Tooth mesh repair method based on side length-area constraint and dihedral angle driven subdivision

While transvaginal permanent mesh is associated with lower rates of awareness of prolapse, repeat surgery for prolapse, and prolapse on examination than native tissue repair, it is also associated with higher rates of total repeat surgery (for prolapse, stress urinary incontinence, or mesh exposure), bladder injury, and de novo stress urinary incontinence. While the direction of effects and effect sizes are relatively unchanged from the 2016 version of this review, the certainty and precision of the findings have all improved with a larger sample size. In addition, the clinical relevance of these data has improved, with 10 trials reporting 3- to 10-year outcomes. The risk-benefit profile means that transvaginal mesh has limited utility in primary surgery. Data on the management of recurrent prolapse are of limited quality. Given the risk-benefit profile, we recommend that any use of permanent transvaginal mesh should be conducted under the oversight of the local ethics committee in compliance with local regulatory recommendations. Data are not supportive of absorbable meshes or biological grafts for the management of transvaginal prolapse.

The article by Dr. Kurzer and colleagues reports more than 100 consecutive patients with incisional hernias repaired with a sublay mesh technique. The outcome is excellent regarding postoperative complications (seromas, abdominal wall discomfort, recurrences). In congruence with the Swedish study cited, a surprisingly large proportion of incisional hernias followed incisions often regarded as being associated with a very low rate of incisional hernia (e.g., gridiron, Pfannenstiel, and subcostal incisions). The operative technique is described in detail concerning what are probably the crucial steps with a sublay mesh technique and seems to have been meticulously followed. It is stated that a standard-weight polypropylene mesh was used, probably reflecting the authors’ sound judgment that the method of repair is more important for the outcome than the trade name of the mesh. Results in this study challenge the concept of incisional hernias recurring late after mesh repair. Placing the mesh with wide overlap may then be important. The method of suturing the aponeurosis to the mesh in case the midline cannot be closed without tension has previously rarely been described. It is a method commonly used in Sweden. and it is attractive because further trauma to the abdominal wall, often necessary when insisting on closure of the midline, is thus avoided. That a mesh should be used for incisional hernia repair seems obvious as results have been poor with suture repair. The questions whether the mesh repair should be laparoscopic or open and if open whether the mesh should be placed in a sublay or an onlay position cannot be answered from this study. The discussion in this article on the subject, however, is highly erudite. The problem is that those questions cannot be answered at all today because randomized control studies are lacking. While awaiting results from such studies we mainly rely on clinical series presented. At best, then, we can presume that these results can be reproduced if the operative technique described is followed. This is a thorough presentation that sets a good standard on how to conduct and present studies on incisional hernia repair that could be used in randomized trials. How is more knowledge to be achieved on how to repair incisional hernia? One difficulty with randomized control studies in this field is that participating surgeons are often familiar with, or interested in, only one of the methods studied. One answer might be expert-based randomized studies; that is, patients are randomized to surgeons with expert knowledge of the methods to be scrutinized. Another possibility may be clustered randomized studies; in other words, results are compared in prospective studies among centers specializing in different methods of incisional hernia repair.

The optimum method for inguinal hernia repair has not yet been determined. The recurrence rate for non-mesh methods varies between 0.2 and 33 per cent. The value of tension-free repair with prosthetic mesh remains to be confirmed. The aim of this study was to compare mesh and non-mesh suture repair of primary inguinal hernias with respect to clinical outcome, quality of life and cost in a multicentre randomized trial in general hospitals. Between September 1993 and January 1996, all patients scheduled for repair of a unilateral primary inguinal hernia were randomized to non-mesh or mesh repair. The patients were followed up at 1 week and at 1, 6, 12, 18, 24 and 36 months. Clinical outcome, quality of life and costs were registered. Three hundred patients were randomized of whom 11 were excluded. Three-year recurrence rates differed significantly: 7 per cent for non-mesh repair (n = 143) and 1 per cent for mesh repair (n = 146) (P = 0.009). There were no differences in clinical variables, quality of life and costs. Mesh repair of primary inguinal hernia repair is superior to non-mesh repair with regard to hernia recurrence and is cost-effective. Postoperative complications, pain and quality of life did not differ between groups.

The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair. It involved 70 investigators in 20 countries. Twenty eligible trials (5016 participants) of open mesh vs. non-mesh groin hernia repair were identified. Meta-analysis was performed using raw individual patient data where possible. Fewer hernia recurrences were reported after mesh repair. There were no clear differences between mesh and non-mesh groups in complications. Overall, those in the mesh groups had a shorter hospital stay, quicker return to usual activities and less frequent persisting pain, but individual trial results varied. The review provides strong evidence that open mesh repair is associated with a reduction in the risk of recurrence of between 50% and 75%. There is also some evidence of quicker recovery and of lower rates of persisting pain following open mesh repair.

AIMS: Though there are so many methods in repair of hernia, no one is exempted from complications hence surgery on hernia is still a challenging subject.The objectives of this study are to study the incidence and different modes of presentation of inguinal hernia, to compare between mesh repair and Bassini's repair in relation to hernia recurrence.METHODOLOGY: 60 cases of inguinal hernia who were admitted in various surgical units of K.R. Hospital, Mysore from JAN 2008 to JULY 2009 were selected randomly for study.All complicated inguinal hernias were excluded from the study.Sixty cases of inguinal hernia (30 mesh repair, 30 Bassini's repair) were randomly selected and studied in detail..The data was analysed by using standard statistical methods.RESULTS: K. R. Hospital incidence of inguinal hernia in is 8.3%.sex ratio: M:F::19:1.Smoking is the major risk factor.43.3% came to the hospital after one year of onset of symptoms.55% of the patients had right sided hernia.The mean hospital stay in conventional repair is 6.8 days and mean hospital stay in mesh repair is 5.6 days.The postoperative complications were more in patients who underwent conventional repair.80-85% of patients were followed up for 3 years.One recurrence was noted in Bassini's repair group and no recurrence in mesh repair group.13% developed chronic groin pain following mesh repair, whereas 23% developed chronic groin pain after Bassini's repair.CONCLUSION: Lichtenstein mesh repair has significantly reduced complications, less hospital stay, low recurrence rate, less duration of surgery and early return to work when compared to the conventional repair & is cost effective.

Objective: To compare post-operative pain outcomes between self-gripping mesh repair and prolene sutured mesh fixation in Lichtenstein repair for inguinal hernia at a tertiary care hospital in Karachi. Study Design: Randomized Controlled Experiment. Setting: Surgical Unit 3, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. Period: April 2023 to September 2023. Methods: A full six months of research were dedicated to the topic. Methodology: A total of 100 male patients aged 18 to 60 years undergoing elective inguinal hernia repair were randomly allocated into two groups: Group 1 received self-gripping mesh repair, and Group 2 received prolene sutured mesh repair. Pain scores were assessed post-operatively at 8 hours, 24 hours, and on the 5th day using the Visual Analogue Scale (VAS). Demographic and clinical data were analyzed using SPSS version 20, and comparison of pain scores between the groups was performed using the independent t-test with significance set at P < 0.05. Results: Total 100 patients admitted for inguinal hernia repair were included. The mean age was 31.840+3.606 years. The mean post-operative pain score (at 8 hours, 24 hours & at 5th day) in group 1 was 4.640+0.631, 2.640+0.622 & 1.540+0.542 respectively while in group 2 it was 6.640+1.045, 5.580+0.730 & 3.780+0.932 respectively. Conclusion: In conclusion the mean post-operative pain in self gripping mesh repair was significantly low as compared to prolene sutured mesh repair. So self-gripping mesh repair method is superior over prolene sutured mesh repair method.

BackgroundUmbilical hernia repairs (UHRs) are commonly performed worldwide, yet knowledge regarding methods of repair remains limited. This study aimed to assess the trends and prevalence of suture versus mesh repairs for UHRs in Sweden over time.MethodsThis observational population-based registry study utilised prospectively collected data from the nationwide Swedish Perioperative Registry. Patients aged ≥18 who received a UHR between the years 2017–2022 were eligible. Surgical units were categorised into six healthcare regions. The primary outcome was to observe the trend in repair methods (suture vs. mesh) over time. The secondary outcome included descriptive patient- and hernia characteristics of the UHRs, along with regional variations.ResultsOut of 10,374 primary elective UHRs, mesh was used in 47.9% of cases, with 14.2% performed laparoscopically. Mesh repairs were less common in women (38.7%) compared to men (52.1%) (p < 0.001). Suture repair patients had a lower median age (49 years) and BMI (27.2 kg/m2) compared to those with mesh repairs (55 years, BMI 29.7 kg/m2) (p < 0.001). A higher ASA class (3–4) was more common for mesh repair recipients (17.1%) compared to suture repair recipients (10.9%). The use of mesh repairs increased from 46.2% to 49.4% over the study period (p = 0.063), with only the Southern healthcare region showing a significant rise from 25.0% to 56.1% (p < 0.001).ConclusionThe use of mesh repairs has not yet significantly influenced UHR practices in Sweden. Mesh was used more frequently among men, obese patients, older individuals, and those with greater co-morbidities.

Background: Hernia repair is one of the most common procedures in general surgery, which is performed by various methods. One of the consequences of hernia repair is the recurrence of hernia in the short or long term. In this study, the rate of hernia recurrence in surgical patients with mesh and non-mesh repair methods was investigated. Methods: This prospective cohort study was conducted on 138 patients who underwent repair surgery with mesh (28 individuals) and without mesh (110 individuals) due to hernia in Hamadan Ba’ath Hospital in 2019 and 2014. The authors investigated and compared in terms of frequency of recurrence and complications. Part of the required data was obtained from the patient’s medical records and part was obtained through telephone calls. Data analysis was done with SPSS software version 26. Results: The average age of the patients was 41.2±26.25 years, 88.4% were male and 11.6% were female. The frequency of hernia recurrence was 3.6% in total, all of which were in the non-mesh repair group. No significant difference was observed between hernia repair with and without mesh in terms of frequency of recurrence (P=0.583) and complications (P=0.964). Also, no significant relationship was observed between hernia recurrence with gender, age, smoking, employment status, and body mass index (P&gt;0.05). Conclusions: Hernia repair with both methods with and without meshing have a relatively favorable short-term outcome. Although meshing reduces hernia recurrence; However, there was no significant difference between the two methods of hernia repair with and without meshing in terms of recurrence and complications.

The aim of this study was to determine the feasibility of prosthetic mesh repair according to the degree of bowel necrosis in the emergency management of acutely strangulated groin hernias. Emergency prosthetic mesh repair versus primary suture repair was randomly performed in 208 consecutive strangulated groin hernia patients with bowel necrosis between January 2005 and August 2016. The degree of bowel necrosis of each patient was determined according to a modified three-grade classification system. Patient characteristics sorted by repair method were analyzed by using Pearson's chi-squared tests. Correlations between mortality and wound-related morbidity with bowel necrosis grade and repair method were analyzed. There was no difference in gender, age, body mass index, comorbid diseases, hernia type (left or right, primary or recurrent), necrosis grade, and mortality between the mesh repair and suture repair groups (all P > 0.05). However, with regard to wound-related morbidity, there was significant difference between the two groups (P < 0.05). Mortality and wound-related morbidity showed significant relationship with necrosis grade, especially with regard to postoperative wound infection (P < 0.001). The wound infection rate with mesh repair was significantly higher than that with primary suture in Grade II and III necrosis patients (P < 0.05), but there was no difference in Grade I patients (P > 0.05). The use of prosthetic mesh in the emergency repair of acutely strangulated groin hernias seems to be as safe as suture-only repair in patients with noninfected strangulated bowel (Grade I necrosis). The use of prosthetic mesh repair is a rational choice made based on the degree of bowel necrosis in the emergency management of acutely strangulated hernias.

BACKGROUND: The standard method of repair of Para-umbilical hernia (PUH) and Epigastric herniais by the Mayo technique, using a double-breasted flap of the rectus sheath. The result of this techniquein the hands of others is highly variable. The present study describes and evaluates the comparison of aProlene mesh versus simple anatomical repair of (PUH) and Epigastric hernias. The use of a Prolenemesh in hernia repair is not a new concept with previous investigators yielding consistently excellentresults in the repair of Para-umbilical and Epigastric Hernias.OBJECTIVE: To compare the outcomes of the two modalities of surgical procedures (mesh versussimple anatomical repair) in terms of post-operative complications, hospital stay and rate of recurrencein two groups of Para-umbilical and epigastric hernia patients.MATERIAL AND METHODS: This comparative prospective study was conducted in the Departmentof Surgery Saidu group of teaching Hospital Saidu Sharif Swat KPK. One Hundred and Thirty twoconsecutive patients having large size, Para umbilical and epigastric hernia were included for the study,from Feb 2010 to Feb 2014 in two groups, 72 (group A) for mesh repair and 60 (group B) for simpleanatomical repair. All patients of these type hernias were admitted throughout patient department(OPD). Less than 4cm size hernia, Pregnant ladies, patients having strangulated hernia presented asemergency and patient unfit for general anesthesia were excluded from study.RESULTS: Majority of patients 63% belong to age of 35 to 60 years and 87 % were females. Supraumbilical swelling was the commonest presentation 80%.Cough impulse and reducibility was positive in90% of cases (some Epigastric hernias were irreducible). Contents of sac were omentum in 74% to 83%and small intestine 17% to 26%. Operative time was longer in group A (mesh repair) ranged from 60 to90 minutes while that was 50 to 70 minutes in group B (simple anatomical repair). Post-operativeevaluation took place after 2weeks then, 1, 2, 3months then 6monthly for 30 months (average 18months). The number of complications requiring treatment was the primary aim. There were threerecurrences observed in group A (4.16%) but six cases of group B (10%) presented with recurrence inwhich simple anatomical repaired was performed. The mean hospital stay for group A was 3.7 days andfor group B, 4.6 days.CONCLUSION: Mesh repair compare to simple anatomical repair, is with less hospital stay and lessrecurrence for Para umbilical and epigastric hernia having a defect of more than4 cm in leneaAlba.KEYWORDS: Para-umbilical hernia, simple repair, meshplasty, complications, recuurence.

The use of mesh has revolutionized the management of hernias in many parts of the world. There is, however, limited experience on its use in sub-Saharan Africa. This study describes a single hospital experience after 500 cases of mesh hernia repairs in a sub-Saharan African country. We reviewed the records of the first 500 cases of abdominal wall hernia operations performed using commercial mesh since year 2007. Socio-demographic characteristics, hernia type, method of repair and outcome data were analyzed and presented as descriptive statistics. The first 500 cases of mesh hernia repairs were performed between 2007 and 2017 during which a total of 1,175 hernia operations were carried out, mesh repair accounting for 42.5% of the total. There was a progressive rise in the uptake of mesh repairs over time, with mesh repairs overtaking tissue based repairs in the last few years of the review. Inguinal hernia was by far the commonest indication for mesh use (80.4%), followed by incisional hernia (9%). Polypropylene mesh was the most common type of mesh used in about 96.2% of cases. Overall, there were seven recurrences (1.4%) at a mean follow-up period of 15.3months (1-108months) CONCLUSION: In spite of resource limitations, the use of mesh for hernia repairs continues to rise and has overtaken tissue-based repairs in a sub-Saharan African setting. Results show good outcomes justifying continued use.

: The Swedish Hernia Register (SHR) is a national quality register with more than 350,000 prospectively registered groin hernia repairs. Studies from the SHR have addressed important and clinically relevant issues within the field of laparoscopic groin hernia surgery and the aim of this paper is to present five of the most innovative patient-oriented publications including analysis of laparoscopic hernia repairs based on data retrieved from the SHR published between 2010 and 2020. After a Medline search was conducted, papers were graded and five papers were selected because of their specific nature, quality of methodology or international interest. The papers in our review studied a wide range of topics such as the risk of male infertility after mesh repair, risk of groin hernia surgery after open and minimally invasive prostatectomy, chronic pain after groin hernia surgery vs. method of repair, gender differences in risk of reoperation vs. method of repair and risk of reoperation vs. low and high molecular weight of the mesh. When gathering large amount of high-quality data, including almost total national coverage of all inguinal surgeries performed, it is possible to make valid conclusions and recommendation even on rare conditions and to sort out techniques that does not perform as intended, or does not apply to specific clinical situations. The studies above show that a laparoscopic repair is associated with a decreased risk of chronic pain for both gender to the price of a significantly higher risk of reoperation in men. The contrary is shown in women with a decreased risk of reoperation using laparoscopic repair compared to open repair.

Mesh usage in hiatal hernia repair is debated regarding recurrence rates and complications. This study aims to compare the efficacy of Phasix™ ST mesh, biological mesh, and primary repair in terms of recurrence rates, reoperation rates, and mesh-related complications. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to search literature in PubMed, Embase, and Web of Science from January 2011 to November 2023. Included studies focused on participants aged 18+ undergoing hiatal hernia repair with specific mesh types or repair methods. Data on recurrence rates, reoperation rates, and mesh-related complications were analyzed by BMI and follow-up time subgroups. Statistical analysis used the Mantel-Haenszel random-effects model. Bias in studies was assessed using the ROBINS-I and Cochrane risk of bias tools for non-randomized and randomized trials. Twenty-two studies involving 2,008 patients were included. A double-arm meta-analysis comparing biological mesh and suture cruroplasty found no significant difference in recurrence or reoperation rates. The randomized trial showed no significant difference in recurrence (OR 2.02; 95% CI 0.71-5.76) or reoperation (OR 0.71; 95% CI 0.17-2.96). Non-randomized studies also showed no significant difference in recurrence (OR 0.32; 95% CI 0.03-3.06) or reoperation (OR 0.35; 95% CI 0.05-2.37). In single-arm meta-analyses, Phasix™ ST mesh had the lowest recurrence rate, followed by biological mesh and suture cruroplasty. No reoperations were reported with Phasix™ ST mesh. Postoperative dysphagia was lowest with Phasix™ ST mesh. In conclusion, Phasix™ ST mesh showed the lowest recurrence, reoperation rates, and dysphagia compared to biological mesh and primary repair, making it a preferred option.

To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair. Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair. Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 3-4 years. Secondary outcomes - clinical symptom scores at 2, 3, and 5 years. 126 patients were enrolled - 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% - absorbable mesh, and 42.9% - nonabsorbable mesh (P = 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh. No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias.

Background: Laparoscopic mesh repair is the standard of care for inguinal hernias. But, our center being in a rural setup catering mainly poor patients who are daily wagers and laborers, open repairs are commonly done. Lichtenstein’s tension-free mesh repair is the standard technique used worldwide. This study was performed to compare the effectiveness of Reverse darning repair over traditional mesh repair in a rural setup and to reciprocate the changes generally. The outcomes such as postoperative pain, seroma formation, postoperative analgesic use, and the recurrence rate were compared.Methods: Retrospective analysis of patients who had undergone mesh repair and reverse darning procedure between January 2013 and December 2017 was performed in a rural tertiary center.Results: The reverse darning group was found to have significantly lesser mean duration of surgery (15.7±1.7 min. vs. 31.2±2.5 min.; t=37.4, p&lt;0.005), analgesic use (4.4±1.2 doses vs. 7.4±1.3 doses; t=12.2, p&lt;0.005), hospital stay (39.4±8.2 hours vs. 58.1±9.5 hours; t=10.7, p&lt;0.005), and the cost of treatment (Rs. 5188±286 vs. Rs. 7154±1290; t=11.6, p&lt;0.005) compared to the Lichtenstein group. The Reverse daring group was also better than Lichtenstein repair in terms of seroma formation (1 vs. 7; chi-square value=7.9; p=0.005), hematoma (0 vs. 6; chi-square value=9.4, p=0.002), and secondary hydrocele (1 vs. 5; chi-square value=4.9, p=0.03).Conclusions: Reverse darning repair was found to be much better than traditional mesh repair due to its simplicity, lesser duration of surgery, hospital stay, cost of treatment, and postoperative complications.