Abdominal Wall Repair Research Articles

Contemporary role of the plastic and reconstructive surgeon in the outcome of female peripelvic defects after oncologic extirpation.

Reconstruction of female oncologic peripelvic defects is challenging due to complex anatomy, neoadjuvant chemoradiation, operative resection margins, and wound healing risks. Functional restoration requires thoughtful management focused on defect reconstruction and patient-reported outcomes. A retrospective chart review of peripelvic reconstruction in female patients at MD Anderson Cancer Center from 2016 to 2023. Data collected included the patient'scomorbidities, tumor characteristics, and reconstructive details. Complications were classified as nonoperative or operative within 30 days. Patient outcomes included hernia rates, sexual activity, and revision needs. In the study period, 164 patients underwent peripelvic defect reconstruction. Most had colorectal (57%), anal (17%), or gynecologic malignancies (10%). 83% had prior radiation. 33.3% had Class II or III obesity. The most common resection was open colorectal resection with partial vaginectomy (66%). Pedicled flaps (93%) were frequently used, mainly vertical rectus abdominis muscle (65%) and gracilis (11%). For multi-visceral resections, abdominal-based flaps were used in 95% of open casesand thigh-based flaps in 88.9% of robotic cases. 51% had formal abdominal wall repair. Complications occurred in 47%, with 9.1% needing surgery. Postoperative hernias were reported in 4.9%, with 3% requiring repair. Approximately 11% reported being sexually active at the last follow-up. Of those instructed on vaginal dilator therapy (42%), 24.6% were sexually active. Peri-pelvic soft tissue reconstruction in the oncologic population is safe. Operative complications and hernia rates are low. In robotic surgery, thigh-based flaps are increasingly used to reconstruct the peripelvic region. Return to sexual activity is higher in patients when given dilator therapy instruction.

Choice of Alternative Method of Surgical Intervention in Abdominal Rectus Diastasis with Concomitant Midline Hernias

INTRODUCTION: To date, no consensus has been achieved on the most appropriate surgical method for the treatment of abdominal rectus diastasis concomitant with midline hernias. AIM: Study of the results of three original methods of surgical treatment of patients with abdominal rectus diastasis concomitant with midline hernias. MATERIALS AND METHODS: The results of treatment of 74 patients have been analyzed. The patients were divided into three comparable groups: in the first group (n = 25), repair with local tissues with formation of aponeurotic duplication was performed, in the second group (n = 24), autodermal de-epithelialized graft was used, in the third group (n = 25) — mesh sub-lay implants. The following parameters were evaluated: duration of narcotic analgesia in the postoperative period, period of activation of patients, periods of inpatient treatment and results on Clavien-Dindo and EuraHSQoL scales. The follow-up period was from 1 to 10 years after surgery. RESULTS: The period of postoperative use of narcotic analgesics was 1.08 ± 0.38 days in the first group, 0.98 ± 0.33 days in the second group, 2.13 ± 0.93 days in the third group. The period of activation was 3.00 ± 1.53 days in the first group, 0.89 ± 0.36 days in the second group, 1.5 ± 0.48 days in the third group; the duration of inpatient treatment was 9.24 ± 1.88 bed-days, 6.34 ± 3.04 bed-days and 8.36 ± 2.14 bed-days, respectively. Postoperative complications in the first group were CDI class 6, CDII class 3, in the second group CDI class 1, in the third group CDI class 6, CDII class 3. At 12 months after the operation, painful sensations and functional discomfort on EuraHSQoL scale were absent in the second group, in the first and third groups, limitations in physical activity were noted (р ≤ 0.05; differences between the first and third groups were statistically insignificant, p ≥ 0.05). There were no statistically significant differences in the cosmetic discomfort between the groups (p ≥ 0.05). CONCLUSION: A safer and more effective method of repair of the anterior abdominal wall in patients with concomitant abdominal rectus diastasis and midline hernias is plastic surgery with application of de-epithelialized autodermal graft.

Hughes abdominal wall repair versus conventional mass closure: Our initial results.

Hughes abdominal wall repair versus conventional mass closure: Our initial results.

Allogeneic abdominal non-vascularized rectus fascia transplantation without immunosuppression equals syngeneic transplantation in a rabbit model at short-term follow-up

Complex abdominal wall repair remains a major surgical challenge. In transplant patients, non-vascularized rectus fascia (NVRF) is successfully used to bridge the defect. To extrapolate this to non-transplant patients, we developed a rabbit model of NVRF-transplantation without immunosuppression comparing syngeneic versus allogeneic transplants. Short-term outcome (4 weeks) was evaluated macroscopically (ingrowth, seroma/hematoma, herniation, infection), histologically at the graft interface and center (inflammation, neovascularization, collagen deposition) and by mechanical testing. In both groups a similar macroscopic ingrowth of the NVRF was observed. In the syn-group one seroma and one hematoma was seen. Two small herniations were detected at the suture line in the allo-group. No surgical site infections were observed. Histologically, graft neovascularization was observed in all animals. Infiltration of T-lymphocytes was seen at the graft interface in both groups, but more in the allo-group (p < 0.0001). Deposition of collagen was not different between groups. Macrophages were present in both groups around sutures and in the center more abundantly in the allo-group (p = 0.0001). Graft stiffness and strength were similar for both groups. With this model, we showed that allogeneic transplantation without immunosuppression results in favorable short-term inflammatory and mechanical outcomes. Long-term experiments are needed to further evaluate the effect on graft integration and hernia development.

Rectus Muscle Flap-augmented Closures in Wide-gap Exstrophy Bladder.

Wound dehiscence is one of the main complications in complete primary repair of exstrophy (CPRE). In our pediatric urology unit, we have switched to the use of inferior epigastric artery based rectus abdominis flap cover for abdominal wall closure in addition to measures like osteotomy and postoperative hip spica. to assess the efficacy of Recus abdominis flap in prevenion of wound dehisence. This study was conducted from June 2014 to June 2021 comparing two groups of the patients; group I consisted of thirty patients of CPRE with rectus flap repair of abdominal wall (CPRE-RF) and group II consisted of thirty patients with CPRE without rectus flap. Clinical and surgical details, including the outcome with regards to wound dehiscence and continence, were recorded. The mean age of the patients in CPRE-RF was 5 months and that with only CPRE was 4.6 months. Mean pubic diastasis in Group l was 4.8± 1.07 cm and that of Group II was 4.6±1.3 cm. None of the patients in CPRE-RF had wound dehiscence or bladder prolapse while as 6 patients in CPRE alone had wound dehiscence and 1 had bladder prolapse. This difference was statistically significant. Primary bladder continence was achieved in 4 patients in CPRE-RF and 3 patients in CPRE group. Hypospadias had almost similar occurrence in the two groups. One patient in each group had bladder neck fistula. Use of rectus muscle flap in complete Primary Repair ofExtrophy bladder helps in prevention of wound dehiscence and contributes in achievement of final goal of continence in wide gap pubic diatasis.

FP5.5 - Simulated Abdominal Wall - a valuable educational tool for Abdominal Wall Reconstruction and Small Bite closure techniques.

Abstract Background Incisional hernia is a common complication following laparotomy (31.8% at 2 years, HART collaborative, 2022) and this may require complicated reconstructive techniques. Studies suggest that poor closure technique contributes to incisional hernia formation. Junior trainees are often left to close the abdominal wall. European and American guidelines have suggested closing the abdomen with the "small bites technique". Simulated training has gained traction. Reduction in theatre training hours necessitates simulated training. This study aims to:generate a synthetic model that anatomically represents the layers of the abdominal wall.use this model as a simulated training tool for general surgical and plastic surgical trainees who are often left to close the abdominal wall in laparotomy cases / abdominal wall reconstruction.use this model to teach reconstructive abdominal wall repair techniques. Methods 2021: literature search and research. Theatre observation of complex abdominal wall procedures and techniques. Cadaveric lab attendance at Leeds University. 2022: prototype - first model produced from medial grade silicone. 2022: amendments - alterations to the prototype. 2023: accreditation and delivery - Small Bites Course delivered and accredited by RCS Edinburgh. Results 86% of course attendees found the abdominal wall models "as realistic as possible". Attendees felt more confident to perform small bites closure and simple abdominal wall reconstruction. Total cost saving per model compared with competitors = £1109.50. Conclusions Our simulated abdominal wall model has proved to be realistic and cost effective. It is an ethical and improved way to train junior surgeons in the small-bites technique and some elements of abdominal wall reconstruction. These models have been implemented on training courses for surgical trainees within the deanery.

Combined use of composite mesh and acellular dermal matrix graft for abdominal wall repair following tumour resection

BackgroundSurgeries for sarcomas in the abdominal wall require wide resections, often radical en bloc resections, which generate major defects involving a very complex repair. The combined use of porcine dermal xenografts, together with composite meshes, may assist in the repair of these defects with minimal complications.MethodWe present a series of 19 patients (10 males and 9 females), with a mean age of 53.2 years (range: 11–86 years) treated in the Sarcoma Unit of the Virgen de la Arrixaca University Hospital from January 2015 to December 2021. Histopathologically, there were four chondrosarcomas (21%), three Ewing sarcomas (15.7%), two desmoid tumours (10.5%), two undifferentiated pleomorphic sarcomas (10.5%), two well-differentiated liposarcomas (10.5%), two leiomyosarcomas (10.5%), one synovial sarcoma, one dermatofibrosarcoma protuberans, one fibromyxoid sarcoma (or Evans tumour), and one metastasis from an adenocarcinoma of unknown origin. All the patients were resected following surgical oncology principles and reconstructed by means of the combined use of a composite mesh acting as a neoperitoneum and a porcine dermal xenograft acting as an abdominal neofascia.ResultsThe mean size of the defects generated after surgery for tumour excision was 262.8 cm2 (range: 150–600 cm2). After a mean follow-up of 38 months, six patients (31.5%) developed complications—two cases of wound dehiscence, one case of surgical wound infection, one case of graft partial necrosis, one case of anastomotic leak and one death due to multiorgan failure secondary to massive bronchoaspiration.ConclusionSurgeries for sarcomas of the abdominal wall require wide oncological resections, which generate major abdominal wall defects. The repair of these defects by means of the combined use of synthetic and biological meshes is a technique associated with minimal complications and excellent medium-term results.

Vascularization of Human Acellular Dermal Matrices: A Comparative Study in a Nonhuman Primate Model.

Four human acellular dermal matrices (hADMs) were characterized in a nonhuman primate abdominal wall repair model by evaluating host immune response, vascularization, and incorporation into host tissues. AlloDerm™ (electron beam-sterilized hADM [e-hADM]), AlloMax™ (gamma beam-sterilized hADM, freeze-dried [g-hADM-FD]), DermaMatrix™ (hADM, freeze-dried [hADM-FD]), and FlexHD™ (ethanol-treated hADM [EtOH-hADM]) were each implanted in an abdominal wall-bridging defect in nonhuman primates (n = 3 animals/time point, n = 36 animals). Immunohistochemical and histological assessments were conducted on biopsies from each hADM at 1-, 3-, and 6-months postimplantation to assess vascularization (hematoxylin and eosin [H&E], CD31, alpha smooth muscle actin [αSMA], collagen IV), inflammatory/immune response (H&E, CD3, CD20, CD68), and collagen turnover (H&E, matrix metalloproteinase-9 [MMP-9]). MMP-9 immunolabeling was similar among different hADMs at 1 month; however, hADM-FD and EtOH-hADM showed higher total mean MMP-9-immunopositive areas at approximately 16% compared with <1% for e-hADM and g-hADM at 6 months postimplantation. Cells that stained positively for CD68, CD3, and CD20 were generally higher for hADM-FD and EtOH-hADM compared with other hADMs. The mean CD31-immunopositive area, CD31 vessel density, CD31 vessel diameter, and collagen IV-immunopositive area increased over time. Among all the hADM types, e-hADM had the highest mean (±standard deviation [SD]) CD31-immunopositive area at 1.54% ± 1.01%, vessel density at 7.86 × 10-5 ± 3.96 × 10-5 vessels/µm2, and collagen IV-immunopositive area at 2.55% ± 0.73% 1-month postimplantation. The pattern of αSMA immunolabeling varied among the hADMs. Histology showed that overall inflammation was mild at 1 month. Overall fibroblast repopulation and collagen remodeling increased over time from 1 to 6 months postimplantation. Fibroblast infiltration was minimal to mild at 1 month, with e-hADM showing the highest mean (±SD) score at 2.00 ± 0.00 compared with other hADMs. Only hADM-FD was not completely replaced by neotissue formation at 6 months postimplantation. All hADMs promoted vascularization, cell infiltration, and incorporation into host tissue, which were associated with acute inflammation and immune responses, within a 6-month period. A trend toward relatively enhanced early vascularization in e-hADM compared with other hADMs was observed. Immunogenic responses among the hADMs in the present study showed a slight distinction toward more quiescent terminally sterilized hADMs (e-hADM, g-hADM-FD) versus aseptically processed hADMs (EtOH-hADM, hADM-FD).

Spatiotemporal delivery of microenvironment responsive hydrogel incorporated with stem cells-loaded porous microspheres for abdominal wall repair

Healing the wounds of abdominal wall defects characterised by severe complications represents a significant clinical challenge. Mesenchymal stem cells (MSC)-based therapies have emerged as a promising strategy for tissue regeneration. However, the low engraftment and survival rates limit their application owing to the complicated wound microenvironment and large wound areas in abdominal wall defects. Inspired by focal biointerfaces, the present research engineered a spatiotemporal delivery microenvironment-responsive therapeutic platform, termed MSC-GSM@HG, for abdominal wall repair. The constructed platform proved capable of dissolving HA-PBA/Gel-DA (HG) hydrogels in response to in vivo inflammatory responses and subsequently releasing MSC-laden gelatine and silk fibroin microspheres (GSMs). Meanwhile, the HG hydrogels can not only protect the MSCs from excessive reactive oxygen species but also exhibit haemostatic and anti-inflammatory properties. Strikingly, this microsphere-releasing hydrogel platform actively enhanced the repair of abdominal wall defects in vivo, by reducing inflammatory response, facilitating angiogenesis and promoting collagen deposition. Therefore, the microenvironment-responsive platform represents a promising strategy for MSC-based therapies for abdominal wall defects through spatiotemporal delivery mechanisms.

Minimally Invasive Stapled Abdominal Wall Repair: A New Surgical Technique.

Background: Diastasis recti (DR) is a common condition, especially in women after pregnancy, often associated with concomitant hernia defects and defined as a rupture of the midline and a separation of the rectus muscle more than 2 cm. Symptoms related to this are low back pain, urinary incontinence and pelvic prolapse, as well as abdominal bulging and core instability. We analyzed clinical and functional outcomes after treatment of DR alone or associated with midline hernias in 219 patients who underwent a midline reconstruction using miSAR® technique (minimally invasive stapled abdominal wall reconstruction). Methods: Between April 2019 and April 2022, 219 patients were treated with miSAR®. All patients were requested to quantify preoperative and postoperative functional symptoms (urinary incontinence, low back pain, abdominal swelling, and respiratory distress). Results: Twenty-seven men and 192 women underwent the miSAR® technique. The mean body mass index was 23.9 kg/m2. We performed the miSAR® technique in patients affected by incisional midline hernia and umbilical hernia alone or associated with DR. Composite mesh was used in 91.8% of cases. The average operating time was 90 minutes. Seven percent of the patients had postoperative complications, including two retromuscular hematomas, two retromuscular seromas, and one postoperative bleeding event. Two patients were readmitted for bowel obstruction. After surgery, there was symptomatic improvement in urinary incontinence, low back pain, respiratory symptoms, and abdominal swelling; this improvement was confirmed at 6 months and at 1- and 2-year follow-up. At the 1-year follow-up, the overall recurrence rate was 2.83%. Conclusion: miSAR® is a feasible and effective technique and shows promising results in the treatment of DR and ventral hernia. Possible enhancements include use of preoperative Botox to treat defects larger than 6 cm. Multicentric analysis is needed to validate the technique, and longer follow-up is required to assess the recurrence rate.

Long-term results with biosynthetic absorbable P4HB mesh in ventral abdominal wall repair: a multicentre analysis.

The aim of this multicentre study was to analyse the outcomes of biosynthetic absorbable poly-4-hydroxybutyrate (P4HB) prosthesis implantation in patients undergoing ventral hernia repair (VHR) in the context of different degrees of contamination. From May 2016 to December 2021, a multicentre retrospective analysis of patients who underwent elective or urgent hernia repair with P4HB prosthesis was performed in seven hospitals in Spain and Portugal. Patients with a postoperative follow-up of less than 20months and those within the theoretical period of prosthesis resorption were excluded from the study. Regarding the degree of contamination, patients were assessed according to the modified Ventral Hernia Working Group (VHWG) classification. Epidemiological data, hernia characteristics, surgical and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. Risk factors related to long-term recurrence were studied by a multivariate analysis. In 236 cases of P4HB prosthesis implantation, repair in cases of Grade 3 was the most frequent (49.1%), followed by Grade 2 in 42.3% of cases and Grade 1 in 8.4%. The most frequent complications were Grade 1, with the majority occurring during the first year. The overall rate of surgical site occurrences (SSO) was 30%. The hernia recurrence rate was 14.4% (n = 34), with a mean postoperative follow-up time of 41months (22-61). The multivariate analysis showed that the onlay location of the mesh (OR 1.07; CI 1.42-2.70, p = 0.004) was a significant independent risk factor for recurrence. The use of a P4HB bioresorbable mesh for the VHR with different degrees of contamination leads to favourable results overall, with an acceptable rate of hernia recurrence. The onlay location of the P4HB prosthesis is the main factor in recurrence in both elective and emergency settings.

Mininvasive surgery in abdominal wall repair: lights and shadows

Mininvasive surgery in abdominal wall repair: lights and shadows

Pelvic Ring Reconstruction with an Osteocutaneous Fibula Flap for Abdominal Wall Repair in Adults with Bladder Exstrophy

AbstractAbdominal wall repair in adults with bladder exstrophy is challenging. We present a case of a 46-year-old woman with bladder exstrophy presenting with a large midline incisional hernia associated with a 13-cm hypoplasia of both pubic rami that precluded fixation of any abdominal mesh. A two-stage approach was adopted. First, a free vascularized osteocutaneous fibula flap was used to reconstruct the pelvic ring. After complete bone union 18 months later, a mesh was anchored to the fibula flap to restore the abdominal wall competence. After 2 years of follow-up, no hernia recurrence was observed, and the patient reported improved quality of life and self-esteem. This novel technique may provide long-term stability and good functional outcomes for reconstruction of the abdominal wall in selected adults with bladder exstrophy.

The Madrid Posterior Component Separation: An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias.

In recent years, Posterior Component Separation (PCS) with the Madrid modification (Madrid PCS) has emerged as a surgical technique. This modification is believed to enhance the dissection of anatomical structures, offering several advantages. The study aims to present a detailed description of this surgical technique and to analyse the outcomes in a large cohort of patients. This study included all patients who underwent the repair of midline incisional hernias, with or without other abdominal wall defects. Data from patients at three different centres specialising in abdominal wall reconstruction was analysed. All patients underwent the Madrid PCS, and several variables, such as demographics, perioperative details, postoperative complications, and recurrences, were assessed. Between January 2015 and June 2023, a total of 223 patients underwent the Madrid PCS. The mean age was 63.4years, with a mean BMI of 33.3kg/m2 (range 23-40). According to the EHS classification, 139 patients had a midline incisional hernia, and 84 had a midline incisional hernia with a concomitant lateral incisional hernia. According to the Ventral Hernia Working Group (VHWG) classification, 177 (79.4%) patients had grade 2 and 3 hernias. In total, 201 patients (90.1%) were ASA II and III. The Carolinas Equation for Determining Associated Risks (CeDAR) was calculated preoperatively, resulting in 150 (67.3%) patients with a score between 30% and 60%. A total of 105 patients (48.4%) had previously undergone abdominal wall repair surgery. There were 93 (41.7%) surgical site occurrences (SSO), 36 (16.1%) surgical site infections (SSI), including 23 (10.3%) superficial and 7 (3.1%) deep infections, and 6 (2.7%) organ/space infections. Four (1.9%) recurrences were assessed by CT scan with an average follow-up of 23.9months (range 6-74). The Madrid PCS appears to be safe and effective, yielding excellent long-term results despite the complexity of abdominal wall defects. A profound understanding of the anatomy is crucial for optimal outcomes. The Madrid modification contributes to facilitating a complete retromuscular preperitoneal repair without incision of the transversus abdominis. The extensive abdominal wall retromuscular dissection obtained enables the placement of very large meshes with minimal fixation.

Three-year follow-up of the grip concept: an open, prospective, observational registry study on biomechanically calculated abdominal wall repair for complex incisional hernias

PurposeWe studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial.MethodsFrom July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva’s maneuver.ResultsLarger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years.ConclusionsBiomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.

A comparison of patient-reported outcomes in patients undergoing abdominal wall repair with either synthetic or biosynthetic mesh: a pilot study.

Repair of midline ventral incisional hernias (VIHR) requires mesh reinforcement. Mesh types can be categorised into synthetic, biosynthetic, or biological. There is a lack of evidence to support one type of mesh over another. The aim of this pilot study was to compare mesh sensation in patients having undergone elective open repair with synthetic or biosynthetic mesh. Four years of prospectively collected data were retrospectively reviewed on 40 patients who had undergone VIHR, using either biosynthetic or synthetic mesh placed in the retromuscular plane. The decision on type of mesh used was governed by patient characteristics. Patients were invited to complete the Carolinas Comfort Scale (CCS) questionnaire, the higher the score indicating a poorer quality of life. The maximum length of follow-up was 36months. Twenty patients received permanent synthetic and 20 biosynthetic mesh. There was no clinical evidence of hernia recurrence in either group in the short to medium term. Overall, 97% (39/40) patients reported an average of either no or mild symptoms (mean CCS score 17.9 of 115). Patients with a biosynthetic repair had a significant lower CCS at ≥ 18months (p < 0.05). After VIHR, patients have low CCS scores, indicating good quality of life outcomes, in the short to medium term irrespective of the mesh used. However, biosynthetic mesh had lower CCS scores in the medium term. This may help surgeons and patients make better informed decisions about which mesh to use in their individual circumstances.

Obstrucción intestinal tardía secundaria a migración de cono de polipropileno

The use of meshes for abdominal wall repair has been widely accepted worldwide; however, serious complications may occur, such as foreign body reaction, mesh migration, penetration into the peritoneal cavity and even migration into the preperitoneal space mimicking colorectal cancer. The aim of this paper is to report a case of intestinal obstruction secondary to mesh migration into the peritoneal cavity in a previously asymptomatic patient who underwent left inguinal hernia repair 10 years prior to admission.

A rapid crosslinking injectable polygalacturonic acid barrier modified with zwitterion bottlebrush for preventing postoperative adhesion

Postoperation adhesion, as a worldwide problem, are often accompanied by serious complications and cause severe pain to patients, and traditional medicines and commercial anti-adhesion barriers have limited protective effects. So, we designed a novel injective, antifouling and photo-crosslinked polygalacturonic acid (PGA) hydrogel barrier composed of PGA methacrylate (PGAMA) and 2-methacryloyloxyethyl phosphorylcholine (MPC) with excellent effect of covering the wound and preventing adhesion. The product termed, as PGAMA-MPC, enhanced hydration as expected with the introduction of abundant MPC, showing an obvious resistance to protein, cell, and microorganism. Simultaneously, as injectable medical materials, stable attachment to the wound and low invasiveness for tissue were provided by photo-crosslinking of PGAMA-MPC hydrogel during Minimally invasive surgery. In the rat model of cecal injury, the PGAMA-MPC hydrogel effectively prevented the postoperative peritoneal adhesion, showing an obvious protective effect within 7 d and the excellent ability to repair of cecum and abdominal wall after 14 d. Compared with the control group, the rats treated with PGAMA-MPC3 almost recovered to the level of the normal level. Furthermore, we found that PGAMA-MPC3 hydrogel significantly reduced the expression of inflammation and deposition of fibrin. The underlying mechanism of anti-adhesion was subsequently confirmed by analyzing the signaling pathway TGF-β1. The PGA-MPC3 hydrogel promoted fibrinolysis by blocking the activation of TGF-β1/Smad3 pathway. In conclusion, we developed an available polysaccharide hydrogel for rapid repair of peritoneum and prevention of postoperative adhesion, possessing an extensive application as medical materials.

The utilization of chitosan/Bletilla striata hydrogels to elevate anti-adhesion, anti-inflammatory and pro-angiogenesis properties of polypropylene mesh in abdominal wall repair.

Polypropylene (PP) mesh is commonly used in abdominal wall repair due to its ability to reduce the risk of organ damage, infections and other complications. However, the PP mesh often leads to adhesion formation and does not promote functional tissue repair. In this study, we synthesized one kind of aldehyde Bletilla striata polysaccharide (BSPA) modified chitosan (CS) hydrogel based on Schiff base reaction. The hydrogel exhibited a porous network structure, a highly hydrophilic surface and good biocompatibility. We wrapped the PP mesh inside the hydrogel and evaluated the performance of the resulting composites in a bilateral 1 × 1.5 cm abdominal wall defect model in rats. The results of gross observation, histological staining and immunohistochemical staining demonstrated the positive impact of the CS hydrogel on anti-adhesion and wound healing effects. Notably, the addition of BSPA to the CS hydrogel further improved the performance of the composites in vivo, promoting wound healing by enhancing collagen deposition and capillary rearrangement. This study suggested that the BSPA-modified CS hydrogel significantly promoted the anti-adhesion, anti-inflammatory and pro-angiogenesis properties of PP meshes during the healing process. Overall, this work offers a novel approach to the design of abdominal wall repair patches.

Abdominal wall repair with acellular bovine pericardial membranes - Part I - Clinical and radiological findings

Abdominal wall repair with acellular bovine pericardial membranes - Part I - Clinical and radiological findings