Repair Of Abdominal Wall Defects Research Articles

Repair of Large Abdominal Wall Defect Using Glycerolized Bovine Tunica Vaginalis and Prolene Mesh Implants in Dogs

The repair of large abdominal defects remains a complex surgical problem of insufficient autogenous tissue for adequate reconstruction.

Robotic Ventral Hernia Repair and Endoscopic Component Separation: Outcomes.

Background and Objectives:Robot-assisted hernia repair, combined with endoscopic component separation, has reduced recurrence and complication rates and allowed immediate intervention in obese patients. We sought to study surgical outcomes in this high-risk group of patients in a community hospital.Methods:We conducted a retrospective chart review of ventral, incisional, and umbilical hernia repairs performed at a small community hospital by a single surgeon from March 2014 through November 2016, with statistical analysis of the surgical outcomes. Patients included were those who underwent hernia repair during the study period and had a body mass index (BMI) >30. Patients were followed up for a minimum of 6 months (range, 6–37).Results:Forty-seven hernia repairs were performed, including 33 combined and 14 control cases. The demographics of each group were comparable when comparing sex, age, BMI, and ASA classification. Mean follow-up was 19.39 months in the study group and 28.64 months in the control group. There were no significant differences in total operative time, estimated blood loss, conversion rates, or hospital length of stay. Two complications occurred in each of the study and control groups, with no recurrences in the study group and 3 in the control group and no mortalities.Conclusion:Robotic laparoscopic repair of abdominal wall defects offers significant advantages, including easier primary defect closure. Our analyses showed that combining robot-assisted hernia repair with mesh and endoscopic component separation is an effective intervention in obese patients.

Enhancement of abdominal wall defect repair using allogenic platelet-rich plasma with commercial polyester/cotton fabric (Damour) in a canine model

Platelet-rich plasma (PRP) has an important role in musculoskeletal surgery; however, it has been underutilized for accelerating the healing of abdominal wall defects in veterinary practice. Therefore, the aim of this study was to evaluate the use of commercial polyester/cotton fabric (Damour) as a new composite mesh for the repair of experimentally induced abdominal wall defects in canine models, and to investigate the possible role of PRP for improving such repair and reducing allied complications. For this purpose, abdominal wall defects were created in 24 healthy mongrel dogs and then repaired with mesh alone (control group) or mesh and allogenic PRP (PRP group). Dogs were euthanized after 2 or 4 months for gross examination of implantation site, detection of adhesion score and hernia recurrence. Moreover, tissue samples were collected for histological and gene expression analyses for neovascularization, collagen formation and tissue incorporation. Hernia recurrence was not recorded in PRP-treated dogs that also displayed significantly more neovascularization and less severe adhesion to the underlings (1.08 ± 0.51) in comparison to control group (2.08 ± 0.99). Histological and molecular evaluation confirmed the gross findings that collagen deposition, new vessel formation, and overexpression of angiogenic and myofibroplastic genes (COL1α1, COL3α1, VEGF and TGFβ1) were observed more frequently in the PRP group, at both time points. In conclusion, we found that addition of allogenic PRP to Damour mesh enhanced neovessel formation, and increased tissue deposition and incorporation, with subsequent reduction of peritoneal adhesion and recurrence rate.

Repair of Large Abdominal Wall Defects Using Total Anterior Aponeurotic Flap: Anatomical Feasibility Study and Comparison with Ramirez’s Technique

Summary:In this cadaveric study, we explored the feasibility of a maximal mobilization of the superficial abdominal fascia, in a continuous flap, to achieve a tension-free covering of midline defects. The aponeurosis of the external oblique muscle was incised along the anterior axillary line and then detached up to the anterior rectus sheath. The latter was opened between the external and the internal oblique aponeurosis while keeping the continuity with the external oblique fascia. The obtained flap was solid and uninterrupted. The width gain reached 15 ± 3 cm on each sides, providing tissue advancement 60% longer than Ramirez’s technique (n = 8). The described technique allows large covering with respect to the anatomical planes. Further clinical tests should evaluate the validity of such concept in the repair of giant and asymmetrical hernias.

Synthetic versus Biologic Mesh in Single-Stage Repair of Complex Abdominal Wall Defects in a Contaminated Field.

Synthetic meshes have been used with varying rates of success in a contaminated setting, although their use is not widely accepted because of concerns for infection. A biologic mesh (BM) is assumed to be more resistant to infection than a synthetic mesh; however, sparse clinical data support this theory. The hypothesis for this study: Uncoated polypropylene synthetic mesh (USM) can be used to obtain a durable repair in the setting of a contaminated abdominal wall reconstruction (AWR) in a single-stage procedure with comparable infectious outcomes to a biologic mesh repair. We performed a retrospective chart review on contaminated AWR, comparing 34 BM with 24 USM with infection as the primary outcome of interest. Secondary outcomes were re-admission and re-operation. We also investigated the microbial isolates that were cultured. Mesh groups were similar in their demographics, duration of surgery, previous mesh, surgical site class, and source of contamination. Length of stay was 4 d longer in BM, p = 0.01. Overall infection rate was 50% for BM vs. 29.2% for USM, p = 0.18. Treatment in case of infection was similar across both groups. Gram positive bacteria comprised 39% of BM microbiology vs. 63% for USM. Re-admission rate was 52.9% for BM versus 45.8% for USM, p > 0.5. The BMs re-admitted for surgical site infection/abdominal abscess were 38.9% versus 55.6% for USM. No USM were re-admitted for seroma versus 33.3% of BM, p = 0.06. Re-operation rate was 26.5% for BM versus 33.3% for USM, p > 0.5. Procedures performed at re-operation were similar between groups. Regression analysis did not demonstrate an association between mesh type and our outcomes. Our results show that synthetic meshes are not inferior to biologic meshes in contaminated AWR. This is important in view of the tremendous cost disparity between these two products and the questionable ability of biologic mesh to offer a durable hernia repair.

Silk Fibroin Scaffolds Facilitating the Repair of Rat Abdominal Wall Defect

Silk Fibroin Scaffolds Facilitating the Repair of Rat Abdominal Wall Defect

Complex abdominal wall repair using a combination of porcine dermal matrix and omentum flap in patient with digestive tract fistula: report of a case and review of the literature

Purpose: The purpose of this article is to propose an effective approach for giant abdominal wall defects repair in a contaminated field, using a combination of porcine dermal collagen graft (Permacol) and omental interpositional flap. Case: We report a case of a 41-year-old woman submitted to emergency laparotomy, splenectomy and hepatic haemostasis for massive hemoperitoneum. She developed enteric fistula, cutaneous, muscolar and fascial necrosis leading to evisceration. At the fourth intervention we finally reconstructed abdominal wall defect using a combination of Parmacol and omental flap. Conclusion: The reconstruction of large, full-thickness, eventually contaminated abdominal wall defects is often a challenging undertaking. Similar difficulties are usually encountered with early abdominal wall closure after damage-control surgery and/or open-abdomen management. In these situations the use of synthetic mesh is contrindicated; adsorbable mesh can be used as temporary solution and some techniques of autologous tissue repair have been suggested. Therefore no ideal operative repair technique or prosthetic material for reconstruction of the fascial defect is currently available in the literature. Recently, the development of biologic meshes has shown successful rates in the management of these parietal wall defects. Also in this patient, porcine dermal collagen mesh combined with omental flap allowed us to reconstruct large abdominal wall defect.

Preparation of poly(vinyl alcohol) modified polypropylene mesh and its antiadhesion efficacy in experimental hernia repair

Abstract In surgical hernia repair, the intraabdominal adhesion formation needs to be prevented. As currently used prosthetic mesh materials, antiadhesion properties of polypropylene (PP) still be highly desirable. In the present study, we developed a new type of polypropylene (PP) hernia mesh, namely, polyvinyl alcohol (PVA) modified PP mesh (PP-g-PVA). The native PP mesh was first activated with O2 plasma for 30 s, and then reacted with benzoyl peroxide (BPO) and maleic anhydride for 2 h, finally grafted with PVA in phosphorus pentachloride (PCl5) solution in pyridine. The chemical group changes on the surface of PP was monitored by X-ray photoelectron spectroscopy (XPS) spectra, and analysis results confirmed that the PVA was effectively grafted onto the PP. Antiadhesion efficacy and complications of PP-g-PVA mesh were evaluated through repairing rabbit abdominal wall defect at implantation time point of 7 days, 1 month and 3 months. Cross-sections of the mesh parietal peritoneum overlap were examined histologically and graded for inflammation reaction. Compared with the control groups (native PP mesh), a very strong ability to resist peritoneal cavity adhesions (P 0.05). This PVA-modified PP mesh displayed a rather satisfying antiadhesion property in animal abdominal wall defect repair.

Simultaneous abdominal wall defect repair and Tenckhoff catheter placement in candidates for peritoneal dialysis.

IntroductionThe presence of pre-existing abdominal wall defect (AWD) could represent a potential contraindication for peritoneal dialysis (PD) treatment. We report the results of our 6-year experience involving simultaneous repair of pre-existing AWD and catheter insertion for PD.MethodsPatients with estimated glomerular filtration rate (e-GFR) 7–10 ml/min attending a single nephrology clinic between January 2008 and December 2014 were evaluated. Simultaneous AWD repair and catheter placement was performed. For inguinal (IH) or umbilical hernia (UH), a prolene mesh repair technique was adopted. Except for one case of total anaesthesia, the surgical procedure was performed under either spinal or local anaesthesia. Ceftazidime alone or in association with quinolones was administered 1 h before surgery in a single dose. Patients were discharged 2 days after surgery, and returned to the clinic twice during the 1st week for peritoneum washing (first volume of peritoneal dialysis solution: 300 ml). From week 3, volume (2000 ml) and dwells were personalized according to the patient’s clinical condition; options were: incremental PD, standard PD, or continuous cycling PD. Surgical follow-up was planned at 1, 6, and 12 months.ResultsPeritoneal catheters were inserted in 170 patients. IH, UH and incisional hernia were found in 18, 2 and 1 patients, respectively. IH was bilateral in 4 patients; concomitant IH and UH occurred in 1 patient. There were no deaths, nor intra-operative complications apart from scrotal haematoma in 1 patient. Over a mean follow-up of 551 days (range 342–1274) no hernia recurrence was registered and the peritoneal catheter continued functioning without problems.ConclusionsSimultaneous AWD repair and peritoneal catheter placement seems a reliable and safe surgical procedure that allows patients with AWD to benefit from PD treatment.

Strategies for functional repair of complex abdominal wall defects

It is still a challenge for surgeons to deal with the complex abdominal wall defect. The purpose of surgical treatment is not only to restore the integrity of the abdominal wall, but also to maintain the function of the abdominal wall. Accurate classification and partition of the abdominal wall defects before operation are the base of surgical procedure for complex abdominal wall defects. Reinforcement of the abdominal wall defects with mesh, component separation technique and tissue flap technique are important methods to achieve functional repair of the abdominal wall defects. Key words: Complex abdominal wall defect; Functional reconstruction; Mesh; Component separation technique; Tissue flap

A randomized controlled experimental study comparing chitosan coated polypropylene mesh and Proceed™ mesh for abdominal wall defect closure.

BackgroundAbdominal wall defects and hernias are commonly repaired with synthetic or biological materials. Adhesions and recurrences are a common problem. A study was conducted to compare Chitosan coated polypropylene mesh and a polypropylene–polydioxanone composite with oxidized cellulose coating mesh (Proceed™) in repair of abdominal wall defect in a Rabbit hernia model.MethodsA randomized controlled experimental study was done on twelve New Zealand white rabbits. A ventral abdominal defect was created in each of the rabbits. The rabbits were divided into two groups. In one group the defect was repaired with Chitosan coated polypropylene mesh and Proceed mesh™ in the other. The rabbits were operated in two phases. They were followed up at four weeks and twelve weeks respectively after which the rabbits were sacrificed. They were evaluated by open exploration and histopathological examination. Their efficacy in reducing adhesion and ability of remodeling and tissue integration were studied.ResultsThere was no statistical significance in the area of adhesion, the force required to remove the adhesions, tissue integration and remodeling between Chitosan and Proceed™ group. Histological analysis revealed that the inflammatory response, fibrosis, material degradation and remodeling were similar in both the groups. There were no hernias, wound infection or dehiscence in any of the studied animals.ConclusionChitosan coated polypropylene mesh was found to have similar efficacy to Proceed™ mesh. Chitosan coated polypropylene mesh, can act as an anti adhesive barrier when used in the repair of incisional hernias and abdominal wall defects.

Effects of nitrofurazone on correction of abdominal wall defect treated with polypropylene mesh involved by fibrous tissue

To evaluate the effects of nitrofurazone on the correction of abdominal wall defect treated with polypropylene mesh involved by fibrous tissue in rats. A defect in the abdominal wall was created and corrected with polypropylene mesh in 20 rats. They were randomly distributed into four groups: control, fibrous mesh, nitrofurazone and nitrofurazone dip in the mesh. Euthanasia was performed in 21 post-operative days. The healing process was analyzed regarding the meshes and macroscopic and microscopic aspects. All animals had adhesions. However, no statistically significant difference (p>0.05) when compared between groups. Similarly microscopic analysis, in which there was no statistical significance level for the evaluated parameters such as mono and polymorphonuclear lymphocytes, granuloma, fibrosis, necrosis and collagen proliferation. There was no significant effect on the abdominal wall defect repair with polypropylene mesh surrounded by fibrous tissue when dipped in nitrofurazone 2%.

Critical analysis of experimental model for study of adhesions after incisional hernias induced in rats' and repair of abdominal wall with different biomaterials.

Background: Adhesions induced by biomaterials experimentally implanted in the abdominal cavity are basically studied by primary repair of different abdominal wall defects or by the correction of incisional hernias previously performed with no precise definition of the most appropriate model. Aim: To describe the adhesions which occur after the development of incisional hernias, before the prosthesis implantation, in an experimental model to study the changes induced by different meshes. Methods: Incisional hernias were performed in 10 rats with hernia orifices of standardized dimensions, obtained by the median incision of the abdominal wall and eversion of the defect edges. Ten days after the procedure adhesions of abdominal structures were found when hernias were repaired with different meshes. Results: The results showed hernia sac well defined in all rats ten days after the initial procedure. Adhesions of the greater omentum occurred in five animals of which two also showed adhesions of small bowel loops besides the omentum, and another two showed liver adhesions as well as the greater omentum, numbers with statistical significance by Student's t test (p<0.05). Conclusion: Although it reproduces the real clinical situation, the choice of experimental model of incisional hernia repair previously induced implies important adhesions, with possible repercussions in the evaluation of the second operation, when different implants of synthetic materials are used.

Engineered composite fascia for stem cell therapy in tissue repair applications

A critical challenge in tissue regeneration is to develop constructs that effectively integrate with the host tissue. Here, we describe a composite, laser micromachined, collagen–alginate construct containing human mesenchymal stem cells (hMSCs) for tissue repair applications. Collagen type I was fashioned into laminated collagen sheets to form a mechanically robust fascia that was subsequently laser micropatterned with pores of defined dimension and spatial distribution as a means to modulate mechanical behavior and promote tissue integration. Significantly, laser micromachined patterned constructs displayed both substantially greater compliance and suture retention strength than non-patterned constructs. hMSCs were loaded in an RGD-functionalized alginate gel modified to degrade in vivo. Over a 7day observation period in vitro, high cell viability was observed with constant levels of VEGF, PDGF-β and MCP-1 protein expression. In a full thickness abdominal wall defect model, the composite construct prevented hernia recurrence in Wistar rats over an 8-week period with de novo tissue and vascular network formation and the absence of adhesions to underlying abdominal viscera. As compared to acellular constructs, constructs containing hMSCs displayed greater integration strength (cell seeded: 0.92±0.19N/mm vs. acellular: 0.59±0.25N/mm, p=0.01), increased vascularization (cell seeded: 2.7–2.1/hpf vs. acellular: 1.7–2.1/hpf, p<0.03), and increased infiltration of macrophages (cell seeded: 2021–3630μm2/hpf vs. acellular: 1570–2530μm2/hpf, p<0.05). A decrease in the ratio of M1 macrophages to total macrophages was also observed in hMSC-populated samples. Laser micromachined collagen–alginate composites containing hMSCs can be used to bridge soft tissue defects with the capacity for enhanced tissue repair and integration. Statement of SignificanceEffective restoration of large soft tissue defects caused by trauma or treatment complications represents a critical challenge in the clinic. In this study, a novel composite construct was engineered and evaluated for stem cell delivery and tissue repair. Laser micromachining was used to fabricate patterned, microporous constructs designed with pores of defined size and distribution as a means to tune mechanical responses, accommodate and protect incorporated cells, and enhance tissue integration. The construct was embedded within an engineered alginate gel containing hMSCs. Upon repair of a full thickness abdominal wall defect in a rat model, the composite construct modulated host innate immunity towards a reparative phenotypic response, promoted neovascularization and associated matrix production, and increased the strength of tissue integration.

The influence of mesh topology in the abdominal wall repair process.

The tissue integration and the formation of adhesions in the repair of abdominal wall defects are principally led to the topology and the mechanical properties of implanted prosthesis. In this study we analyzed the influence of the topology of the meshes for abdominal wall repair, made of polypropylene (PP), evaluating its ability to prevent and to minimize the formation of adhesions, and to promote tissue ingrowth. Two series of in vivo studies were performed. In the first, two types of PP meshes, a lightweight macroporous mesh (LWM) and a heavyweight microporous mesh (HWM) were compared with determine the optimal porosity for tissue integration. In the second, a composite mesh, Clear Mesh Composite (CMC), made of a LWM sewn on a PP planar smooth film, was compared with a PP planar film, to demonstrate how two different topologies of same material are able to induce different tissue integration with the abdominal wall and different adhesion with internal organs. In both studies, the prostheses were implanted in Wistar rats and histological analysis and mechanical characterization of tissue coupled with the implants were performed. LWM showed better host tissue ingrowth in comparison to HWM. CMC prosthesis showed no adhesions to the viscera and no strong foreign body reaction, moreover its elasticity and anisotropy index were more similar to that of natural tissue. These results demonstrated that the surface morphology of PP surgical meshes allowed to modulate their repair ability. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1220-1228, 2016.

Bacterial adhesion to biological versus polymer prosthetic materials used in abdominal wall defect repair: do these meshes show any differences in vitro?

Although clinical data suggest the similar performance of collagen-based biological prosthetic materials to some polymer materials, the use of a biomesh for abdominal hernia repair in a setting of infection is controversial. This in vitro study compares the adhesion of two Staphylococcus strains to polymer and biological meshes. Sterile fragments of Optilene(®) (Op), Surgipro™ (Surg), Preclude(®) (Precl), TIGR(®) (TIGR), Bio-A(®) (BioA), Permacol™ (Perm), Surgisis(®) (SIS), and Tutomesh(®) (Tuto) were inoculated with 10(6) CFU of S. aureus (Sa) or S. epidermidis (Se) (n = 18 per strain per mesh). The first five meshes are polymer materials while Perm, SIS and Tuto are biomeshes. After 24/48 h of incubation, bacterial adhesion was examined by sonication, scanning electron microscopy (SEM) and light microscopy. Sa and Se showed a high affinity for the absorbable meshes (TIGR, BioA, Perm, SIS, Tuto) (p < 0.001). Precl yielded the lowest bacterial loads (p < 0.001). Surg, Precl and BioA underwent no substantial change over time, while Op (p < 0.001) and TIGR (p < 0.05) showed decreasing bacterial loads during incubation. The Sa-contaminated biomeshes behaved similarly while biomeshes inoculated with Se returned higher bacterial yields at 48 h, especially SIS (p < 0.001). SEM and light microscopy observations revealed planktonic bacteria and biofilms on the polymer surface and bacterial niches in biomesh pores. Within 48 h of contamination, the absorbable polymer and biological meshes exhibited high bacterial loads. Given their lower affinity for both bacterial strains, the conventional non-absorbable polymer materials could be better candidates for use in contaminated surgical fields.

Safety and durability of one-stage repair of abdominal wall defects with enteric fistulas.

To evaluate the safety and long-term durability of 1-stage repair of enteric fistulas in the presence of an abdominal wall defect. Patients with enteric fistulas and an abdominal wall defect present an extreme challenge to surgeons and have been associated with significant morbidity and mortality. Durability of repair is unknown as studies fail to report this or use limited follow-up periods. Chart review was done of consecutive patients who underwent 1-stage repair. Short-term outcomes included morbidity (wound and medical) and mortality. Long-term durability of repair was determined by prospective outpatient follow-up at least 3 years after surgery. Thirty-nine patients were included with a mean age of 61.2 years, a mean BMI of 24.4 kg/m2, and a mean abdominal wall defect size of 247.9 cm2. Component separation technique was used in 34 (87.2%) and synthetic mesh in 13 (33.3%) patients. There was 1 (2.6%) postoperative death. Twenty-four wound complications developed in 18 (46.2%) patients, including surgical-site infection in 8 (20.5%) patients. Two (5.1%) enteric fistulas recurred and were treated conservatively resulting in closure. Medical complications were seen 36 times in 23 (59%) patients. Twelve of 33 (36.4%) living patients developed a recurrent hernia after a mean follow-up of 62.7 months (range: 36-130). One-stage abdominal wall reconstruction with enteric fistula takedown is feasible at the cost of considerable morbidity. Our treatment strategy including component separation technique with synthetic mesh on-demand results in a durable repair in 6 to 7 of 10 patients.

Spontaneous cholecystocutaneous fistula

Abstract Background Spontaneous cholecystocutaneous fistula is defined as a gallbladder communication with the external environment through the abdominal wall rupture. The first reports were written in the seventeenth century by Thilesus. During the past 50 years, 25 cases have been reported. Clinical case The case is presented of a 30-year-old woman, who had a five-year history of biliary colic. Six months prior to her medical assessment there was a leak of biliary material and gallstones spontaneously in the right upper quadrant. Fistulogram was performed with no evidence of obstruction. A cholecystectomy and resection of the fistula was subsequently performed. Discussion The biliary fistulas are an abnormal communication from the gallbladder into another surface. It is a rare condition nowadays, as it only occurs in 10% of patients with gallbladder lithiasis. Although the clinical signs of spontaneous cholecystocutaneous fistula clinic are more than evident, it is imperative to perform studies like ultrasound, tomography, and a fistulogram. The mainstay of treatment is cholecystectomy, resection of the fistula, and repair of abdominal wall defect. Conclusion The incidence of cholecystocutaneous fistula today is minimal and it seems that the current trend is to become an entity anecdotal. The subcostal abdominal examination approach remains as the first choice. The laparoscopic approach is an option reserved for the experienced surgeon.

A retrospective analysis of surgical treatment of mesh infection after repair of ventral hernia or defect.

This study aimed to summarize our experience in surgical treatment of mesh infection after repair of ventral hernia or defect. A retrospective analysis was conducted on clinical data of 22 patients who accepted surgical treatment of mesh infection after ventral hernia or defect repair. Included were 16 cases of infection after incisional hernia repair, 5 cases of infection after abdominal wall defect repair following abdominal wall tumor resection, and 1 case of infection with fistula caused by a parastomal hernia of an ileal neobladder repair with a prosthetic patch. All patients had received local dressing treatment for 2 to 24 months but were not healed. The affected mesh was removed successfully in all patients. Six patients had abdominal wall repair using the component separation technique; 4 patients were treated by strengthened repair with polypropylene mesh; 10 patients were repaired with human acellular dermal matrix; 1 patient received local dressing changes and vacuum sealing drain treatment without repair; and 1 patient received wound closure without strengthened repair. The postoperative hospital stay was 9-29 days (mean 16 days). After treatment, 19 patients recovered with primary wound healing and 3 patients recovered with secondary healing. All patients were followed up for 6-38 months (mean 26 months), and no ventral hernia or defect recurred except 1 case of lower abdominal bulge. Mesh infections after ventral hernia or defect repair are difficult to treat using prosthetic materials. For satisfactory results, surgery should be performed according to the specific condition of the individual.

Evaluation of component separation technique in the repair of complex large ventral hernia with large defects

Background Component separation technique was initially developed in 1990 by Ramirez and colleagues for reconstruction of large abdominal wall defects. The aim of this study was to report the effectiveness of this technique over 1-year follow-up. Patients and methods Sixteen patients were included in the study. The indications, operative details, and clinical outcomes were recorded. The mean operative time ranged from 140 to 210 min and the hospital stay ranged from 2 to 5 days. Postoperative complications were mild, and none of the studied patients had clinical recurrence during the follow-up period. Conclusion Component separation technique is a feasible procedure and effective in the repair of large abdominal wall defects.