Prolene Research Articles

Laparoscopic preperitoneal ventral hernia repair with prolene mesh with fixation through transabdominal prolene stitches

Objective To evaluate the efficacy and safety of our technique in laparoscopic repair of ventral hernias. Summary background data Laparoscopic ventral hernia repair (LVHR) was first reported in 1993. The successful application of laparoscopic techniques for the repair of ventral hernias has been well accepted. The recurrence rate after standard repair of ventral hernias may be as high as 10%, and the wide surgical dissection required often results in wound complications. Use of a laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair. Patients and methods Data on all patients who underwent LVHR performed using our procedure between February 2013 and February 2015 were collected retrospectively. Results LVHR was completed in 27 of the 30 patients (nine men and 21 women) in whom it was attempted. The patients’ mean BMI was 36.5; the mean defect size was 3.2 cm. Mesh averaging 6.3 cm was used in all cases. Mean operating time was 105 min, and hospital stay averaged 1.9 days. Our complication rates were 16.6%. The most common complications were ileus (6.6%) and prolonged seroma (6.6%). During a mean follow-up time of 12 months, the hernia recurrence rate was 3.3%. Overall, 10% of patients had pain for 1 month. Recurrence was associated with vigorous exercise within the first 3 months postoperatively. Conclusion In this series, the preperitoneal laparoscopic technique for ventral hernia repair had a low rate of conversion to open surgery, a short hospital stay, a moderate complication rate, and a low risk of recurrence avoiding the potential complications related to intraabdominal mesh position.

Endoscopic preaponeurotic mesh placement in cases of divarication of recti associated or not with midline hernia

Background Divarication of rectus abdominis muscle is common especially after childbirth. Usually it is asymptomatic but may be associated with backache. Its problem is mainly esthetic and managed by plastic surgeons. General surgeons are called for management of divarication if associated with hernia defects. Till now, there is no unique procedure for the optimal management of divarication of recti associated with midline hernia defects. Open surgical repair, subcutaneous endoscopic repair, and transabdominal laparoscopic repair all with or without mesh fixation could be an accepted solution. Aim of the study The aim of this study is to evaluate the subcutaneous endoscopic plication of the divarication of rectus abdominis muscle, repair of the hernia defect if present, and placement of preaponeurotic nonabsorbable mesh. Patients and methods The study is a prospective clinical trial carried out in Zagazig university hospitals in the period between March 2018 and October 2018, where endoscopic placement of nonabsorbable prolene mesh on the anterior rectus sheath after plication and repair of the defect in cases of divarication of rectus abdominis muscles associated or not with midline hernia was done. Results A total of 19 patients underwent endoscopic plication of rectus abdominis muscle; 12 of them had midline hernia, in whom repair of the defect was done, and the nonabsorbable mesh was placed over the anterior rectus sheath, with good outcome comparable to most studies on that topic, apart from seroma, which occurred in five cases, and prolonged operative time. Conclusion Preaponeurotic endoscopic technique for plication of divarication of rectus abdominis muscle and onlay mesh placement is better than open surgical management. It is a safe, reproducible, and effective alternative for patients with ventral hernias associated with divarication of rectus abdominis muscle.

Carotid artery approach as an alternative to femoral access for balloon dilation of aortic valve stenosis in neonates and infants.

to evaluate the efficacy of a right common carotid artery cutdown as alternative access in neonates and small infants requiring a balloon dilation of aortic valve stenosis. In infants, the femoral approach is limited by difficulties in advancing the catheter across the valve and by the risk of femoral artery injuries. from January 1997 to July 2000, 16 infants at our department underwent balloon dilation through a carotid artery cutdown. Infant weight ranged from 2670 to 6450 g; mean weight 3967 g, and age ranged from 1 to 157 days, mean age 42,8 days. Fifteen of 16 infants had aortic valve stenosis; the remaining infant presented with a aortic coartation relapse. In 15 infants an adequate dilation of the valve was obtained with no complications. In only one infant an arterial intimal disconnection was caused by inadequate choice of surgical instruments. At the end of the procedure, the carotid arteries were reconstructed with interrupted 7-0 prolene stitches. There were no neurological sequaelae observed. All infants were followed-up and examined by echocolordoppler ultrasound: all carotid arteries were open with no significant stenosis. Our experience confirms that the carotid access proposed in 1973 by Azzolina et al is a valid and safe alternative to the usual percutaneous femoral access. In particular it could be useful in neonates and infants were the size of femoral vessels could facilitate important and dangerous complications.

Comparison of the life quality and recurrence in patients with concealed penis after degloving and root fixation surgery with three different suture material

To compare the life quality and recurrence in patients with concealed penis after degloving and root fixation surgery with three different suture material. From March 2011 to April 2015,64 cases with concealed penis were treated by degloving and root fixation with three different suture material, including PDS in 21 cases, Prolene in 23 cases,common absorbable suture in 20 cases. The operative time,intraoperative bleeding, postoperative life quality, recurrence and complication were retrospectively analyzed. There were 14 cases(6 months later) and 7 cases(1 year later) in Prolene group who complained negative effect on their life quality, while none in PDS and common suture groups (both P ＜ 0.05).6 months after operation, recurrence happened in one case in Prolene group,8 cases in common group and none in PDS group (both P ＜ 0.05).There were no significant difference in operative time, bleeding, as well as life quality, recurrence and complication within 3 months between these three groups (all P ＞ 0.05). PDS is suitable for root fixation in patients with concealed penis. Satisfactory result can be achieved without interfere of life quality.

Comparative efficacy of Prolene and Prolene-Vicryl composite mesh for experimental ventral hernia repair in dogs.

In this study, efficacy of two hernia mesh implants viz. conventional Prolene and a novel Prolene-Vicryl composite mesh was assessed for experimental ventral hernia repair in dogs. Twelve healthy mongrel dogs were selected and randomly divided into three groups, A, Band C (n=4). In all groups, an experimental laparotomy was performed; thereafter, the posterior rectus sheath and peritoneum were sutured together, while, a 5 × 5 cm defect was created in the rectus muscle belly and anterior rectus sheath. For sublay hernioplasty, the hernia mesh (Prolene: group A; Prolene-Vicryl composite mesh: group B), was implanted over the posterior rectus sheath. In group C (control), mesh was not implanted; instead the laparotomy incision was closed after a herniorrhaphy. Post-operative pain, mesh shrinkage and adhesion formation were assessed as short term complications. Post-operatively, pain at surgical site was significantly less (P<0.001) in group B (composite mesh); mesh shrinkage was also significantly less in group B (21.42%, P<0.05) than in group A (Prolene mesh shrinkage: 58.18%). Group B (composite mesh) also depicted less than 25% adhesions (Mean ± SE: 0.75 ± 0.50 scores, P≤0.013) when assessed on the basis of a Quantitative Modified Diamond scale; a Qualitative Adhesion Tenacity scale also depicted either no adhesions (n=2), or, only flimsy adhesions (n=2) in group B (composite mesh), in contrast to group A (Prolene), which manifested greater adhesion formation and presence of dense adhesions requiring blunt dissection. Conclusively, the Prolene-Vicryl composite mesh proved superior to the Prolene mesh regarding lesser mesh contraction, fewer adhesions and no short-term follow-up complications.

Technology of Prosthetic Material.

Prosthetic material to repair a hernia is indicated for large defects, attenuated muscle, or tension avoidance on a repair. Biological, absorbable, and permanent material can be used to repair a hernia. Absorbable substances such as Dexon (Davis & Geck, Wayne, NJ) and Vicryl (Ethicon, Inc, Somerville, NJ) are useful in infected areas but have a high recurrence rate. Nonabsorbable material such as polyethylene, polypropylene, and polytetrafluoroethylene (PTFE) are the most commonly used materials for mesh repair of a hernia. The properties of these meshes are determined not only by their composition but also by the size of the fibrils and interstices. Marlex (Bard Vascular, Billerica, MA) has a thicker fibril diameter and large interstices that allow ingrowth of surrounding material but has some stiffness in handling. PTFE has small fibrils and interstices that result in less ingrowth of tissue but ease in handling. Prolene (Ethicon, Somerville, NJ) has intermediate size fibrils and interstices and moderate ingrowth of tissue and ease of handling.

Application of transperineal single-port access assisted extralevator abdominoperineal excision in low rectal cancer

To explore the feasibility and safety of transperineal single-port laparoscopy assisted exralevator abdominoperineal excision(TPSP-ELAPE). Three cases (2 males and 1 female) who underwent TPSP-ELAPE at lithotomy position in the Peking University People's Hospital from January to February 2016 were analyzed retrospectively. The mean age was(55.3±7.2) years. Mean body mass index (BMI) was (23.0±1.3) kg/m(2). Mean distance between tumor and anal verge was (1.8±0.3) cm. Abdominal procedure was done firstly and then perineal procedure under lithotomy position. Abdominal procedure was performed by routine laparoscopy with 5 trocars. TPSP-ELAPE procedure was performed in perineal procedure. The perineal defect was closed by purse string, followed by spindle incision around the anus. Perianal skin and subcutaneous tissue was dissected until the junction between extra anal sphincter and levator ani muscle under direct vision. Perineal skin was sutured with double purse string by 2-0 prolene, and single port canal was placed inside in order to close perineal defect. The pneumoperitoneal pressure was set to 10 mmHg and laparoscopy and instrument was placed through the single-port canal. Space between isochioanal fossa and levator ani muscle was exposed by the contraction of laparoscopic clam. Lateral and posterior side was mobilized firstly. The anterior was dissected under the help of vaginal examination and contraction by abdominal group. The levator ani muscle was divided near the initial site, and negative resection margin was confirmed in the operation. Specimen was exteriorized through the perineum. The mean intraoperative blood loss of three cases was (123.3±25.2) ml. The total operative time was (296.7±25.1) minutes. The time used by the perineal group was (196.7±20.8) minutes. The volume of drainage was (39.0±10.1) ml at the third day after operation. The time to first stoma output was (2.3±0.6) days. The perineal drainage removal time was (7.7±0.6) days. The circumferential resection margins were negative in all specimens, and there were no perioperative complications. TPSP-ELAPE is feasible and safe, which could avoid turning over the patient and facilitate anesthesia. It follows the anatomic plane of open ELAPE procedure with minimally invasive advantage.

A simplified approach for bicanalicular silicone tube intubation for the management of canalicular lacerations

We report the surgery of a bicanalicular laceration of the lacrimal system in which a simplified annular intubation of silicone tube had been used. After passing the silicone tube through the canalicular system guided by the prolene suture, the tip of the silicone tube was stuck and advancing it through the lach - rymal system was not possible. Then this threaded 6-0 prolene suture was tied to the wall of the silicone tube at the tip and pulled gently from the opposite side. The silicone tube was threaded easily with no obstacle. We hope that our result in this case will create an alternative way for surgeons while repairing canalicular system lacerations

Clinical efficacies of ambulatory surgery for inguinal hernia in 1892 patients

Objective To explore the clinical efficacies of ambulatory surgery for inguinal hernia. Methods The clinical data of 1892 patients with inguinal hernia who underwent ambulatory surgery at the West China Hospital of Sichuan University from November 2009 to June 2015 were retrospectively analyzed. Preoperative examinations including blood routine test, blood bio-chemistry checking, blood electrolytes, coagulation convention, pre-transfusion test, blood type, chest X-ray, electrocardiogram were applied to patients. Operation time was rescheduled after abnormal indexes were corrected for elective surgery. Preventive use of antibiotics was not needed. Preperitoneal space tension-free repair or Bassini method was adopted after local infiltration anesthesia. Anesthesia method, operation method, patching material, operation time, number of patients transferred to inpatient department and reasons and treatment expense were recorded. Ambulatory surgery center did satisfaction survey on patients at the discharge. Patients were followed up at postoperative month 1, 3, 6, 12 regularly by the doctor responsible for the surgery till July 2015, including occurrence of complications and chronic pain, recurred hernia, number of readmission and reasons. Measurement data with normal distribution were presented as±s. Results Among 1 892 patients, 1 889 patients underwent operation under local anesthesia and 3 patients were transferred to general anesthesia. There were 1 874 patients undergoing tension-free repair including 1 592 using the material of ultrapro hernia system (UHS), 264 of ultrapro plug (UPP), 8 of prolene hernia system (PHS), 6 of Gore hernia patch, 4 of 3-dimensional plug (3DP), and 18 patients underwent Bassini without preoperativedeath. The operation time of 1 892 patients was (28±12) minutes. Three patients were transferred to inpatient department for postoperative cut incision pain, ecchymoma, abdominal distention after satiation and discharged from hospital after treatment. Among 26 patients with complications after discharge, 12 had superficial incision infection and recovered after dressing change without removal of patches, 5 had edema in scrotum and inguinal region, 3 had ecchymoma, 2 had nausea and vomiting, 2 had urinary retention, 2 had disruption of wound, and they all recovered smoothly after symptomatic treatment. Treatment expense of the 1 892 patients was (6 956±249)yuan per hermia. Satisfaction rate of patients was 99.049%(1 874/1 892) when discharged. The follow-up rate was 86.152%(1 630/1 892). The follow-up time was 1-67 months with a median time of 35 months. During the follow-up, 4 patients had chronic pain and recovered after analgesia and physiotherapy, 3 patients had recurrence of inguinal hernia including 1 case of recurrent hernia and 2 cases of huge hernia. Conclusion Ambulatory surgery for inguinal hernia is safe and effective, with the advantages of few complications, high satisfactory rate and low hospital expenses. Key words: Inguinal hernia; Ambulatory surgery; Efficacy; Quality control

Comparative evaluation of glycerolized bovine pericardium implant with prolene mesh for closure of large abdominal wall defects in dogs

Summary The aim of this investigation was to evaluate the use of polypropylene mesh and glycerol preserved bovine pericardium (GBP) to repaire abdominal wall defects in 24 clinically healthy mongrel dogs using inlay and underlay techniques. Twenty four healthy mongrel dogs were used in this study. The animals were divided into two main groups according to the type of the prosthetic material used. Each group was further divided into two subgroups according to the implantation technique. The prosthetic materials used were polypropylene mesh (Prolene, Ethicon, Johnson and Johnson, Belgium) and GBP. The two implantation techniques were the inlay and underlay techniques. Based on postmortem findings, biomechanical analyses and histopathological examinations, GBP patches were found to be successful alternatives for the reinforcement and repair of large abdominal wall defects as compared to prolene mesh.

Efficacy of Prolene 3D patching in tension-free hernioplasty for femoral hernia via femoral approach

A total of 114 cases of femoral hernia undergoing 3D Prolene patching via femoral approach were examined for duration of surgery, length of stay, recurrence, postoperative pain and complications.Among them, 53 cases received both pre- and post-operative Doppler ultrasonic examinations.The vein thrombus, diameter and flow rate of femoral vein were observed to compare with the pre-operative data to learn whether it had difference or not.The operative duration was 13.3 minutes.There was no event of recurrence, compression, stricture or thrombosis of femoral vein. Key words: Hernia, ventral; Reconstructive surgical procedures

Applying transductal invaginational pancreaticojejunostomy to decrease pancreatic leakage after pancreaticoduodenectomy.

Pancreatic leakage after pancreaticoduodenectomy is not fully prevented despite pancreaticojejunostomy or pancreaticogastrostomy being applied. Here, a new type of transductal invaginational pancreaticojejunostomy (TDI) was devised to prevent pancreatic leakage. Briefly, prolene was penetrated from inside the pancreatic duct through the pancreatic stump at ventral and dorsal sides, respectively, and penetrated from the jejunal cavity outwards; so the pancreatic duct was kept patently and pancreaticojejunostomy was fixed by the prolene stitches. From August 2009 to March 2012, 29 patients received TDI with their consent. No pancreatic leakage was found postoperatively. The postoperative complications included 1 instance of biliojejunostomy leakage, 1 abscess and 2 incision infections. Our primary experience of applying TDI suggests that it is a simple and effective technique to prevent pancreatic leakage after pancreatoduodenectomy, especially in those cases with soft pancreas and normal pancreatic duct diameter.

STUDY OF CLINICAL AND FUNCTIONAL RESULTS OF ABDOMINAL RECTOPEXY USING PROLENE MESH FOR COMPLETE RECTAL PROLAPSE

Background and Objectives: There are many often confusing, surgical procedures available for treating complete rectal prolapse ranging from complex abdominal interventions to simple perineal procedures with varying results. The ideal procedure suitable in all cases is still an enigma. Many surgeons today believe that abdominal rectopexy has become the operation of choice not only in the young but even in the elderly patients, resulting in a low recurrence rate and restoration of continence in significant number of patients. The present study attempted to evaluate clinical and functional results of abdominal rectopexy using prolene mesh for complete rectal prolapse in our centre.Results: There was no mortality or recurrence in any patient. There was significant (100%) improvement in continence in a lone patient with incontinence. There was decrease in bowel frequency in 2 patients (13%), postoperatively but this did not result in clinical constipation in any of the patient. There were no major postoperative complications.Interpretation and Conclusion: Abdominal rectopexy using prolene mesh is a simple operation with satisfactory low recurrence rate, good functional out come with low morbidity and mortality. This procedure can be considered in all patients who areconsidered fit to undergo an abdominal procedure.

Pseudotumor of the bladder due to chronic inflammation of a prolene mesh in sacral colpopexy

Pseudotumor of the bladder due to chronic inflammation of a prolene mesh in sacral colpopexy

STUDY OF SKIN STAPLES AND CONVENTIONAL SUTURE FOR ABDOMINAL SKIN WOUND CLOSURE

Introduction: The use of automatic stapling device for skin closure has become more popular due to its minimum disadvantages as compared to conventional suturing. Hence, this study was undertaken to compare the time required for abdominal skin closure and pain during suture removal, between skin staplers and conventional suture. Materials and Methods: The study includes 100 patients with age group of 45yrs-75yrs undergoing elective surgery, of which 50 patients underwent wound closure by staplers (Group-I) and 50 patients underwent closure using prolene suturing (Group-II), during June 2009 to June 2011 at Basaweshwar Teaching and General Hospital, Gulbarga. Patients were randomly selected for conventional suture and skin staple. Time duration for wound closure was recorded and pain scoring was given during suture removal, between both groups. Results and conclusion: In our study duration of wound closure was statistically significant (P<0.001) with staplers requiring lesser time than conventional prolene sutures, we also found that pain during suture removal between both groups was statistically significant (P<0.001). We believe the advantages of speed and convenience of skin staples outweigh the extra cost, provided the disposable instruments are reused until empty.

Biocompatiblity of various polypropylene meshes in breast ptosis correction

Objective Implanting surgical meshes to support breast in periareoler mammaplasty shows an excellent prospect.But shrinking of the mesh and the adhesion formation affected the postoperative shape and palpation of the breast.The aim of this study was to compare biocompatible properties of four different polypropylene meshes (Prolene(R) ; Vypro Ⅱ(R) ; Premilene Mesh (R) and Premilene Mesh LP(R)) and to discuss the inclusion criteria of meshes in this technique.Methods The study was carried out in pigs.Four different polypropylene meshes were implanted subcutaneously in belly.90 days after implantation the mesh samples were explanted,and complications,foreign-body reaction,collagen fiber and elastic fiber formation were observed,as well as ultrastructures for the biocompatible properties.Results The biocompatible properties of each mesh were different.The foreign-body reactions determined the biocompatible properties,and affected the postoperative shape greatly.Conclusions Premilene Mesh LP o as a newer low-weight polypropylene mesh,has superior properties to the others. Key words: Polypropylene mesh; Biocompatibility; Animal experiment; Breast ptosis

The Evolution of Groin Hernioplasty, an Update

Hernia repair is one of the most common surgical procedures; the evolution of hernia management reflects the development of surgery. Recently, due to the advance in repair techniques and utilization of a prosthetic mesh, the overall recurrence rate has been reduced from 15% to less than 5%. An ideal hernia repair should have short convalescence, low recurrence, low complications, and minimal postoperative pain. Most tissue to tissue repairs, which were still popular two decades ago, have now been replaced by open tension-free repairs and endoscopic repairs. Tension-free repairs are the most popular repairs, representing 70% of repairs performed in developed countries, followed by endoscopic repairs, which represent 15-20% of repairs. The former includes the Lichtenstein repair (plain flat mesh, for 25 years), the Plug and Patch repair (for 20 years), the Kugel posterior patch (for 15 years) and Prolene Hernia System (for 11 years). In the year of 2009, about half of the adult herniorraphy in Taiwan utilized some kind of mesh. The important concepts in herniorraphy today are: treating the myopectineal orifice as a whole, using prosthetic material to replace or re-enforce the attenuated abdominal fascia and muscles, to reduce the suture line tension and postoperative pain, and to prevent recurrences. However, hernioplasties using a prosthetic mesh are not without complications. The mesh will evolve rapidly and always improve in material, configuration, and three-dimentional design. Only those surgeons who know thoroughly the details of different kinds of mesh, including the interaction between the mesh and human body after they are implanted, can select the best and most appropriate repair for each of their individual patients. Further basic studies on collagen metabolism and related genetic anomalies may provide nonsurgical treatment of groin hernias.

Sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis

To explore the therapeutic effect of sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis (UVCP). Included in this study were 19 patients with UVCP lasted for 12 months to 15 years. The surgical technique was as follows. The thyroid cartilage was engaged with a skin hook and gently rotated anteriorly. The lateral-inferior corner of the thyroid cartilage was exposed and the muscular process of the arytenoid was identified. Then, the thyroid lamina on the involved side was parasagittally separated 5 mm off the midline. The inner perichondrium was carefully freed from the overlying thyroid cartilage. The lamina was retracted laterally, and a 3-0 prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle. A bipedicled strap muscle flap was then transposed into the space between the lamina and the inner perichondrium. Pre- and postoperative voice evaluations measured mean fundamental frequency, jitter, shimmer, harmonic ratio and maximal phonation time, as well as assessments of voice quality. Vocal improvement was obtained in 100% (19 of 19) of patients. Immediately after the operation, the ingression could be observed in vocal cord membrane and vocal process, vocal cord volume was amplified. There was a significant difference (P < 0.05) in all parameters (fundamental frequency, jitter, shimmer, harmonic ratio and maximal phonation time) between pre- and postoperative voice evaluations measured mean. There was no significant difference (P > 0.05) in voice evaluations measured mean between 2 months and 12 months after operation in all patients. No major complications were noted in any patient. Sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis is simple and convenient, no immune rejection, and the long-term result is stable.

Surgical treatment of inguinal hernia recurrence with prolene hernia system

Objective To summarize the experiences of tension-free method in inguinal hernia recurrence.Methods Using the PHS Ethicon Ine,42 patients with recurrent hernia were performed tension-free hemioptasty.Results The operation time was from 40 to 150 minutes.The patients could walk up within 1 d after the procedure.No incision infection was found.The eomplicatiom included 4 retention of urine.3 large serotal hematoma requiring surgical drainage.The follow-up period ranged from 6 months to 3 years,no recurrence and foreign body sensation in inguinal region were observed.Conclusion PHS call be anatomically adapted to repairing and augmenting the myopectineal orifice.It is suitable to the patients with recurrent inguinal hernia. Key words: Hernia,inguin.I; Recurrence; Protheses and implants

The observation of follow-up and application of the prolene hernia system in inguinal hernioplasty of aged patients

Objective To explore applied characteristics of the prolene hernia system(PHS) in inguinal hernioplasty, and management during and after operation, and long-term effect of this kind of hemioplasty in aged patients. Methods 69 aged patients using PHS were followed and analyzed retrospectively. Results Tension-free inguinal hernioplasty with the PHS were performed in 69 aged patients of groin hernia. Operative time ranged from 45min to 160min. Post-operatively, 3 patients developed gentle scrotal swelling, and 20 patients had been adminis- tered anodyne for pain of incision, and 12 cases experienced retention of urine, 1 case developed pneumonia, and 2 cases oeeurred incisional infection and gore. 68 cases of them recovered daily life about 2 to 3 weeks after operation. During follow-up period from 6 months to 77 months,there was no recurrence of inguinal hernia and no pain in in-guinal region, but 2 patients feel discomfort sporadically. Conclusion The PHS strengthens the myopectineal orifice and seals up-area of it,so the system is especially preferred in treating aged patients of groin hernias who have some defectsof anatomic structure in inguinal region. The local anaesthesia is also suitable for this kind of hernioplasty in aged patients.