Comparison of biomaterials in the early postoperative period

Background: Laparoscopic hernia repair necessitates the use of biocompatible materials. A prospective, double-blind study was conducted to compare two different polypropylene meshes. Methods: The study included 40 men with primary inguinal hernia undergoing transabdominal preperitoneal polypropylene mesh repair. In 20 of these men, a monofile, heavy-weight, rigid mesh was implanted (group A), and in the remaining 20 men, a smooth, heavy-weight variant of polypropylene mesh was implanted (group B). Complications, pain development, inability to work, physical conditions, testicular volume, and blood circulation were documented. Results: Reconvalescence in group A was slower than in group B. In group A, the postoperative values of the visual scales for pain development were higher; inability to work was 7.3 days longer; urologic disorders were worse; activities of everyday life were more reduced; and SF-36 data showed a significant reduction of physical problems (p < 0.05). Conclusions: The polypropylene mesh variant seems to be more compatible with the human organism than conventional mesh. Not only the material, but also the structure seems to influence the comfort of the mesh.     

Sixty-month follow-up after endoscopic inguinal hernia repair with three types of mesh: a prospective randomized trial

Background  This prospective, clinical, randomized, double-blind study was intended to investigate the impact of the structure and the amount of polypropylene (PP) mesh used in laparoscopic transabdominal preperitoneal hernioplastic (TAPP) on physical function and life quality. Methods  180 male patients with primary inguinal hernia undergoing TAPP were randomized for using a heavyweight (108 g/m²), double-filament PP mesh (Prolene, 10 × 15 cm, group A, n = 60), a multifilament, heavyweight variant (116 g/m²) of PP mesh (Serapren, 10 × 15 cm, group B, n = 60), or a composite mesh (polyglactin and PP) (Vypro II, 10 × 15 cm, group C, n = 60). We compared in terms of complications (seromas, recurrence rate) and life quality (pain development, physical function). The development of life quality was documented according to the SF-36 Health Survey. The follow-up period was 60 months. Results  The recurrence rate (2.2% overall) during 60-month follow-up was not significantly different between the groups. Convalescence in group A was slower than in groups B and C: mean-term values of the visual scales for pain development were significantly (p < 0.05) higher, incapacity for work was 8.2 days longer, and urological adverse effects were stronger. The mean-term development of life quality was significantly lower in group A up to 12th week postoperatively. There were no significant differences between groups B and C. Beyond the 12th postinterventional week the differences diminished. Conclusions  The composite mesh does not provide an advantage concerning physical function or pain development in comparison to the multifilament, heavyweight, pure polypropylene mesh. Independently of which mesh was implanted 5% of patients are still suffering from discomfort after 5 years.     

Central rupture and bulging of low-weight polypropylene mesh following recurrent incisional sublay hernioplasty

A recurrent incisional hernia resulting from the rupture of low-weight polypropylene mesh is rarely reported in the literature. Three patients with recurrent incisional hernia due to low-weight polypropylene mesh central rupture were operated 5, 7 and 13 months after initial sublay hernioplasty. The posterior myofascial layer was fully reconstructed in all patients during the hernioplasty, whereas the anterior myofascial layer was only partially reconstructed. The recurrent hernia was managed using heavy-weight polypropylene mesh; in two patients, a new sublay hernioplasty was performed and in one patient an “open preperitoneal flat mesh technique” was performed under local anaesthesia as a day case procedure. If closing of the anterior myofascial layer cannot be ensured during the incisional hernioplasty, the use of low-weight polypropylene meshes should be avoided; preference should be given to the heavy-weight polypropylene meshes.     

What do we know about titanized polypropylene meshes? An evidence-based review of the literature

Purpose

Despite the vast selection of brands available, nearly all synthetic meshes for hernia surgery continue to use one or other of three basic materials: polypropylene, polyester and ePTFE. These are used in combination with each other or with a range of additional materials such as titanium, omega 3, monocryl, PVDF and hyaluronate. This systematic review of all experimental and clinical studies is aimed at investigating whether titanized meshes confer advantages over other synthetic meshes in hernia surgery.

Materials and methods

A search of the medical literature from 2002 to 2012, as indexed by Medline, was performed, using the PubMed search engine (http://www.pubmed.gov). The search terms were: hernia mesh, titanium coating, lightweight mesh, TiMesh, mesh complications. All papers were graded according to the Oxford hierarchy of evidence.

Results

Patients operated on with the Lichtenstein technique performed using the lightweight titanium-coated mesh have a shorter convalescence than those with the heavy-weight mesh Prolene. For inguinal hernias operated on with the TAPP technique and using a lightweight titanium-coated mesh in comparison to a heavy-weight Prolene mesh, the early postoperative convalescence seems to improve. Titanized meshes do exhibit a negative effect on sperm motility 1 year after a TEP operation, but not after 3 years. The laparoscopic IPOM technique with a titanium-coated polypropylene mesh was associated with less postoperative pain in the short term, lower analgesic consumption and a quicker return to everyday activities compared with the Parietex composite mesh.

Conclusion

In clinical studies, the titanium-coated polypropylene mesh shows in inguinal hernia repair certain benefits compared with the use of older heavy-weight meshes.     

Mesh configurations in laparoscopic extraperitoneal herniorrhaphy

Background: Laparoscopic total extraperitoneal (TEP) hernia repair utilizes slit mesh that is placed around the spermatic cord to secure the prosthesis and prevent recurrence. Because of concern that encircling of the cord might increase pain and morbidity, we compared patients with mesh repairs using encircled and nonencircled techniques. Methods: The 191 male patients who underwent bilateral TEP repairs were divided into three groups. In 100 consecutive patients (group A), the slit mesh was closed around both spermatic cords; in 56 patients (group B), the slit mesh was tucked under the spermatic cords but not closed; in 35 consecutive patients (group C), the slit was closed around one cord and tucked under the other, in a randomized fashion. Results: The groups had similar operative times (A: 83 ± 25 min; B: 79 ± 21; C; 77 ± 24), use of pain medication (A: 2.7 ± 2.5 days; B: 2.4 ± 1.9; C: 3.1 ± 2.4), and recovery before return to work (A: 7.9 ± 7.0 days; B: 8.2 ± 6.1; C: 6.7 ± 4.8). The incidence of indirect hernias was similar in all groups. Complication rate was 20% in A, 20% in B, and 14% in C (p= NS). Chronic pain was more frequent in A (A: 6, B: 0, p= 0.06). In group C, fluid collections were more common on the closed side (closed: 3, tucked: 0; p= 0.08). There were no recurrences in any group. Conclusions: Closing the slit around the spermatic cord in laparoscopic inguinal hernia repair is not essential for prevention of early recurrence. Fluid collections tended to be more frequent when the mesh was closed around the cord, and chronic pain was more frequent in the group with closed mesh bilaterally. Received: 3 April 1997/Accepted: 3 July 1997     

The role of hernia sac ligation in postoperative pain in patients with elective tension-free indirect inguinal hernia repair: a prospective randomized study

Background Tension-free inguinal hernia repair is one of the so-called painless operations. Mild or medium postoperative pain, however, even in the mesh repair era, is common and usually due to ilioinguinal nerve entrapment or mesh fixation in the periostium of the pubic tubercle. Especially in indirect inguinal hernia repair, however, hernia sac ligation and excision may be the cause of pain. The aim of this study was to conduct a single-center prospective randomized trial with a view to clarify this issue on a scientific basis. Methods In an 8-year period, all patients undergoing elective indirect inguinal hernia repair using a tension-free polypropylene mesh technique were randomized to induce high hernia sac ligation or not in a double blind manner. The main endpoint was to detect any difference in postoperative pain between the two groups. Results Between January 1999 and December 2006, 477 patients with indirect inguinal hernia entered the study and were randomized to have high hernia sac ligation and excision (group A, n = 238) or not (group B, n = 239). The two groups were comparable regarding demographic data. Postoperative pain was associated with statistically significantly more episodes in group 1, 27% (65/238), than in group 2, 10% (24/239), on day 1, 9% (22/238), compared to 3% (8/239) on day 7, 2% (5/238), compared to 0% (0/239), on day 30, respectively, and these results were statistically significant (P ≤ 0.05). All patients were treated conservatively. Conclusion From the results of this study, it appears that we are able to demonstrate a significant benefit from the omission of high hernia sac ligation and excision on postoperative pain in patients who undergo tension-free indirect inguinal hernia mesh repair.     

Impact of Polypropylene Amount on Functional Outcome and Quality of Life after Inguinal Hernia Repair by the TAPP Procedure Using Pure,Mixed, and Titanium-coated Meshes

Background Laparoscopic inguinal hernia repair requires the use of prosthetic material. This prospective, single-center study was intended to investigate the impact of the amount of polypropylene (PP) mesh used in hernia repair on functional results and quality of life. Methods For this series, 672 consecutive patients with primary inguinal hernia undergoing transabdominal preperitoneal hernia repair (TAPP) using a heavyweight PP mesh (Prolene 10 × 15 cm, 1.5 g, group I, n = 232), a mixed PP- and Polyglactin mesh (Vypro II, 10 × 15 cm, 0.53 g, group II, n = 217), or a light-weight titanized PP mesh (Ti-Mesh, 10 × 15 cm, 0.24 g, group III, n = 223) were compared in terms of postoperative complications (seroma, wound healing disorders), quality of life score (pain development, physical condition, urologic disorders), and hernia recurrence. Results During a 12-month follow-up there were no significant differences in the recurrence rate (1.3%-1.7%). Patients with a pure PP mesh (group I) showed significantly more postoperative seromas (12.1% versus 4.1%/1.8%), foreign body sensations (9.1% versus 5.5%/3.5%), and sensitivity to weather changes (5.6% versus 3.2%/2.2%) compared to groups II and III. In all groups, the quality of life score was improved postoperatively. However, among those patients in our series with few preoperative complaints, the postoperative quality of life was worsened when heavy-weight PP meshes (group I+II) were used but significantly improved when light-weight titanized PP meshes were used. Conclusions Comparable functional results, fewer postoperative complications, and improved quality of life can be achieved by reducing the amount of PP in meshes used for laparoscopic hernia repair by TAPP procedure.     

不同类型疝补片对大鼠生殖功能的影响

目的建立大鼠腹股沟疝实验模型,对比不同类型的疝修补网片对大鼠生殖功能的影响。方法选取30只成年雄性SD大鼠,(8.5±0.3)周,体质量(230±35)g。随机分成5组,每组6只。正常对照组(NC组)、假手术组(SO组)、轻型聚丙烯补片组(LWPP组)、重型聚丙烯补片组(HWPP组)和复合补片组(CM组)。NC组仅给予腹腔麻醉后下腹部脱毛处理,SO组仅分离右侧腹股沟区输精管后逐层缝合切口,而后3组分别实施右侧腹股沟区手术分离输精管,而后用各自相对应补片包绕输精管。术后3个月采集标本并制作病理切片,观察补片对大鼠睾丸、精子和输精管的影响。结果CM组与周围组织及精索轻度粘连,对睾丸输精管损伤较小,生殖细胞质量下降不明显。LWPP和HWPP组与周围组织粘连较重,对睾丸输精管损伤严重,生殖细胞质量下降明显,生殖功能受到影响,材质相同的聚丙烯补片中,LWPP的影响程度明显小于HWPP。5组精子活率、a+b级精子、摆动性、线性度、前向性及直线运动精子活率比较,差异均有统计学意义(P均<0.05)。SO组、CM组、LWPP组及HWPP组精子活率及a+b级精子与NC组比较,差异均有统计学意义(P均<0.05);LWPP组及HWPP组精子活率及a+b级精子与SO组比较,差异均有统计学意义(P均<0.05);LWPP组与HWPP组精子活率及a+b级精子比较,差异有统计学意义(P<0.05)。5组大鼠精子总数比较,差异无统计学意义(P>0.05);5组大鼠精子密度、直线速度、曲线速度及鞭打频率比较,差异有统计学意义(P<0.05)。SO组、CM组、LWPP组及HWPP组精子密度与NC组比较,差异均有统计学意义(P均<0.05);LWPP组及HWPP组精子密度与SO组比较,差异均有统计学意义(P均<0.05);LWPP组与HWPP组精子密度比较,差异有统计学意义(P<0.05)。5组大鼠输精管管壁变化分级评分比较,差异有统计学意义(P<0.05);术后3个月5组大鼠输精管腔内皱襞个数比较,差异有统计学意义(P<0.05)。结论不同类型的疝补片对雄性大鼠生殖功能的影响不同,轻量型大网孔补片对生殖功能造成的影响比重量型小网孔补片造成的影响小。CM组较LWPP组和HWPP组对生殖功能的影响小,造成的损伤轻。建议对需行腹股沟疝修补手术且有生育要求者,在有条件的前提下可推荐使用复合补片。     

Postoperative hypoesthesia and pain: qualitative assessment after open and laparoscopic inguinal hernia repair

Background Chronic pain is an important outcome variable after inguinal hernia repair that is generally not assessed by objective methods. The aim of this study was to objectively investigate chronic pain and hypoesthesia after inguinal hernia repair using three types of operation: open suture, open mesh, and laparoscopic. Methods A total of 96 patients were included in the study with a median follow-up of 4.7 years. Open suture repair was performed in 40 patients (group A), open mesh repair in 20 patients (group B), and laparoscopic repair in 36 patients (group C). Hypoesthesia and pain were assessed using von Frey monofilaments. Quality of life was investigated with Short Form 36. Results Pain occurring at least once a week was found in 7 (17.5%) patients of group A, in 5 (25%) patients of group B, and in 6 (16.6%) patients of group C. Area and intensity of hyposensibility were increased significantly after open nonmesh and mesh repair compared to those after laparoscopy (p = 0.01). Hyposensibility in patients who had laparoscopic hernia repair was significantly associated with postoperative pain (p = 0.03). Type of postoperative pain was somatic in 19 (61%), neuropathic in 9 (29%), and visceral in 3 (10%) patients without significant differences between the three groups. Conclusions The incidence of hypoesthesia in patients who had laparoscopic hernia repair is significantly lower than in those who had open hernia repair. Hypoesthesia after laparoscopic but not after open repair is significantly associated with postoperative pain. Von Frey monofilaments are important tools for the assessment of inguinal hypoesthesia and pain in patients who had inguinal hernia repair allowing quantitative and qualitative comparison between various surgical techniques. This work was presented at the 10th World Congress of Endoscopic Surgery, Berlin, Germany, 13–16 September 2006     

Inguinal hernia repair with beta glucan-coated mesh: results at two-year follow up

In a prospective study, 115 patients with a mean age of 55 years, presenting a primary or recurrent hernia were treated with a beta glucan-coated polypropylene mesh (Glucamesh). Fifty-eight underwent a Lichtenstein procedure and 57 had a laparoscopic procedure (TEP/TAPP). Oat beta glucan is an entirely natural plant product that eliminates the risk of viral or prion contamination associated with the use of collagen of animal origin. The beta glucan coated mesh is of lower weight and profile compared to a typical polypropylene implant. Preliminary results have been previously reported. With a mean follow up of 2 years, patients were evaluated by a physician and or a standardized questionnaire in order to evaluate the incidence rate of recurrence discomfort and residual chronic pain. One hundred nine (94.7%) questionnaires were returned. Of these, 104 (90.4%) were complete and analyzed. Mean follow up was 24 months (21–27). Two years after operation the recurrence rate was 1.9% (two cases: one in each group); 98 patients (94.2%) had no pain and have returned to normal activity, work and sport. Five patients (4.8%) had mild pain on moving or at rest and one (0.96%) had moderate pain at rest. There was no correlation between pain and hernia type or surgical technique. At 2 years follow up hernia repair with beta-glucan coated mesh has a low recurrence rate. Incidence of chronic pain is low. The situation is in relationship with a lightweight and smooth mesh of polypropylene and the role of oat beta glucan optimizing the healing and inclusion of the mesh into the tissues.     

Urologische Symptome nach laparoskopischer Leistenhernienversorgung

In the context of a prospective, randomized, controlled double-blind study concerning a reduction of postoperative, urogenital affections after laparoscopic hernia repair using a polypropylene mesh, laparoscopic polypropylene implantation was performed in 40 male patients. Twenty patients received a heavyweight, rigid polypropylene mesh (group A) and the remainder a heavyweight, but softer polypropylene mesh (group B). Questionnaires were used to assess the severity of pain, impairment of sexual life, appearance of urogenital affections, and general condition. On the 3rd postoperative day, testicle blood circulation and testicle volumes were documented by ultrasound, and a congestion of the plexus pampiniformis was excluded by ultrasound with 5 MHz. Starting in the 1st postoperative week, a prevalence of affections such as testicular sensitivity to touch, pain upon ejaculation, and a pulling sensation during urination became apparent in group A. In the 12th postoperative week, 20% in group A still described testicular sensitivity to touch and 10% pain upon ejaculation and a pulling sensation during urination but only 5% in group B. It is essential to reduce urogenital affections after laparoscopic hernia repair by strict indications and appropriately adapted polypropylene meshes.     

Functional impairment and complaints following incisional hernia repair with different polypropylene meshes

The influence of mesh material on the clinical outcome of hernia repair has often been neglected, although recent studies have clearly demonstrated the importance of mesh properties for integration in the abdominal wall. Of particular significance are the amount of mesh material and the pore size. In the following study, patients received different mesh types with distinct amounts of polypropylene and of various pore sizes for incisional hernia repair. We investigated whether the type of material influenced the clinical and functional outcomes. Between 1991 and 1999, 235 patients received polypropylene meshes in a sublay position for incisional hernia repair: 115 patients were implanted with a Marlex heavy-weight mesh (Mhw mesh), 37 patients with an Atrium heavy-weight mesh (Ahw mesh) and 83 with a Vypro low-weight mesh (Vlw mesh). The study protocol included ultrasound examination and 3D-stereography in all patients, with a total follow-up of 24±13 months (Mhw-mesh), 11±8 months (Ahw-mesh) and 8±7 months (Vlw-mesh). Our findings demonstrate that the side effects of mesh implantation, comprising paraesthesia and restriction of abdominal wall mobility, were significantly affected by the type of material implanted. Three-dimensional stereographic examinations were well in accordance with our clinical findings. Our data support the hypothesis that the use of low-weight large-pore meshes is advantageous for abdominal wall function. Electronic Publication     

Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial

Background A new persistent groin pain is reported by a significant number of patients following laparoscopic totally extraperitoneal hernia repair (TEP). Mesh fixation has been implicated as a possible cause, but is widely considered essential for mesh stabilization and early recurrence prevention. This study investigates whether any association exists between mesh fixation by metal tacks and the incidence of new groin pain or early hernia recurrence. Methods A prospective multicenter double-blinded randomised trial was conducted between December 2004 and January 2006. Standardized TEP repair was performed with a rectangular 10 × 15cm polypropylene mesh. Hernia were randomized to either mesh fixation by metal tacks or left entirely unfixated. Clinical review by physical examination was performed by a separate blinded surgeon after a minimum of six months, with another review planned after two years. The incidence of new groin pain and recurrence were compared. Results Five hundred herniae in 360 patients were entered into the study. At the first wave of clinical follow-up (median eight, range 6–13 postoperative months) a new pain was reported by 38 versus 23% (p = 0.003), occurring at least once a week in 22 versus 15% (p = 0.049), or several times per week in 16 versus 8% (p = 0.009) for fixated versus unfixated repairs, respectively. Patients with bilateral repairs were five times more likely to report the unfixated side being more comfortable (p = 0.006). There was one recurrence in the fixated group (1/247) whilst none have yet occurred in the unfixated group. Fixation increased operative costs by approximately 375 AUD. Conclusion Mesh fixation in TEP is associated with increased operative cost and chronic pain but no difference in the risk of hernia recurrence at six months was observed.     

Sutureless hernioplasty with light-weight mesh and fibrin glue versus Lichtenstein procedure: a comparison of outcomes focusing on chronic postoperative pain

Purpose

Groin hernia is one of the most common disease requiring surgical intervention (8?C10% of the male population). Nowadays, the application of prosthetic materials (mesh) is the technique most widely used in hernia repair. Although they are simple and rapid to perform, and lower the risk of recurrence, these techniques may lead to complications. The aim of the present study is to assess the incidence and degree of chronic pain, as well as the impairment in daily life, in two procedures: (1) the ??Lichtenstein technique?? with polypropylene mesh fixed with non-absorbable suture, and (2) the ??sutureless?? technique carried out by using a partially absorbable mesh (light-weight mesh) fastened with fibrin glue.

Methods

This was a study conducted over a period of 3?years from July 2006 to July 2009. A total of 148 consecutive male patients suffering from groin hernia were divided randomly into two groups: (1) Group A: patients operated with ??sutureless?? technique with partially absorbable mesh and plug fastened with 1?ml haemostatic sealant; (2) Group B: patients operated with Lichtenstein technique using non-absorbable mesh and plug anchored with polypropylene suture. Follow-up took place after 7?days, and 1, 6 and 12?months and consisted of examining and questioning patients about chronic pain as well as the amount of time required to return to their normal daily activities.

Results

No major complications or mortality were observed in either group. In group A there was a faster return to work and daily life activities. Six patients (7.8%) in group B suffered from chronic pain, whereas no patient in group A demonstrated this feature.

Conclusions

Our experience shows that the combined use of light-weight mesh and fibrin glue gives significantly better results in terms of postoperative pain and return to daily life.     

Inguinal hernia repair: the choice of prosthesis outweighs that of technique

Background The use of prostheses in inguinal hernia repair reduces the incidence of recurrence. Quality of life and pain after hernia repair are largely correlated with the technique and type of prosthesis. Aims of study To evaluate the 2-year incidence of recurrence and pain for two types of hernioplasty, Lichtenstein repair and laparoscopy (totally extraperitoneal approach or TEP), and two types of mesh, polypropylene mesh and beta-d-glucan-coated mesh (Glucamesh). Patients A total of 410 consecutive patients of mean age 54 years (18–84) underwent repair of inguinal hernias, 96 (23%) of which were bilateral and 56 (13%) recurrent. A total of 273 (66.5%) patients underwent Lichtenstein repair: 215 (78.7%) with polypropylene mesh, 58 (21.3%) with Glucamesh; 137 patients underwent laparoscopy: 80 (58.4%) with polypropylene mesh, 57 (41.6%) with Glucamesh. In each group, the populations were comparable and the techniques utilized were identical. Methods The patients were followed-up for at least 2 years, after which the incidence of recurrence was determined, and chronic pain was assessed by means of a visual analog scale and a validated questionnaire. Results A total of 349 patients (85.1%) were reassessed, 117 of whom had undergone laparoscopy and 232 Lichtenstein repair. There were ten recurrences (2.8%), and incidence which was independent of the technique (laparoscopy 1.7% vs. Lichtenstein 3.4%) (ns) and the type of prosthesis (Glucamesh 1.9% vs. polypropylene 2.4%) (ns). Chronic pain was noted in 69 patients (19.7%) and severe pain in 11 (3.1%). The incidence of chronic pain was the same for the two techniques: laparoscopy 17.9% vs. Lichtenstein 20.7% (ns). The same was true for severe pain: laparoscopy 3.4% vs Lichtenstein 3% (ns). The incidence of chronic pain was closely correlated with the type of prosthesis utilized: Glucamesh 4.8% vs. polypropylene 26.5% (P = 0.02), irrespective of the technique. The same was true for severe pain (0.9 vs. 4%) (P = 0.02). Conclusion The utilization of beta-d-glucan-coated mesh did not involve more recurrence and was accompanied by a significant decrease in chronic pain at 2 years, independent of the technique. After 2 years, the results of hernia repair show that the choice of prosthesis was more determinant than choice of technique.     

腹腔镜完全腹膜外疝修补术治疗腹股沟疝不同补片固定方式探讨

目的 分析腹腔镜完全腹膜外疝修补术治疗腹股沟疝中不同补片固定方式的有效性.方法 选择2013年12月至2018年12月在武警北京市总队医院接受腹腔镜下全腹膜外疝修补术的患者为研究对象.依照使用补片方式不同,将其分为A组(144例)以及B组(118例)、C组(90例).A组受试者用3D免固定补片,B组受试者使用钉合固定平...     

Is a circular polypropylene mesh appropriate for application at the esophageal hiatus? Results from an experimental study in a porcine model

Background  Mesh reinforcement in hiatal hernia surgery is debated. Randomized controlled trials have shown that recurrences may be reduced, but there is also the fear of mesh-related complications. Experimental studies on the characteristics of specific mesh types with regard to the risk of such complications are rare. The current study aimed to investigate the properties of a circular heavy-weight polypropylene mesh in terms of stenosis, migration, erosions, and adhesions in a porcine model. Methods  A 55 × 55-mm heavy-weight polypropylene mesh with a 16.5-mm eccentric hole for the esophagus corresponding to a calculated mesh area of 2811 mm² and a hole area of 214 mm² were implanted in nine German Landrace pigs. Six weeks later, the meshes were explanted and investigated for size, shrinkage, migration and adhesions. Results  The total mesh area shrank to a mean of 2,040 ± 178 mm² (p < 0.001), and the hole for the esophagus showed a trend toward an increase to 239 ± 38 mm² (p = 0.108). In not a single location did the mesh overhang the hiatal margin. The mean distance of retraction from the hiatal margin was 4.3 ± 2.8 mm. Therefore, no stenoses, migrations, or erosions occurred. Conclusions  A circular heavy-weight polypropylene mesh seems to be appropriate for the application at the esophageal hiatus in terms of safety and stability. This means that it is characterized by a position-stable centered fixation around the esophagus without a tendency toward stenosis, migration, or erosion.     

Does type of mesh used have an impact on outcomes in laparoscopic inguinal hernia?

Background

Theoretically, a lighter and softer mesh may decrease nerve entrapment and chronic pain by creating less fibrosis and mesh contracture in laparoscopic inguinal hernia repair.

Methods

We performed a telephone survey of patients who underwent laparoscopic inguinal hernia surgery between 2001 and 2007. We recorded patient responses for chronic pain, foreign body sensation, recurrence, satisfaction, and return to work, and then studied the effect of type of mesh (polypropylene vs polyester) on these factors.

Results

Of 109 consecutive patients surveyed (mean age, 54.5 y), 67 eligible patients underwent 84 transabdominal extraperitoneal procedures and 2 transabdominal preperitoneal procedures. Patients with polypropylene mesh had a 3 times higher rate of chronic pain (P = .05), feeling of lump (P = .02), and foreign body perception (P = .05) than the polyester mesh group. Our overall 1-year recurrence rate was 5.9%. The recurrence rate was 9.3% for the polypropylene group and 2.9% for the polyester group (P = .26).

Conclusions

A lightweight polyester mesh has better long-term outcomes for chronic pain and foreign body sensation compared with a heavy polypropylene mesh in laparoscopic inguinal hernia repair. We also saw a trend toward higher recurrence in the polypropylene group.     

Functional and Morphologic Properties of a Modified Mesh for Inguinal Hernia Repair

Inguinal hernia repair is one of the most frequently performed operations. Next to conventional techniques, open and laparoscopic tension-free methods using mesh implants to reinforce the abdominal wall are increasingly carried out, even becoming the standard procedure in many countries. Because of the benefits of material-reduced meshes for incisional hernia repair, a new mesh modification for tension-free inguinal hernia repair has been developed. In the present study this new low-weight mesh (Vypro II) made of polypropylene and polyglactin multifilaments was compared to a common heavy-weight polypropylene mesh (Prolene) regarding their functional consequences and the morphologic tissue response. After implantation in rats as an inlay, abdominal wall mobility was recorded by three-dimensional photogrammetry and the tensile strength of the suture zone and the mesh itself was measured at 3, 21, and 90 days. Explanted tissue samples have been investigated for their histologic reaction in regard to the inflammatory infiltrate, vascularization, and connective and fat tissue ingrowth. Numbers of granulocytes, macrophages, fibroblasts, lymphocytes, and foreign giant body cells have been evaluated to reflect the quality of the tissue response. The cellular response was assessed by measuring DNA strand breaks and apoptosis (TUNEL), proliferation (Ki67), and cell stress (HSP70). The results indicated that restriction of abdominal wall mobility was significantly reduced with Vypro II compared to that seen with heavy-weight mesh modification, and the inflammatory reaction and connective tissue formation were markedly diminished. Apoptosis and cell proliferation showed considerably lowered levels, and expression of cytoprotective HSP70 was significantly increased. The present study thus confirms the benefits of material-reduced mesh modifications. The new low-weight mesh (Vypro II) could be advantageous in inguinal hernia repair.     

腹腔镜疝修补术中网片是否固定与开放式无张力疝修补术的疗效比较

目的对比腹腔镜疝修补术网片固定、网片免固定与开放式无张力疝修补术治疗腹股沟疝的有效性及安全性,以期为未来腹股沟疝治疗术式的选择提供依据。 方法回顾性分析2015年1月至2018年1月,宝应县人民医院收治的腹股沟疝93例患者的临床资料,根据手术方法分为3组：A组,腹腔镜疝修补术网片固定（34例）;B组,腹腔镜疝修补术网片免固定组（31例）;C组,开放式无张力疝修补术（28例）。术后随访1年,对比3组患者手术实施情况、术后并发症发生情况及复发率。 结果B组术中失血量、手术时间、术后下床活动时间、进食时间、疼痛持续时间、住院时间、术后2 d疼痛评分与A组比较,差异无统计学意义（P>0.05）;A、B组术中失血量少于C组,术后下床活动时间、进食时间、疼痛持续时间、住院时间短于C组,术后2 d疼痛评分低于C组,差异有统计学意义（P<0.05）;3组手术时间两两比较,差异无统计学意义（P>0.05）;3组术后并发症发生率、复发率比较,差异均无统计学意义（P>0.05）。 结论腹腔镜与开放式无张力疝修补术治疗腹股沟疝疗效相当,且患者术后均无较多并发症,安全性均理想。但因腹腔镜手术无需作较大切口,患者受到创伤小,术后恢复快,其应用价值优于开放式手术。腹腔镜术中补片在不固定的情况下仍能获得与补片固定后相似的效果,故腹腔镜网片免固定疝修补术操作简单,并发症少,临床推广价值更高。