Mesh Repair Of Hernia Research Articles

Comparative analysis of efficacy and quality of life between totally extraperitoneal sublay and intraperitoneal onlay mesh repair for ventral hernia.

Ventral hernias pose a prevalent challenge in abdominal wall surgery, with ongoing advancements in repair techniques designed to enhance patient outcomes. This study evaluates the efficacy, safety, and socio-economic impact of Totally Extraperitoneal Sublay Repair (TES) versus Laparoscopic Intraperitoneal Onlay Mesh Repair (IPOM) for small to medium-sized ventral hernias, with a particular focus on postoperative quality of life and patient satisfaction. A retrospective cohort study was conducted, encompassing 125 patients who underwent ventral hernia repair between May 2018 and November 2023. The cohort included 55 patients treated with TES and 70 with Laparoscopic IPOM. Baseline characteristics, including age, gender, BMI, operative time, postoperative pain, hospitalization costs, and patient satisfaction score, were compared. Postoperative quality of life was evaluated through outpatient visits or telephone follow-ups. The propensity score matching (PSM) technique was applied in a 1:1 ratio to balance the significant differences in general characteristics between the two groups. Out of 125 patients, 70 cases were successfully matched using the PSM method, resulting in 35 cases in each group. The baseline characteristics of patients in groups were well-matched (P > 0.05). The TES group exhibited a significantly longer operative duration (P < 0.001); however, this group also experienced markedly reduced postoperative pain, decreased hospitalization costs, and diminished postoperative drainage (all P < 0.001). The length of hospital stay and the incidence of long-term complications were similar between the two groups. Follow-up evaluations at 3 and 6 months showed a significantly improved quality of life and higher patient satisfaction in the TES group. Both TES and IPOM demonstrate comparable safety and efficacy in the repair of ventral hernias. Although TES is associated with a longer operative duration, it provides significant advantages in postoperative quality of life, patient satisfaction, and cost-effectiveness, thereby supporting its broader clinical adoption.

Self-gripping versus polypropylene mesh for incisional hernia repair in a rat model.

Self-gripping mesh, made of monofilament polypropylene and covered by a layer of polylactic acid micro-hooks, is applied in ventral hernia repair, whereas cytological change and collagen expression around the mesh are rarely reported. The objective of this research was to compare inflammatory response and collagen proliferation between self-gripping and polypropylene mesh in rat model of incisional hernia. Forty-five rats were randomly divided into unrepaired (UR) group, polypropylene (PP) mesh group, and self-gripping (SG) mesh group and euthanized at 1, 2 and 4weeks postoperatively. The levels of inflammation, neovascularization, and collagen expression were measured by immunohistochemistry, quantitative real-time polymerase chain reaction, and Western blot. One rat died and others developed typical incisional hernia in UR group, and hematoma, seroma, or wound infection were not observed in PP and SG groups. There was no significant difference in mesh shrinkage and inflammatory infiltration between PP and SG groups. With regard to neovascularization, 2 groups were comparable at 1 and 2weeks, while the neovascularization score of PP group was statistically higher than that of SG group at 4weeks. One week after surgery, the amounts of Collagen I (Col I) mRNA in PP group were significantly higher than SG group, while the amounts of Collagen III (Col III) mRNA were comparable between 2 groups. Two weeks following operation, the expressions of Col I mRNA and Col III mRNA in PP group were statistically lower than those in SG group. Four weeks postoperatively, the levels of Col I mRNA and Col III mRNA in PP group were significantly higher than those in SG group. Self-gripping mesh induced comparable inflammatory response and collagen proliferation compared with polypropylene mesh in a rat model. ZZU-LAC2023080121.

A comparative study of Desarda technique versus Lichtenstein mesh repair for inguinal hernia at a tertiary care centre

A comparative study of Desarda technique versus Lichtenstein mesh repair for inguinal hernia at a tertiary care centre

BHSeP36 Laparoscopic mesh repair of sciatic hernia containing ureter and small bowel: a case report

BHSeP36 Laparoscopic mesh repair of sciatic hernia containing ureter and small bowel: a case report

Laparoscopic repair of inguinal hernia using GORE SYNECOR biomesh

Inguinal hernia repair, historically performed through open surgery, has evolved to favour laparoscopic techniques due to reduced recovery time, minimized pain, and lower recurrence rates. The type of mesh used in repair plays a crucial role in surgical outcomes. Synthetic meshes are known for their durability and tensile strength, while biological meshes offer better biocompatibility and reduced risk of chronic inflammation. Recently, hybrid meshes such as GORE SYNECOR have emerged, integrating the strengths of both types. These composite meshes provide structural support while promoting tissue integration, yielding promising results in terms of low recurrence rates and improved patient-reported outcomes post-surgery. This report discusses an 81-year-old male with a left-sided indirect inguinal hernia managed through laparoscopic transabdominal preperitoneal (TAP) repair, utilizing GORE SYNECOR biomesh. His clinical presentation, surgical course, and recovery highlight the effectiveness of hybrid meshes for elderly patients, offering both durability and reduced complication risks. The use of a hybrid composite intraperitoneal device like the GORE SYNECOR mesh for inguinal and abdominal hernia repair demonstrates encouraging early outcomes. These include low recurrence rates, a strong safety profile, and notable enhancements in patients' health-related quality of life extending beyond one year.

Use of Biologic and Biosynthetic Mesh for Ventral Hernia Repair in Current Practice

Originally developed for use in contaminated fields, there is growing evidence against the use of biologic and biosynthetic mesh in ventral hernia repair. However, its prevalence and patterns of use in current practice are largely unknown. To describe the prevalence of biologic and biosynthetic mesh use in ventral hernia repair and to identify factors associated with its use. This retrospective cohort study used a statewide clinical registry in Michigan to identify adults who underwent mesh-based ventral hernia repair between January 1, 2021, and December 31, 2023. Data analysis was performed from February to May 2024. Use of biologic or biosynthetic mesh vs synthetic mesh. The main outcome was use of biologic or biosynthetic mesh, abstracted directly from the operative report. Multivariable logistic regression was used to identify factors associated with use of biologic or biosynthetic mesh. A total of 10 838 patients (mean [SD] age, 55.7 [14.0] years; 4619 [42.6%] female) who underwent mesh-based ventral hernia repair were identified, among whom 1174 repairs (10.8%) were performed with biologic or biosynthetic mesh and 9664 (89.2%) were performed with synthetic mesh. Of the 1174 cases using biologic or biosynthetic mesh, 1023 (87.1%) had a clean wound classification and 1039 (88.5%) were performed electively. In multivariable logistic regression, wound contamination was associated with increased odds of biologic or biosynthetic mesh use (clean-contaminated: adjusted odds ratio [aOR], 2.17 [95% CI, 1.62-2.89]; contaminated: aOR, 2.95 [95% CI, 1.63-5.34]; dirty or infected: aOR, 36.22 [95% CI, 12.20-107.56]). Other operative factors associated with increased odds of biologic or biosynthetic mesh use included urgent or emergent surgical priority (aOR, 1.69 [95% CI, 1.33-2.16]), laparoscopic or robotic approach (aOR, 1.31 [95% CI, 1.15-1.50]), larger hernia width (aOR, 1.03 [95% CI, 1.01-1.04] per centimeter), and use of myofascial release (aOR, 2.10 [95% CI, 1.64-2.70]). In this large cohort of patients undergoing ventral hernia repair, 1 in 10 mesh-based repairs was performed with biologic or biosynthetic mesh. Although urgent or emergent repair and wound contamination were associated with increased odds of biologic or biosynthetic mesh use, nearly 90% of biologic and biosynthetic mesh use occurred in elective repairs with clean wound classifications. These results raise questions regarding the appropriateness of its application in current practice.

Misapplication of Biologic Mesh in Clean-Site Elective Ventral Hernia Repair

Misapplication of Biologic Mesh in Clean-Site Elective Ventral Hernia Repair

Outcomes of porcine small intestinal submucosa mesh compared to polypropylene mesh in laparoscopic transabdominal preperitoneal inguinal hernia repair: a retrospective cohort study.

To compare the long-term outcomes of porcine small intestinal submucosa (SIS) mesh and polypropylene (PP) mesh after an laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Mesh-based surgical techniques for inguinal hernia repair are recommended in the guidelines due to the lower rate of recurrence. Biologic meshes (BMs) may have advantages in terms of chronic pain due to the different postoperative remodeling, without the disadvantages of a permanent implant. SIS mesh is the most commonly used BMs, mostly used for young male patients. Until now, the long-term efficacy of SIS mesh in laparoscopic inguinal hernia repair (LIHR) has rarely been reported and remains elusive. We retrospectively reviewed prospectively collected data from consecutive LIHR performed at Beijing Chaoyang Hospital between January 1, 2014 and December 31, 2018. Two groups of meshes were selected: SIS mesh and PP mesh. To reduce potential selection bias, patients were matched based on the logit of propensity scores through age, gender, and body mass index (BMI). Follow-up was until January 30, 2024. Long-term outcomes were analyzed, including the rate of recurrence, the rate of re-operation, and the postoperative discomfort. A total of 2,348 patients with LIHR were eligible. After exclusion criteria, a total of 1,240 unilateral hernias treated using the TAPP approach were included for statistical analysis. Of these, 143 hernias (11.5%) were operated on with SIS mesh. Applying propensity score matching resulted in 115 matched pairs for comparative analysis. The mean operative time with the SIS mesh was 63.2 ± 18.5min, which was longer than the operative time with PP mesh of 50.1 ± 17.6min (P < 0.001). The SIS mesh was used more frequently to repair indirect hernias, while the PP mesh was more often employed to direct and femoral hernias at a higher rate (P = 0.009). The mean follow-up was 84.2months and a total of seven patients (3%) were lost to follow-up. Overall, five (2.3%) patients experienced hernia recurrence postoperatively, all in the SIS group, but no statistical difference was observed between the two groups (4.4% vs. 0%; P = 0.06). All underwent a second operation, with three in TAPP approach and two in Lichtenstein approach, no recurrence was found afterward. More patients in the SIS group reported postoperative discomfort than those in the PP group (8.8% vs. 0.9%; P = 0.006), notably experiencing discomfort more frequently and to a greater degree during movement. The SIS mesh in TAPP hernia repair leads to more frequent discomfort and a higher recurrence rate (though not statistically significant) compared to PP mesh. Continued follow-up and an increased sample size are needed to analyze the effectiveness of SIS mesh and to explore risk factors for recurrence.

A normalized quality of life approach for regulatory approval of medical devices

Abstract Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the impact of treatment on patients’ symptoms, function and quality of life. High-quality PRO data from trials can inform shared decisionmaking, regulatory and economic analyses and health policy. The heterogeneity between the patient groups and the associated differences in morbidity and quality of life can be taken into account by standardization to the general population. As a result, our study shows that despite the retrospective design with the corresponding level of evidence, mesh repair of a ventral hernia leads to an equivalent result compared to tissue hernia surgery.

EE729 Clinical and Economic Impact of a Tri-Layer Hybrid Biomaterial vs Synthetic Mesh for Ventral Hernia Repair in Australia: A Cost-Consequence and Budget Impact Analysis

EE729 Clinical and Economic Impact of a Tri-Layer Hybrid Biomaterial vs Synthetic Mesh for Ventral Hernia Repair in Australia: A Cost-Consequence and Budget Impact Analysis

Exploring Early Complications in Paraumbilical Hernia Mesh Repair: A Rigorous Six-Month Prospective Study and In-Depth Analysis.

Introduction When an organ, such as the colon, pushes through the wall of the abdominal cavity, a hernia results. After femoral and inguinal hernias, umbilical hernias account for the third most common kind of abdominal hernia in adults precipitated by conditions such as obesity, ascites, and repeated pregnancies. A subtype of umbilical hernias called paraumbilical hernias is more likely to cause problems such as rupture, skin ulceration, and obstruction. Seroma, hematoma, and infection are the reported post-repair consequences but data regarding early complications is limited. High-quality data assessing early complications is necessary to improve mesh repair outcomes. Materials and methods This cross-sectional study was carried out in the Department of General Surgery at Medical Teaching Institute (MTI) Lady Reading Hospital, Peshawar over one year, from January to December 2022. A total of 167 patients were selected using simple random sequential selection. Patients aged 20-60 years of both genders who were diagnosed with paraumbilical hernia in the emergency department were included. To prevent bias, those with uncontrolled diabetes or existing complications from hernia were excluded. Following informed consent, data were gathered using pre-designed proformas. Patients underwent open mesh repair during each surgery, and they were monitored at one and three months following the procedure. Complications such as seroma, hematoma, and wound infection were documented. Data were analyzed using SPSS version 20 (IBM Corp., Armonk, NY) with chi-square tests for categorical variables and a significance level of p < 0.05. Results The study included a total of 167 patients, with a mean age of 42 years (SD ±8.77). The majority of patients (40%) ranged in age from 41 to 50 years old, with 33% aged 31 to 40. Gender distribution revealed that 63 (38%) of the patients were male and 104 (62%) were female. Early complications included 25 (15%) wound infections, 32 (19%) seromas, and 63 (38%) hematomas. The occurrence of wound infections, seromas, and hematomas did not differ significantly by age or gender (p > 0.05). Conclusion Early complications from paraumbilical hernia mesh repair include wound infections (15%), seromas (19%), and hematomas (38%). Postoperative monitoring is critical to reducing these complications.

Utilizing T-Line Mesh for Periumbilical Hernia Repair: Evaluation of Short-term Outcomes.

Abdominal periumbilical hernias are prevalent within the adult population. When symptomatic, quality of life may be affected. This case series of 10 patients evaluates the short-term outcomes of using the T-Line mesh in periumbilical hernia repair. A retrospective review of adult patients with symptomatic periumbilical abdominal hernia treated with open repair with T-Line mesh was performed at a tertiary referral center. Ten patients with an average age of 51 years were offered surgical treatment. Measures of postoperative outcomes included readmission within the 30-day postoperative period; recurrence; surgical site infection; development of seroma and hematoma; and the presence of pain, numbness, or bloating. Descriptive statistics were computed in Microsoft Excel. All 10 patients reported improvement in symptoms. All repairs were elective and classified as clean (100%). Hernias included 40% primary umbilical, 50% ventral, and 10% incisional. The average defect size was 10 cm2, with a range from 1 to 25 cm2. The T-Line mesh was placed in a sublay manner, with an average mesh size of 36 cm2. No patients were readmitted in the 30-day postoperative period. There were no occurrences of surgical site infection or hernia recurrence. No hospital readmissions and no follow-up visits with hernia recurrence were noted at 3 months. We present a case series of 10 patients presenting with symptomatic periumbilical hernias who underwent repair with the T-Line hernia mesh without short-term surgical occurrences. Long-term studies are required to accurately reflect safety and efficacy.

A comparative study between condensed polytetrafluoroethylene hernia mesh versus other composite meshes in Endo-laparoscopic ventral hernia repair

IntroductionLaparoscopic ventral hernia mesh repair (LVHR) is gaining popularity possibly due to reduced complications, reduced hospital stay, early return to work and better cosmesis. In intra-peritoneal onlay method (IPOM) a dual layer composite mesh with an absorbable barrier on the visceral surface is used for minimising bowel adhesions. Three most popular prosthetic mesh scaffolds are polypropylene (PP), polyester and expanded polytetrafluoroethylene (ePTFE). A new generation of monolayer condensed polytetrafluoroethylene (cPTFE) Omyra® mesh, which theoretically has better tissue integration with parietal tissue and possibly lesser adhesions with visceral organs is now available for use. ObjectiveThe aim of our study is to assess the safety and efficacy of Omyra (cPTFE) mesh versus other mesh types in LVHR. MethodWe retrospectively collected data from 62 patients who underwent LVHR using cPTFE, as well as other mesh types from January 1, 2011 to December 31, 2020. Patient demographics, Hernia Characteristics, perioperative events, postoperative results and complications were documented and analysed. ResultsAmong the 62 patients studied, there were 27 (43.55 %) in the Omyra group and 35 (56.45 %) in the other synthetic meshes group. The mean age of the Omyra group was 53.19 (31–85) and 55.03 (22–81) for the other synthetic meshes group. There were no differences in terms of patient demographics and major comorbidities. At presentation, the indication was more commonly for recurrence (p = 0.043), and patients were more symptomatic (p = 0.0034) in the Omyra group than the other synthetic meshes group. There were no differences in mean operating time, post-operative recovery and complications, as well as early (<30 days) and late (>30 days) complications during follow up. ConclusionThe use of cPTFE (Omyra™) mesh yielded comparable operative characteristic compared to other synthetic meshes for LVHR. The rate of perioperative complications and early recurrence was similar between Omyra and other synthetic meshes group.

Potentiality of Antibacterial Gels for the Prophylactic Coating of Hernia Repair Prosthetic Materials.

Prosthetic mesh infection constitutes one of the major postsurgical complications following abdominal hernia repair. Antibacterial coatings represent a prophylactic strategy to reduce the risk of infection. This study assessed the in vitro response of two antibacterial gels made of 1% carboxymethylcellulose (CMC) functionalized with an antiseptic (chlorhexidine, CHX) or an antibiotic (rifampicin, RIF), developed for the coating of polypropylene (PP) meshes for hernia repair. Fragments of a lightweight PP mesh (1 cm2) presoaked in the unloaded or drug-loaded CMC (0.05% CHX; 0.13 mg/mL RIF) were challenged with 106 CFU/mL Staphylococcus aureus (Sa) and methicillin-resistant S. aureus (MRSA). Agar diffusion tests, sonication, turbidimetry, crystal violet staining, scanning electron microscopy and cell viability assays (fibroblasts, mesothelial cells) were performed to evaluate the response of the gels. Both compounds-especially the RIF-loaded gel-exerted a biocidal effect against gram-positive bacteria, developing wide inhibition halos, precluding adhesion to the mesh surface, and hampering bacterial survival in culture. The antibiotic gel proved innocuous, while lower viability was found in cells exposed to the antiseptic (p < 0.05). Together with their fast, affordable, convenient processing and easy application, the results suggest the potential effectiveness of these drug-loaded CMC gels in providing meshes with an antibacterial coating exhibiting great biocide performance.

A Comparative Study of Tackers Versus Sutures in Transabdominal Preperitoneal Hernia Repair: Tackers Versus Sutures in Mesh Fixation and Peritoneal Closure in Tapp

Background: This study evaluates the surgical outcomes of using tackers versus sutures for mesh fixation and peritoneal closure in transabdominal preperitoneal (TAPP) mesh repair of inguinal hernia, focusing on postoperative pain, quality of life, and other key metrics. Although there are many studies in studying various outcomes of Transabdominal preperitoneal mesh repair (TAPP), there exists only few trials that compare peritoneal closure techniques in TAPP Methods: A prospective comparative study was conducted at Mahatma Gandhi Medical College and Research Institute. Sixty patients undergoing TAPP were divided into two groups: one using non-absorbable sutures and the other using non-absorbable titanium tackers for mesh fixation and peritoneal closure. Intraoperative and postoperative outcomes were assessed, including time taken for procedures, postoperative pain (measured using the Visual Analog Scale), incidence of seroma formation, and short-term quality of life assessed using the Carolinas Comfort Scale. Results: The suture group demonstrated significantly less postoperative pain on postoperative day (POD) 1 and at 3 months compared to the tacker group (p=0.001 and p=0.004, respectively). The time taken for mesh fixation and peritoneal closure was shorter in the tacker group, but the overall operative time was significantly longer in the suture group (p=0.001). The cost of using sutures was substantially lower than tackers. Quality of life scores at 3 months indicated better outcomes in the suture group (p=0.001). Conclusions: Sutures for mesh fixation and peritoneal closure in TAPP repair provide better postoperative outcomes in terms of pain, quality of life, and cost compared to tackers, despite a longer operative time. These findings suggest that sutures may be a preferable option for TAPP inguinal hernia repair.

Meta-analysis of RCTs on the safety of non-fixation of mesh in TAPP inguinal hernia repair: an updated meta-analysis

ObjectiveThis meta-analysis aims to compare the clinical efficacy of mesh non-fixation and fixation in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair, systematically evaluating the application value of the mesh non-fixation technique in clinical settings.MethodsA computerized search of PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases was conducted to identify randomized controlled trials (RCTs) comparing mesh non-fixation and fixation in TAPP inguinal hernia repair. Meta-analysis was performed using RevMan 5.3 software, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence grading system was employed for outcome quality assessment. Publication bias analysis was performed using Begg’s test. A trial sequential analysis (TSA) was performed using TSA 0.9.5.10 Beta software.ResultsA total of nine RCTs involving 1,879 inguinal hernia patients were included. Meta-analysis results demonstrated that, compared to the fixation group, the non-fixation group exhibited significantly lower seroma occurrence rate [RR = 0.43, 95% CI (0.20, 0.89), P = 0.02, heterogeneity P = 0.28, I²=22%], Visual Analog Scale (VAS) pain score at 6 months postoperatively [MD=-0.21, 95% CI (-0.29, -0.12), P < 0.00001, heterogeneity P = 0.34, I²=0%], and cost [MD=-3.23 thousand yuan, 95% CI (-4.26, -2.19), P < 0.00001, heterogeneity P = 0.0003, I²=92%]. There were no statistically significant differences in overall complication rate [RR = 0.88, 95% CI (0.62, 1.23), P = 0.45, heterogeneity P = 0.11, I²=44%], overall infection event rate [RR = 0.96, 95% CI (0.36, 2.56), P = 0.93, heterogeneity P = 0.62, I²=0%] and recurrence rate [RR = 0.75, 95% CI (0.28, 1.99), P = 0.56, heterogeneity P = 0.44, I²=0%] between the two groups. The results of the TSA indicated that the observed lower seroma occurrence rate in the non-fixation group compared to the fixation group requires further validation through the inclusion of additional RCTs.ConclusionMesh non-fixation in TAPP inguinal hernia repair is deemed safe and does not elevate the risk of hernia recurrence. However, given certain limitations in this study, future comprehensive and reliable validation will require further multicenter, high-quality, large-sample double-blind RCTs.

Comparing the Postoperative Analgesic Efficacy of Ketorolac and Tramadol After Open Inguinal Hernia Mesh Repair: A Randomized Controlled Trial.

Background Opioids are the mainstay for postoperative pain control. However, due to the increasing dependence on opioids and their side effects, multiple adjuncts are used to reduce opioid consumption, including non-steroidal anti-inflammatory drugs (NSAIDs). Inguinal hernia repair is one of the most common procedures performed by general surgeons worldwide. Despite various advancements in operative techniques, postoperative pain remains a major risk factor for morbidity and delayed hospital discharge following surgery. Objective The objective of this study was to compare ketorolac with tramadol for postoperative pain control following open inguinal hernia mesh repair. Methods This was a randomized controlled trial. Sixty patients undergoing unilateral primary open inguinal hernia repair with mesh were randomly divided into two groups: Group A received injection ketorolac intravenously postoperatively, while Group B received injection tramadol intravenously following surgery. Pain scores and vitals were measured at two, six, 12, and 24 hours post procedure. Other secondary outcomes included the time for nausea to stop, time to pass flatus, and time to start ambulation. Data was analyzed by independent-sample t-test using IBM SPSS Statistics for Windows, Version 30.0 (Release 2024; IBM Corp., Armonk, New York, United States); a p-value of < 0.05 was considered significant. Results Pain scores were lower in the ketorolac group when compared to tramadol. However, patients in the tramadol group had nausea for a longer duration, delayed return of bowel function, and took longer to start ambulation. There was no significant difference in vitals. Conclusion Injection ketorolac, when used in isolation, provides more effective postoperative analgesia along with fewer side effects when compared to tramadolin inguinal hernia repair.

Severe Anaphylaxis Following Intradermal Test Dose of Ceftriaxone

Abstract Ceftriaxone is a third-generation cephalosporin antibiotic used commonly for treating infections; however, hypersensitivity reactions, including anaphylaxis, occur in approximately 1%–3% of patients. Anaphylaxis can vary from minor skin rashes to life-threatening events affecting multiple organ systems, making it challenging for anesthesiologists. We present a case of severe anaphylaxis resulting in anaphylactic shock after an intradermal test dose of ceftriaxone in a 55-year-old female undergoing umbilical hernia mesh repair. The patient was a well-controlled hypertensive who came with stable vital signs before surgery. However, soon after administering the test dose, she began to exhibit asystole and unresponsiveness; hence, cardiopulmonary resuscitation immediately commenced, along with intravenous administration of adrenaline. Although consciousness returned, she failed to show palpable pulses while maintaining adequate respiratory effort. She was put on 100% oxygen with noninvasive ventilation and managed on noradrenaline and adrenaline infusions due to significant hypotension. After 6 days in critical care, the patient’s condition improved, allowing for weaning from the ventilator and eventual discharge. This incident, despite a negative history of allergy testing, points to the unpredictable nature of drug hypersensitivity and the importance for anesthesiologists and surgical teams to be keen on monitoring patients. As there was normal recovery with adequate left ventricular function, we did not think in terms of any other cause. Clear documentation of such reactions is essential for future medical care, underlining the importance of complete allergy reviews to avoid similar life-threatening events. This case is also an important reminder about the vigilance that should be maintained during the perioperative period.

Assessing the Safety of Mesh Repair in Strangulated Groin Hernias: A Systematic Review and Meta-Analysis.

The use of mesh in emergency repair of complicated groin hernias has been a subject of discussion for decades. While it is now generally accepted that mesh could safely be used in incarcerated (irreducible) and obstructed hernias (without strangulation), with wound infection rates comparable to suture repairs, the use of mesh in strangulated hernias involving bowel resection is still controversial. The aim of this study, therefore, was to analyse the safety of mesh use in strangulated hernias with ischaemic bowel at the time of surgery.A literature search was carried out using relevant keywords. The study was conducted in accordance with the Preferred Reporting Items forSystematic Reviewsand Meta-Analyses (PRISMA) 2020 framework anddata analysis was done using the Review Manager version 5.4 (The Cochrane Collaboration, Oxford, UK) meta-analysis software.Seven studies comprising 1,159 patients who had emergency surgery for strangulated groin hernias were analysed. A pooled random effect meta-analysis did not show any significant difference in the surgical site infection rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) = 0.39-1.96, p = 0.75), seroma formation (OR = 3.39; 95% CI = 0.70-16.43; p = 0.13), and hernia recurrence (OR = 0.33; CI = 0.05-2.22; p = 0.26) between the two groups. The long-held concern that mesh could not be safely used in strangulated groin hernias has not been validated by the results obtained from this systematic review and meta-analysis. However, more randomised controlled trials in this clinical area would need to be carried out to further validate the results of this study.

Enhanced chitosan and Carboxymethylcellulose scaffolds with natural fiber reinforcement for hernia repair meshes

AbstractChitosan (Chi) and carboxymethylcellulose (CMC) scaffolds, with and without reinforcement by Luffa cylindrica (Lc) or Asclepias curassavica (Ac), were synthesized to evaluate their potential application as hernia repair meshes. These meshes are crucial as they provide structural support to weakened tissues, reducing the risk of hernia recurrence and promoting faster recovery. They improve patient outcomes by enhancing the durability and effectiveness of hernia repairs. Chi scaffolds exhibited lower porosity compared to CMC scaffolds, with fiber inclusion enhancing porosity. The CMC4‐Ac scaffold demonstrated the highest porosity at 67.2%, which is crucial for supporting cell growth and tissue regeneration. All scaffolds exhibited exceptional hydration levels, which is vital for cell growth. Scanning electron microscope (SEM) images revealed open pores in the CMC4 scaffolds, which enhances tissue formation. Tensile strength tests indicated that all scaffolds surpassed the minimum requirements, with CMC4‐Ac standing out for its exceptional properties. CMC scaffolds showed greater degradation, which was mitigated by fiber reinforcement. Chi scaffolds absorbed more Croton draco extract (Cdext) but exhibited lower release rates compared to CMC scaffolds. No hemolytic and non‐cytotoxicity effects were observed. CMC4‐Ac emerged as the most promising scaffold due to its superior properties, making it suitable for hernia repair meshes.