residual gap between the rectus muscles and reinforced with a 30 cm × 30 cm lightweight polypropylene onlay mesh (BARD? soft mesh). The patient later developed a large persistent seroma that was excised 18 weeks later. On exploration of the previous hernia repair, it was noted that the onlay polypropylene mesh had fractured leaving a 3 cm by 2 cm defect, but the underlying biological mesh was intact preventing a recurrence of the hernia (see Fig. 1). The fractured mesh was repaired with an additional onlay 10 cm × 10 cm polypropylene mesh, the seroma was de-roofed, and the patient was later discharged. This case highlights the early mechanical failure of a lightweight polypropylene mesh; the precise mechanism of failure in this case is unclear and, however, may be related to high intra-abdominal pressures postoperatively.

Netzschrumpfung in der Hernienchirurgie

Objectives

According to an estimated mesh shrinkage following hernia repair of up to 40% a current dogma in hernia surgery requires a mesh overlap of 5 cm around the hernia. However, no valid data addressing this problem of mesh shrinkage are available at present.

Patients and methods

Within the framework of a prospective randomized double-blinded clinical trial, 50 patients were operated on for a ventral abdominal hernia with the open sublay technique using specially prepared radio-opaque polypropylene (PP) meshes. Of the patients 27 received a conventional heavyweight mesh (P group) and 23 a new lightweight mesh construction (NK group). Follow-up for at least 2 years after mesh repair included conventional abdominal x-rays after 7 days, 3 weeks and 4, 12 and 24 months, as well as computed tomography after 7 days and 4 and 12 months. Main criteria were mesh shrinkage, recurrence and complication rates and quality of life comparing groups P and NK.

Results

In 46 cases (92%) no mesh shrinkage could be detected and only 4 meshes (8%) showed a moderate shrinkage (1 of 22.2%, 2 of 8% and 1 of 3%) all from the P group. While no hernia recurrences were found, 2 surgical complications occurred with 1 seroma in the P group and 1 hematoma in the NK group. Quality of life showed a linear improvement over time up to the 2 year time point following mesh repair with advantages for the NK group. Pain and mobility scores reached standard values 12 months postoperatively without significant differences between the two groups.

Conclusions

In principle PP meshes following an uncomplicated ventral hernia repair do not shrink at all. A moderate shrinkage in isolated cases might occur following heavyweight mesh implantation. Under controlled conditions recurrence as well as complication rates are equal for heavyweight and lightweight PP meshes. Quality of life improves up to 2 years following mesh repair with a trend to a better outcome for lightweight meshes. Pain and mobility scores reached standard values 12 months postoperatively without significant differences between the lightweight and heavyweight meshes.     

电纺丝纳米白芨覆膜生物补片作为修复重建腹壁缺损替代材料的可行性

[摘要] 目的 探讨电纺丝纳米白芨覆膜生物补片作为修复重建腹壁缺损替代材料的可行性。方法 通过静电纺丝技术制备白芨纳米纤维,覆膜于生物补片,得到电纺丝纳米白芨覆膜生物补片,利用扫描电子显微镜观察静电纺丝膜的形貌与结构。取成年雄性SD大鼠12只,体质量200～280 g,随机分为电纺丝纳米白芨覆膜生物补片组（实验组）和普通生物补片组（对照组）,制备大鼠腹壁缺损模型（缺损面积2 cm × 2 cm）,分别使用以上两种补片完成一期修复,术后12 d处死大鼠,切取补片及其周围组织进行病理学观察。结果 扫描电子显微镜观察显示生物补片纤维粗细不均一,有蜘蛛网状纤维,利用静电纺丝制备的白芨电纺丝纳米白芨覆膜生物补片形态相似,纤维表面光滑且形貌良好。术后12 d实验组大鼠组织重建速度要快于对照组。结论 电纺丝纳米白芨覆膜生物补片是可用于腹壁缺损的理想材料,具有较好的临床应用前景,但其远期效果及生物安全性尚需进一步研究和评价。     

Comparative evaluation of adhesion formation, strength of ingrowth, and textile properties of prosthetic meshes after long-term intra-abdominal implantation in a rabbit

BACKGROUND: Effective laparoscopic ventral herniorrhaphy usually mandates the use of an intraperitoneal prosthetic. Visceral adhesions and changes in textile characteristics of prosthetics may complicate repairs, especially long-term. The aim of this study was to compare the adhesion formation, tissue ingrowth, and textile characteristics one year after intra-abdominal placement of the commonly used prosthetic meshes. MATERIALS AND METHODS: Forty (4 x 4 cm) meshes were sutured using absorbable suture to an intact peritoneum in 20 New Zealand white rabbits. The study groups included: polypropylene (PP) [Marlex; C.R. Bard Inc, Cranston, NJ], expanded polytetrafluoroethylene (ePTFE) [DualMesh; WL Gore, Flagstaff, AZ], ePTFE and PP (ePTFE/PP) [Composix, C.R. Bard Inc], reduced weight PP and oxidized regenerated cellulose (rPP/C) [Proceed; Ethicon, Inc, Somerville, NJ]. The meshes were explanted after one year. Adhesions were scored as a percentage of explanted biomaterials' affected surface area. Prosthetic shrinkage was calculated. The strength of incorporation and mesh compliance were evaluated using differential variable reluctance transducers. Mesh ingrowth was measured as the load necessary to distract the mesh/tissue complex. Mesh compliance was calculated as the change in linear displacement of the sensors due to applied load. The groups were compared using Student's t-test and Fisher's exact test. RESULTS: ePTFE had significantly less adhesions (0%) than both ePTFE/PP (40%) and PP (80%) groups (P < 0.001). The mean area of adhesions for the rPP/C (10%) and the ePTFE/PP (14%) groups was less than that for the PP group (40%) (P = 0.02). Prosthetic shrinkage was greatest in the ePTFE (32%) group than in any other group (P = 0.001). There were no differences in mesh incorporation between the groups. At explantation, mesh compliance in the ePTFE group was superior to other meshes (P < 0.0001). The rPP/C mesh induced the smallest change in the compliance of the tissue adjacent to the mesh (P = 0.0001). CONCLUSIONS: Prosthetic materials demonstrate a wide variety of characteristics. Although exposed PP formed the most adhesions, up to 40% of the other PP-based meshes formed adhesions despite protective barriers. The ePTFE mesh did not induce adhesions and was the most compliant, however, this prosthetic's contraction was greatest. Reduced weight polypropylene (rPP/C) mesh induced the smallest change in the adjacent tissue pliability/compliance. Understanding of the long-term effects of various prosthetic materials is important to ensure an adequate hernia repair while minimizing postoperative morbidity and patient discomfort.     

Protrusion of prosthetic meshes in repair of inguinal hernias

BACKGROUND: Although techniques with prosthetic meshes have improved results of inguinal hernia repair, the problem of recurrence remains. In addition to patient- and surgeon-related causes, protrusion of prosthetic mesh through the hernia defect can be considered as a factor of recurrence. METHODS: To simulate inguinal hernia, porcine tissue with standardized defects (3, 4, and 5 cm) was used. Nine different meshes (9 cm diameter) were positioned on the defects. In a pressure chamber the depth of protrusion through the defect was assessed. Both sides of each mesh were measured. Protrusion at a pressure representing Valsalva pressure was used for statistical analysis. RESULTS: Protrusion, including the incidence of collapse, increased with larger defect sizes. Significant protrusion differences were found between different meshes and occasionally between the 2 sides of the same mesh. CONCLUSIONS: The differences between the effects of the various meshes emphasize the importance of material characteristics when developing new surgical techniques. The 3 meshes showing least protrusion are considered especially suitable when repairing large defects or when preferring a small mesh when repairing inguinal hernias with a preperitoneal sublay approach.     

Comparison of tissue integration between polyester and polypropylene prostheses in the preperitoneal space

Tissue integration and implant characteristics of various biomaterials commonly used for inguinal hernia repair have not been studied extensively. The aim of this study is to compare behavior and tissue response between two new polyester prostheses and a commonly used polypropylene (PP) mesh. The polyester prostheses utilized were polyester flat (PF) and polyester soft three-dimensional (PS); the PP mesh utilized was Marlex. Eight randomly assigned 4 x 4-cm2 pieces of two different meshes were fixed in the preperitoneal space with a centrally placed single suture. Gross evaluation included shrinkage and stiffness. Histological evaluation included amount of fibrous and fat encapsulation, connective tissue, foreign-body reaction, neovascularization, hemorrhage, necrosis, and exudate. Evaluations were graded on a zero to four scale. The area and the area ratio were measured using a calibrated micrometer. PP mesh resulted in more fibrous encapsulation and stiffness than PF and PS prostheses. PP also resulted in less connective tissue formation and foreign-body reaction than PF and PS prostheses. There was no difference in fat encapsulation, necrosis, hemorrhage, or exudate between prostheses. Both polyester prostheses (PF and PS) have better tissue integration than the PP mesh, as evidenced by the higher amount of connective tissue and lower extent of fibrous encapsulation.     

Effects of Polyglycolic Acid and Polypropylene Meshes on Postoperative Adhesion Formation in Mice

p > 0.05). Adhesion degree and tissue OHP levels as determinants of adhesion severity were higher in the PGA mesh group than the control group and the PP mesh group on day 90 ( p < 0.001). There was no difference between the control group and the PP mesh groups ( p > 0.05). Adhesion degree was higher on day 90 than on day 5 in the control group and the PGA mesh group ( p < 0.05), whereas tissue OHP level was higher on day 90 than on day 5 in all three groups ( p < 0.001). Also there was linear correlation between adhesion degree and tissue OHP levels ( r = 0.86, p < 0.001). The study demonstrates that ABS PGA mesh has higher potential for adhesion formation than the NA PP mesh, probably related to the increased foreign body and inflammatory reactions during the absorption process of the mesh.     

Evaluation of sepramesh biosurgical composite in a rabbit hernia repair model

BACKGROUND: In cases such as incisional hernia repair, polypropylene mesh (PPM) can be exposed to the underlying viscera and cause adhesions to the mesh. In this study, a composite prosthesis that was designed to be less susceptible to adhesion formation than PPM was evaluated in a rabbit incisional hernia repair model. MATERIALS AND METHODS: A 5 x 7-cm full-thickness defect was created in the abdominal wall of 30 female New Zealand White rabbits. Ten animals each were repaired with PPM, Bard Composix (PP/ePTFE), or Sepramesh biosurgical composite-a polypropylene mesh coated on one side with chemically modified sodium hyaluronate and carboxymethylcellulose (HA/CMC). The animals were sacrificed after 28 days and the overall performance, including adhesion formation and tissue integration by histology and mechanical testing, was evaluated. RESULTS: In the Sepramesh group, there was a significant reduction in the percentage of surface area covered by adhesions and a significant increase in the percentage of animals with no adhesions compared to standard materials. The tissue integration strength and overall cellular response were similar in all groups. A partially remesothelialized peritoneal surface was often apparent overlying the Sepramesh implant. CONCLUSIONS: Sepramesh biosurgical composite effectively repaired abdominal wall defects in rabbits and reduced adhesion development to the mesh compared to the use of a PPM and a PP/ePTFE composite.     

组织工程骨修复兔颅骨缺损中骨形态发生蛋白的表达

目的 探讨组织工程骨修复骨缺损,内源性骨形态发生蛋白（BMP）在组织工程骨再生过程中的分布及作用,方法 将自体成骨样细胞即刻种植在胶原包埋的聚羟基乙酸（PGA）基质材料上, 然后将该复合体或单纯基质材料移植到兔颅骨的一侧全层骨缺损区,作为实验侧Ⅰ或实验侧Ⅱ。对凤对照,不作任何植入。18只新西兰兔分别于术后3、8及14天处死,标本行组织学及BMP免疫组织化学检查,切片上,确定骨缺损区中央,距骨断端2mm、5mm为A、B、C三区,利用真彩色计算机图像分析系统在各区间测量BMP值。结果 术后3天,实验侧Ⅰ基质间存在BMP阳性细胞,8天时,实验侧Ⅰ新骨形成明显优于实验侧Ⅱ及对照侧。14天时,实验侧Ⅰ可见骨小梁形成,对照侧为纤维组织修复。BMP定量分析中,实验侧（Ⅰ、Ⅱ）三区的BMP值高于对照侧,但实验侧的浓度梯度差值小于对照侧。结论 即刻种植于PGA基质材料上的成骨样细胞在体内可合成和分泌BMP,利用组织工程技术将内源性BMP局限于骨缺损区,提高内源性BMP浓度并改善其分布,可能是组织工程骨诱导骨再生机制之一。     

Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias

Background

Incisional hernia is a frequent complication after abdominal surgery. Today open sublay mesh repair and the laparoscopic intraperitoneal onlay mesh repair are the most widely used techniques for its cure. We developed a laparoscopic transperitoneal sublay mesh repair for the treatment of small- and medium-size ventral and incisional hernias. Outcomes of the new technique and the Rives–Stoppa repair were compared.

Methods

This prospective cohort study with a control group involved 93 patients. Between 2008 and 2010, 43 patients underwent the laparoscopic transperitoneal sublay mesh repair. During the same period of time, a control group of 50 patients underwent an open sublay repair after Rives and Stoppa. In 2011, all patients were invited for follow-up. This included pain assessments and physical examinations with use of ultrasound.

Results

The two groups were comparable in terms of patient characteristics and hernia data. The operating time was slightly longer for the laparoscopic technique. The hospital stay was shorter in the laparoscopy group. There was less chronic pain in the laparoscopy group, but this difference was not statistically significant. There was no significant difference in postoperative complications, use of analgetics, foreign body sensation, and paresthesia between the two groups. We found one long-term hematoma in the laparoscopy group and one seroma in the open group. In this series, there were no recurrences and no wound infections.

Conclusions

Our initial results indicate that the new laparoscopic transperitoneal sublay mesh repair is a safe and effective method for the treatment of small- and medium-size ventral and incisional hernias.     

Omental patch reinforced with polypropylene mesh and split-thickness skin grafting: A new procedure to close the “open abdomen”

IntroductionThe “open abdomen” expression widely used to define a full-thickness defect of the abdominal wall intentionally made in some situations like abdominal compartment syndrome, has been replaced by a newest one called “laparostomy”. The definitive closure of an open abdomen with a giant full abdominal thickness defect remains a problem.Case reportWe present a 67-year old male with a descompressive laparostomy treated with a greater omentum flap sutured hermetically with interrupted stitches at the edges of the muscle wall, reinforced with large mesh of polypropylene (PP) placed on-lay and sutured to the fascia by two concentric running sutures of polypropylene. A vacuum-assisted closure device was placed on the second postoperative day and it was kept during three weeks. By then the PP mesh was completely integrated so skin grafts were applied to the surface of the granulation tissue. An incisional hernia was easily repaired at three years of follow-up. Eight months after the last surgery the patient is satisfied with the result achieved.DiscussionThe great omentum has immunological and angiogenic properties that allow a rapid integration of the polypropylene mesh, even in septic environments, facilitating the engraftment of split-thickness skin graft.The reactive fibrosis caused by the PP mesh replaces the fat tissue but the inner surface is preserved, thereby avoiding subsequent adhesion and facilitates surgical access to the abdominal cavity if necessary in the future.ConclusionThe structure achieved is a strong structure, capable of visceral isolation that can be useful to close some OA.     

Tension-free mesh repair of umbilical hernia as a day case using local anaesthesia

Background: Umbilical hernias are a common surgical problem with a high recurrence rate using conventional suture techniques. This prospective study examined the feasibility of tension-free mesh repair as a day case using local anaesthetic (LA) for all primary umbilical hernias. Method: Fifty-four patients (eight women) were operated on; 49 using LA. Through a periumbilical skin incision the margins of the sac were freed from the edges of the defect, and a space was made in the extraperitoneal plane. In defects <3 cm in diameter, a cone of polypropylene (pp) mesh was inserted and attached with nonabsorbable sutures. In defects >3 cm, a flat piece of pp mesh was inserted into the extraperitoneal space as a sublay. No attempt was made to close the fascial defect. Results: Postoperative pain was graded as mild (n=37) and moderate (n=17). No patient had severe postoperative pain. Seven superficial wound infections responded to oral antibiotics. In no case it was necessary to remove the mesh. There were no other complications. Patients were recalled between 2 and 6 years postopertively—mean follow-up 43 months (28– 67). There were no recurrences. Conclusion: Umbilical hernia repair can be carried out safely and securely under LA with a tension-free mesh technique (cone or a sublay patch) with a low morbidity, negligible recurrence rate, and a high degree of patient satisfaction. It should be the procedure of choice for all such hernias.Presented to the 24^th International Congress of the European Hernia Society, Amsterdam, the Netherlands, June 2002     

Effectiveness of Hyalobarrier and Seprafilm to prevent polypropylene mesh shrinkage: a macroscopic and histological experimental study

Introduction and hypothesis

Polypropylene (PP) mesh shrinkage represents a serious complication, as a significant cause of pain and recurrence of pelvic organ prolapse or ventral hernias, frequently requiring several surgical interventions. The retraction seems to be caused by the host, in response to the implantation, through the occurrence of periprosthetic adhesions and fibrosis. We hypothesized that avoiding the postoperative adhesions can prevent PP mesh shrinkage.

Methods

Sixty rats were randomly assigned to three groups. A standardized hernia defect was induced on the abdominal wall, which was repaired using an extraperitoneal PP mesh alone (group 1), with application of a hyaluronate carboxymethylcellulose-based bioresorbable membrane (Seprafilm®, group 2), or an auto-cross-linked polysaccharide hyaluronan-based solution (Hyalobarrier® gel, group 3). Eight weeks after the procedure, a repeat laparotomy was performed. After scoring the adhesion and measuring the mesh surface, a microscopic study of the prosthesis-host tissue interfaces was performed.

Results

Group 1 displayed a median shrinkage of 29 % of the mesh. The Seprafilm® group (p?=?0.0238) and Hyalobarrier® gel group (p?=?0.0072) displayed a significantly smaller reduction of 19.12 and 17 %, respectively. Control group 1 displayed a significantly greater adhesion score (30.40) than the Seprafilm® (11.67, p?=?0.0028) and Hyalobarrier® gel groups (11.19, p?=?0.0013). The fibrosis was reduced in the Hyalobarrier® gel group only.

Conclusion

This experimental study revealed that Hyalobarrier® gel and Seprafilm® can prevent PP mesh shrinkage and postoperative adhesions. They might be integrated in a mesh size-saving strategy, which should preserve the quality and durability of the surgical repair and limit the postoperative pain.