Intraperitoneal Mesh Research Articles

Safety and efficacy of absorbable and non-absorbable fixation systems for intraperitoneal mesh fixation: an experimental study in swine.

Choice of the best possible fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of the present study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation. Fourteen Landrace swine were utilized in the study. The experiment included two stages. Initially, four pieces of mesh (Ventralight ™ ST) sizing 10 × 5cm were placed and fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. These defects were repaired primarily with absorbable suture before mesh implantation. Each mesh was anchored with a different tack device between Absorbatack™, Protack™, Capsure™, or Optifix™. The second stage took place after 60days and included euthanasia, laparoscopy, and laparotomy via U-shaped incision to obtain the measurements for the outcome parameters. The primary endpoint of the study was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks. Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Capsure™ tacks had higher peel strength when compared to Absorbatack™ (p = 0.028); Protack™ (p = 0.043); and Optifix™ (p = 0.009). No significant differences were noted regarding the extent of visceral adhesions (Friedman's test p value 0.854), the adhesion quality (Friedman's test p value 0.506), or the mesh shrinkage (Friedman's test p value = 0.827). Four out of the ten animals developed no adhesions at all 2months after implantation. Capsure™ fixation system provided higher peel strength that the other tested devices in our swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.

Complete migration of a composite mesh into small bowel incidentally found during laparotomy for colectomy in an asymptomatic patient: a case report

BackgroundComposite meshes are used for incisional hernia repair because they enable intraperitoneal mesh placement due to their dorsal surface, which is made of inert material. We report, for the first time, to our knowledge, a case of composite mesh migration detected incidentally during a laparotomy for colon cancer in an asymptomatic patient.Case presentationOur patient was a 71-year-old South Asian man who underwent ventral mesh repair following a postoperative complication after right hemicolectomy for colon cancer. The patient was diagnosed with a metachronous sigmoid cancer 5 years later, for which he underwent laparotomy. During laparotomy, a migrated mesh was incidentally found and extracted from his proximal ileum without any evidence of abscess or fistula formation.ConclusionTo our knowledge, this is the first report of an incidentally found migrated composite mesh from a bowel lumen in an asymptomatic patient.

Permanent end-colostomy parastomal hernia prevention using a novel three-dimensional mesh.

Prophylactic mesh placement has been proposed to reduce the high occurrence of parastomal hernia (PSH) after stoma formation. This is an observational study comparing two cohorts of patients: a mesh prophylaxis group (who received mesh prevention since introduction at our Institution) and a no mesh prophylaxis group (retrospectively selected from our historical series). Same exclusion criteria were applied for both groups. The study was conducted at a tertiary referral center for colorectal surgery. 43 patients were operated with mesh prophylaxis between May 2015 and may 2019. 45 patients underwent end-colostomy formation without prophylaxis between April 2011 and April 2015. The primary outcome measure was PSH development at 12-month follow up. Demographic variables and risk factors for PSH were comparable between the two groups. There was no difference between the two cohorts in terms of operative time and main early postoperative outcomes. 37 patients completed the 12-month follow up in each group. PSH occurrence after 12-months was 11% in the mesh prophylaxis group and 54% in the no mesh prophylaxis group (p < 0.0001). There were no differences in long-term complications. 5% of patients who received mesh prophylaxis underwent emergency surgery for bowel occlusion at 7 and 10months after surgery, with partial or complete mesh removal. At multivariate analysis, mesh prophylaxis was a protective factor for PSH development at 12months (p < 0.0001). Prophylactic intraperitoneal mesh placement appears to be effective in preventing PSH.

Patient-Reported Outcomes of Robotic vs Laparoscopic Ventral Hernia Repair With Intraperitoneal Mesh

Despite rapid adoption of the robotic platform for ventral hernia repair with intraperitoneal mesh in the United States, there is no level I evidence comparing it with the traditional laparoscopic approach. This randomized clinical trial sought to demonstrate a clinical benefit to the robotic approach.To determine whether robotic approach to ventral hernia repair with intraperitoneal mesh would result in less postoperative pain.A registry-based, single-blinded, prospective randomized clinical trial at the Cleveland Clinic Center for Abdominal Core Health, Cleveland, Ohio, completed between September 2017 and January 2020, with a minimum follow-up duration of 30 days. Two surgeons at 1 academic tertiary care hospital. Patients with primary or incisional midline ventral hernias of an anticipated width of 7 cm or less presenting in the elective setting and able to tolerate a minimally invasive repair.Patients were randomized to a standardized laparoscopic or robotic ventral hernia repair with fascial closure and intraperitoneal mesh.The trial was powered to detect a 30% difference in the Numerical Rating Scale (NRS-11) on the first postoperative day. Secondary end points included the Patient-Reported Outcomes Measurement Information System Pain Intensity short form (3a), hernia-specific quality of life, operative time, wound morbidity, recurrence, length of stay, and cost.Seventy-five patients completed their minimally invasive hernia repair: 36 laparoscopic and 39 robotic. Baseline demographics and hernia characteristics were comparable. Robotic operations had a longer median operative time (146 vs 94 minutes; P < .001). There were 2 visceral injuries in each cohort but no full-thickness enterotomies or unplanned reoperations. There were no significant differences in NRS-11 scores preoperatively or on postoperative days 0, 1, 7, or 30. Specifically, median NRS-11 scores on the first postoperative day were the same (5 vs 5; P = .61). Likewise, postoperative Patient-Reported Outcomes Measurement Information System 3a and hernia-specific quality-of-life scores, as well as length of stay and complication rates, were similar. The robotic platform adds cost (total cost ratio, 1.13 vs 0.97; P = .03), driven by the cost of additional operating room time (1.25 vs 0.85; P < .001).Laparoscopic and robotic ventral hernia repair with intraperitoneal mesh have comparable outcomes. The increased operative time and proportional cost of the robotic approach are not offset by a measurable clinical benefit.ClinicalTrials.gov Identifier: NCT03283982.

What are the trends in incisional hernia repair? Real-world data over 10years from the Herniamed registry.

There is an increasingly controversial debate about the best possible incisional hernia repair technique. Despite the good outcomes of laparoscopic IPOM, concerns about the intraperitoneal mesh placement and its potential intraabdominal complications have risen. Against that background, this paper now analyzes changes and trends in incisional hernia repair techniques in the recent decade. Between 2010 and 2019 a total of 61,627 patients with primary elective incisional hernia repair were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves to visualize trends. The explorative Fisher's exact test was used for statistical calculation of significant differences. Since the number of cases entered into the Herniamed Registry for the years 2010-2012 was still relatively small, the years 2013 and 2019 were compared for statistical analysis. In the analyzed time period, the proportion of incisional hernias repaired in open suture technique remained unchanged at about 10%. The proportion of laparoscopic IPOM repairs decreased significantly from 33.8% in 2013 to 21.0% (p < 0.001) in 2019. Conversely, the proportion of open sublay repairs increased significantly from 32.1% in 2013 to 41.4% (p < 0.001) in 2019. Starting in 2015, there has also been the introduction and increasing use (4.5% in 2013 vs. 10.0% in 2019; p < 0.001) of new minimally-invasive techniques with placement of a mesh into the sublay/retromuscular/preperitoneal abdominal wall layer (E/MILOS, eTEP, preperitoneal mesh technique). Analysis of data from the Herniamed Registry shows a significant trend to the disadvantage of the laparoscopic IPOM and to the advantage of the open sublay operation and the new minimally-invasive techniques (E/MILOS, eTEP, preperitoneal mesh technique). Despite all the recommendations in the guidelines, 10% of incisional hernias continue to be treated by means of a suture technique.

A peritoneal defect covered by intraperitoneal mesh prosthesis effects an increased and distinctive foreign body reaction in a minipig model.

The incidence of incisional hernia is with up to 30% one of the frequent long-term complication after laparotomy. After establishing minimal invasive operations, the laparoscopic intraperitoneal onlay mesh technique (lap. IPOM) was first described in 1993. Little is known about the foreign body reaction of IPOM-meshes, which covered a defect of the parietal peritoneum. This is becoming more important, since IPOM procedure with peritoneal-sac resection and hernia port closing (IPOM plus) is more frequently used. In 18 female minipigs, two out of three Polyvinylidene-fluoride (PVDF) -meshes (I: standard IPOM; II: IPOM with modified structure [bigger pores]; III: IPOM with the same structure as IPOM II + degradable hydrogel-coating) were placed in a laparoscopic IPOM procedure. Before mesh placement, a 2x2cm peritoneal defect was created. After 30 days, animals were euthanized, adhesions were evaluated by re-laparoscopy and mesh samples were explanted for histological and immunohistochemichal investigations. All animals recovered after implantation and had no complications during the follow-up period. Analysing foreign body reaction, the IPOM II mesh had a significant smaller inner granuloma, compared to the other meshes (IPOM II: 8.4 µm ± 1.3 vs. IPOM I 9.1 µm ± 1.3, p < 0.001). The degradable hydrogel coating does not prevent adhesions measured by Diamond score (p = 0.46). A peritoneal defect covered by a standard or modified IPOM mesh was a significant factor for increasing foreign body granuloma, the amount of CD3+ lymphocytes, CD68+ macrophages and decrease of pore size. A peritoneal defect covered by IPOM prostheses leads to an increased foreign body reaction compared to intact peritoneum. Whenever feasible, a peritoneal defect should be closed accurately before placing an IPOM-mesh to avoid an excessive foreign body reaction and therefore inferior biomaterial properties of the prosthesis.

Management of late onset septic complications after IPOM implantation: case series from ahernia center

The intraperitoneal onlay mesh (IPOM) is for many surgeons apragmatic solution for the operative treatment of extensive and complex abdominal wall hernias. Afew years after mesh implantation we are now faced with anumber of late complications of the IPOM procedure. Chronic septic complications, such as mesh infections and fistula formation have an outstanding position. With this case series we would like to share our experiences with the operative treatment of severe late onset septic complications after abdominal wall augmentation with IPOM. Furthermore, the current indications for the IPOM procedure are discussed. For the period February 2016-July 2019 a total of 10patients with late septic complications after IPOM implantation were treated in our clinic. The index interventions took place between 2010 and 2017. The clinical picture varied from mesh infections with only minor symptoms to formation of multiple intestinal fistulas. Multiple stage procedures were required in 9out of the 10patients in order to achieve sufficient decontamination of the surgical field. Due to enterocutaneous fistulas, bowel resection was performed in 5patients. The mesh could be preserved in situ in only one patient. For the reconstruction of the abdominal wall, both plastic surgical methods and implantation of absorbable and non-absorbable meshes were used. Aconsistent treatment with great effort is required for septic complications of the IPOM procedure. The interventions are often associated with extensive adhesiolysis and intestinal resection. Therefore, the indications for intraperitoneal mesh implantation should be handled with caution and an alternative surgical procedure should be considered. There are still special cases, such as hernias with very large abdominal wall defects in which the IPOM method is asuitable treatment option for tension-free reconstruction.

Mesh position for hernia prophylaxis after midline laparotomy: A systematic review and network meta-analysis of randomized clinical trials

Mesh can be used to prevent incisional hernia (IH) occurrence. However, the effect of various mesh positions has never been compared. This study aimed to compare and rank the effect and safety of various mesh-augmented fascia closure techniques on hernia prophylaxis in midline laparotomy. MEDLINE and SCOPUS were searched from inception to December 2019. Randomized clinical trials (RCTs) were eligible if they met the following criteria: comparison of any of the following interventions: onlay (OM), retrorectus (RM), preperitoneal (PM), intraperitoneal mesh (IM) augmentation, and primary suture closure (PSC); and reporting on any of these outcomes: IH, wound infection, seroma, hematoma, and dehiscence. Two independent reviewers extracted data and assessed the risk of bias. A two-stage random-effect network meta-analysis was performed, then intervention effects were pooled and ranked accordingly. A total of 20 RCTs were eligible. Only OM and RM showed a significantly lower risk of IH than PSC with pooled risk ratios (RRs), 95% confidence intervals (95%CI) of 0.24 (0.12, 0.46) and 0.32 (0.16, 0.66), and number needed to treat (NNTs) of 4 and 5, respectively. However, OM showed a significantly higher risk of seroma than PSC (RR 2.21 (1.44, 3.39) with a number needed to harm (NNH) of 14). Most mesh placements showed a higher risk of wound infection, except for RM, but none of these was significantly different. All mesh techniques, except RM, showed a reduction in dehiscence, but again these were not significantly different. OM and RM provided the most effective IH prevention relative to PSC. However, OM had a higher rate of seroma than RM and PSC. Other complications, including wound infection, hematoma, and dehiscence, were not significantly observed among these fascia closure techniques.

Biologic mesh implantation is associated with serious abdominal wall complications in patients undergoing emergency abdominal surgery: A randomized-controlled clinical trial.

Open, emergency abdominal surgery is associated with a high incidence of fascial dehiscence and incisional hernia. Implantation of biologic meshes potentially reinforces the abdominal wall and therefore decreases such complications. The aim of this prospective randomized study was to compare the outcome after prophylactic intraperitoneal implantation of a biologic Strattice mesh (Allergan, Dublin, Ireland) with standard abdominal closure in patients undergoing emergency abdominal surgery. A two-arm randomized clinical trial was performed in patients undergoing emergency abdominal surgery at Bern University Hospital, University of Bern, Switzerland, from April 2016 to March 2019. Patients were randomly assigned to prophylactic implantation of a biological intraperitoneal mesh using Strattice, Allergan (mesh group), or standard abdominal closure using a single, continuous running suture (no-mesh group). Because of safety concerns, patient enrollment was closed prematurely. Eligibility for inclusion was assessed in 61 patients. A total of 48 patients were randomized (21 in the mesh group, 28 in the no-mesh group). No differences in baseline characteristics were found. Abdominal wall complications requiring reoperations were more frequent in the mesh group compared to the no-mesh group (5 [83.3%] of 13 vs. 1 [14.3%] of 13 patients, p = 0.026). Mesh-associated abdominal wall complications included nonintegration of the mesh into the abdominal wall, dissolution of the mesh, and mesh-related infections. In patients undergoing emergency abdominal surgery, intraperitoneal biologic Strattice mesh implantation is associated with significantly more frequent abdominal wall complications requiring reoperation. Therefore, the use of such meshes cannot be recommended in the contaminated environment of emergency abdominal surgery. Therapeutic, level I.

Laparoscopic Repair of Primary and Secondary Epigastric Hernias. Technical Considerations of the IntraPeritoneal On Lay Mesh + Defect Closure (IPOM-Plus Technique)

We present our experiences with the laparoscopic repair of primary and secondary (incisional) epigastric hernias that occur in the vicinity of bony structures. In our institute, we retrospectively reviewed 51 patients with primary and secondary epigastric hernias from 2002 to 2016. The European Hernia Society guidelines were used for classifying these hernias. Laparoscopic dissection of the falciform ligament, intracorporeal suturing of the defect and intraperitoneal composite mesh onlay placement was performed in all patients. There were 32 males and 19 females with a mean age of 40 years and a mean BMI of 29.5kg/m2. There were multiple defects in eight patients (15.68%). The mean hernial defect size was 5.75 cm2 (range 3–8.5 cm2). The surface of the used mesh was ranging from 225–400 cm2 (mean 312.5 cm2). Mean follow-up was nine months. Morbidity rate was 11.7% and the recurrence rate was 1.9%. Upper abdominal hernias are difficult to manage laparoscopically because of the complexity of dissection and their anatomic proximity to the falciform ligament, xiphoid and costal margins. Multiple defects and associated hernias can also be easily identified and laparoscopically repaired simultaneously with the placement of a large mesh. The mesh borders can be adequately fixed beyond the bony confines via the laparoscopic approach, which would otherwise be impossible in the open technique. Laparoscopic repair of these hernias is safe and effective and provides all the benefits of minimally invasive surgery.

Outcome of inlay ventralex hernia patch among patients with ventral hernia at Zagazig University Hospitals, Egypt

Background Multiple techniques have been clarified for mesh placement in the hernia repair surgery, including onlay, sublay, and inlay positioning. Meshes with a dual layer have been developed to prevent the formation of adhesions of the viscera to the intraperitoneal mesh. So, the present investigation was conducted to compare the outcome of the ventral hernia repair using inlay ventralex hernia patch with the classic onlay prolene mesh. Patients and method s A randomized clinical trial was carried on 60 patients with a ventral hernia in the Department of General Surgery, Zagazig University Hospitals, Egypt, from January 2018 to January 2020. The patients were equally divided into two groups: group A with inlay ventralex hernia patch and group B with onlay prolene mesh. Results Regarding demographics and clinical presentation, no statistically difference was found between both groups, whereas there was a highly significant differences between group A and group B in the operative time, with mean of 35.4±0.25 and 50.2±0.14 min, respectively, with no significant difference between them in anesthesia type, defect size, and mesh size. On comparing the postoperative complications, a significant difference was found between them regarding wound seroma, wound infection, and postoperative pain. Moreover, a highly significant shorter hospital stay, time of return to work or normal activity, and mean postoperative follow-up were observed in group A. Conclusion The inlay ventralex hernia patch is an effective and easier technique and can also save the operative time with less postoperative complications and better outcomes as compared with the classic onlay prolene mesh. So, its use is considered cost-effective.

Preventing Hernia Recurrence: Optimising Mesh Use in Incisional Hernia Repair

Incisional hernia is a common complication of abdominal surgery, affecting up to a quarter of patients undergoing laparotomy. This case report discusses a 72-year-old lady with a recurrent incisional hernia following an emergency Hartman’s procedure. The discussion covers the properties of synthetic vs biological meshes, the significance of the anatomical location of the mesh, fixation methods, laparoscopic surgery, short and long term complications.&#x0D; Key points:&#x0D; &#x0D; The ideal mesh is biocompatible, strong, resistant to infection, has minimal bioreactivity and non-immunogenic&#x0D; Pore size is important to the degree of mesh integration, infection risk and the development of chronic pain&#x0D; Synthetic mesh is useful in contaminated cases but adds a significant cost to the procedure&#x0D; Sublay mesh placement is associated with a reduced risk of recurrence&#x0D; Most recurrences occur at the edge of the mesh. Surgeons should ensure a 5cm overlap between the mesh and native tissues and consider dual fixation methods&#x0D; Laparoscopic hernia repair has been associated with a shorter post-op recovery, less pain and a short term reduced risk of recurrence, however there is a greater risk of bowel injury and development of adhesions&#x0D; Composite meshes can reduce the risk of adhesions with intraperitoneal mesh placement&#x0D; Chronic pain is associated with the use of tacks, heavy weight synthetic meshes and chronic infection&#x0D; Resorbable meshes have not been shown to reduce chronic pain&#x0D; The choice of mesh, method of repair and surgical approach should be individualised to the patient.&#x0D;

COMPARISON BETWEEN OUTCOMES OF IPOM AND SUBLAY MESH HERNIOPLASTY FOR VENTRAL HERNIA

Introduction:&#x0D; Abdominal wall hernia is a common condition encounter in surgical OPD. There is 2% chance of developing hernia in lifetime wheres umbilical / paraumbilical hernia accounts for 10-14% of all the hernias. Ultimate treatment of abdominal wall hernia is surgery and mesh placement. Early surgery can avoid multiple complications including incarceration of intestine. Multiple patient factors that can cause recurrence of hernia or development of incisional hernia laprotomy incorporate age, male sex, COPD ,diabetes mellitus, somking and obesity. Multiple operative modalities are present for ventral hernias, commonest being laproscopic IPOM and Open sublay. Different meta-analysis recommends that laproscopic hernia repair is best in defect size not more than 10cm.&#x0D; Objective: &#x0D; objective of this study was to compare the efficacy of intra-peritoneal (IPOM) mesh repair with open sublay mesh repair for PUH in terms of operative time, post operative pain, hospital stay and recurrence.&#x0D; Material and Methods:&#x0D; This study was done in department of surgery at surgical unit III , Lahore General Hospital starting from january 2018 till january 2019. Patients presenting with paraumbilical hernia were admitted from SOPD. An aggregate of 50 participants were included in this study. Majority of patients were females (46 in number) with age ranging from 26 years to 55 years. Rests of patients were males (04 in number) with age ranging from 40 years to 60 years. Patients undergoing open surgery were placed under O-group and patients undergoing laproscopic repair were placed under L-group. Patients were followed up on 10th post-op day, 4 weeks, 6 month and 1 year interval. Inclusion criteria: All patients of both sexes with para umbilical hernia presenting in the SOPD was included in the study. Exclusion criteria: All patients with obstructed, strangulated PUH were excluded in the study. Patients with co-morbid conditions like diabetes mellitus (DM), COPD (Chronic obstructive pulmonary disease), IHD (Ischemic Heart Disease) were also excluded.&#x0D; Results:&#x0D; 50 participants included in this study had age ranging from 26 years to 60 years. Mean duration of operation in L-group was 81 ± 13 minutes while in O-group, duration of operation was 89 ±19 minutes. Hernia defect size in both groups was approximately same. mean size defect was 13.3 ± 2.6 cm2 for L-group and 13.1 ± 2.9 cm2 in O-group. Post-operative Duration of Hospital atay for L-group was 36-60 hours while hospital stay in O-group was 48 to 72 hours. Recurrence rate after 1 year in L-group was 01 while in O-group;recurrence was seen in 02 patients. &#x0D; Conclusion:&#x0D; IPOM is a better option in management of paraumbilical / umbilical hernia in terms of operation duration, hospital stay, post-operative pain and recurrence outcomes as compared to open sublay technique.&#x0D;

Postoperative ileus after laparoscopic primary and incisional abdominal hernia repair with intraperitoneal mesh (DynaMesh®-IPOM versus Parietex™ Composite): a single institution experience.

Laparoscopic primary or incisional abdominal hernia repair with intraperitoneal mesh placement is a well-accepted and safe technique. Evidence for complications however remains inconclusive, and little is known about the occurrence of postoperative ileus secondary to postoperative intra-abdominal adhesions with different types of IPOM meshes used. Therefore, we retrospectively compared the occurrence of postoperative ileus between two of the different meshes used in our center. Three hundred seventy-five patients who underwent ventral hernia repair with intraperitoneal mesh placement, either with a DynaMesh®-IPOM (FEG Textiltechnik mbH, Aachen, Nordrhein-Westfalen, Germany) or a Parietex™ Composite mesh (Medtronic, Minneapolis, MN, USA), at the Heilig-Hart Hospital in Lier (Antwerp, Belgium) between 2012 and 2017 were retrospectively compared with regard to the occurrence of postoperative ileus until 6weeks postoperatively. Baseline demographics and clinical data up to 6weeks postoperatively of the patients in the two mesh groups are provided. The DynaMesh®-IPOM mesh group was associated with a significantly higher incidence of postoperative ileus compared with the Parietex™ Composite mesh group with a cutoff limit at postoperative day 1 (n= 17, 6.8% vs. n= 0, 0.0%; P= 0.003) and postoperative day 4 (n= 13, 5.2% vs. n = 0, 0.0%, P= 0.006), even with a mesh surface area of ≤ 300cm2 and when both meshes were fixated with the same method of fixation (Securestrap™) with a cutoff limit for postoperative ileus at postoperative day 1 (n= 4, 7.7% vs. n= 0, 0.0%; P= 0.013) and postoperative day 4 (n= 3, 5.8% vs. n = 0, 0.0%, P= 0.040). Of the 17 patients with a postoperative ileus, 9 (52.9%) had a suspicion of adhesive small bowel obstruction on CT scan (P= 0.033) with definitive confirmation of small bowel adhesions with the DynaMesh®-IPOM mesh at laparoscopy in 2 patients. Our results confirm current literature available regarding postoperative ileus secondary to postoperative intra-abdominal adhesions with the DynaMesh®-IPOM mesh. However, further research with well-designed, multicenter randomized controlled studies to evaluate the use and related complications of these meshes is needed.

Outcome of Open Intraperitoneal Dual Mesh Versus on–Lay Mesh for Incisional Hernia Repair

Background : incisional hernia is any abdominal wall gap with or without a bulge in the area of a postoperative scar. There are different methods for treating incisional hernia . Mesh is always used to decrease the recurrence rate to less than 10%. Different types and different methods of mesh hernioplasty.Objective : to compare the outcome of open intraperitoneal mesh versus on-lay mesh hernioplasty.Method : this prospective study conducted in Al- Fayhaa Teaching hospital between February 2016 and February 2018. The patients with incisional hernia are divided into two groups . Group A treated by open intraperitoneal optimized composite mesh, and group B managed by on-lay mesh .the patients followed for 24 months following surgery to compare between the two groups regarding , operative time , hospital stay and post operative complications.Result : eighty patients included in the study . In group A , the mean operative time was ( 90 ±10.24 minutes) while for group B was ( 70 ± 17.53 minutes ). The average hospital stay was ( 3.34 ± 1.27 days) and ( 5 ± 3.73 days) for group A and group B respectively .seroma developed in 12.5% for intraperitoneal group and 27% for on-lay group. Surgical site infection was 2.5% in group A and 15 % in group B. No patient developed recurrence of hernia in group A , while 7.5 % of group B developed recurrence during the period of follow up.Conclusion: open intraperitoneal mesh hernioplasty is much better than on-lay method regarding the operative time , hospital stay and post operative complications.

Laparoscopic Incisional Hernia Repair After Liver Transplantation: Long-Term Series and Literature Review

BackgroundLiver transplant (LT) surgery is associated with a high occurrence of hernias, which is related to multiple factors such as body mass index (BMI), diabetes, immunosuppression, corticosteroids, and so on. Laparoscopic ventral hernia repair after LT allows rapid patient recovery with a low postoperative complication rate. MethodsWe conducted a retrospective analysis of all LTs performed since 1998 in patients who underwent laparoscopic hernia repair in our centers. Likewise, we reviewed the literature, including all published studies of the laparoscopic approach to hernia repair after LT. ResultsBetween 2002 and 2018, 37 patients underwent laparoscopic hernia repair surgery after LT. The majority were men (86%) with a mean age of 51 years (48.5-61) and a BMI of 30.4. All patients underwent laparoscopic surgery, with placement of intraperitoneal mesh with a surface area of 414 cm2 fixed with nonresorbable tackers. The mean hospital stay was 2 days. Morbidity included 3 seroma (8%) and a wound infection (2%); there was no major morbidity with involvement of the liver graft. The median follow-up was 43 (18-93) months, with 2 cases of recurrence (5%).In the published literature, we found 11 articles, among which the largest series was 54 patients; however, the majority had fewer than 20 cases. In all articles, a decrease in the morbidity and mortality rates was described after this surgery and previous LT decompensation. ConclusionLaparoscopic hernia repair in patients with previous LT is safe with a low complication rate and is reproducible and therefore should be the first-choice approach.

Intraperitoneal versus retromuscular mesh placement for open incisional hernias: an analysis of the Americas Hernia Society Quality Collaborative

Incisional hernia repair with mesh improves long-term outcomes, but the ideal mesh position remains unclear. This study compared intraperitoneal versus retromuscular or preperitoneal sublay (RPS) mesh positions for open incisional hernia repairs. All patients who had elective open incisional hernia repairs were identified retrospectively in the Americas Hernia Society Quality Collaborative database. The primary outcome was the rate of 30-day surgical-site infection (SSI). Other outcomes of interest included 30-day surgical-site occurrences requiring procedural intervention (SSOPI), hernia-related quality-of-life survey (HerQLes) scores and long-term recurrence. A logistic model was used to generate propensity scores for mesh position using several clinically relevant co-variables. Regression models adjusting for propensity score and baseline characteristics were developed to assess the effect of mesh placement. A total of 4211 patients were included in the study population: 587 had intraperitoneal mesh and 3624 had RPS mesh. Analysis with propensity score adjustment provided no evidence for differences in SSOPI (odds ratio (OR) 0·79, 95 per cent c.i. 0·49 to 1·26) and SSI (OR 0·91, 0·50 to 1·67) rates or HerQLes scores at 30 days (OR 1·20, 0·79 to 1·82), or recurrence rates (hazard ratio 1·28, 0·90 to 1·82). Mesh position had no effect on short- or long-term outcomes, including SSOPI and SSI rates, HerQLes scores and long-term recurrence rates.

Comparison of Results of Dual Mesh Hernioplasty and Omental Interposition Polypropylene Mesh Hernioplasty in Incisional Hernias

Recently, with the improvement of dual meshes, that has no harm when in touch with the intraabdominal organs, intraperitoneal mesh hernioplasty techniques became more popular. Intraperitoneal repair can also be done by polypropylene mesh with interpositioning of the omentum. This study aims to compare the results of omental interposition mesh hernioplasty and intraperitoneal mesh hernioplasty. The study was conducted as a prospective observational study. In between January 2008 and January 2012, patients with incisional hernia were divided into two groups according to the suitability of the greater omentum as omental interposition mesh hernioplasty and intraperitoneal dual mesh hernioplasty. The median follow-up periods of all 49 patients were 17 (4–48) months. Operation time was significantly longer in the omental interposition mesh hernioplasty group (p < 0.05). Length of hospital stay, drain take off time, and the complication rates were similar in between the groups. The recurrence rates were also similar; however, in omental interposition mesh hernioplasty group, the cost was significantly lower (p < 0.05). Although omental interposition mesh hernioplasty technique takes more time, in cases that great omentum is suitable; this technique can be used safely with lower cost.

Factors affecting salvage rate of infected prosthetic mesh

BackgroundProsthetic mesh infection (PMI) is a challenging complication of ventral hernia repair (VHR). The sparsity of data leaves only experience and judgment to guide surgical decision-making. MethodsRetrospective review of patients diagnosed with PMI. Subsequent abdominal operation (SAO) constitutes any intraabdominal operation occurring after the index hernia repair prior to PMI presentation. Any mesh removal was considered salvage failure. Analysis was performed using Chi-square test, Fishers Exact, or Mann-Whitney U test. Analyses completed using R Version 3.0.2. ResultsWe identified 213 instances of PMI. Most cases (58.7%) involved intraperitoneal mesh. Thirty-seven percent of patients had an SAO, only 25.3% of which were clean cases. Enteroprosthetic fistula occurred in 38 patients (17.8%). Mean time to presentation was 19.9 mos after index hernia repair or SAO for infection alone, and 48.1 mos when a fistula was present (p < 0.001). Percutaneous drainage was used to treat 29 cases, successfully in 10 (34.5%), 8 of which were macroporous polypropylene and 2 biologic mesh. Negative pressure wound therapy (NPWT) was used in 46 patients, but successful in only 16 (34.8%), all of which were macroporous polypropylene. Local wound care alone successfully salvaged only 16 of 85 meshes (18.8%), 13 of which were macroporous polypropylene. Macroporous polypropylene mesh was salvaged in 65% of cases overall, and 72.2% when in an extraperitoneal position. Mesh salvage was not possible in any case involving composite or PTFE mesh, and rarely for microporous polypropylene (7.7%) multifilament polyester (4.2%), or intraperitoneal mesh (2.4%). Closure of the defect after mesh removal significantly lowers recurrence rate (p < 0.001). ConclusionPMI involving composite, PTFE, multifilament polyester, or microporous polypropylene mesh requires explantation in nearly all cases. Infected macroporous polypropylene mesh in an extraperitoneal position is salvageable in most cases. Furthermore, the risk of secondary mesh infection after SAO, particularly with intraperitoneal mesh, should be considered during index VHR.

Experimental evaluation of intra-abdominal adhesions comparing two different intraperitoneal meshes and the effect of a natural anti-inflammatory product on their formation.

Purpose:In laparoscopic incisional hernia repair, meshes with a tissue-separating barrier are positioned intraperitoneally. Despite this property, the close contact between mesh and viscera involves a risk of adhesion formation. Some natural products, such as red propolis (RP), could reduce these adhesions owing to their anti-inflammatory properties. This study aimed to compare two different intraperitoneal meshes with respect to their characteristics of adhesion formation, histological findings and evaluate the role of RP in the development of these adhesions.Methods:40 Wistar rats received placement of two different meshes (Symbotex and Dynamesh IPOM) on peritoneum. The animals were divided into two groups: control group (mesh) and treatment group (mesh and RP). After 7 and 14 days, 20 animals of each group underwent midline laparotomy to determine the adhesions and histological characteristics.Results:Out of the 40 animals, there were two deaths in the test group and two in the control group. All animals in both groups developed adherence to the mesh. At postoperative day (POD) 7, two Symbotex meshes presented firm adhesions and at POD 14, two Dynamesh meshes had firm adhesions as well. The comparison between the meshes under the effect of RP in relation to the control group showed no statistical difference.Conclusions:Both meshes showed intraperitoneal adhesions in all evaluated samples with similar results on the characteristics of adhesions. RP showed no effect on the incidence or gradation of intraperitoneal adhesions with the mesh.