Titanium coating of a polypropylene mesh for hernia repair: Effect on biocompatibilty

Titanium and its alloys are used worldwide in surgery. The favorable characteristics that make this material desirable for implantation are corrosion resistance and biocompatibility. Concerning hernia repair, a mesh modification has been developed using titanium layering of a polypropylene mesh implant, which is said to lead to an improved biocompatibility compared to commercially available mesh materials. To analyze the pure effect of titanium coating, two different mesh structures were studied using a standardized animal model. The titanium-coated monofilamentous, large porous, and lightweight mesh made of polypropylene and coated with titanium (PP+T) was compared to a pure polypropylene mesh manufactured with a similar structure and amount of material serving as a control (PP). In Sprague-Dawley rats, mesh samples were placed in a subcutaneuous position. Then 56, 84, and 182 days after mesh implantation, three animals from each group were sacrificed for morphological observations (amount of inflammatory and connective tissue formation, percentages of proliferating and apoptotic cells, percentage of macrophages). Both mesh modifications investigated showed an overall good biocompatibility. Macroscopic clinical observation after implantation of up to 182 days was uneventful. The tissue response to the PP as well as to the PP+T mesh was characterized by a moderate inflammatory tissue reaction limited to the perifilamentary region as is known for low weight, large porous, and monofilamentous mesh structures. No significant improvement of biocompatibility was found when analyzing the effect of titanium coating compared to the pure polypropylene mesh structure.     

Simplified technique for incisional hernia repair with mesh prosthesis

This paper describes a simplified technique for the repair of incisional hernias. The previous scar is resected, and the peritoneal sac is carefully dissected until it is completely exposed. The sac is opened to liberate structures adherent to the sac or to the area immediately surrounding the defect. The peritoneum is closed and invaginated to form a sac bed underlying the entire extent of the defect, and the mesh is laid on this sac bed. The mesh is then fixed with "U" stitches, reinforcing these by inserting a second line from the edge of the defect to the mesh. Suture material used is polypropylene 1/0 or 2/0. This procedure has been carried out on 15 patients, and after 1 year of follow-up, there has been no recurrence of the hernia. Operating time was reduced, and the surgical technique was found to be easier. Placing a mesh prosthesis inside the hernia sac and fixing it to the abdominal wall with two lines of suturing simplifies the repair procedure, reduces operating time, and is effective in the repair of all incisional hernias. A study is required to compare this outcome with the different mesh repair techniques.     

B超对疝环充填式无张力疝修补术后网塞和成型补片的观察(附16例临床报告)

目的　了解疝环充填式无张力疝修补术后网塞与成型补片的形态 ,探讨改进手术方法的必要性。方法　应用B超对 16例疝环充填式无张力疝修补术后病人网塞和成型补片进行观察并复习病历 ,评估手术方法对网塞和成型补片形态的影响及修补效果。结果　 16例中有 4例成型补片下端与耻骨缘重叠 ,12例未达到耻骨缘。对未达到耻骨缘的 12例改变探头切入角度 ,发现 8例成型补片下端呈高密度区增宽影 ,提示有折叠或卷曲 ,此高密度影与耻骨间还出现一低密度组织影间隙。未达到耻骨缘的 12例中 11例在手术中没有将成型补片下端与耻骨结节固定或曾剪短成型补片。结论　施行疝环充填式无张力疝修补术时 ,成型补片的处理应视术中情况把经典的疝环充填式无张力疝修补方法与Lichtenstein的修补方法结合起来 ,将成型补片缝合固定到耻骨结节的腱膜上。     

轻量聚丙烯补片与自固定补片在Lichtenstein疝修补术的研究

目的对比研究轻量大网孔聚丙烯补片与自固定补片在Lichtenstein疝修补术中的应用。 方法选择2021年1-3月在吉林大学第二医院60例单侧男性腹股沟疝患者行前瞻性随机对照研究,随机分为轻量大网孔聚丙烯补片组和自固定补片组各30例,分别应用轻量大网孔聚丙烯补片和自固定补片进行Lichtenstein疝修补术;对比2组一般资料、手术相关指标、术后平均住院时间、血清肿、补片感染、术后疼痛、复发、异物感以及治疗费用等相关情况进而评价两种补片的治疗效果。 结果2组患者一般资料、手术麻醉方式、术后住院时间比较差异无统计学意义（P>0.05）,2组的平均手术时间和治疗费用差异有统计学意义（P<0.05）;术后血清肿、术后短期（7 d及1个月）疼痛和慢性疼痛、补片感染、局部不适或异物感、复发等并发症差异均无统计学意义。 结论自固定补片可明显缩短手术时间,但医疗费用明显高于轻量大网孔聚丙烯补片,在术后复发和慢性疼痛等并发症方面差异不显著。     

应用聚丙烯和e-PTFE复合补片修补腹壁巨大切口疝

目的回顾性分析应用聚丙烯和e鄄PTFE复合补片修补腹壁巨大切口疝的效果,介绍腹腔内应用复合补片的方法和经验。方法1999年5月至2003年12月应用复合补片修补腹膜难以对合的腹壁巨大缺损22例,其中补片置于皮下12例,腹腔内10例。平均随访期39个月。结果手术后切口并发症的发生率为41%(9/22),1例修补术后复发,占4.6%。应用皮下法发生切口感染3例,其中1例因严重感染而将补片取出;切口处皮下积液2例。应用腹腔内法者中仅2例发生切口皮下少量积液。结论腹壁巨大切口疝,特别是难以关闭腹膜的病例,可应用聚丙烯和e鄄PTFE复合补片进行修补。应用腹腔内置补片法并辅以正确的术后处理可使局部并发症明显减少。     

Incisional hernia—comparison of mesh repair with Cardiff repair: an university hospital experience

Background: Incisional hernia is a frequent complication of abdominal surgery. Various types of repair are recommended for incisional hernia. Suture and mesh repair are compared in the present study. Method: One hundred seventy one patients with incisional hernia underwent Cardiff repair (far and near sutures with reinforcement sutures) which was used as an open suture repair while onlay polypropylene mesh was used in the mesh repair technique. Result: Cardiff repair was performed in 116 patients with no mortality with recurrence in two patients with mean follow up of 7.1 years. Both these patients with recurrence had a defect measuring more than 10 cm in width. Mesh repair was carried out in 55 patients with no recurrence in mean follow up of 37 months. Seroma formation was noted in 7 (12.72%) with mesh repair as compared to 4 (3.44%) patients with Cardiff repair. Conclusion: We recommend Cardiff repair for primary and small to medium size incisional hernias. Onlay polypropylene mesh is ideal for tension-free hernia repair, recurrent incisional hernia and hernia defects wider than 10 cm.     

部分可吸收腹壁疝修补材料的研究

目的 对聚丙烯网（polypropylene mesh，PPM）＋壳聚糖膜部分可吸收复合材料修补大鼠腹壁缺损的效果进行研究。方法 S-D大鼠80只，随机分为单纯PPM修补组（Ⅰ组），PPM＋壳聚糖膜复合材料修补组（Ⅱ组）和商品化防粘连复合补片组（Ⅲ组）。手术造成腹壁缺损，分别采用上述三种补片修补，术后分期进行腹腔内粘连评分，组织学检查及抗张强度的测定。结果 Ⅰ组大鼠术后各期腹腔粘连明显高于Ⅱ组及Ⅲ组（分别P〈0．05），而Ⅱ组及Ⅲ组之间差异无统计学意义（P〉0．05）。电镜下，术后90d观察，Ⅰ组网片表面新腹膜的生长不规则，Ⅱ组网片表面有光滑、完整的新腹膜间皮细胞形成，Ⅲ组网片表面则没有新腹膜形成，而是形成纤维素性包裹层。术后60、90d，三组网片修复腹壁缺损后的抗拉强度差异无统计学意义（P〉0．05）。结论 本研究中利用PPM与壳聚糖膜这两种廉价材料组合后设计的部分可吸收复合网片，可安全放置腹腔，能有效的防止术后的粘连，并维持良好的修复强度，值得进一步研究和开发。     

Comparison of recurrence with lightweight composite polypropylene mesh and heavyweight mesh in laparoscopic totally extraperitoneal inguinal hernia repair: an audit of 1,232 repairs

Background In Edinburgh a group of surgeons agreed to convert to a lightweight, composite mesh (Ultrapro—Ethicon) for totally extraperitoneal (TEP) inguinal hernia surgery. The aim of this study was to compare the outcome following the use of a new lightweight vs a standard heavyweight mesh during TEP hernia repair. Methods Patients undergoing TEP using lightweight (LWM) or heavyweight meshes (HWM) between March 2004 and March 2006 were identified from the Lothian Surgical Audit database. The patients who re-presented with recurrence of hernia were studied in greater detail. Date of re-attendance at a clinic with recurrence was used as a surrogate for date of recurrence. Results Two hundred and fifty one patients had 371 hernia repairs with LWM. A total of 16 (4.3%) recurred with a median follow-up of 14.5 months. A concurrent group of 326 patients had 425 repairs with standard mesh and have had 12 (2.82%) recurrences with a median follow-up of 22.4 months. A group of patients operated immediately prior to the introduction of LWM consisted of 328 patients who had 436 repairs using HWM, of whom 13 (2.98%) have recurred with a median follow-up of 43 months. Whilst there are no statistically significant differences in recurrence rates between these groups, we are concerned that the LWM group has the highest recurrence rate despite the shortest follow-up. Conclusion In view of increased patient comfort, we continue to recommend LWM for laparoscopic inguinal hernia surgery but would recommend that, in larger hernias and possibly for all, the surgeon should improve mesh adhesion.     

Indications for incisional hernia repair: an international questionnaire among hernia surgeons

BACKGROUND: Incisional hernia repair can be a significant challenge for both surgeon and patient. Despite the growing amount of literature describing various methods of surgical techniques, little has been published regarding the natural course of incisional hernia and the opinions about indications for incisional hernia repair. METHODS: A questionnaire was sent to a group of surgeons internationally renowned in incisional hernia surgery and research. RESULTS: Pain and limitations of daily activities were considered the most important indications for repair. Cosmetic complaints were seen as least important. About 23% of patients were asymptomatic. More than 20% did not receive surgical treatment. CONCLUSIONS: A large proportion of patients with incisional hernia is not operated. Despite this large group of patients, valid data describing the natural course are absent. A prospective trial monitoring incisional untreated hernias as well as comparing conservative treatment with repair should be performed.     

腹腔镜手术与疝环充填手术对成人腹股沟疝患者应激反应及相关并发症的对比分析

目的对比腹腔镜修补术和疝环充填手术治疗腹股沟疝对患者应激反应的影响及相关并发症情况。 方法分析安徽省第二人民医院2016年3月至2018年3月收治的132例腹股沟疝患者作为研究对象,分成对照组与观察组,每组各66例,对照组通过疝环充填手术进行治疗,观察组通过腹腔镜手术进行治疗,对比2组应激因子、炎性因子、手术效果,随访12个月,记录术后并发症发生率等指标。 结果共120例患者完成手术及术后随访工作,随访率90.91%。观察组的肿瘤坏死因子-α、血浆皮质醇、C反应蛋白、中性粒细胞百分比、白细胞计数等应激因子、炎性因子水平低于对照组（P<0.05）;2组患者的术后下床活动时间、恢复工作时间、术后疼痛持续时间、住院时间等指标对比有明显差异（P<0.05）;对照组、观察组的术后发热、尿潴留、血清肿、感染、慢性疼痛、复发等差异无统计学意义,观察组的术后急性疼痛发生率明显低于对照组（P<0.05）。 结论腹股沟疝患者通过腹腔镜手术进行治疗能够获得较为理想的效果,可明显的改善应激反应与炎性因子水平,不增加术后并发症,利于患者术后恢复。     

Early results for new lightweight mesh in laparoscopic totally extra-peritoneal inguinal hernia repair

Prosthetic mesh reinforcement is now routine in the management of inguinal hernia but can cause considerable pain and stiffness around the groin. The aim of this study was to compare the outcome after laparoscopic TEP inguinal repair using new lightweight or traditional heavyweight mesh performed in a single unit. Between November 2004 and March 2005, 113 patients underwent laparoscopic TEP inguinal repair using either lightweight (28 g/m²) or heavyweight (85 g/m²) mesh. Follow-up data was obtained using case note review and telephone-based questionnaire in April 2005. Follow-up information was obtained for 93 (83%) out of 113 patients. There was no difference between the two groups in the incidence of pain/discomfort at mean 3-month follow-up (45 vs 41%, Mann–Whitney U, P=0.641). However, there was a significant inverse correlation between the length of time since operation and severity of pain/discomfort in the lightweight group (P=0.001, Pearson test), suggesting a faster speed of recovery with lightweight mesh. Laparoscopic TEP inguinal hernia repair with lightweight mesh yields promising early results. Whilst there was no significant difference in pain or recurrence in the short term, post-operative pain scores improved earlier in patients with lightweight mesh compared to heavyweight mesh. This merits further study, with larger cohorts and longer follow-up, to determine the benefits of lightweight mesh. This study has been presented in abstract form at the British Hernia Society Conference 2005, Edinburgh.     

腹股沟疝腹膜前修补与网塞修补术式的对比研究

目的探讨腹股沟疝腹膜前修补与网塞修补术式的对比研究。 方法回顾性分析2010年1月至2018年1月，北京市房山区良乡医院接受开放腹股沟疝无张力修补术1 237例患者的临床资料，根据术式不同分为网塞组（703例）和腹膜前组（534例），分析比较2组患者术后感染、复发、慢性疼痛、异物感等不良事件的发生情况。 结果术后随访12～24个月，腹膜前修补在复发率、补片感染、术后慢性疼痛方面均优于网塞组，差异均有统计学意义（P<0.05）。 结论腹膜前间隙腹股沟疝无张力修补术安全、有效、可行性强，术后并发症发生率低。     

Computed tomographic measurements of mesh shrinkage after laparoscopic ventral incisional hernia repair with an expanded polytetrafluoroethylene mesh

Background  The potential for shrinkage of intraperitoneally implanted meshes for laparoscopic repair of ventral and incisional hernia (LRVIH) remains a concern. Numerous experimental studies on this issue reported very inconsistent results. Expanded polytetrafluoroethylene (ePTFE) mesh has the unique property of being revealed by computed tomography (CT). We therefore conducted an analysis of CT findings in patients who had previously undergone LRVIH with an ePTFE mesh (DualMesh, WL Gore, Flagstaff, AZ, USA) in order to evaluate the shrinkage of implanted meshes. Patients and methods  Of 656 LRVIH patients with DualMesh, all patients who subsequently underwent CT scanning were identified and only those with precisely known transverse diameter of implanted mesh and with CT scans made more than 3 months postoperatively were selected (n = 40). Two radiologists who were blinded to the size of the implanted mesh measured in consensus the maximal transverse diameter of the meshes by using the AquariusNET program (TeraRecon Inc., San Mateo, CA, USA). Mesh shrinkage was defined as the relative loss of transverse diameter as compared with the original transverse diameter of the mesh. Results  The mean time from LRVIH to CT scan was 17.9 months (range 3–59 months). The mean shrinkage of the mesh was 7.5% (range 0–23.7%). For 11 patients (28%) there was no shrinkage at all. Shrinkage of 1–10% was found in 16 patients (40%), of 10–20% in 10 patients (25%), and of 20–24% in 3 patients (7.5%). No correlation was found regarding the elapsed time between LRVIH and CT, and shrinkage. There were two recurrences, one possibly related to shrinkage. Conclusion  Our observations indicate that shrinkage of DualMesh is remarkably lower than has been reported in experimental studies (8–51%). This study is the first to address the problem of shrinkage after intraperitoneal implantation of synthetic mesh in a clinical material.     

Chronic pain after mesh repair of inguinal hernia: a systematic review

BACKGROUND: Chronic pain is a severe complication of mesh-based inguinal hernia repair. Its perceived risk varies widely in the literature. The current objectives are to review the incidence, severity, and consequences of chronic pain and its etiologies. DATA SOURCES: A multi-database systematic search was conducted for prospective trials on mesh-based inguinal hernia repair reporting the measurement and outcome of pain at least 3 months postoperatively with a minimum follow-up of 80%. CONCLUSIONS: After mesh-based inguinal hernia repair, 11% of patients suffer chronic pain. More than a quarter of these patients have moderate to severe pain, mostly with a neuropathic origin. As a consequence of chronic pain, almost one third of patients have limitations in daily leisure activities. Chronic pain is less frequent after endoscopic repair and with the use of a light-weighted mesh.     

Lichtenstein腹股沟疝修补术中使用自固定补片与缝合补片疗效比较的Meta分析

目的:比较自固定补片与缝合补片在Lichtenstein腹股沟疝修补术中应用的效果。方法:计算机检索2010年1月—2019年1月国内外数据库中关于在Lichtenstein无张力疝修补术中应用自固定补片与缝合补片效果比较的随机对照试验(RCT)。按照纳入和排除标准筛选文献后,使用Cochrane风险偏倚评估工具进行质量评价,采用Review Manager 5.3统计学软件进行效应量的合并分析。结果:最终纳入14项RCT共3 904例患者,其中自固定补片组1 930例,缝合补片组1 974例。Meta分析结果显示,与缝合补片组比较,自固定补片组的手术时间明显缩短(MD=-5.31,95%CI=-8.11～-2.51,P=0.000 2),术后切口感染发生率明显降低(RR=0.46,95%CI=0.26～0.81,P=0.007),但术后疝复发率较高(RR=1.67,95%CI=1.12～2.48,P=0.01)。两组患者的术后慢性腹股沟区疼痛发生率、术区异物感发生率、血肿发生率、血清肿发生率差异均无统计学意义(均P0.05)。结论:与传统缝合补片在Lichtenstein无张力修补术中应用效果相比,自固定补片具有缩短手术时间和降低术后切口感染发生率的优势,但术后短期(1年内)疝复发率可能升高,但该结论仍需更大样本高质量的研究予以验证。     

脱细胞基质生物补片与聚丙烯补片在腹股沟嵌顿疝治疗中应用效果的前瞻性随机对照研究

目的探讨脱细胞基质生物补片与聚丙烯补片在腹股沟嵌顿疝治疗中的临床效果及安全性。 方法采用前瞻性随机分组研究2013年5月至2015年5月,四川省人民医院60例腹股沟嵌顿疝患者作为研究对象。试验组采用脱细胞基质生物补片修补,对照组采用聚丙烯补片修补。对比分析2组患者手术时间、术后住院时间2组患者的复发率、手术切口感染、慢性疼痛、异物感等发生率情况。 结果试验组与对照组在一般资料、手术时间、术后住院时间方面比较,差异均无统计学意义（P>0.05）。术后随访3年,2组患者复发率、切口感染率、慢性疼痛发生率比较,差异均无统计学意义（P>0.05）。对照组患者术后异物感发生率高于研究组,对照组的血清肿发生率低于试验组,差异均有统计学意义（P<0.05）。 结论脱细胞基质生物补片治疗腹股沟嵌顿疝可降低术后异物感发生率,但不会增加复发率,具有一定的临床应用价值。     

A prospective study between two different techniques for the repair of a large recurrent ventral hernia: a double mesh intraperitoneal repair versus onlay mesh repair

Background: Massive ventral hernias are difficult to repair, especially with multiple recurrences. Numerous methods of repair have been described with an overall recurrence rate up to 33% after first repair and 44% after second repair, mostly occurring within 3 years of the repair. Methods: This is a prospective study on 41 patients who underwent surgery between January 2000 and August 2004 for recurrent large ventral hernias. Patients were randomized into two groups: group A included 22 patients, who were subjected to suture repair with an onlay polypropylene mesh, and group B, which included 19 patients, who were subjected to a tailored double mesh (Vicryl+polypropylene) intraperitoneal repair. Results: Superficial wound infection occurred in two patients (4.8%), one in each group. By a median follow up of 30 months, seroma formation or hernia recurrence was not found in group B in comparison to seven and six cases, respectively, in group A (p≤0.000). There was no intraabdominal complication in the cases subjected to double mesh intraperitoneal repair due to the protective effect of the inner Vicryl layer, which is characterized by its low reactivity. Conclusions: A double mesh intraperitoneal repair (ADMIR) is successful for the repair of recurrent large ventral hernias as it is applicable to all sites of ventral hernias. The mesh is mostly hidden within the abdomen with relatively affordable pain allowing for early mobilization, the complication rate is low and so far no recurrence was reported. A long-term follow up with a larger number of cases is advisable in order to determine the long-term success of this kind of repair.     

腹股沟疝无张力修补术后补片感染的外科治疗

目的探讨腹股沟疝无张力修补术后,补片感染的临床治疗经验。 方法采用回顾性横断面研究方法,收集2012年5月至2018年1月四川大学华西医院收治的35例腹股沟疝无张力修补术后感染患者的临床资料。观察指标：（1）手术及术后情况包括术后并发症情况、术后住院时间、抗生素的选择和使用。（2）随访情况包括术后再感染和远期并发症情况。采用电话、门诊或住院方式对患者进行6个月的随访,了解患者术后再感染及远期并发症发生情况。随访时间截止至2018年7月。正态分布的计量资料采用 ±s表示。 结果（1）手术及术后情况：35例腹股沟疝无张力修补术后感染患者均接受补片取出术,术后均使用抗生素抗感染治疗及创面敞开引流或安置引流管负压引流,其中行局麻手术患者2例,行全麻手术患者33例。35例补片取出中有3例补片侵及肠管,其中2例行肠切除吻合,1例补片侵蚀肠管为阑尾,行阑尾切除术。平均术后住院时间为（6.72±3.43）d。（2）随访情况：术后随访6个月,随访期间患者无术后并发症发生。患者术后随访均无腹股沟疝复发。 结论对腹股沟疝无张力修补术后补片感染患者,行补片取出术安全可靠,在处理补片感染时应及时手术。     

腹腔镜经腹膜前疝修补术中补片固定方式的演进及研究进展

自无张力疝修补术开展以来,补片类型和固定方式的选择成为外科医师术中必须考虑的问题,选择合适的补片固定方式对患者预后具有重要意义。近年来,随着腹腔镜技术和疝修补材料的发展,新型补片和补片固定技术已在临床普及,钉枪固定和缝合固定在经腹膜前疝修补手术中已较少使用,医用胶和自固定补片成为主流选择,也有学者认为,除大型直疝外,真...