Novel 3D-printed polycaprolactone/gelatin based biopatches loaded with natural antibacterial agents for hernia treatment

Background Any surgical incision can lead to the occurrence of incisional hernia (IH) even laparoscopic trocar incision. IHs typically develop within the first 5 years of surgery; however, their development may be delayed. In large hernias, the amount of viscera which progressively stretches and holds the hernia sac can form a 'second abdomen' making the repair of hernia difficult. Aim IH after abdominal surgery is an important problem. We aimed to evaluate the short-term recurrence rate as well as surgical complications in patients operated with onlay mesh repair technique for large and giant IHs. Patient and methods In our study, we had 40 patients who were complaining of large IH with a defect size of 10 cm or more. All of these patients were operated using the onlay mesh technique in which polypropylene mesh was used. Results A total of 40 cases of IH were repaired with placement of onlay mesh; two (5%) cases developed recurrence. The incidence of seroma in our study was 22.5%, making it the most common complication following the repair of IH. Seroma formation was followed by surgical site infection (15%) as the second most common complication. Conclusion Repair of large and giant IH using prosthetic nonabsorbable mesh has a reasonably good outcome with acceptable rates of recurrence. The technique of mesh placement is still at the surgeon's discretion. However, onlay mesh repair has shown promising results in our study. Seroma is the most common complication following the repair of large and giant IHs.

Background: Incisional hernia and primary ventral hernia are among the most common surgical problems that general surgeons face annually in the United States (U.S.). Over 2 million laparotomies are performed in the US and the subsequent incisional hernia rate is 3–20%. At our institution, over the last several years, one surgeon has been performing a unique repair of intermediate-sized hernias by combining open and laparoscopic approaches. We hypothesized that, through a minimal incision, lysis of adhesions and primary repair can be performed, which can then be buttressed with a laparoscopically placed mesh that provides a generous underlay reinforcement that cannot be achieved in open repair. Furthermore, this technique provides the additional benefit of apposition of the rectus muscles and decreased seroma formation compared to laparoscopic hernia repair. Methods: Patients that underwent ventral hernia repair with laparoscopic assistance at NYU Lutheran Medical Center between October of 2012 and January 2015 form this study population. Each patient’s demographic, intra-operative, and postoperative data were collected and analyzed. Patient demographics included gender, age, BMI, prior abdominal surgery, co morbidities, and anticoagulation use. Intra-operative data included defect size, mesh size, and operative time. Postoperative data included complications, length of hospitalization, re-currences, seroma formation, surgical site infections (SSI), and mesh explantation. The surgical technique was as follows: a minimal incision was used over the defect which was only big enough to allow dissection down to the hernia borders. The hernia was reduced and lysis of adhesions of surrounding tissue performed. The hernia was sized and a mesh chosen to provide at least 3 to 5 cm of underlay around the defect. A series of one to four stay sutures were placed in the midline of the mesh and the mesh was placed intra-corporeally. The defect was closed primarily using the Smead-Jones technique (in 17 of 19 patients) to provide a tension-free double layer closure. The abdomen was in-sufflated, the mesh visualized, fixed to the midline via the stay sutures, and tacked circumferentially. The subcutaneous tissue and the skin were closed with absorbable suture. Results: A total of 19 patients (12 females, 7 males) underwent the hybrid hernia repair from October 2012 through January 2015. Only 1 (5%) was admitted postoperatively due to severe underlying co morbidities. The average size of the hernia defect was 5.94 cm 2 (2.5–15 cm 2 ) with an average mesh size of 16×16 cm 2 (9×9–25×20 cm 2 ) being used. Average operative time was 153 minutes with a range of 69–281 minutes. One (5%) had an early (within the first three months post-surgery) recurrence of the hernia. One patient (5%) had an early superficial SSI noticed during the 1 week follow-up appointment and was treated with oral antibiotics. None of the patients required re-hospitalization. None of the patients developed any seroma or any deep tissue infections requiring mesh explantation. Fourteen (74%) of the 19 patients were reached via telephone for further follow-up. All 14 patients were satisfied with the results of their surgery with only 1 complaint of pre-existing gastritis unrelated to the surgery. All of the patients that were employed prior to the surgery were able to return to work post-operatively. None of the patients reported any residual incisional or back pain. Conclusions: Hybrid ventral hernia repair has the physiological benefit of fascial continuity by re-approximating the hernia edges. This technique also maximizes the benefit of laparoscopic repair while mini-mizing associated complications. Patients had no severe wound complications. This surgical technique resulted in a low recurrence rate, and minimal pain after the procedure, making the hybrid technique a safe alternative method when repairing intermediate sized ventral hernias.

Introduction Ventral hernia repair is one of the challenging surgical operations over time. It is suggested that sublay mesh repair has the lowest recurrence and surgical site infection in open anterior abdominal hernia repair. This study aimed to analyse the pros and cons of sublay mesh in ventral hernia repair to evaluate the significance of this technique as a treatment modality. Hospital stay, acute postoperative complications, and the recurrence rate were the main areas of investigation. Methods A retrospective study on 79 Patients with ventral hernias were operated on (electively) with sublay mesh repair over 3 years. Fit patients with first-time ventral hernias (primary and incisional) were included. Recurrent hernia, associated decompensated cardiopulmonary disorders, and bleeding disorders were excluded. The project Performa includes; patient's demographics, operative details, length of stay, postoperative complications, and follow-up, up to 12 months. Results All patients underwent open mesh repair using the sublay technique. Ventral hernia was five times more common in females than males. Mean age of presentation was at 44.8 years old. Mean operating time was 67 minutes and a 1-day hospital stay. Para-umbilical and incisional hernias represented the majority of cases. Component separation approach was added in three cases (3.7%). Simultaneous cholecystectomy was performed in 2 cases (2.5%). Only 6 cases (6.3%) developed wound-related complications, while 2 cases (2.5%) had a recurrence. Conclusion Sublay mesh repair is favourable for ventral abdominal hernia reconstruction. It is associated with a smooth and short hospital stay and the least incidence of complications and recurrence.

The effects of onlay titanium-coated mesh on recurrence, foreign body sensation and chronic pain after ventral hernia repair

Reliable complex abdominal wall hernia repairs with a narrow, well-fixed retrorectus polypropylene mesh: A review of over 100 consecutive cases

INCISIONAL HERNIA AND ITS REPAIR WITH POLYPROPYLENE MESH IN RENAL TRANSPLANT RECIPIENTS

Mesh options for reinforcement of ventral/incisional hernia (VIH) repair include synthetic or biologic materials. While each material has known advantages and disadvantages, little is understood about outcomes when these materials are used in combination. This multicenter study reports on the first human use of a novel synthetic/biologic hybrid mesh (Zenapro® Hybrid Hernia Repair Device) for VIH repair. This prospective, multicenter post-market clinical trial enrolled consecutive adults who underwent elective VIH repair with hybrid mesh placed in the intraperitoneal or retromuscular/preperitoneal position. Patients were classified as Ventral Hernia Working Group (VHWG) grades 1-3 and had clean or clean-contaminated wounds. Outcomes of ventral and incisional hernia were compared using appropriate parametric tests. In all, 63 patients underwent VIH repair with hybrid mesh. Most were females (54.0%), had a mean age of 54.8±10.9years and mean body mass index of 34.5±7.8kg/m2, and classified as VHWG grade 2 (87.3%). Most defects were midline (92.1%) with a mean area of 106±155cm2. Cases were commonly classified as clean (92.1%) and were performed laparoscopically (60.3%). Primary fascial closure was achieved in 82.5% with 28.2% requiring component separation. Mesh location was frequently intraperitoneal (69.8%). Overall, 39% of patients available for follow-up at 12months suffered surgical site events, which were generally more frequent after incisional hernia repair. Of these, seroma (23.7%) was most common, but few (8.5%) required procedural intervention. Other surgical site events that required procedural intervention included hematoma (1.7%), wound dehiscence (1.7%), and surgical site infection (3.4%). Recurrence rate was 6.8% (95% CI 2.2-16.6%) at 12-months postoperatively. Zenapro® Hybrid Hernia Repair Device is safe and effective in VHWG grade 1-2 patients with clean wounds out to 12months. Short-term outcomes and recurrence rate are acceptable. This hybrid mesh represents a novel option for reinforcement during VIH repair.

Fascial Closure: New Surgery Paradigms

Comparative Study of Laparoscopic versus Open Ventral Hernia Repair.

Introduction: Ventral hernia repair is one of the challenging surgical operations over time. Several surgical techniques for mesh repair have been described (onlay, inlay, sublay, and underlay repairs). It is suggested that sublay mesh repair has the lowest recurrence and surgical site infection in open anterior abdominal hernia repair. This study aimed to analyze the pros and cons of the sublay mesh in ventral hernia repair to evaluate the significance of this technique as a treatment modality. Hospital stay, acute postoperative complications, and the recurrence rate were the main areas of investigation.Methods: A retrospective study on 79 patients with ventral hernias who were operated on with sublay mesh repair between January 2015 and December 2018 was conducted. Patients were admitted through the elective route. The study included fit patients with first-time ventral hernias (primary and incisional). Recurrent hernia, patients with decompensated cardiopulmonary disorders, and bleeding disorders were excluded from the project. The project pro forma includes patient’s demographics, operative details, length of stay, postoperative complications, and follow-up up to 12 months.Results: All patients underwent open mesh repair using the sublay technique. The ventral hernia was five times more common in females than males. The mean age of presentation was 44.8 years old. The mean operating time was 67 minutes and a one-day hospital stay. Paraumblical and incisional hernias represented the majority of cases. The component separation approach was added in three cases (3.7%). Simultaneous cholecystectomy was performed in two cases (2.5%). Only six cases (6.3%) developed wound-related complications, while two cases (2.5%) had a recurrence.Conclusion: The sublay mesh repair is a perfect choice for the repair of ventral abdominal hernia. It is associated with a smooth and short hospital stay and the least incidence of complications and recurrence.

Background: The common abdominal hernias include paraumbilical, umbilical, incisional and epigastric hernia. All varieties of ventral hernias are characterized by a defect in anterior abdominal wall. Incisional hernia is defined as a defect occurring through the operative scar. It is the only hernia considered to be truly iatrogenic. It occurs due to failure of the lines of closure of abdominal wall following laparotomy. Conventionally these hernias are treated by suture repair which has led to a substantial rate of recurrence whereby increasing demand for a better technique of repair. The introduction of mesh repair of these hernias has shown encouraging results over the past few years and many studies have shown a substantial decrease in the rate of recurrence with this technique. Objectives: To assess the early post-operative complications (within 30 days) following Intra peritoneal onlay mesh repair in Dhaka Medical Collage & Hospital, Dhaka, Bangladesh. Methods: This Observational study conducted in department of Surgery, DMCH, Dhaka in study period from June 2016 to May 2017. A total of 30 patients were purposively selected from department of Surgery in DMCH who underwent laparoscopic Intra peritoneal onlay mesh repair for ventral hernia. Patients with ventral hernia in department of Surgery, DMCH, Dhaka in study period. Data analysis was done by SPSS for windows version 21. The 30 days post-operative outcome was analyzed. Postoperatively, patients were observed for Post-operative pain, seroma, post-operative ileus, post- operative cellulitis, wound infection, mesh infection, mesh migration, early mesh failure. Patients were followed up on 7th, 15th and 30th post-operative day. Results: With the objectives to determine the early post-operative complications (within 30 days) following Intra peritoneal onlay mesh repair in department of surgery in DMCH, a total of 30 patients were purposively selected. It was found that more than half of the patients (55.3%) were 31-45 years age group. Only 13.8 % from younger age group (15-30 years). Rest of them are older (>46 years) group. Among the respondents most of the patients were female (65.1%). It was found that 36.66 % patient were with incisional hernia (81.6%) followed by para umbilical hernia (11.2%), only 2.6% were umbilical hernia. It also showed that all hernia cases were common after 30 years except umbilical hernia. Most of the cases in this study, hernia lesions were between 5-7 cm in size (73.7%). 13.8% were hernia with size of defect 8 cm and 12.5 % were hernia defect less than 5 cm. Most of the incisional and Para-umbilical lesions were between 5-7 cm sizes whereas epigastric hernia lesions were less than 5 cm size. Among all post-operative complications, seroma formation was highest in this study. In incisional hernia repair 23.38% patients develop seroma after operation, when post- operative seroma formation compared with different type of hernia repair, it found statistically significant in this study. 16% patients with incisional hernia had developed post-operative wound infection. Conclusion: Among the ventral abdominal hernia incisional and the para umbilical hernia constitute the most. In the repair of these hernias through laparoscopic intraperitoneal onlay mesh repair the most common early post-operative complications were seroma formation and wound infection in the form of superficial surgical site infection. Larger hernia required longer operative duration and associated with more post-operative complication. Journal of Surgical Sciences (2021) Vol. 25 (1) : 10-22

Background and Objectives: This prospective observational study conducted at Parul Sevashram Hospital, Vadodara aimed to examine the diversity in surgical techniques used for primary and incisional ventral hernia repair (VHR). Methods: Twenty-five elective VHR patients treated from January 1, 2023, to March 31, 2023, were enrolled. Patients were monitored for 90 days post-surgery. Exclusion criteria included patients under 18 years old and those undergoing emergency surgeries. The primary objective was to compare surgical approaches between primary and incisional hernia repairs. Secondary objectives focused on intraoperative procedures such as mesh selection, fixation techniques, and drain placement, as well as evaluating postoperative outcomes at 3 months, including infection rates, surgical site issues, mortality, and readmission rates within 90 days. Results: Data from 25 patients were analysed: 14 (58%) had primary hernias (PH) and 11 (42%) had incisional hernias (IH), including 1 (9.09%) recurrent case. – PH Group: Procedures included 6 (42.85%) open Onlay, 4 (28.57%) open Sublay, 1 (7.14%) intraperitoneal Onlay meshplasty (IPOM), and 3 (21.42%) suture repairs. Complications: 7% seroma, 0% surgical site infection (SSI), 0% recurrence. – IH Group: Procedures included 7 (63.63%) open Onlay, 3 (27.3%) open Sublay, and 1 (9.09%) suture repair. Complications: 9% seroma, 9% hematoma, 0% SSI, 9% wound sinus, 0% recurrence. Conclusion: Onlay meshplasty emerged as the predominant procedure for both primary and incisional hernias. However, open Sublay repair showed promising results with fewer seroma-related complications. Standardizing guidelines could optimize outcomes in VHR.

Background: Laparoscopic repair of various abdominal wall hernias are well accepted procedure due to its low post- operative complications, recurrence and long term results. Various procedures have been described like IPOM, MILOS, E-MILOS, SCOLA, TES and E-TEP. Here we present short term outcome of ventral abdominal wall hernia patients operated by extended total extra peritoneal (E-TEP) repair at a tertiary care hospital over a period of two years.Aims and Objectives: To assess the initial outcomes of patients of ventral abdominal hernias operated by extended total extra peritoneal mesh repair (E-Tep).The study was done to find out the effectiveness of E-Tep repair in surgical treatment of ventral abdominal wall hernia patients.Methods: All the patients operated electively for uncomplicated ventral hernias from November 2020 till December 2021 were selected for the study and followed up for one year till December 2022. Results: In our study 35 patients, were operated by E-Tep for ventral hernia repair. There was no incidence of postoperative complications in terms of, haemorrhage, surgical site infection, chronic pain and recurrence. There was 10.5% incidence of seroma in postoperative period which was managed conservatively.Conclusion: In our experience, E-Tep repair is found to be effective as it allows flexibility in placement of ports for better suturing and deployment of an adequate size of polypropylene mesh in a retro muscular space.

Introduction Standard rectus plication techniques may not suffice for severe cases of rectus diastasis, especially with ventral hernia. In our study, prosthetic subfascial sublay mesh and onlay mesh may facilitate the repair of severe rectus diastases, especially with concomitant ventral hernias. There is little agreement about the most appropriate technique to repair these defects, in spite of the fact in the prevalence of ventral hernias we are often faced with reinforcement with prosthetic meshes. In the component separation technique, we found high unaccepted recurrence rate. In an attempt to reduce recurrences, we attempt to use sublay mesh and onlay mesh to inforce the defect and prevent or to decrease the recurrence. Our objective was to determine prosthetic mesh practice patterns of onlay and sublay reconstructive methods regarding indications. Patients and methods A total of 32 consecutive patients who underwent abdominal wall reconstruction by means of component separations associated with polypropylene mesh were included. A technique of placing mesh in a sublay manner, deep to the rectus muscles without anterior dissection of rectus abdominis from anterior sheath to avoid damage of its blood supply and damage deep umbilical perforators during dissection ended by onlay mesh on anterior rectus sheath, was applied. The complications were recorded and follow-up data were obtained after double-mesh technique. Aim To use prosthetic polypropylene mesh sublay (above or anterior to the posterior rectus sheath) with another onlay mesh (above the anterior rectus sheath) for rectus diastasis with or without ventral hernia. Results From May 2016 to January 2018, we had 16 patients who underwent cosmetic abdominal repair either for a ventral hernia repair with mesh or a rectus diastasis repair with mesh. Three patients had (isolated) rectus diastasis alone. The mean age of the patients was 55 years, with a range of 35–75 years of age. Overall, 92% of the patients were female. The mean;Deg;BM;Deg;I of the patients was 32 kg/m2 (range: 25–40 kg/m2). There were no surgical-site infections but three surgical-site occurrences − seromas, which were treated with drainage in the office. After an average of 365 days of follow-up, none of the patients had recurrence of a bulge or a hernia. Conclusion This study used a double-mesh reinforcement procedure, with a low rate of recurrence and occurrences. Moreover, the repair of a large, complex hernia by double-mesh repair technique augmented with polypropylene onlay mesh and sublay results in lower recurrence rates compared with historical reports of component separation technique alone.

Mesh placement during repair of acutely incarcerated ventral and groin hernias is associated with high rates of surgical site infection (SSI). The utility of preoperative computed tomography (CT) in this setting is unclear. We hypothesized that CT evidence of bowel wall compromise would predict SSI while accounting for physiologic parameters. We performed a 4-year retrospective cohort analysis of 50 consecutive patients who underwent mesh repair of acutely incarcerated ventral or groin hernias. We analyzed chronic disease burden, acute illness severity, CT findings, operative management, and herniorrhaphy-specific outcomes within 180 days. The primary outcome was SSI by the Centers for Disease Control and Prevention criteria. Multiple logistic regression was performed to identify independent predictors of SSI. Eighty-four percent of all patients were American Society of Anesthesiologists class III or IV, 28% were active smokers, and mean body mass index (BMI) was 35 kg/m. Fifty-four percent had ventral hernias, 40% had inguinal hernias, and 6% had femoral or combined inguinal/ femoral hernias. Seventy percent of preoperative CT scans had features suggesting bowel compromise, abdominal free fluid, or fluid in the hernia sac. Surgical site infection occurred in 32% of all patients (8% superficial, 24% deep or organ/space). The strongest predictors of SSI were CT evidence of fluid in the hernia sac (odds ratio [OR], 8.3; 95% confidence interval [CI], 1.7-41), initial heart rate 90 beats/min or greater (OR, 6.3; 95% CI, 1.1-34), and BMI 35 kg/m or greater (OR, 5.8; 95% CI, 1.2-28). Surgical site infection rates were significantly higher among patients who had CT evidence of fluid in the hernia sac (56% vs. 19%, p = 0.012). More than half of all patients with CT scan evidence of fluid in the hernia sac developed an SSI. Computed tomography evidence of fluid in the hernia sac was the strongest predictor of SSI, followed by heart rate and BMI. Together, these parameters identify high-risk patients for whom better strategies are needed to avoid SSI without sacrificing durability. Prognostic study, level III; Therapeutic, level IV.