Standard Polypropylene Mesh Research Articles

Study of Operative Outcomes of Hernioplasty Using Mosquito Net Mesh at a Tertiary Hospital.

BackgroundSynthetic mesh is the most efficient way to repair groin hernias. However, many patients in low and middle-income countries cannot afford the above-mentioned mesh. This study's goal was to describe the mosquito net mesh's (MNM) safety, viability, complications, and recurrence rate in hernioplasty done in rural populations.Material and methodsThis study was a single-centre, prospective, descriptive study, conducted in patients >18 years of age, of either gender, with unilateral or bilateral primary inguinal hernias (reducible/irreducible/bilateral hernia), admitted for elective or emergency open inguinal hernia mesh repair. The surgery was performed using reasonably priced (affordable to people of low socioeconomic status) polyethylene mosquito net mesh, which was cut into 8x16 cm rectangles and wrapped in two sealed plastic bags. They were sterilised using the ethylene oxide sterilisation (EtO) method. The type of hernia (unilateral or bilateral), post-operative pain, and complications were noted.ResultsAmong 400 study participants, the incidence of inguinal hernia was highest in the 60-79 year age group (51.5%). Direct inguinal hernia (67.5 %) was higher compared to indirect inguinal hernia (32.5 %). While a majority of the participants had a hernia on the right side (50%), 164 patients (41%) had a hernia on the left side, and 36 patients (9%) had a bilateral inguinal hernia. The average operative time for unilateral inguinal hernia was 73.96 minutes and for bilateral inguinal hernia was 106.66 minutes. Out of 400 patients, 355 patients (88.75%) had no complications. Among the postoperative patients, 14 patients (3.5%) experienced surgical site infection; 9 patients (2.25%) experienced headache; 5 patients (1.25%) experienced hematoma; 12 patients (3%) experienced urinary retention; and 5 patients (1.25%) experienced testicular pain. The average hospital stay of patients was 4.25 days. Patients returned to their daily activities and employment in an average of 7.29 days. The market cost of a single standard polypropylene mesh was Rs.1,660/-. For making a single mosquito net mesh of the same size, we had an expenditure of Rs. 11.83/- including the cost of sterilization. In this study, 382 patients (95.5%) gave us good feedback, 11 patients (2.75) gave satisfactory feedback, and 7 patients (1.75%) gave excellent feedback.ConclusionIn environments with limited resources, using mosquito net mesh for hernioplasty is reasonable, acceptable, doable, and economical.

Association of Mesh and Fixation Options with Reoperation Risk after Laparoscopic Groin Hernia Surgery: A Swedish Hernia Registry Study of 25,190 Totally Extraperitoneal and Transabdominal Preperitoneal Repairs.

BACKGROUNDInternational guidelines concerning mesh and mesh fixation options in laparoscopic totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. We hypothesized that the value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The current registry-based nationwide cohort study compared different mesh/fixation combinations for relative risks for reoperation after TEP and TAPP groin hernia repair.STUDY DESIGNAll TEP and TAPP registered in the Swedish Hernia Registry 2005 to 2017 with standard polypropylene (StdPPM) or lightweight (LWM) flat mesh, having tack, fibrin glue, or no fixation, were included. The endpoint was reoperation due to recurrence as of December 31, 2018. Multivariable Cox regression rendered relative risk differences between the exposures, expressed as hazard ratios (HR) with 95% CIs.RESULTSOf 25,190 repairs, 924 (3.7%) were later reoperated for recurrence. The lowest, mutually equivalent, reoperation risks were associated with StdPPM without fixation (HR 1), StdPPM with metal tacks (HR 0.8, CI 0.4 to 1.4), StdPPM with fibrin glue (HR 1.1, CI 0.7 to 1.6), and LWM with fibrin glue (HR 1.2, CI 0.97 to 1.6). Except for with fibrin glue, LWM correlated with increased risk, whether affixed with metal (HR 1.7, CI 1.1 to 2.7), or absorbable tacks (HR 2.4, CI 1.8 to 3.1), or deployed without fixation (HR 2.0, CI 1.6 to 2.6).CONCLUSIONSWith StdPPM, neither mechanical nor glue fixation seemed to improve outcomes. Thus, for this mesh category, we recommend nonfixation. With LWM, we recommend fibrin glue fixation, which was the only LWM alternative on par with nonaffixed StdPPM.

A Non-randomized Comparative Study of Self-Fixing and Standard Polypropylene Mesh in Open Inguinal Hernia Repair

A Non-randomized Comparative Study of Self-Fixing and Standard Polypropylene Mesh in Open Inguinal Hernia Repair

P067 HUMANITARIAN HERNIA SURGERY - 10 YEARS OF PERSONAL EXPERIENCE AND THE SAFETY OF LDPE MOSQUITO MESH

Abstract Aim Many people from low-income countries suffer from late or no treatment of incarcerated hernias. That can cause permanent consequences or even death. Hernia International is a 100% volunteer organisation, delivering humanitarian hernia surgery in the countries of the third world. A LDPE mosquito mesh is widely used. Its safety and full functionality was described. Material and Methods A LDPE Mosquito mesh was a subject of testing for a heavy metal content; the same-size piece of a mosquito mesh, and a standard commercial mesh, were tested by spectral photometry. I have had the chance to join 11 international voluntary teams in the years of 2011-2019. More than 1000 procedures were performed, including large inguinoscrotal, incisional, and pediatric hernias. The conditions were often very basic, and a LDPE mosquito mesh and local anaeshesia were used in most adult cases. Results The test shows comparable or less presence of heavy metals in the LDPE mosquito mesh, in comparison with a standard polypropylene mesh. A very low number of early post-op complications, such as haematoma and wound infection, were recorded (less than 1%) in a group of patients operated during voluntary missions. 1-2 local young surgeons were trained in basic hernia procedures. Conclusions Hernia International provides a high-quality surgical care to the patients from the developing countries. Using a mosquito mesh is a safe and effective method with a comparable low complication rate but with minimal costs.

Evaluation of the histological and biomechanical properties of poly-4-hydroxybutyrate scaffold for pelvic organ prolapse, compared with polypropylene mesh in a rabbit model.

Poly-4-hydroxybutyrate (P4HB) is a biopolymer produced by Escherichia coli K12 bacteria. P4HB is fully resorbed in vivo by 18-24months post-implantation. The aim of this study is to evaluate P4HB in the rabbit abdomen and vagina to determine that the biomechanical and histological properties are similar to the standard polypropylene mesh. Our hypothesis is that the histological and biomechanical properties of a fully absorbable graft will be similar to a lightweight polypropylene (PP) mesh when implanted in rabbit vagina and abdomen. Sixteen (n = 16) female New Zealand White (retired breeder) rabbits were equally divided between two time points (3 and 9months). A total of 17 rabbits were used owing to one death secondary to suspected cardiomyopathy. P4HB scaffold and PP mesh were subcutaneously and peri-vaginally implanted into the rabbit abdomen and vagina respectively. All rabbits had both posterior and anterior vaginal implants, and half of the rabbits had four abdominal implants in addition to the vaginal implants. The abdominal implants were 4.5cm long × 1.5cm wide whereas the vaginal implants were 1.5cm long × 0.5cm wide. At 3 and 9months, gross necropsy was performed and samples were obtained, sectioned, stained and evaluated via histological analysis. Specimens were assessed for host inflammatory response, neovascularization, elastin content, and collagen deposition/maturation. Specimens were also biomechanically evaluated via uniaxial tensile test to determine the stiffness, ultimate tensile strength and load at ultimate tensile strength of the device/tissue composite. No abdominal mesh exposures were noted. A comparable number of asymptomatic partial vaginal exposures were observed at 3months (P4HB: n = 3; PP: n = 2) and 9months (P4HB: n = 3; PP: n = 2) respectively. Histological analysis of specimens showed comparable results in the P4HB and PP groups at 3 and 9months post-implantation. Although no acute inflammation was seen, chronic inflammation was demonstrated in all specimens. Elastic fibers were present in the 3-month vaginal PP and P4HB specimens, but were not seen again. There was an increase in type I/III collagen noted over time. Biomechanical evaluation of the vaginal mesh tissue complex showed ultimate tensile strength was not significantly different between P4HB and PP groups at 3 (P = 0.625) and 9months (P = 0.250) respectively. P4HB scaffold may represent a fully absorbable alternative to permanent mesh for pelvic organ prolapse (POP) repair.

Pharmacological stimulation of mesh implant engraftment after ventral hernia repair

Aim. To study the effect of pyrimidine medication hydroxyethyldimethyldihydropyrimidine on the systemic inflammation after prosthetic repair of the anterior abdominal wall hernia.
 Methods. We prospectively analyzed two groups of patients aged between 18 and 80 years, who underwent prosthetic repair of the aponeurosis defect in the anterior abdominal wall hernia with a standard polypropylene mesh implant. The main group (n=16) was given 0.5 g hydroxyethyldimethyldihydropyrimidine per os 3 times a day before meals for 57 days from the first day after the operation. In the control group (n=16), patients received basic therapy without hydroxyethyldimethyldihydropyrimidine.
 Results. The postoperative period in patients after elective prosthetic hernioplasty of anterior abdominal wall was associated with an imbalance of the immune system with a tendency to lymphocytopenia (count in blood changed by 27.0%; p=0.20, Wilcoxon criterion) without significant leukocytopenia (count in blood changed by 4.9%; p=1.00, Wilcoxon criterion) and an 82.8% increase in C-reactive protein content (p=0.2, Wilcoxon criterion) compared to baseline values before the surgery. The proposed pharmacological support of prosthetic hernioplasty of the anterior abdominal wall with hydroxyethyldimethyldihydropyrimidine allowed to correct the postoperative lymphocytopenia (p=0.04, U-criterion) and reduce the concentration of C-reactive protein by 223.6% (p=0.03, U-criterion) compared with the control, which was also associated with a decrease in the number of local complications of prosthetic hernioplasty.
 Conclusion. The use of hydroxyethyldimethyldihydropyrimidine in patients after prosthetic hernioplasty is associated with a significant decrease in the C-reactive protein level, prevention of postoperative lymphocytopenia and a decrease in the number of local wound complications; C-reactive protein level can serve as one of the early and significant indicators of postoperative complications in this category of patients.

Long-term outcomes after Lichtenstein repair using titanium-coated mesh: A retrospective cohort study.

Objective:To examine the long-term outcomes such as recurrence, foreign body feeling and chronic pain of titanium-coated mesh (TCM) versus standard polypropylene mesh (PM) after Lichtenstein repair (LR).Methods:In this retrospective cohort study, patients who underwent TCM and PM in LR were evaluated between May 2014 and January 2018 at Ordu University Training and Research Hospital in Turkey. Primary outcomes (age, gender, body mass index, smoking habits, comorbid diseases, American Society of Anesthesiologists score, hernia type, side of hernia, duration of hernia presentation and operative time) and secondary outcomes (surgical site occurence, recurrence, foreign body feeling and chronic pain) were analyzed. Patients were divided into two groups according to the mesh elected (TCM and PM); titanium group (TG) and polypropylene group (PG), respectively.Results:In this study, 221 patients were analyzed; TCM was used in 72 (32.6%) patients and PM was used in 149 (67.4%) patients. No difference was found between groups in terms of primary outcomes (p>0.05). In the analysis of secondary outcomes, surgical site occurence was similar in both groups (p>0.05). Recurrence was observed in 1.39% (n=1) of TG and 2.01% (n=3) of PG. No difference was found between groups in terms of recurrence (p=0.606). Foreign body feeling was observed in 15.3% (n=11) of TG and 27.5% (n=41) of PG. Chronic pain was observed in 4.2% (n=3) of TG and 12.8% (n=9) of PG. Significant differences were found between groups in terms of chronic pain and foreign body feeling (p=0.046 and p=0.044, respectively).Conclusion:The result of this study shows that in LR, TCM leads to less foreign body feeling and chronic pain than PM. However, there was no difference in terms of recurrence between these meshes.

A Meshless Practical Laparoscopic Sacrohysteropexy Modification and Long-term Outcomes

Study ObjectiveTo describe a new modification of laparoscopic sacrohysteropexy without using a mesh and report the 3-year outcomes. DesignA prospective cohort study. SettingMinimally Invasive Gynecology Unit, Bursa Uludag University Hospital, Turkey. PatientsWomen who were diagnosed with ≥ stage 2 uterine prolapse. InterventionsA laparoscopic sacrohysteropexy modification using a polyester fiber suture instead of a standard polypropylene mesh. Measurements and Main ResultsThe primary outcome was the anatomic success of the repair, with success defined as objective parameters using the pelvic organ prolapse quantification system. The secondary outcomes were subjective outcomes, which were assessed using the quality-of-life scales. Forty-seven women who underwent the procedure were followed up for a minimum of 3 years. Forty-four of the 47 patients had stage 0 or 1 prolapse at the end of the second year, according to the primary outcomes. The anatomic success rate was 93.6%. In the secondary outcomes, 2 patients were not satisfied with their pelvic floor after the second year. The subjective cure rate was 95.7%. There was a statistically significant improvement in both pelvic organ prolapse quantification and quality-of-life scores in the third postoperative year. The mean operating time was 84.6 minutes, and the mean estimated blood loss was 21.3 mL. There were no bladder or bowel complications in the perioperative or postoperative period. ConclusionLaparoscopic sacrohysteropexy can be performed safely with this meshless modification in uterine prolapse as an alternative.

Evolution of the mechanical properties of a medical device regarding implantation time

BackgroundOur study aimed at understanding the influence of healing time on the mechanical properties of meshes used in pelvic organ prolapse, once implanted in an animal model using the rat. MethodsA standard polypropylene mesh was implanted in 42 rats in order to evaluate the mechanical properties of the implanted mesh. Explantation occurred at 1, 2, 3, 4 and 5 months and mechanical tests were performed. Each sample was mechanically evaluated by a uniaxial tensile test with a machine (BIOTENS). Biological tissues presented a nonlinear relation between stress and strain so it could be modeled by the 2 parameters C0 and C1 of a second-order Mooney-Rivlin law. ResultsThe rigidity in small deformation might not be affected by healing time or the presence of the synthetic implant. On the contrary, changes seemed to occur on the stiffness in large deformation (C1). The stiffness with the mesh composite changed with healing time. The “two-month implantation” rat group was significantly more rigid than the two control groups (pcontrol/2months = 0,04 and pplacebo/2months = 0,04). The 2- and 3-month healing groups were significantly more rigid than the 1-month healing group (p1/2months = 0,01 and p1/3months = 0,003). After 2 months, the mechanical properties seemed to stabilize (p2/3months = 0,44, p2/5months = 0,16 et p3/5months = 0,3). ConclusionIn order to evaluate the mechanical properties of an implanted mesh, the optimal time for explantation seems to be 2 months. Once this period is over, a more physiological mesh will be developed in order to be similar to native vaginal tissue once implanted and colonized by scar tissue.

Comparison between Lichtenstein procedure using polypropylene mesh and self-fixating mesh for management of primary inguinal hernia in adult male patients in terms of chronic postoperative pain: a prospective randomized controlled trial

Aim The aim of this study was to evaluate the self-gripping mesh compared with standard polypropylene mesh (PM) in treating primary inguinal hernia in adult male patients in terms of chronic postoperative pain. Patients and methods One hundred male patients with primary inguinal hernia were randomly allocated into two groups: group I included 50 patients (mean age, 35.92±13.21 years) who were treated with the standard PM and group B included 50 patients (mean age, 36.60±13.12 years) who were treated with the self-fixating mesh (SF). Results Recurrence was encountered in only one patient in the PM group and in one patient of the SF group. Visual analog scale showed significant less early and late postoperative pain in the SF group compared with the PM group. The operative time for the SF group (47.54±6.51 min) was significantly shorter compared with the PM group (58.82 ±11.90 min). Both PM and SF groups showed no significant differences as regards hospital stay (0.78± 0.53 vs.0.74±0.31 days), time to return to domestic activity (1.96±1.16 vs. 1.66±0.80 days), time to return to work activity (7.34±2.17 vs. 6.98±1.66 days), and early postoperative complications. Conclusion After 1 year follow-up, in Lichtenstein repair, using the Self-gripping ProGrip mesh showed significant less chronic postoperative pain compared with the standard PM. The use of Self-gripping ProGrip mesh was also associated with a significantly less operative time.

Repair of recurrent rectocele with posterior colporrhaphy or non-absorbable polypropylene mesh\u2014patient-reported outcomes at 1-year follow-up

Introduction and hypothesisThe aim of this study was to compare the results of repair of isolated, recurrent, posterior vaginal wall prolapse using standard posterior colporrhaphy versus non-absorbable polypropylene mesh in a routine health care setting.MethodsThis cohort study was based on prospectively collected data from the Swedish National Register for Gynaecological Surgery. All patients operated for recurrent, posterior vaginal wall prolapse in Sweden between 1 January 2006 and 30 October 2016 were included. A total of 433 women underwent posterior colporrhaphy, and 193 were operated using non-absorbable mesh. Data up to 1 year were collected.ResultsThe 1-year patient-reported cure rate was higher for the mesh group compared with the colporrhaphy group, with an odds ratio (OR) of 2.06 [95% confidence interval (CI) 1.03–4.35], corresponding to a number needed to treat of 9.7. Patient satisfaction (OR = 2.38; CI 1.2–4.97) and improvement (OR = 2.13; CI 1.02–3.82) were higher in the mesh group. However, minor surgeon-reported complications were more frequent with mesh (OR = 2.74; CI 1.51–5.01). Patient-reported complications and re-operations within 12 months were comparable in the two groups.ConclusionsFor patients with isolated rectocele relapse, mesh reinforcement enhances the likelihood of success compared with colporrhaphy at 1-year follow-up. Also, in our study, mesh repair was associated with greater patient satisfaction and improvement of symptoms, but an increase in minor complications. Our study indicates that the benefits of mesh reinforcement may outweigh the risks of this procedure for women with isolated recurrent posterior prolapse.

Comparative Study Between Lightweight Meshes Versus Traditional Heavyweight Meshes for the Repair of Inguinal Hernia

Background and aim: the ideal outcome of inguinal hernia surgery is to provide a repair that is free from recurrence, pain and infection with minimal scarring and with improvement in patient's quality of life. Aim of the work: this study aimed to compare light weight poliglecaprone (Ultrapropolypropylene/Monocryl), UltraPro™ mesh with the standard heavy weight polypropylene mesh in tension free Lichtenstein inguinal hernia repair. Patients and methods: the current study included 40 patients complained of uncomplicated inguinal hernia and they were randomized into two groups according to the type of mesh used in tension free Lichtenstein inguinal hernia repair. Group I, 20 patients received the standard polypropylene mesh. Group II, 20 patients received light weight UltraPro™ mesh, using sutures for their fixation. Results: the UltraPro™ (LWM) mesh proved to be as safe and effective as the standard (HWM) prolene mesh in repair of uncomplicated inguinal hernia. There was no difference between the two groups as regard to the technical difficulties, operative complications and surgeons were equally satisfied. There was more incidence of chronic pain with prolene mesh (25%) compared to (zero%) with UltraPro™ mesh. The mesh fixation time and the overall operative time were shorter with UltraPro™ mesh. Conclusion: the shorter operative time and the no-need to use analgesics could partially compensate the higher cost of UltraPro™ mesh in the absence of other economic factors such as the duration of patient improvement and return to work.

Comparative study between lightweight poliglecaprone meshes versus traditional heavyweight polypropylene meshes for the repair of inguinal hernia

Introduction The ideal outcome of inguinal hernia surgery is to provide a repair that is free from recurrence, pain and infection with minimal scarring and with improvement in patient's quality of life. Aim of the work Is to compare lightweight poliglecaprone (Ultrapropolypropylene/Monocryl), UltraPro™ mesh with the standard heavyweight polypropylene mesh in tension free Lichtenstein inguinal hernia repair. Patients and methods The current study included 200 patients complained of uncomplicated inguinal hernia and they were randomized into two groups according to the type of mesh used in tension free Lichtenstein inguinal hernia repair. Group I, 100 patients received the standard polypropylene mesh. Group II, 100 patients received light weight UltraPro™ mesh, using sutures for their fixation. Results The UltraPro™ (LWM) mesh proved to be as safe and effective as the standard (HWM) prolene mesh in repair of uncomplicated inguinal hernia. There was no difference between the two groups as regard to the technical difficulties, operative complications and surgeons were equally satisfied. There was more incidence of chronic pain with prolene mesh (25%) compared to (zero%) with UltraPro™ mesh. The mesh fixation time and the overall operative time were shorter with UltraPro™ mesh. Conclusion The shorter operative time and the no-need to use analgesics could partially compensate the higher cost of UltraPro™ mesh in the absence of other economic factors such as the duration of patient improvement and return to work.

Comparative Study Between Lightweight Meshes Versus Traditional Heavyweight Meshes for the Repair of Inguinal Hernia

Background and aim: the ideal outcome of inguinal hernia surgery is to provide a repair that is free from recurrence, pain and infection with minimal scarring and with improvement in patient's quality of life. Aim of the work: this study aimed to compare light weight poliglecaprone (Ultrapropolypropylene/Monocryl), UltraPro™ mesh with the standard heavy weight polypropylene mesh in tension free Lichtenstein inguinal hernia repair. Patients and methods: the current study included 40 patients complained of uncomplicated inguinal hernia and they were randomized into two groups according to the type of mesh used in tension free Lichtenstein inguinal hernia repair. Group I, 20 patients received the standard polypropylene mesh. Group II, 20 patients received light weight UltraPro™ mesh, using sutures for their fixation. Results: the UltraPro™ (LWM) mesh proved to be as safe and effective as the standard (HWM) prolene mesh in repair of uncomplicated inguinal hernia. There was no difference between the two groups as regard to the technical difficulties, operative complications and surgeons were equally satisfied. There was more incidence of chronic pain with prolene mesh (25%) compared to (zero%) with UltraPro™ mesh. The mesh fixation time and the overall operative time were shorter with UltraPro™ mesh. Conclusion: the shorter operative time and the no-need to use analgesics could partially compensate the higher cost of UltraPro™ mesh in the absence of other economic factors such as the duration of patient improvement and return to work.

Post-Operative Complications After Repair Of Incisional Hernia

AbstractBackground:-Incisional hernia is frequently met by the general surgeon, itis frequently complicated (3.8-11.5%)of patients after abdominal surgery. Repair oflarge incisional hernia is a difficult surgical problem with recurrence being a common. Numerous methods of repair have been described simple opposition in one layer orcomplex opposition and the use of prosthetic mesh. The aim of this study is to report our experience with the use of mesh repair and risk factors that influence post operative complications.Methods:-A prospective study done in Al-hussain teaching Hospital, Department of Surgery between January 2011 to December 2013.One hundred and ten patients with prosthetic repair of incisional hernia were included in this study. History was taken and thorough examination was done, all patients were asked for history of diabetes mellitus, obesity, corticosteroid use, their original operations,primary or recurrent hernia and examined for their body mass index, size and duration of the hernial defect were recorded. A proforma was completed for each patient, noting prophylactic antibiotics hadbeen given or not, type of the sac and whether opened or inverted, type and size of mesh had been used, intraoperative and postoperative complications and postoperativehospital stay. 
 Results:-Of (110) patients, (62) were females, (48)were males,their median age was(45.5) years for women and (58) years for men,(31)patients(28.2%)weighted more than their ideal body weight and had body mass index equal or more than(30).Forty eight patients (43.6%) were diabetic and (24)patients(21.8%)were corticosteroid used. The original operations were bowel related and gynecological in the majority ofpatients. Previous incisions were long midline in(38) .Twenty patients had one past operation, (13)had two,(5) had three and one patient had four past repair, theremaining were new Incisional hernia patients. The main hernia size was (12.3) cm and (4.6) cm in vertical and horizontal direction respectively. Forty four patients had additional surgical procedures, consisted of Fallopian tube ligation in (12) ,division of small bowel adhesions in (8) ,suturing of small bowel perforation in (4) and abdominoplasty in (20) patients. In the majority of patients (78), standard polypropylene mesh had been used and vicryl-prolene (Vypro) mesh in the remaining (32) patients. The main postoperative complications were seroma formation (17.3%), wound haematoma (10%), wound infection (9.1%), chest infection (6.4%), one patientdeveloped intestinal fistula and mesh need to be removed. Five recurrent incisional hernias occurred. Most patients developed complications were obese, diabetic and corticosteroid used. No death in our series.Conclusion:-Tension free incisional hernia repair using prosthetic mesh is a safe and easy procedure with no major morbidity or recurrence. The patient-doctor should advise weight loss to help reduce risks of surgery and improve the surgical results. Control of diabetes, corticosteroid drug use and smoking cessation are recommended for better results. Rigid sterile condition, precise and meticulous technique with the use of closed suction drains is important.

Self-fixing parietex progrip versus the standard sutured prolene mesh in tension-free repair of inguinal hernia: effect on testicular volume and testicular blood flow.

Our study was conducted to compare self-fixing lightweight polyester mesh (group I) to the standard heavy weight polypropylene mesh (group II) using tension-free Lichtenstein hernioplasty as regard to the effect of mesh implantation and perimesh fibrosis on testicular blood flow. 80 patients with uncomplicated inguinal hernia were divided in two groups. Doppler ultrasonography measured testicular volume, testicular artery velocity preoperative and 3rd month post operative. Blood flow in the testicles was represented by resistive index (RI). No case of testicular atrophy occurred in either group, however, in both groups a significant postoperative decrease in testicular volume (p = 0.001 in group I and p < 0.001 in group II) was accompanied by a significant increase in RI as compared to their pre-operative values (p < 0.001 in group I and p = 0.009 in group II). Comparing the two groups, patients in group I showed higher values of decrease in testicular volume accompanied by more increase in RI values postoperatively compared to group II patients, but these values did not reach a significant value (p = 0.107, p = 0.136). There was a significant increase in the number of post-operative varicocele and hydrocele in group I compared to group II. Mesh implantation has an effect on testicular size and blood flow by decreasing the testicular size and increasing the RI. This effect was more obvious in the parietex progrip. Although there is an indirect relation between RI and the sperm count, testicular blood flow alone is not enough to judge fertility.

Groin Pain Characteristics and Recurrence Rates: Three-year Results of a Randomized Controlled Trial Comparing Self-gripping Progrip Mesh and Sutured Polypropylene Mesh for Open Inguinal Hernia Repair.

The aim of this study was to investigate long-term groin pain and inguinal hernia recurrence rates of 2 types of mesh and to describe the evolution of postoperative groin sensory disturbances. Some patients with an inguinal hernia develop chronic pain following open mesh insertion. Previous trials comparing a semi-resorbable, self-gripping Progrip mesh with a standard sutured polypropylene mesh found conflicting results regarding recurrence rates and residual groin pain. Patients aged >18 years scheduled for open primary hernia repair were randomized to a self-gripping mesh (Progrip) or a polypropylene mesh (standard). Removal of the inguinal nerves was left to the discretion of the surgeon. Pain was measured using Visual Analogue Scale (VAS) over a 3-year period. Pain characteristics and hernia recurrences were determined using physical examination. Data of 274 patients were complete (75% three-year follow-up rate). Pain steadily decreased over time in both groups in a similar fashion (moderate pain 3.7% in each group). Hyperesthesia was experienced by 2.2% and 3.7% and hypoesthesia in 12% and 19% in Progrip and standard group, respectively. One of seven Progrip patients reported a foreign body feeling versus 1 of 5 standard patients (P = 0.06). Altered skin sensations were not related to a neurectomy. Hernia recurrence rate was 11.5% in the Progrip and 5% in the standard group (P = 0.05). Three years after insertion of a self-gripping Progrip mesh or a sutured polypropylene mesh for an open primary inguinal hernia repair, groin pain is minimal, although altered groin skin sensations and foreign body feeling are quite common. A Progrip hernia repair is associated with a high recurrence rate.

A polypropylene mesh modified with poly-ε-caprolactone nanofibers in hernia repair: large animal experiment.

PurposeIncisional hernia repair is an unsuccessful field of surgery, with long-term recurrence rates reaching up to 50% regardless of technique or mesh material used. Various implants and their positioning within the abdominal wall pose numerous long-term complications that are difficult to treat due to their permanent nature and the chronic foreign body reaction they trigger. Materials mimicking the 3D structure of the extracellular matrix promote cell adhesion, proliferation, migration, and differentiation. Some electrospun nanofibrous scaffolds provide a topography of a natural extracellular matrix and are cost effective to manufacture.Materials and methodsA composite scaffold that was assembled out of a standard polypropylene hernia mesh and poly-ε-caprolactone (PCL) nanofibers was tested in a large animal model (minipig), and the final scar tissue was subjected to histological and biomechanical testing to verify our in vitro results published previously.ResultsWe have demonstrated that a layer of PCL nanofibers leads to tissue overgrowth and the formation of a thick fibrous plate around the implant. Collagen maturation is accelerated, and the final scar is more flexible and elastic than under a standard polypropylene mesh with less pronounced shrinkage observed. However, the samples with the composite scaffold were less resistant to distracting forces than when a standard mesh was used. We believe that the adverse effects could be caused due to the material assembly, as they do not comply with our previous results.ConclusionWe believe that PCL nanofibers on their own can cause enough fibroplasia to be used as a separate material without the polypropylene base, thus avoiding potential adverse effects caused by any added substances.

Preventing parastomal hernia with modified stapled mesh stoma reinforcement technique (SMART) in patients who underwent surgery for rectal cancer: a case–control study

Parastomal hernia is a frequent complication of an abdominal wall stoma. Surgical repairs have high complication and recurrence rates. Several different techniques have been suggested to prevent parastomal hernia during stoma creation. The aim of the present case-control study was to evaluate the efficacy of modified Stapled Mesh stomA Reinforcement Technique (SMART) for prevention of parastomal hernia compared with conventional colostomy formation in patients who underwent open or laparoscopic rectal resection and end colostomy for cancer. Between January 2014 and May 2016, all consecutive patients who underwent open or laparoscopic resection and end colostomy for primary or recurrent rectal cancer were identified from a prospectively collected database. Since January 2014, one surgeon in our team has routinely offered modified SMART procedure to all patients who are candidates for permanent terminal colostomy. In the SMART group patients, while creating an end colostomy, we placed a standard polypropylene mesh in the retromuscular position, fixed and cut the mesh by firing a 31- or 33-mm-diameter circular stapler and constructed the stoma. In the control group, a stoma was created conventionally by a longitudinal or transverse incision of the rectus abdominis sheath sufficiently large for the colon to pass through. Twenty-nine patients underwent parastomal hernia prophylaxis with modified SMART and 38 patients underwent end-colostomy formation without prophylaxis (control group). Groups were similar in terms of age, sex and underlying conditions predisposing to herniation. Median follow-up time is 27 (range 12-41)months. Nineteen patients (28.4%) developed parastomal herniation. In the SMART group, 4 patients (13.8%) developed parastomal herniation which is significantly lower than the control group in which 15 patients (39.5%) developed parastomal herniation (p=0.029). We did not observe mesh infection, stenosis, erosion or fistulation in the SMART group. One patient in the control group underwent surgical correction of stoma stricture, another patient underwent surgery for stoma prolapse and four patients underwent surgery for parastomal herniation. New systemic reviews and meta-analysis support parastomal hernia prevention with the use of a prophylactic mesh. Until more evidence is available, prophylactic mesh should be routinely offered to all patients undergoing permanent stoma formation. SMART is easy to use, safe and effective for paracolostomy hernia prophylaxis.

Sacrocolpopexy with polyvinylidene fluoride mesh for pelvic organ prolapse: Mid term comparative outcomes with polypropylene mesh

ObjectiveThe aim of this study was to compare the surgical, anatomical, and functional outcomes of sacrocolpopexy (SCP) using polyvinylidene fluoride (PVDF) mesh versus SCP using the standard polypropylene (PP) mesh. Study designThis was a retrospective single centre case-control study including female patients who underwent laparoscopic or abdominal SCP for POP with either PP (Cousin Biotech®) or PVDF (DynaMesh®-PRS) mesh between March 2005 and May 2015. Anatomical outcomes were assessed by the Pelvic Organ Prolapse Quantification (POP-Q) system. Functional outcomes included voiding and storage urinary symptoms (VS and SS, respectively), urgency and stress urinary incontinence (UUI and SUI) and sexual dysfunction (SD). Symptoms and their impact on patients’ quality of life (QoL) were assessed using validated questionnaires as Incontinence Impact Questionnaire (IIQ-7), Urinary Distress Inventory (UDI-6) and Female Sexual Function Index (FSFI). Global patient perception of improvement (PGI-I questionnaire) and mesh erosion rates were also recorded. ResultsOf the 166 patients enrolled, 136 could be included in the analysis: 73 in the PP group and 63 in the PVDF group. The mean follow-up was 94± 17.31 months for the PP and 25.6± 13.8 months for the PVDF group. There were no statistically significant differences in patient demographics and preoperative clinical characteristics. Postoperative anatomical correction were not significantly different between the two groups. The PVDF group showed superior results in term of storage symptoms (PVDF=0% versus PP=8.2%; p=0.02) and lower rate of sexual dysfunction (PVDF=0% versus PP=16,4%; p=0.001). Only 1 patient in PP group and 2 in PVDF group (p=0.47) presented a mesh exposure. There was no statistical difference in PGI-I scores (PP=1.5±1.0 vs PVDF=1.8±0.5; p=0.40). ConclusionsOur findings suggest that both meshes can be safely and effectively used with good anatomical outcomes. Interestingly, PVDF use was associated with significantly less storage symptoms and sexual dysfunction.