Absorbable Prostheses Research Articles

Comparison of patient-reported outcomes and clinical outcomes between pleurectomy and pleural covering added to thoracoscopic bullectomy for primary spontaneous pneumothorax.

An optimal surgical procedure for primary spontaneous pneumothorax (PSP) has not yet been established. The study aimed to compare patient-reported outcomes (PROs) and clinical outcomes between parietal pleurectomy (pleurectomy) and visceral pleural covering with absorbable prosthesis (covering) added to thoracoscopic bullectomy in patients with PSP. From January 2015 to April 2018, PROs were prospectively evaluated using EuroQOL-5 dimensions-5 levels (EQ5D). Questionnaires were administered preoperatively and at 1, 3, and 5 days and 1 month postoperatively. The perioperative outcomes were compared retrospectively. Recurrences and postoperative symptoms in the distant period were investigated cross-sectionally by telephone and mail surveys in February 2020. In total, 26 and 29 patients underwent covering and pleurectomy, respectively. The visual analog scale score of the EQ5D on postoperative day 1 was significantly better in the pleurectomy group than in the covering group. There was no significant difference in the frequency of PROs in the EQ5D including pain. Perioperative outcomes, such as postoperative chest tube placement, and hospital stay, were comparable between the groups, except for the operative time. There was no significant difference in the recurrence rate and frequency of residual symptoms, e.g., chest discomfort in the long-term outcomes. PROs and clinical outcomes were comparable between the two procedures. Further studies are required to determine the optimal treatment procedure.

Endoscopic transposition with the hernial sac (eTHS) in ventral hernia repair - technical description.

Incisional hernia is a late complication of the most frequent after abdominal surgeries, with resulting morbidity that can worsen the condition. The treatment has been done both by open techniques, using screens or not, and by laparoscopic and robotic methods, which use them systematically. However, introducing a permanent foreign body into the tissues requires more surgical time, despite not closing the parietal defect in most cases and a higher risk of infections. New technologies have been trying to improve these results, with absorbable prostheses (biological or synthetic), but their high cost and recurrences remain a severe problem. Even so, standard repair establishes reinforcement with screens, routine, and whether the approach is traditional or mini-invasive. The authors report their first case of endoscopic repair of incisional hernia, which occurred two years ago, with a Brazilian technique already fifty years old: the transposition with the hernia sac proposed by Prof. Alcino Lázaro da Silva in 1971.

Traitement du prolapsus génital par promontofixation laparoscopique : recommandations pour la pratique clinique

Open sacrocolpopexy have demonstrated its efficiency in surgical treatment of pelvic organ prolapse with an important backward on a large number of patients. Laparoscopic sacrocolpopexy reproduced the same surgical technique with reduced morbidity and may benefits from the recent development of robotic. Numerous technical variants have been developped around the original procedure but results seems not ever equivalent. Our objectives are to establish practical recommendations issues from the data of the litterature on the various technical aspects of this technique. This work leans on an exhaustive lecture of the literature concerning meta analyses, randomized tries, registers, controlled studies and the largest non controlled studies published on the subject. Recommendations were developed by a multidisciplinary workgroup then reread and amended by an also multidisciplinary group of proofreaders (urologists, gynecologists, gastroenterologists and surgeons). The methodology follows at best the recommendations of the HAS with a scientific argument for every question (accompanied with the level of proof, NP) and the recommendations, the officers (In, B, C and agreement of experts) and validated at the end of the phase of review. Surgical treatment of uro-genital prolapse by abdominal route classically associated hystero and anterior vaginopexy on the sacral ligament with a synthethic mesh. There are no argument to systematically associated a posterior vaginopexy to prevent secondary rectocele (level C). The consensual indication of laparoscopic rectopexy is represented by symptomatic rectal prolapse, the anatomical and functional results of which are the best estimated (level C). The surgical treatment of rectocele, elytrocele and enterocele with a posterior vaginopexy is not well estimated (level 3). Thus, it is not possible to conclude on the results of a posterior vaginal fixation with a mesh in these indications (AP). In the absence of colpocèle, the interest brought by the posterior vaginal mesh is not established (level 3). There is no comparative studies which allows to conclude on the type and mode of fixation of the prostheses of sacrocolpopexy. We would only report the most common practices without other conclusion. The anterior mesh is usually fixed upper on the anterior part of uterus cervix and lower on the anterior vaginal wall. These fixations are most of the time made by suture and on the promontory with non absorbable suture. The great majority of the authors recommend to make a peritonisation of prostheses to limit the risk of post-operative occlusion. It is now recommended to use only 2 kind of not absorbable prostheses: type I (macroporous polypropylene) or type III (polyester) and not to use any more prostheses type II (PTFE, Silicone) (level C) because of a high rate of mesh erosion: PTFE (9 %) or Silicone (19%) (level 3). Biological prostheses are no more recommended, because of short and medium-term lower anatomical results (level B). Anatomical and functional results are not stastistically differents between laparotomy and coelioscopy (NP1) but the comparison of tong-term results between both ways is not yet established. Coelioscopy allows significant reduction of blood losses, hospital stay and return to normal activity (level 1). Furthemore, there is a higher level of post-operative complications in laparotomy (level 1). When sacrocolpopexy is indicated, coelioscopy is thus recommended (level B). During coelioscopic sacrocolpopexy, anatomical and functional result have not shown any significance difference when using or no a robotics assistance but real randomised studies does not exist (level 2). In comparison to coelioscopy, robotic seems not to improve post-operative consequences and not to decrease the rate of complications of sacrocolpopexy (level 3). Robotic assistance cannot be yet recommended when a coelioscopic sacrocolpopexy is indicated (rank B). Sacrocolpopexy using not absorbable meshes allows to cure pelvic organ prolapses with very good results with few complications in terms of prothetic exposure and infection and thus is now considered as the referent prothetic surgical technique in this indication. Thus, it seems very important to establish clear recommendations on the numerous operating technical variants which developed around the original technique. © 2016 Published by Elsevier Masson SAS.

Analysis of bone healing in flail chest injury: do we need to fix both fractures per rib?

Surgical rib fixation (SRF) for severe rib fracture injuries is generating increasing interest in the medical literature. It is well documented that poorly healed fractured ribs can lead to chronic pain, disability, and deformity. An unanswered question in SRF for flail chest injury is whether it is sufficient to fix one fracture per rib, on successive ribs, thus converting a flail chest injury into simple fractured ribs, or whether both ends of the floating segment of the chest wall should be fixed. This study aimed to analyze SRF in flail chest injury, assessing 3-month outcomes for nonfixed fractured rib ends in the flail segment. This is a retrospective review (2005-2013) of 60 consecutive patients who underwent SRF for flail chest injury admitted to the Alfred Hospital, Melbourne, Australia. Imaging by three-dimensional computed tomography (3D CT) of the chest at admission was compared with follow-up 3D CT at 3 months after injury. The 3-month CT scans were assessed for degree of healing and presence of residual deformity at the fracture fixation site. Follow-up CT was performed in 52 of the 60 patients. At 3 months after surgery, 86.5% of the patients had at least partial healing with good alignment and adequate fracture stabilization. Hardware failure was noted in five patients (9.6%) and occurred with the absorbable prostheses only. Six patients who had preoperative overlapping or displacement showed no improvement in deformity despite fixing the lateral fractures. Callus formation and bony bridging between adjacent ribs was often noted in the rib fractures not fixed (28 of 52 patients, 54%) This retrospective review of 3D CT chest at 3 months after rib fixation indicates that a philosophy of fixing only one fracture per rib in a flail segment does not avoid deformity and displacement, particularly in posterior rib fractures. Therapeutic study, level V; epidemiologic study, level V.

Rectus Abdominis Muscle Malignant Fibrous Histiocytoma Causing a Large Abdominal Wall Defect: Reconstruction with Biological Mesh

Malignant fibrous histiocytoma (MFH) is a common soft tissue sarcoma usually involving limbs and retroperitoneum. MFH of the rectus abdominis muscle is extremely rare. Surgery in similar cases leads to large abdominal wall defects needing reconstruction. Biological and synthetic laminar absorbable prostheses are available for the repair of hernia defects in the abdominal wall. They share the important feature of being gradually degraded in the host, resulting the formation of a neotissue. We herein report the case of an 84-year-old man with MFH of the rectus abdominis muscle which was resected and the large abdominal wall defect was successfully repaired with a biological mesh.

Repair of Abdominal Wall Defects with Biodegradable Laminar Prostheses: Polymeric or Biological?

IntroductionBiological and synthetic laminar absorbable prostheses are available for the repair of hernia defects in the abdominal wall. They share the important feature of being gradually degraded in the host, resulting in place the formation of a neotissue. This study was designed to assess the host tissue’s incorporation of collagen bioprostheses and a synthetic absorbable prosthesis.MethodsPartial defects were created in the abdominal walls of 72 New Zealand rabbits and repaired using collagen bioprostheses Tutomesh® and Strattice® or a synthetic prosthesis Bio-A®. Specimens were collected for light microscopy, collagens gene and protein expression, macrophage response and biomechanical resistance at 14, 30, 90 and 180 days post-implantation.ResultsTutomesh® and Bio-A® were gradually infiltrated by the host tissue and almost completely degraded by 180 days post-implantation. In contrast, Strattice® exhibited material encapsulation, no prosthetic degradation and low cell infiltration at earlier timepoints, whereas at later study time, collagen deposition could be observed within the mesh. In the short term, Bio-A® exhibited higher level of collagen 1 and 3 mRNA expression compared with the two other biological prostheses, which exhibited two peaks of higher expression at 14 and 90 days. The expression of collagen III was homogeneous throughout the study and collagen I deposition was more evident in Strattice®. Macrophage response decreased over time in biomeshes. However, in the synthetic mesh remained high and homogeneous until 90 days. The biomechanical analysis demonstrated the progressively increasing tensile strength of all biomaterials.ConclusionsThe tissue infiltration of laminar absorbable prostheses is affected by the structure and composition of the mesh. The synthetic prosthesis exhibited a distinct pattern of tissue incorporation and a greater macrophage response than did the biological prostheses. Of all of the laminar, absorbable biomaterials that were tested in this study, Strattice® demonstrated the optimal levels of integration and degradation.

Use of Mesh in Vaginal Pelvic Organ Prolapse Surgery

The use of macroporous monofilament lightweight mesh in cases of vaginal prolapse surgery repair has been in practice for several years now. The type 1 monofilament, macroporous polypropylene should be used because it has been suggested to have the lowest incidence of infection and erosion among the non absorbable prostheses Synthetic meshes have been used with increasing frequency in gynecological surgery, both vaginally and abdominally, over the last 30 years [1].

The abdominal compartment syndrome: review, experience report and description of an innovative biological mesh application

Intra abdominal hypertension (IAH) is defined as an intra-abdominal pressure (IAP) >12 mmHg. Abdominal compartment syndrome (ACS) is defined as an IAP above 20 mmHg with evidence of organ dysfunction/failure. The real incidence of the ACS is not clear, because there are few perspective studies. The origin of ACS can be divided into retroperitoneal, intraperitoneal, parietal and intestinal, and the diagnostic algorithm includes base and toxicological laboratory examinations, thorax X-ray, abdomen X-ray, abdomen TC, peritoneal washing, abdomen ultrasonography, diagnostic laparoscopy, and measurement of IAP. To allow a suitable decompression and avoid the damages to the abdominal organs, abdominal wall normally is not sutured primarily but secondarily and there are many methods of temporary closing: absorbable net, non-absorbable nets, 'Bogota bag', 'vacuum pack ice', gradual approximation of side cutaneous edges on the half-way line with permanence of an ample ventral hernia that could be subsequently repaired, and the use of 'skin expanders'. Since January 2000, until December 2008, eight patients were submitted to laparostomy, four of them for re-laparotomy, with mortality incidence of 37.5%. The defective size to fill was on the average 300 cm as reported by Bradley and Bradley (J Clin Invest 26:1010-1015, 1947). The abdominal wall reconstruction was performed using ample muscle edges derived from the slip in medial sense of the rectus muscle of the abdomen 'unmoored' through an incision 1 cm distant from semi-lunar line, and using absorbable prosthesis to cover the solution of continuity, thus allowing the closing of defects over 30 cm. We have found median post surgical hernia in one patient corrected in accordance with the time using polypropylene prosthesis. In one patient with parietal disaster and multiple traumatic splanchnic ruptures, we have used a pure pork-derived acellular collagen mesh (Permacol(®)) to close the wound, leaving enough space between fascia extremities, to solve the IAP. The employment of ample muscle edges represents the ideal solution in the reconstruction of the abdominal walls after laparotomic operations, offering a valid dynamic support preferable in comparison with the employment of alloplastic material. In consideration of the limits of this technique in the enormous parietal disaster-ACS treatment, we describe a new kind of innovative mesh application (Permacol(®)), most often used for parietal disaster or enormous incisional hernias, which can easily be preferred to dual mesh prosthesis, having a better biological profile and no capacity to produce intestinal adherences.

Mode of Failure of Rib Fixation With Absorbable Plates: A Clinical and Numerical Modeling Study

Rib fractures as a result of trauma are a relatively common injury. There is an increasing interest in the operative stabilization of these injuries. Absorbable fixation plates are an option for improved rib fracture treatment. The aim of this study was to review our plating failures and to create a numerical model of muscle forces on fractured ribs to identify the mechanism by which these rib fixations have failed. Thirteen patients who had 58 ribs fixed with absorbable prostheses were reviewed. Finite element modeling was used to simulate the fixation of a lateral rib fracture using an absorbable plate and screw system. Internal pressure, intercostal forces, and appropriate displacement and rotational constraints were enforced at the rib ends. Ten rib fixation failures were noted in the clinical series. The modeling results showed that stresses on the plate differ during inspiration and expiration. Failure to use the two central screws resulted in higher stresses on the plating system. During inspiration simulations, the screws on both rib parts are active in keeping the rib and plate surfaces unseparated. However, during expiration, there is a greater stress on the screws on the posterior part of the broken rib, and separation of the plate from the rib seems to be more likely to occur at this site. This study indicates that the likely mode of failure of this absorbable plating system occurs on the posterior part of the rib, which correlates with the clinical failures seen.

Evaluation of healing prosthetic materials polyester mesh resorbable film and collagen elastin matrix /polypropylene used in rabbits abdominal wall defects

To compare polyester with absorbable layer prosthesis with collagen-elastin/polypropylene prosthesis in the repair of abdominal wall defects. The 16 studied rabbits were divided in groups A and B (euthanized on the 30th and 60th days, after the implant of the mesh). The animals underwent laparotomy and received a 2 cm wall 'defect' on each side of the Alba linea. The repair was made with the suture of a polyester mesh with absorbable film on the left side of the Alba Linea and with collagen-elastin/polypropylene mesh on the right side. Adherences were classified according to Nair Score and microscopic evaluation observing types I and III collagen formation and other immunohistochemical analyses. There were no significant differences in adhesion formation. The collagen type I showed higher deposition in polyester with absorbable layer. In group B, the difference between the meshes was significant, with higher collagen III deposition in polyester with absorbable layer (60 masculine P.O.). About the metalloproteinases, the presence of MMP -1 and MMP-8 were about the same; the expression of MMP-13 increased near to the 60th day. There is no significant difference between the two meshes in adhesion formation and immunohistochemical evaluation. The polyester mesh resorbable film presented a higher deposition of collagen.

Postimplant Behavior of Lightweight Polypropylene Meshes in an Experimental Model of Abdominal Hernia

Background. Over the years, reticular prostheses have undergone changes in their structure and composition to give rise to today's partially absorbable lightweight meshes. This study was designed to assess the biological and biomechanical behavior of these prostheses to establish whether they offer any advantages over nonabsorbable lightweight polypropylene prostheses. Materials and Methods. 7 × 5 cm defects were created in the anterior abdominal wall of New Zealand White rabbits and repaired by securing different prostheses to the edges of the defect with a running 4/0 polypropylene suture. The lightweight biomaterials compared were two nonabsorbable meshes: Parietene® and Optilene elastic®, and two partially absorbable prostheses: Vypro II® and Ultrapro®. At 14 and 90 days postimplant, tissue/prosthesis specimens were subjected to histological, immunohistochemical, shrinkage, and biomechanical analyses. Results. Adhesion formation on the peritoneum-facing surface of the meshes was significantly less extensive in the meshes with absorbable components at 90 days postimplant. The newly formed tissue around the prosthetic filaments was comprised of collagen fibers, fibroblasts, blood vessels, and macrophages. The partially absorbable meshes showed higher macrophage proportions (due to remnants of absorbable material and their structure) than the nonabsorbable meshes at 90 days, although differences were not significant. At 90 days postimplant, similar tensile strengths were recorded for all the implants. Conclusions. All the prosthetic materials induced good host tissue ingrowth, with no significant differences in tensile strength observed. Our findings suggest that partially absorbable lightweight prostheses could offer advantages over nonabsorbable lightweight meshes since less foreign material persists in the recipient, improving abdominal wall compliance.

Prosthetic abdominal wall hernia repair in emergency surgery: from polypropylene to biological meshes

The use of nonabsorbable prosthetic materials such as polypropylene, polyester, and ePTFE, have expanded and are now widely used in reparative surgery for abdominal wall hernias.There are still difficulties to find correct indication for prosthetic implant in emergency hernia surgery: as a matter of fact there is still a great debate if to use non-absorbable prostheses in potentially or truly infected operating fields [e.g. after intestinal resections].All these problems can be avoided with the use of absorbable prosthetic materials such as those composed of lactic acid polymers or lactic and glycolic acid copolymers: however, the use of these absorbable prosthesis exposes the patient to a rapid and inevitable hernia recurrence.It is important to remember that prosthetic repair has been proven to have a significant less risk of recurrence than repair with direct sutures.Recently, new "biologic" prosthetic materials have been developed and proposed for the clinical use in infected fields. These materials can be called "remodeling" for the way by which they are replaced after their placement within the patient. The "remodeling" process is made possible through a process of incorporation, where a reproduction of a site-specific tissue similar to the original host tissue is created.

Partially absorbable meshes for hernia repair offer advantages over nonabsorbable meshes

Background The aim of this study was to establish whether new prosthetic materials with absorbable components, designed to reduce the amount of foreign material in abdominal wall repair, offer advantages over the conventional polypropylene meshes. Methods Seven × 5 cm defects created in the anterior abdominal wall of New Zealand white rabbits were repaired by using a nonabsorbable polypropylene prosthesis (Surgipro; Tyco, Barcelona, Spain) or 1 of 2 partially absorbable prostheses available on the market (Vypro II and Ultrapro; Johnson & Johnson, St. Stevens-Woluwe, Belgium). At 14 and 90 days after surgery, tissue/prosthesis specimens were subjected to histological studies, biomechanical strength tests, and shrinkage evaluation. Results At 90 days, the absorbable filaments of Vypro II had been completely reabsorbed, whereas Ultrapro only showed signs of biodegradation in a few zones. Host tissue infiltration and collagen I deposition in the 3 reticular meshes was optimal. Macrophage counts, mesh shrinkage, and biomechanical resistance values were similar. Conclusions Partially absorbable prostheses perform as well as the standard polypropylene mesh and have the benefit that less foreign material remains in the recipient, without compromising mechanical resistance.

Tissue integration and tolerance to meshes used in gynecologic surgery: An experimental study

Objective To evaluate the tissue integration of and tolerance to five different mesh types used in genital prolapse surgery to provide mechanical support. Study design We placed five different meshes (Vicryl ®, Vypro ®, Prolene ®, Prolene soft ®, and Mersuture ®) on the peritoneums of 12 pigs. After 10 weeks, we used light microscopy to analyze the tissue integration of and tolerance to these meshes. We looked for inflammation, vascularization, fibroblasts, collagen fibers and the organization of connective tissue. Results The absorbable prostheses made of polyglactin 910 (Vicryl ®) and the non-absorbable prostheses made of polypropylene (Prolene ® and Prolene soft ®) induced the least severe inflammatory reactions. Tissue integration was best with the polypropylene meshes, which allowed the development of a well-organized, fibrous, mature, connective tissue. Conclusion The tissue response to prosthetic meshes depends on the material used and its structure. This work highlights the feasibility of carrying out experimental studies to test the tolerance to and integration of biomaterials used in gynecology. Such studies need to be carried out whenever new prostheses become available to validate their use in common practice.

Absorbable plates for rib fracture repair: preliminary experience.

Absorbable prostheses are currently used in a variety of bone reconstructions and fixations. This is a case series of rib fracture fixation using absorbable plates and screws consisting of 70:30 poly(L-lactide-co-D,L-lactide) from April 2001 through November 2002. Ten patients underwent rib fracture fixation with absorbable plates and screws. Indications included flail chest with failure to wean (five patients), acute pain with instability (four patients), and chest wall defect (one patient). All patients with flail chest weaned from mechanical ventilation successfully. All patients with pain and instability reported rapid subjective improvement or resolution. The patient with a chest wall defect repair returned to full athletic activity without limitations at 6 months. Thoracoscopic assistance was used in three cases and muscle-sparing incisions were used in eight cases. Two patients with screw fixation only developed loss of rib fracture reduction. One patient developed a wound infection requiring drainage. The period of follow-up ranged from 3 to 18 months. Absorbable plates produce good clinical results and are an option for rib fracture repair. Two-point fixation (screw fixation plus suture cerclage) is required. Further refinements in technique should focus on minimally invasive methods.

Surgical treatment of incisional hernias with marked loss of substance

The surgical approach for the treatment of abdominal incisional hernias is a difficult problem. Only the use of prosthetic materials can provide a solution, yet their use in case of abundant loss of peritoneum can involve complications due to direct contact between the mesh and the intestine. The use of prosthetic materials in reconstruction of the abdominal wall highlights two closely connected problems: the kind of mesh to be used and the best implant site The prosthesis should be positioned only in the pre-peritoneal space or in the retromuscular prefascial plane. We report our experience with a surgical technique in which the peritoneum is integrated with an absorbable prosthesis and the nonabsorbable prosthesis is positioned in the neo-preperitoneal plane. From January 1992 to January 2000 65 patients underwent surgery for large incisional hernias. The follow-up period ranged from 6 to 60 months. There were 15 (23.1%) early complications (seromas, hematomas and infections) and 2 (3.1%) late complications: a fistula between the skin and the prosthesis and a subacute infection of the abdominal wall. No recurrence was noted. In patients with abundant loss of substance there is no real pre-peritoneal space; therefore a new one must be created to restore the mechanical and functional structure of the peritoneum. The prosthetic Vicryl® mesh permits good tissue repair with almost no involvement of the intestinal loop. Follow-up studies confirm the efficacy of this method.

Some considerations on the use of heterologous prostheses in incisional hernias at risk of infection

The authors report their experience in the use of heterologous prostheses in incisional hernias at risk of infection. 45 out of 260 large incisional hernias (17.3%) were treated with nonabsorbable heterologous prostheses between January 1 1984 and January 1 1999. The literature shows a particular rigor in the treatment of incisional hernias, as in the French research by Chevrel and Flament [1990], where, in 1078 cases, the surgeons used autoplasty, relaxing techniques and, sometimes, absorbable prostheses, choosing to delay definitive treatment. The present authors deal with a series of cases treated with nonabsorbable prostheses. Even in incisional hernias at risk of infection, particularly with associated visceral surgery, the use of synthetic meshes has given encouraging results. The low incidence of suppurative complications, with neither removal of the patch nor recurrences in the short term, shows that this is a safe and definitive cure.

Preliminary Results of External Sapheno–Femoral Valvuloplasty: A Trial by the Italian Society of Phlebolymphology

A multicentric trial was conducted to compare the various methods, materials and results employed in external valvuloplasty of the sapheno-femoral junction. Dacron, PTFE and absorbable prostheses have been used and have lead to the following conclusions: careful diagnosis and selection of patients is necessary; dilatation of both terminal and sub-terminal saphenous valves should be treated; at present, PTFE seems the best material to use (follow-up for the absorbable material is too short); the operation is effective and can be recommended in selected cases.