Parastomal ileal loop hernia repair with marlex mesh

We report a case of a complicated ileal conduit parastomal hernia that was repaired using marlex mesh. The characteristics of this material and the techniques of its use are described. When primary repair of a parastomal hernia is not possible without tension, marlex mesh may be used to reinforce or even to replace the fascia. The stoma may be brought out adjacent to or possibly even through the mesh.     

Pregnancy following laparoscopic mesh repair of ventral abdominal wall hernia

Background:

There are no data on laparoscopic repair of ventral and incisional hernias (LRVIH) in fertile women who intend to have further pregnancies. A unique series is described of 8 women who got pregnant and gave birth after LRVIH.

Methods:

Medical records of 875 consecutive patients who underwent LRVIH were reviewed. Women who gave birth after LRVIH were identified. At follow-up, patients answered a questionnaire on pain, discomfort, recurrence, and problems during pregnancy and delivery and underwent a physical examination.

Results:

Eight patients were identified; all agreed to inclusion. Four women received LRVIH for incisional hernia; 4 were operated on for primary ventral hernia. Median age at LRVIH was 29 years (range, 24 to 34). No postoperative complications occurred. Median time between LRVIH and delivery was 22.5 months (range, 12 to 44). Median follow-up after delivery was 23.5 months (range, 2 to 40). Five patients experienced a tearing pain in the area of hernia repair during the last months of pregnancy. This pain was not continually present and disappeared after delivery in all patients. All infants were born healthy at full term. Seven patients had a vaginal birth and one had a caesarean delivery. There were no major complications during pregnancy or delivery. At control examination, all patients were asymptomatic and, with one exception, without signs of recurrence. One patient had a swelling in the repaired area indicating either recurrence or mesh bulging. Being asymptomatic, she refused any further diagnostics.

Conclusion:

LRVIH in fertile women who intend to have further pregnancies is an acceptable therapeutical option that causes no significant problems during pregnancy or delivery.     

Outcome of patients with chronic mesh infection following abdominal wall hernia repair

Purpose

Mesh infection following incisional hernia repair has been reported at around 6–10 %. The aim of this study is to assess the outcome of patients following treatment for chronically infected mesh after repair of an abdominal wall hernia.

Methods

Data were gathered on all patients with chronically infected mesh following failed conservative management treated under the care of one surgeon between January 2004 and December 2010. This included patient demographics, reason for first operation, number of previous operations and the number of previous hernia repairs. In addition, the type of mesh removed was recorded as was the organism cultured from the wound. Patients were followed up in a clinic at 1 month, 3 months and 1 year after surgery.

Results

15 patients had 18 operations under general anaesthesia for infected mesh (10 partial and 8 complete mesh excisions). The interval between the last mesh implantation or abdominal operation and re-operation for infection was a median of 17 months (range 7–49 months). All patients who had complete mesh removal had complete healing of their wound at 3 months compared with four in the partial excision group (P = 0.011). At a median follow-up of 19 months, only five in the complete and three in the partial excision group had complete wound healing (P = 0.184).

Conclusion

The outcome of patients treated for chronic mesh infection is unsatisfactory with high risk of recurrent herniation and development of further chronic abdominal wall sepsis; therefore, every effort should be made to prevent this problem in the first instance.     

Parastomal hernia repair and prevention with PHSL type mesh after abdomino-perineal rectum extirpation

The parastomal hernia is a continuing challenge, because of the disappointing results of the different procedures available to repair it. The mesh implantation seems to be the best, but not optimal method with 8-22 % recurrence rate and about 15-20% other complications. The PHSL (Polypropylene hernia system large; Ethicon inc. Johnson and Johnson, USA) device proved to be an acceptable solution in correction the medium and large parastomal hernia with low recurrence and complication rate. The device enforces the abdominal wall with double mesh layer connected with a tube. The sigmoid colostomy is lifted trough the tube to the abdominal surface. The device was implanted with preventive intent in 14 cases, without any parastomal hernia formation in the first postoperative year. The preventive PHSL mesh implantation at the Miles operation seems to be an useful method for prevention of parastomal hernias.     

腹膜前间隙疝修补术与平片式无张力疝修补术对比研究

目的：对腹膜前间隙（Bogros间隙）疝修补术与平片式无张力疝修补术在临床应用效果进行分析探究。方法回顾性分析2013年3∽7月,丰顺县人民医院收治的腹股沟疝患者100例,随机分为二组,每组各50例。观察组采用腹膜前间隙疝修补术,对照组采用平片式无张力疝修补术。对比分析二组患者的临床疗效和手术指标。结果二组患者经不同方法进行治疗后,观察组患者显效率（56％）明显高于对照组显效率（26％）,二组比较差异有统计学意义（χ2＝8．815,P＝0．003）。观察组患者总有效率（92％）,对照组患者总有效率（64％）,二组比较差异有统计学意义（χ2＝5．015, P＝0．001）。观察组手术时间（48±9）min,对照组手术时间（62±10）min,二组比较差异有统计学意义（t＝2．807,P＝0．001）;观察组恢复时间（3±1）d,对照组恢复时间（2±1）d,二组比较差异有统计学意义（t＝0．949,P＝0．000）;观察组住院时间（6±1）d,对照组住院时间（3±1）d,二组比较差异有统计学意义（t＝0．695,P＝0．002）。结论腹膜前间隙疝修补术明显优于平片式无张力疝修补术,更符合人体工程学原理,安全可靠,值得广大医院推广使用。     

Incisional abdominal hernia: the open mesh repair

BACKGROUND: Mesh techniques are the methods of choice for the repair of incisional hernias since these are due to the formation of unstable scar tissue. METHODS: We review the materials and techniques used in the repair of incisional hernias. We describe in detail the operative technique performed in our clinic, the pitfalls of the repair, and the overlap behind the xiphoid and the pubic bone. RESULTS: Polypropylene is the material widely used for open mesh repair. New developments have led to low-weight, large-pore polypropylene prostheses, which are adjusted to the physiological requirements of the abdominal wall and permit a proper tissue integration. These meshes provide the possibility of forming a scar net instead of a stiff scar plate and therefore help to avoid former known mesh complications. CONCLUSIONS: The ideal position for the mesh is the retromuscular sublay position where the force of the abdominal pressure holds the prosthesis against the deep surface of the muscles. The lowest incidence rates of recurrence have been reported for the retromuscular sublay repair; even after long-term follow-up recurrence rates of 10% are possible. Attaining such good results requires an adequate size of the mesh with sufficient overlap of at least 5-6 cm in all directions. Open mesh repair using modern low-weight polypropylene meshes in the retromuscular sublay technique offers excellent results for the treatment of incisional hernias.     

Obturator hernia: a new device in mesh repair

Summary Obturator hernia is a rare cause of bowel obstruction which occurs mostly in elderly patients. Because symptoms are non-specific and hernia is rarely detectable on physical examination, preoperative diagnosis is difficult. Delay in diagnosis frequently leads to strangulation of the hernia and bowel resection so mortality remains high (25%). Although several techniques of obturator hernia repair have been described, surgical repair has not been standardized. We report a case of obturator hernia in a male patient previously operated on for inguinal hernia. It was discovered while operating for suspected recurrence of the right inguinal hernia. A new technical device which consists of the use of metal anchors allowed precise positioning of the mesh and avoids future dislocation.     

腹壁切口疝网片无张力修补术

目的 评估腹壁切口疝无张力修补术。方法 回顾分析15例腹壁切口疝用聚丙烯网片修补。网片用单丝不吸收缝线连续缝合固定在缺损边缘，网片必须超过缺损边缘2cm。常规术前预防性用单剂抗生素。结果 随访15－38个月无一例复发。结论 腹壁切口疝用聚丙烯网片无张力修补是一安全简单方法且术后疼痛轻微。     

补片修补腹壁切口疝126例

目的探讨应用肌腱膜上补片置人手术（premuscular positioning of prosthesis Onlay，ONLAY）修补术治疗腹壁切口疝的治疗。方法1999年9月至2007年6月应用复合补片修补腹壁切口疝126例。其中男性60例，占47．5％，女性66例，占52．5％，年龄28—89岁，平均58．5岁。上腹部切口疝占36％，下腹部切口疝占64％。按中华医学会外科学会疝和腹壁外科学组分类，大切口疝（疝环缺损5—10cm）67例，巨大切口疝（疝环缺损≥10cm）59例。均采用肌腱膜上补片置人手术（ONLAY）修补法。结果全部患者顺利完成手术，无死亡病例及严重并发症。平均手术时间95min（70—120min），术中平均出血80na（60—250m1），术后住院14．5d（10—28d）。术后随访3个月至8年，复发3例，手术复发率为2．38％。结论ONLAY手术安全可靠，复发率低，是可以接受的切口疝修补方法。     

Massive incisional hernia: abdominal wall replacement with Marlex mesh

Marlex (polypropylene) mesh was used to replace the abdominal wall in massive incisional herniation in 50 patients. Seventeen unsuccessful attempts at primary repair had previously been made on nine patients. Patient follow-up ranged from 6 to 120 months (mean = 45 months). There was minor hernia recurrence in four (8 per cent) patients. In each instance it was due to partial detachment of the peripheral fixation of the patch. Complications were: wound infection, four (8 per cent); wound seroma, two (4 per cent); wound haematoma, one (2 per cent); and wound sinus, six (12 per cent). Complications did not necessitate removal of the patch in any case. Inadequate peripheral attachment of the patch has been the only cause of hernia recurrence and should be avoidable.     

Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair

Purpose

Treatment of chronic mesh infections (CMI) after parietal repair is difficult and not standardized. Our objective was to present the results of a standardized surgical treatment including maximal infected mesh removal.

Methods

Patients who were referred to our center for chronic mesh infection were analyzed according to CMI risk factors, initial hernia prosthetic cure, CMI characteristics and treatments they received to achieve a cure.

Results

Thirty-four patients (mean age 54?±?13 years; range 23–72), were included. Initial prosthetic cure consisted of 26 incisional hernias and eight groin or umbilical hernias of which 21% were considered potentially contaminated because of three intestinal injuries, two stomas and two strangulated hernias. The mesh was synthetic in all cases. CMI appeared after a mean of 83 days (range 30–6740) and was characterized by chronic leaking in 52 cases (50%), an abscess in 22 cases (21%) and synchronous hernia recurrence in 17 cases (16.5%). Eighty-six reinterventions were necessary, including 36 mesh removals (42%), and 13 intestinal resections for entero-cutaneous fistula (15%). The CMI persistence rate was 81% (35 reinterventions out of 43) when mesh removal was voluntarily limited to infected and/or not incorporated material, but was 44% when mesh removal was voluntarily complete (19 reinterventions out of 43; p?<?0.001). On average, 3.4 interventions (1–11) were necessary to achieve a cure, after 2.8 years (0–6). Fourteen incisional hernia recurrences occurred (41%).

Conclusions

Treatment of chronic mesh infection is lengthy and resource-intensive, with a high risk of hernia recurrence. Maximal mesh removal is mandatory.

     

Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall.

OBJECTIVE: To develop a new mesh for hernia repair that is adapted to the physiological forces. DESIGN: Animal experiment. SETTING: Surgical Department of the RWTH-Aachen. ANIMALS: Wistar rats MAIN OUTCOME MEASURES: Textile analysis, tensile strength, bending stiffness, histology and morphometry. RESULTS: After textile analysis of commercially available meshes in clinical use we defined the physiological forces and constructed a new mesh (Soft Hernia Mesh, SHM) based on a combination of non-absorbable polypropylene and absorbable polyglactin 910. The amount of non-absorbable material could be reduced to < 30% compared with Marlex while still guaranteeing the necessary pulling force of 16 N/cm. Improvements of the hosiery structure improved the symmetrical distribution of the retaining forces in all directions. Compared with the considerable restriction of the abdominal wall mobility by Prolene (polypropylene) and Mersilene (polyester) meshes there was no increase in the bending stiffness after the implantation of the new mesh. Histological examination showed a pronounced reduction of the inflammatory reaction in the tissues, and the collagen bundles were orientated merely around the mesh filaments instead of forming a scar plate that completely embedded the mesh. CONCLUSION: Different meshes caused specific histological reactions with changes of their mechanical properties after implantation in rodents. A new mesh with a reduced amount of polypropylene showed both less inflammation and less restriction in the mobility of the abdominal wall though it exceeded the required tensile strength of 16 N/cm.     

Parastomal hernia repair with acellular dermal matrix.

PURPOSE: Treatment of parastomal hernia is often complicated by a high recurrence rate and likelihood of wound contamination. We reported an initial series of parastomal hernia repairs performed with acellular dermal matrix. METHODS: We reviewed a series of 11 patients who had parastomal hernia repairs with acellular dermal matrix and recorded the type of ostomy, previous repair, associated intestinal pathology, type of repair performed, perioperative complications, and rate of recurrence. RESULTS: Between 2004 and 2006, 11 patients underwent parastomal hernia repair with acellular dermal matrix by the senior author. Nine of 11 patients had associated Crohn's disease or ulcerative colitis and 3 had recurrent parastomal hernias that had failed initial repair. Mean follow-up was 8.7 months (range: 1-21 months). Two patients developed wound infections that did not require implant removal and healed with local wound care. Three patients developed recurrent hernias. CONCLUSIONS: Parastomal hernia with acellular dermal matrix results in recurrence rates comparable to those reported in the literature for synthetic mesh repair. It offers the advantages of avoiding stoma relocation and of not requiring implant removal in cases of wound infection.