Mesh Repair Of Hernia Research Articles

Clinical outcomes of patients undergoing Desarda versus Lichtenstein mesh for inguinal hernia repair: our experience in Qazi Hussain Ahmed Medical Complex, Nowshera Pakistan

Background: The objective of this study was to compare the outcome of Desarda versus Lichtenstein mesh for surgical repair of inguinal hernia.Methods: This randomized controlled trial was done at Qazi Hussain Ahmed Medical Complex, Nowshera from 01 February 2019 to 30 December 2020 with total duration 1 year and 10 months. Study included patients admitted in hospital for inguinal hernia repair. Patients were divided into 2 groups. Group 1 consisted of patients in whom Lichtenstein mesh repair was done while group 2 with patients having Desarda non-mesh repair done. Total time of surgery was noted. Patients were assessed for pain using a visual analog scale (VAS) after 72 hours and for seroma and infection within seven days. Recurrence and resumption of normal gait was assessed after 6 months. Data was analyzed with statistical package for the social sciences (SPSS) 21.Results: Total of 100 male patients were included in the study. About 45 patients were included in group 1 and 55 in group 2. Mean age of the patients was 53±10.55 years in Lichtenstein group and 50±08.11 years in Desarda group. The mean duration of surgery was 47.57±4.95 min with Lichtenstein while 37.96±4.76 min with Desarda. The mean pain score was 2.5±1.0 after 72 hours with Lichtenstein while 1.72±0.20 with Desarda (p<0.05). Seroma was developed in 4 (8.8%) patients, infection in 5 (11.11%) patients and recurrence occurred in 1 (2.2%) patient in group 1 (Lichtenstein) while no patient developed infection in group 2 (Desarda). The rate of normal gait observed in 6 months post operative was in 25 (55.5%) patients with Lichtenstein repair while in group 2, 30 (54.54%) patents resumed normal gate respectively (p>0.05).Conclusions: Both methods for repair are acceptable but the Desarda has less complications and operative time as compared to Lichtenstein repair.

AN EXPERIENCE COMPARING INGUINAL HERNIA MESH REPAIR VS DARN REPAIR

Background: Several methods for fixing inguinal hernias have been documented. Anterior or posterior approaches,open or laparoscopic procedures, may be used for hernia repair. While the technique of darn repair first presented byMoloney is still a useful treatment for inguinal hernias, polypropylene mesh repair has gained popularity lately becauseof the remarkable outcomes shown by Lichtenstein. In elderly guys, inguinal hernias account for 50% of cases. Oldertreatments like darn repair have become less common with modern techniques like laparoscopy and mesh for correctinginguinal hernias. But in underdeveloped nations like Pakistan, where affordability is a top priority, the darn repair isstill well-liked and often used for inguinal hernia repairs. This research aimed to compare the early results of darnedrepair with Lichtenstein repair.Objectives: Comparing inguinal hernia mesh repair vs. Darn repair evaluates postoperative discomfort, healing,hernia recurrence, and patient satisfaction. This informs patients and doctors about the pros and cons of each inguinalhernia surgery.Study design: A descriptive cross-sectional studyDuration and place of study: this study was conducted in the Surgical unit of Bacha Khan Medical Complex,Swabi, from April 2017 to April 2018.Methods: This descriptive cross-sectional research included 121 male patients, ages 18 to 60, who had been reportedfor elective or emergency Mesh/Lichtenstein or indirect or direct inguinal hernias with open surgical repair betweenApril 2017 and April 2018. Comparing the duration of hospital stay, surgery site infection, and hernia recurrenceusing various procedures was the main goal.Results: For the patients who had Lichtenstein repair, their stay in the hospital was longer, with (5.3%) superficialsite infection and no deep wound infection, and Darn repair (3.5%) Superficial surgical site infections and 1.7% deepinfection were noted. Complications of recurrence in Lichtenstein repair were zero at 1-year follow-up compared toDarn repair, which had a recurrence of 1.7%.Conclusion: Compared to Darn Repair regarding the recurrence of inguinal Hernia, the results of Lichtensteinrepair are more promising.Keywords: Darn repair, Mesh Repair, Inguinal hernia

Complex Abdominal Wall Reconstruction with Biologic Mesh for Ventral Hernia Repair in Solid Organ Transplant Recipients.

Ventral hernia is a common occurrence in patients undergoing solid organ transplant (SOT) and who require complex abdominal wall reconstruction (CAWR). The aim of this study was to analyze the outcomes of CAWR in SOT patients in a tertiary center. We performed a prospective cohort study in patients who underwent CAWR with biological mesh at our center from January 2016 to November 2021. As per the study protocol, all patients will be followed for 3 years. During the study period, we performed CAWR in 38 SOT patients. The mean age (Standard Deviation: SD) was 61 (9.5) years and the majority were males (68%). Mean body mass index (SD) was 30.3 (5.5) kg/m2 and hernia repair was performed electively in 33 patients. The majority (82%) of the hernias were less than class 2 with a median mesh size (interquartile range) of 600 (400-800) cm2. Seventy-nine percent of patients were liver transplant recipients and the mesh was placed sub-lay (retro-rectus) (82%); the most common technique was posterior component separation (82%). Five patients (13.2%) had surgical site infection and 4 (10.5%) had unplanned reoperations. None of the patients died postoperatively and the 30-day readmission rate was 21%. Three patients (7.9%) had recurrence during follow-up and all of them underwent reoperation. Complex abdominal wall reconstruction (CAWR) using biologic mesh for solid organ transplant patients with ventral hernia is safe and has low recurrence when performed by a dedicated CAWR team.

Comparative study of efficacy and safety between sublay and onlay polypropelene mesh repair for incisional hernia of abdominal wall

To compare the efficacy and safety between sublay and onlay polypropylene mesh repair for incisional hernia of abdominal wall. Department of General Surgery from January 2018 to December 2021 in BHIMA BHOI MEDICAL COLLEGE OF WESTERN ODISHA. It is a randomized controlled trial. In this study a total of 144 (72 in each group) patients were observed. The patients were randomly allocated in two groups by random method. Patients in group-A was subjected to onlay polypropylene mesh open repair procedure and patients in group-B was subjected to sublay polypropylene mesh open repair procedure for incisional hernia repair in abdominal wall. Post-operatively all patients were kept under observations for 7-10 days in surgery ward and observed for complications if any. Post-operatively all patients were followed at 20 days, 2nd months, 6th month and 9 months to confirm the efficacy and safety of the procedure. The mean age of patients in Group-A was 30 years± 2.16 and 32 years ± 3.71 in Group-B. In group-A 28 patients were male and 44patients were female where as in group-B 27 patients were male and 45 patients were female.

Incisional hernia repair with a slowly absorbable P4HB mesh: what happens after the mesh disappears? A retrospective longitudinal clinical study.

To analyze the incisional hernia recurrence rate at a long-term follow-up using a biosynthetic long-term absorbable mesh in patients with a higher risk of surgical infection in a contaminated surgical field. This was a retrospective multicentric study. All patients undergoing incisional hernia repair between 2016 and 2018 at 6 participating university centers were included. Patients were classified according to the Ventral Hernia Working Group (VHWG). All consecutive patients who underwent abdominal wall repair using biosynthetic long-term absorbable mesh (Phasix®) in contaminated fields (grade 3 and 4 of the VHWG classification) were included. Patients were followed-up until September 2021. Preoperative, operative, and postoperative data were collected. All patients' surgical site infections (SSIs) and surgical site occurrences (SSOs) were recorded. The primary outcome of interest was the clinical incisional hernia recurrence rate. One hundred and eight patients were included: 77 with VHWG grade 3 (71.3%) and 31 with VHWG grade 4 (28.7%). Median time follow-up was 41months [24; 63]. Twenty-four patients had clinical recurrence during the follow-up (22.2%). The SSI and SSO rates were 24.1% and 36.1%, respectively. On multivariate analysis, risk factors for incisional hernia recurrence were previous recurrence, mesh location, and postoperative enterocutaneous fistula. At the 3year follow-up, the recurrence rate with a biosynthetic absorbable mesh (Phasix®) for incisional hernia repair in high-risk patients (VHWG grade 3 and 4) seemed to be suitable (22.2%). Most complications occurred in the first year, and SSI and SSO rates were low despite high-risk VHWG grading.

Designing Double-Layer Multimaterial Composite Patch Scaffold with Adhesion Resistance for Hernia Repair.

Hernia repair mesh is associated with a number of complications, including adhesions and limited mobility, due to insufficient mechanical strength and nonresorbability. Among them, visceral adhesions are one of the most serious complications of patch repair. In this study, a degradable patch with an antiadhesive layer is prepared for hernia repair by 3D printing and electrospinning techniques using polycaprolactone, polyvinyl alcohol, and soybean peptide (SP). The study into the physicochemical properties of the patch is found that it has adequate mechanical strength requirements (16 N cm-1 ) and large elongation at break, which are superior than commercial polypropylene patches. In vivo and in vitro experiments show that human umbilical vein endothelial cells proliferated well on composite patches, and showed excellent biocompatibility with the host and little adhesion through a rat abdominal wall defect model. In conclusion, the results of this study show that composite patch can effectively reduce the occurrence of adhesions, while the addition of SP in the patch further enhances its biocompatibility. It is believed that a regenerative biological patch with great potential in hernia repair provides a new strategy for the development of new biomimetic biodegradable patches.

Comparison Between Open Shouldice Versus Laparoscopic Unilateral Inguinal Hernia Repair: A Randomized Controlled Trial

Aim: To compare the outcomes of laparoscopic Inguinal hernia repair and open Inguinal hernia Shouldice repair. Study design: A randomized controlled trial Place and duration: This study was conducted at Liaquat University of Medical Health Sciences Jamshoro, Pakistan from April 2020 to April 2021. Methodology: In this study comparison of a laparoscopic and open procedure was done. A total of 124 patients were included in the study. A total of 64 patients underwent a Laparoscopic Transabdominal Pre Peritoneal (TAPP) Inguinal Hernia Mesh Repair and 60 patients underwent the Shouldice technique of hernia repair which is an open surgical Non Mesh Technique. The measured Variable were Early Complication, Return to work, Duration of analgesia requirement and Reoccurrence Rate. The data were analyzed using IBM SPSS version 26. Results: The rate of complications in both groups was similar. Patients who underwent the laparoscopic procedure mean duration to return back to work was 12 days. On the other hand, those who had the Shouldice procedure mean duration was 17 days return back to work. The mean duration of analgesia intake after a laparoscopic procedure was 2.2 days and after a Shouldice procedure was 2.8 days. Recurrence of the hernia was reported by 3 (4.69%) patients who underwent the laparoscopic procedure and 2 (3.33%) patients who underwent the open procedure. Conclusion: The laparoscopic procedure is a better procedure than the open procedure of primary unilateral hernia repair in terms of early recovery, return to work and postoperative pain. Keywords: Laparoscopy, hernia repair, Shouldice procedure

Pathways of the preperitoneal plane: from the "fatty triangle" in Rives to the "fatty trident" in extended retromuscular abdominal wall reconstruction. A tribute toProf. Schumpelick.

Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence in retromuscular preperitoneal dissections. Thirty frozen cadaver torsos were dissected by posterior component separation. The shape of the preperitoneal fat was identified, and the dimensions and more significant distances were calculated. The results showed that the preperitoneal fat resembles a trident, exists along the midline under the linea alba, and expands in the epigastric area into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach the Retzius space. Laterally, the Bogros space communicated the root of the trident with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum not covered by the preperitoneal fatty trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair. The concept of preperitoneal fatty trident may be of practical assistance to perform various hernia procedures, from the simple ventral hernia repair to the more complex preperitoneal ventral repair or posterior component separation techniques. The consistency of this layer allows us to follow three specific pathways to find our plane between the peritoneum and muscle layers to extend the preperitoneal dissection.

Comparative review of outcomes: single-incision laparoscopic total extra-peritoneal sub-lay (SIL-TES) mesh repair versus laparoscopic intraperitoneal onlay mesh (IPOM) repair for ventral hernia

To compare outcomes between single-incision laparoscopic totally extra-peritoneal sub-lay (SIL-TES) mesh repair and laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral hernia (VH). A retrospective selection of 104 patients who underwent VH repair (50 and 54 in the SIL-TES and IPOM groups, respectively) was made. Patient data were collected, and quality of life was evaluated using Carolinas Comfort Scale (CCS) 1 month and 3 months after surgery. There were no significant differences in sex, American Society of Anesthesiologists class, defect size, mesh area, estimated blood loss, and complication rate between the groups. Age was lower, body mass index was higher, prevalence of primary VH was significantly higher (p < 0.0001), and pain was less at 24 and 48 h post procedure (p < 0.0001) in the SIL-TES group. Drainage placement was more (p < 0.0001), operation time was shorter (p = 0.012), and hospitalization duration and total hospitalization cost were greater in the IPOM group than that in SIL-TES group (8.3 ± 0.3 vs 4.3 ± 0.4 days, p < 0.0001; $7126.9 ± 141.4 vs $2937.3 ± 58.3, p < 0.0001, respectively). Pain and movement limitation scores evaluated by CCS were significantly worse at 1 month (4.93 ± 0.28 vs 1.75 ± 0.28: p < 0.0001; 2.52 ± 0.24 vs 1.15 ± 0.18: p < 0.0001, respectively) and 3 months (4.32 ± 0.37 vs 0.9 ± 0.29: p < 0.0001; 2.06 ± 0.25 vs 0.69 ± 0.11: p < 0.0001, respectively) in IPOM group, compared with the according scores in SIL-TES group. There was no readmission within 30 days and no hernia recurrence at mean follow-up of 12 months. SIL-TES mesh repair is safe and effective and is superior to IPOM repair.

Comparative study between mayo’s repair and retro-rectus mesh repair in umbilical and para-umbilical hernias

To assess if Mayo’s repair can be used with an equal efficacy as Retro-rectus Mesh&#x0D; Repair in cases of uncomplicated Umbilical and Paraumbilical hernias. Method: A Prospective Comparative study was conducted from December 2019 to June 2021 at Department of Surgery OPD, Krishna Hospital, Karad. A total of 120 subjects with uncomplicated Umbilical and Paraumbilical hernia were enrolled in this study and were randomly allocated to Group A and Group B. In Group A umbilical hernia repair was done using Mayo’s repair whereas in Group B subjects underwent Retro-rectus Mesh repair. Results: The 120 subjects were divided into two groups of 60(50%) each. We observed that majority of the study subjects were females (85% and 86.67% in either groups). The M:F ratio in the current study was 1:5.6 in first group and 1:6.5 in second group. We observed that majority of the study subjects were overweight (40% &amp; 43.33% in either group). We observed that diabetes was present among 28.33% and 10% subjects in either group, whereas hypertension was reported among 16.67% and 5% subjects in either groups. COPD was observed among 1.67% and 10% study subjects respectively.

Sublay and overlay mesh repair in paraumbilical hernias– which surgery you will prefer??

Background: Paraumbilical hernia accounts for 33.9% of anterior abdominal wall hernia. Mesh can be applied onlay; on the anterior fascia, inlay; in the hernia defect, sublay; to retro-rectus or preperitoneal space or underlay; in the intraperitoneal position. Aims and Objectives: The objectives of the study are as follows:1) To compare the efficacy between sublay and onlay mesh repair for paraumbilical hernia. 2) To compare the safety between sublay and onlay mesh repair for paraumbilical hernia. Materials and Methods: A prospective study was conducted on 120 patients (60 in each group) patients. The patients were randomly allocated in two groups by lottery method. Patients in Group-A were subjected to sublay mesh repair procedure and patients in Group-B were subjected to onlay mesh repair procedure for paraumbilical hernia repair. Postoperatively, every patient was kept under observations for 3–4 days in ward and observed for complications. Postoperatively, all patients were followed at 10 days, 3 months, and 6thmonth to confirm efficacy and safety of the procedure. Results: The average age of Group-A was 39 years and 32 years in Group-B. In Group-A, 55% patients were female and 45% patients were male; whereas in Group-B, 60% patients were female and 40% patients were male. More over sublay mesh repair was effective in 82% patients on the bases of recurrence while this procedure was safe in 90% cases on the bases of complications whereas onlay mesh repair was effective in 90% patient’s cases on the bases of recurrence while this procedure was safe in 93% cases on the bases of complications. Conclusion: Onlay mesh repair technique is more effective, quick, and safe as compared to sublay mesh repair technique for the treatment of paraumbilical hernia.

“COMPARATIVE STUDY BETWEEN PREPERITONEAL AND INTRAPERITONEAL ONLAY MESH REPAIR OF VENTRAL HERNIA”

In this study we compare the results between Preperitoneal and Intraperitoneal Onlay Mesh Repair of Ventral Hernia. It is a Prospective Randomized Controlled study conducted in a tertiary care centre in Eastern India between September 2018 and March 2020.In this study 78 patients were enrolled. They are randomized into two groups. About 65% of patients who enrolled for the study are females. 12% patients had Umbilical hernia, 55% had Paraumbilical hernia and 24% had Epigastric hernias. Patients with Incisional Hernia were not included. The mean duration of surgery, hospital stay and pain score (as per the visual analog scale) was signicantly less in IPOM compared to PPOM. There was no Haematoma formation in either of the groups. Return to normal work was signicantly earlier in the group undergoing IPOM over those undergoing PPOM. Patients undergoing IPOM were more satised with the cosmetic appearance in the post-operative period as compared to those undergoing PPOM however the incidence of seroma formation was more in the former.

Inflatable penile prosthesis reservoir placement—Are we ready for a paradigm change?

In 2002, Steve Wilson pioneered new procedures for alternative placement of reservoirs for inflatable prostheses in patients who have suffered damage to the space of Retzius following pelvic surgery or obliteration of the transversalis fascia by mesh hernia repair. Since then, surgical techniques and tools for ectopic reservoir placement have gradually gained acceptance to minimize palpability, and the risk of visceral and vascular lesions for high risk patients has been all but eliminated. Lockout valves and high submuscular placement techniques are now recommended, and reports of vascular, bowel or bladder injuries are uncommonly rare. While surgeons continue their search for safer and more effective placement methods, new skills and instruments are constantly being introduced to make recommendations to minimize complications and provide safety and functionality. Additional studies and comparisons of techniques are needed to achieve a consensus of best practice for reservoir placement solutions.

Suture or Mesh Repair of the Smallest Umbilical Hernias: A Nationwide Database Study.

Mesh is recommended for umbilical hernias with defects > 1cm to reduce recurrence. For umbilical hernias with defect width ≤ 1cm, the literature is sparse. The aim of this nationwide cohort study was to assess outcomes after suture and mesh repair of umbilical hernias with defect width ≤ 1cm and to evaluate outcomes after onlay mesh repair specifically. By merging data from the Danish Hernia Database and the National Patients Registry from 2007 to 2018, patients undergoing elective open repair of an umbilical hernia with defect width ≤ 1cm were identified. Available data included details about comorbidity, surgical technique, 90-day readmission, 90-day reoperation and operation for recurrence. A total of 7849 patients were included, of whom 25.7% (2013/7849) underwent mesh repair. Reoperation for recurrence was significantly decreased after mesh repair 3.1% (95% C.I. 2.1-4.1) compared with suture repair 6.7% (95% C.I. 6.0-7.4), P < 0.001. Readmission and reoperation rates were significantly higher for mesh repair 7.9% (159/2013) and 2.6% (52/2013) than for suture repair 6.5% (381/5836) and 1.5% (89/5836), P = 0.036 and P = 0.002, respectively. Onlay mesh repairs had the lowest risk of recurrence 2.0% (95% C.I. 0.6-3.5), and readmission [7.9% (65/826)] and reoperation [3.9% (32/826)] rates within 90 days were comparable to suture repairs [6.5% (381/5836)] and [3.3% (192/5836)], P = 0.149 and P = 0.382, respectively. Even for the smallest umbilical hernias, mesh repair significantly decreased the recurrence rate. Onlay mesh repair was associated with lowest risk of recurrence without increasing early complications.

Learning Curve of Resident Surgeons for Open Mesh Repair of Inguinal Hernia

Objective We evaluated the effect of postgraduate surgical education on inguinal hernia repair for resident surgeons. Methods A total of 93 adult patients underwent open mesh repairs for inguinal hernias. These patients were randomly assigned to junior or senior resident surgeon groups for inguinal hernia repairs. The surgical training program for inguinal hernia repair was subdivided into 3 consecutive steps: sections A, B, and C. The sections were defined as follows: (A) the starting point of the surgery to hanging the spermatic cord, (B) dissection of the hernia sac, and (C) placement of the hernia mesh. The time to complete each procedure was recorded. We then evaluated the learning curve of the junior resident surgeons for open mesh repair of inguinal hernia. Results The mean operative time of the junior resident group was significantly longer than that of the senior resident group. Particularly, the mean times of the junior residents for sections B and C were significantly longer than those of the senior resident group. However, the volume of intraoperative blood loss and the short-term outcomes were not significantly different between the groups. For section C of the procedure, the learning curve seemed shorter for junior resident surgeons who had completed the training program for inguinal hernia repair than that for junior resident surgeons who were just beginning this program. Conclusion This study demonstrates that a junior resident surgeon's initial experience with hernia repair is associated with an identifiable learning curve when participating in a suitable training program.

A prospective randomized study of eTEP and TEP repair for inguinal hernia in terms of ease of operability, complication and recurrences

Background: Inguinal hernia is one of the diseases that has haunted humanity from its very beginning to the modern times. Groin hernias are the most common conditions referred to surgeons all over the world and over five lakh hernia repairs are performed annually. The lifetime risk for men is 27.0% and for women is 3.0%. Approximately 75.0% of all abdominal wall hernias occur in the groin. Inguinal hernias are more common on the right than on the left and are seven times more likely in males than in females. Aims and Objectives: Aim and objective of the study is to compare extended total extra peritoneal (e-TEP) and total extra peritoneal (TEP) repair in terms of complications and recurrence. To evaluate ease of operability of e-TEP and TEP for inguinal hernia repair. Materials and Methods: Patients with inguinal hernia who were hospitalized to the Department of General Surgery at GSVM Medical College, Kanpur, and who were over the age of 18 years of both sexes were studied from December 2019 to October 2021 after signing a consent form. The research procedure followed was in accordance with the approved ethical standards of GSVM Medical College, Kanpur, UP, India Ethics Committee (Human). Data were analyzed and evaluated using Statistical Package for Social Sciences, version 23 (SPSS Inc., Chicago, IL). Results for continuous variables are shown as mean ± standard deviation, whereas results for categorical variables are shown as number (percentage). For comparison of nominal data, Chi-square (χ2) test was used. The level P&lt;0.05 was considered as the cut-off value of significance. Results: Majority of the patients of Group TEP (25 patients) had complications as Conversion to trans abdominal pre-peritoneal (TAPP) 4 (16.0%) and proceed surgery without veress needle decompression 2 (8.0%). In Group eTEP (25 patients) majority of patients had complications as proceed surgery without veress needle decompression 8 (32%) followed by Seroma 2 (8.0%). No recurrences seen in either groups. Mean operative time of eTEP was less as compared to TEP. Conclusion: With TEP, complications such as SSI, hematoma, and conversion to TAPP are more common; however with eTEP, proceed surgery without veress needle decompression and seroma. Considering the average operative time of eTEP and TEP, as well as the bigger defect size that eTEP can readily handle. For new surgeons, eTEP is a more straightforward procedure. Moreover, our study findings showed that e-TEP mesh repair of inguinal hernia showed more firm and efficacious results than TEP repair. We suggest that long-term randomized control trials with enhanced sample size and reduced confounding factors are still required to establish the absolute superiority of e-TEP over TEP.

Report of novel application of T-line hernia mesh in ventral hernia repair

IntroductionVentral hernia repair is one of the most common surgeries performed in the United States. Failure of hernia repairs can be attributed to sutures pulling through tissue or mesh (anchor point failure). T-Line Hernia Mesh is the first mesh designed to specifically prevent anchor point failure by distributing tension. This case study of two patients is the first clinical application of the novel T-Line Hernia Mesh.Presentation of caseTwo separate patients presented with symptomatic ventral hernia secondary to previous laparotomy. Patient 1 is a fifty-five year-old male who underwent open ventral hernia repair with T-Line Hernia Mesh onlay placement. Patient 2 is a fifty-eight year-old female with a symptomatic ventral hernia that underwent bilateral component separation and primary hernia repair with T-Line Hernia Mesh. Both patients postoperative course was uneventful with no reported surgical site occurrences or hernia recurrence.DiscussionT-Line Hernia Mesh provides a new innovative approach to hernia surgery. This provides the first clinical outcomes. No complications were observed. In addition, this manuscript also demonstrates the surgical technique for the first time.ConclusionThis cases and technical description provides the initial report for a new designed T-Line Hernia Mesh that could result in a paradigm shift in hernia surgery concepts.

Outcome and complications of Ventralex mesh repair in umbilical hernia

In recent time, various techniques have been applied for the hernia repair surgery. Considering the possibility of the recurrence rates up to 40%, umbilical and umbilical port hernias have been repaired without mesh for a long time. The repair of these hernias by the Ventralex hernia patch may decrease recurrent hernia rates. The aim of this study was to evaluate the outcome and complications of mesh repair in umbilical hernia by the Ventralex hernia patch. A total of 36 patients were studied retrospectively who underwent mesh repair surgery by the Ventralex hernia patch between April 2017 and October 2019 at Anower Khan Modern Medical College &amp; Hospital, Care Medical College &amp; Hospital and LABAID Specialized Hospital. They have also been evaluated for instant post-operative complications, recurrence rate &amp; pain. Short-term clinical outcomes were assessed during post-operative follow up at first and sixth week. One year long-term outcomes were assessed over telephone. In this study, there were 28 female and 8 male patients with the range of age from 24-68 years (Mean 41.5 ±8.36) having 27 umbilical hernias and 9 umbilical port hernias. No major short-term complications were found but early minor complications were found in 5 patients (13.89%). No pain or mild pain was reported in 31 patients after one week’s post-operative follow up. 34 patients reported being very satisfied with their repairs. In this study we found that the Ventralex hernia patch is an effective and easier technique for mesh repair in umbilical and umbilical port hernias. This technique can also save the operative time with less post-operative complications and better outcomes. BSMMU J 2021; 14(3): 79-84

Antimicrobial Meshes for Hernia Repair: Current Progress and Perspectives.

Recent advances in the development of biomaterials have given rise to new options for surgery. New-generation medical devices can control chemical breakdown and resorption, prevent post-operative adhesion, and stimulate tissue regeneration. For the fabrication of medical devices, numerous biomaterials can be employed, including non-degradable biomaterials (silicone, polypropylene, expanded polytetrafluoroethylene) or biodegradable polymers, including implants and three-dimensional scaffolds for tissue engineering, which require particular physicochemical and biological properties. Based on the combination of new generation technologies and cell-based therapies, the biocompatible and bioactive properties of some of these medical products can lead to progress in the repair of injured or harmed tissue and in tissue regeneration. An important aspect in the use of these prosthetic devices is the associated infection risk, due to the medical complications and socio-economic impact. This paper provides the latest achievements in the field of antimicrobial surgical meshes for hernia repair and discusses the perspectives in the development of these innovative biomaterials.

Comparison of glue versus suture mesh fixation for primary open inguinal hernia mesh repair by Lichtenstein technique: a systematic review and meta-analysis.

The use of glue as a mesh fixator in open Lichtenstein inguinal hernia repair (IHR) has gained popularity to reduce recurrence and postoperative complications. This meta-analysis aims to provide an up-to-date review to compare glue versus suture fixation in primary open Lichtenstein IHR. PubMed, Embase, The Cochrane Library, Web of Science, and Springer were systematically searched till June 2021 for randomized controlled trials (RCTs) comparing glue versus suture fixation in open Lichtenstein IHR. Primary outcomes were early (at 1year) and late recurrence (5years or more). Secondary outcomes were the length of operation, postoperative haematoma and seroma, and chronic pain at 1year. A total of 17 RCTs with 3150 hernias (glue n = 1582, suture n = 1568) were included. Only three studies reported late recurrence. Glue fixation was associated with shorter operative duration (MD -4.17, 95% CI -4.82, -3.52; p < 0.001 and a lower incidence of haematoma formation (OR 0.51, 95% CI 0.32, 0.81; p = 0.004). There was no significant difference in postoperative seroma (OR 0.72, 95% CI 0.35, 1.49; p = 0.38), chronic pain after 1year (OR 1.10, 95% CI 0.73, 1.65; p = 0.65), early recurrence (OR 1.11, 95% CI 0.45, 2.76; p = 0.81, I2 = 0%), and late recurrence (OR 1.23, 95% CI 0.59, 2.59; p = 0.59, I2 = 0%). Early and late recurrence were comparable between glue and suture fixation in open Lichtenstein IHR patients. Glue fixation had shorter operating time and lower haematoma formation than suture fixation. Chronic pain and seroma formation were comparable. More RCTs should report long-term outcomes.