Ventralight ST and SorbaFix Versus Physiomesh and Securestrap in a Porcine Model

Background and Objectives:

The objective of this study was to compare mesh contracture, adhesion characteristics, tissue ingrowth, and histologic response of Ventralight ST/SorbaFix (C.R. Bard/Davol, Warwick, RI, USA) with Physiomesh/Securestrap (Ethicon, Somerville, NJ, USA) in a porcine model of laparoscopic ventral hernia repair.

Methods:

Standard laparoscopic technique was used to bilaterally implant meshes in 10 female Yorkshire swine. Each animal received either two Ventralight ST meshes (oval shaped, 10.2 × 15.2 cm) or two Physiomesh meshes (oval shaped 10 × 15 cm), one on either side of the midline. The meshes were fixated to the intact peritoneum with either SorbaFix (for animals receiving Ventralight ST) or Securestrap (for animals receiving Physiomesh). There were 5 animals in each group, yielding 10 of each mesh-fixation combination. Mesh contracture, adhesion characteristics, tissue ingrowth, and histologic response were evaluated after 14 days by image analysis, mechanical testing, and histologic staining (hematoxylin-eosin, Masson trichrome, picrosirius red, and von Willebrand factor).

Results:

Ventralight ST/SorbaFix and Physiomesh/Securestrap exhibited a similar percentage of mesh contracture, percentage of adhesion coverage, adhesion tenacity, collagen deposition, and levels of necrosis (P > .05 in all cases). However, Ventralight ST/SorbaFix exhibited significantly less inflammation (P = .0001), fibrosis (P = .0017), hemorrhage (P = .0001), and angiogenesis (P = .0032) and significantly greater strength of tissue ingrowth (P = .0003) than Physiomesh/Securestrap after the 14-day implantation period.

Conclusions:

Ventralight ST/SorbaFix exhibited more favorable strength of tissue ingrowth and histologic response and similar mesh contracture and adhesion characteristics compared with Physiomesh/Securestrap over a short-term 14-day implantation period in a preclinical porcine model.     

注水分离腹膜法在腹腔镜小儿疝手术中的应用

目的探讨注水分离腹膜法在腹腔镜小儿腹股沟斜疝高位结扎术中的价值。方法选取确诊为腹股沟斜疝的男性患儿56例,应用注水分离腹膜法进行腹腔镜手术。结果56例均顺利完成手术,平均手术时间11min,平均出血量少于1ml,无腹内脏器损伤、阴囊血肿、输精管或精索损伤等并发症发生。结论应用注水分离腹膜法,使得腹腔镜小儿疝手术相对简化,提高了手术安全性,得值推广应用。     

Adult umbilical hernia with vertical dislocation

We present a case of adult umbilical hernia with vertical dislocation along the abdominal wall. The hernial sac arose from the internal ring and connected to the umbilicus 20?mm below the internal ring. The postoperative course was uneventful. Two years and four months after the operation there was no evidence of recurrent hernia even when abdominal pressure was increased, and the umbilicus looked acceptable. An umbilical hernia is usually within the umbilicus. The hernial sac arose from the internal ring so should be called an umbilical hernia not an epigastric hernia. It is unusual that the umbilical hernia dislocates vertically along the abdominal wall, while the umbilicus stays depressed. This atypical form of umbilical hernia has not been described previously as far as we know.     

A defect of the abdominal wall with intestinal fistulas after the repair of incisional hernia using Composix Kugel Patch

INTRODUCTIONIn the present paper, we show a rare case of the large abdominal wall defect and enterocutaneous fistulas after the tension free repair using prostheses for incisional hernia.PRESENTATION OF CASEThe patient, a 70-year-old man, had a history of a hemicolectomy for a perforating colon cancer, complicated by a large incisional hernia that was closed primarily but recurred. Three years later, the hernia was repaired at the time of a second colectomy using a Composix Kugel Patch. His course was complicated by a chronic postoperative wound infection with eventual development of enterocutaneous fistulas. The patient was successfully treated with extirpation of the prosthesis, resection of the fistulized bowel, and placement of a tensor fasciae latae myocutaneous flap.DISCUSSIONEnterocutaneous fistulas are a known complication of incisional hernia repairs using prostheses. Additional clinical data are required to confirm the safety and efficacy of this procedure as it becomes more widely adopted.CONCLUSIONExtirpation of the prosthesis should be performed without delay to prevent serious complications. Reconstruction with a tensor fasciae latae myocutaneous flap was useful for the large abdominal wall defect.     

Traumatic abdominal wall hernia: Delayed repair: Advantageous or taxing

INTRODUCTIONTraumatic abdominal wall hernia (TAWH) is a rare entity. Most cases occur in children, following an injury from the bicycle handle bar. In adults, it usually results from road traffic accidents (RTA). We present one of the largest reported cases of TAWH following RTA managed by delayed mesh repair.PRESENTATION OF CASEA 35 yr old obese male with RTA was diagnosed with TAWH with 19 cm × 15 cm defect in left flank. As there were no intra abdominal injuries and overlying skin was abraded, he was planned for elective repair after 6 months. On exploration a defect of 30 cm × 45 cm was found extending from midline anteriorly to 8 cm short of midline posteriorly in transverse axis and costal margin to iliac crest in craniocaudal axis. After restoration of bowel into abdominal cavity, primary closure or even approximation of muscular defect was not possible thus a mesh closure using 60 cm × 60 cm prolene mesh in subcutaneous plane was done. After 4 months follow up, patient is healthy and has no recurrence.DISCUSSIONEmergent surgical management of TAWH is usually favoured due to high incidence of associated intra abdominal injuries. Delayed repair may be undertaken in selected cases.CONCLUSIONTAWH, although rare, should be suspected in cases of RTA with abdominal wall swellings. With time, the hernia defect may enlarge and muscles may undergo atrophy making delayed repair difficult.     

Management of Spigelian hernia caused by necrobiotic fibroma of the uterus in a pregnant woman

INTRODUCTIONSpigelian hernias are a rare type of hernia through the Spigelian aponeurosis. Spigelian hernias are very uncommon and constitute only 0.12% of all abdominal wall hernias. These hernias are located in the aponeurosis of the internal oblique muscle and transverse abdominal muscle.PRESENTATION OF CASEA 30-year-old woman at 28 weeks’ gestation was admitted to the obstetrics department due to pain and swelling in the anterior abdominal right region. On inspection, we suspected either a lipoma, a spontaneous hematoma, a tumor of the abdominal wall, or a Spigelian hernia. A Doppler USG and abdominal and pelvic Magnetic Resonance Imaging revealed necrobiotic fibroma of the uterus in Spigelian hernia. The patient was started on dual analgesic and corticotherapy. Overall, the patient improved one week after the acute episode and had no further pain during her gynecologic follow-up.DISCUSSIONWe have reported a first case of Spigelian hernia that was complicated by uterine fibroid. The clinical presentation varies, depending on the contents of the hernial sac and the degree of herniation. MRI is the preferred method for accurately identifying masses of the abdominal wall. Our treatment options were based on the extent of the acute-phase reaction and the venous thrombosis.CONCLUSIONIt is important to differentiate this rare Spigelian hernia from other hernias as the treatment for this hernia is medical rather than surgical. Before the final choice of treatment is made, digestive surgeons should bear this rare hernia in mind.     

Autologous reconstruction of the inguinal ligament using pedicled fascia lata flap: A new technique

INTRODUCTIONA technique of reconstructing the inguinal ligament using a pedicled fascia lata flap is described.PRESENTATION OF CASEA 62-year-old man was referred with massive bilateral abdominal wall hernias, following numerous attempts at repair and subsequent recurrences. There was complete absence of the right inguinal ligament.The inguinal ligament was reconstructed using a strip of fascia lata, pedicled on the anterior superior iliac spine. This was transposed to cover the external iliac vessels, and sutured to the pubic tubercle. The musculoaponeurotic abdominal wall was reconstructed with two 20 cm × 20 cm sheets of porcine acellular dermal matrix and an overlying sheet of polypropylene mesh, sutured to the remaining abdominal wall muscles laterally, and to both inguinal ligaments. The cutaneous abdominal wall was closed with an abdominoplasty technique.The reconstruction has remained intact nine months following surgery.DISCUSSIONComplete destruction of the inguinal ligament is rare but can occur following multiple operative procedures or trauma. To date, the only published reports of inguinal ligament reconstruction have been performed using synthetic mesh. The use of autologous tissue should reduce the risk of erosion into the neurovascular bundle, seroma formation, and enhance integration into surrounding tissues.CONCLUSIONThis new technique for autologous reconstruction of the inguinal ligament provides a safe alternative to the use of synthetic mesh in the operative armamentarium of plastic and hernia surgeons.     

Transmesenteric hernia: A rare cause of bowel ischaemia in adults

INTRODUCTIONTransmesenteric herniae are a rare cause of bowel ischaemia in adults with few reported cases in published literature.PRESENTATION OF CASEWe report a rare case of a 26-year-old female with spontaneous transmesenteric hernia of jejunum and proximal ileum due to a congenital mesenteric defect resulting in bowel gangrene, presenting initially with no haemodynamic or biochemical abnormalities. The hernia was reduced, small bowel resected and primary side to side anastomosis performed, following which the patient made a good recovery and was discharged 5 days later.DISCUSSIONThe insidious onset of transmesenteric herniae and lack of specific radiological or laboratory investigations reaffirms the importance of surgeons maintaining a high index of suspicion for this critical surgical emergency.CONCLUSIONClose monitoring of the patient's general condition in cases of non-specific abdominal pain is essential to identify the rare deteriorating patient for early surgical intervention and optimal outcome.     

A rare inguinal mass: Round ligament leiomyoma

INTRODUCTIONLeiomyoma of the round ligament is a rare condition and usually appears like an inguinal hernia.PRESENTATION OF CASEWe report a case of a 40 year-old women found to have an inguinal mass which it was finally diagnosed as leiomyoma.The patient was admitted to our hospital with a history of painless groin mass. The mass was thought to be irreducible inguinal hernia. Surgical exploration demonstrated a round ligament leiomyoma.DISCUSSIONA smooth muscle tumor in the round ligament of the uterus in the inguinal region is a rare entity and can be mistaken for an irreducible inguinal hernia. It is a rare condition occurring predominantly in premenopausal middle-aged women. Abdominal, inguinal, and vulvar locations have been described. Surgical excision is the curative treatment.CONCLUSIONLeiomyoma of the round ligament should be entertained as a possible etiology of inguinal mass.