Underwent Mesh Repair Research Articles

Short-range clinical, dynamic magnetic resonance imaging and P-QOL questionnaire results after mesh repair in female pelvic organ prolapse

Objective To evaluate clinical, quality-of-life (QoL) and dynamic magnetic resonance imaging (dMRI) results in patients with pelvic organ prolapse (POP) preoperatively, and 4 and 12 weeks after anterior and/or posterior mesh repair. Study design Thirty-six patients (mean age 65 years) with symptomatic pelvic floor descent underwent mesh repair. The prolapse was quantified using the POP-Q system. Before surgery as well as 4 and 12 weeks after surgery, the pelvic organ positions were measured on dynamic magnetic resonance imaging during Valsalva manoeuvre in relation to the pubococcygeal and mid-pubic lines to assess surgery outcome. Patients also completed the P-QOL questionnaire to evaluate subjective changes at each visit. Results Four and 12 weeks after surgery patients showed improvement of the POP on clinical examination and on dynamic MRI. The latter demonstrated high significance ( p < 0.001) especially in bladder and vaginal cuff/cervix positions during maximal straining. All quality-of-life domains and some symptom questions of the P-QOL questionnaire significantly improved ( p < 0.05) 12 weeks after surgery. Conclusion Significant anatomical and quality-of-life improvement was demonstrated after anterior and/or posterior mesh repair for POP using dynamic MRI and the P-QOL questionnaire.

Spigelian hernia

Spigelian hernia is a rare ventral hernia which occurs due to defect / weakness in the spigelian fascia. They are difficult to diagnose and have vague symptoms. We report a 62 year male who presented with a left lower abdominal lump after a fall. A diagnosis of left spigelian hernia was made after clinical examination and confirmed by ultrasound. He underwent mesh repair and had an uneventful post operative period.

Urologic pelvic surgery following mesh hernia repair

Few and controversial reports have recently appeared on the role of previously performed surgery in the inguinal region using a prosthetic mesh and the ensuing difficulties encountered by urologists during radical retropubic prostatectomy. We analyzed our experience with various surgical urological procedures performed after prior low abdominal wall hernia repair with synthetic mesh. We reviewed our database for all patients who underwent mesh repair of lower abdominal hernias and subsequent urologic surgery in our department between 2002 and 2008. Their perioperative parameters, complications, and postoperative outcomes were analyzed. Twenty-three patients (one female) underwent pelvic urologic surgery for benign and malignant disease after having undergone previous prosthetic hernia repair. The mean patient age was 75.3 years (range 58-91). The mean interval between hernia repair and pelvic urologic surgery was 3.8 years (range 1-7). Twenty-two patients underwent previous mesh inguinal hernia repair and one had prosthetic postoperative ventral hernia repair after a transabdominal hysterectomy. The urologic procedures included 16 open suprapubic prostatectomies, two radical cystoprostatectomies, one bladder augmentation, and four laparoscopic radical prostatectomies. Severe postoperative complications were abortion of surgery (n = 1), inability to perform lymph node dissection (n = 2), bleeding (n = 1), bladder injury (n = 2), and additional surgery (n = 3: mesh removal, transurethral prostatectomy, and transurethral fulguration of the prostatic fossa). Prior application of synthetic mesh during abdominal wall surgery creates difficulties during subsequent urological procedures and may dictate change in operative planning. Nevertheless, the surgery is feasible and should not be ruled out.

Anterior Rectus Sheath in Inguinal Hernia Repair: Preliminary Study

Inguinal hernia repair using the anterior rectus sheath flap represents a tension-free repair with potential advantages (no foreign material or tension on the suture line). The aim of this research was to evaluate the method of inguinal hernia repair using the anterior rectus sheath and to compare it with tension-free mesh repair (modified Lichtenstein repair). In total, 62 patients were evaluated. Each patient's age, gender, type of hernia, total operating-room time, the length of postoperative hospital stay, and the recurrence-free period were recorded, as well as the total number of postoperatively administered doses of analgesics, and analyzed using the Mann–Whitney test. No difference in age (p =. 08), postoperative hospital stay (p = 0.810), or postoperative use of analgesics (p =. 116) was observed between two groups. Total operating-room time was significantly longer in patients undergoing mesh repair (median 80 min, range 45–150) compared to anterior rectus sheath repair (median 65 min, range 45–125) (p =. 049). No complications or recurrences were noted in either group. Thus, this study showed good results using the anterior rectus sheath repair for primary, uncomplicated inguinal hernias, comparable to mesh repair.

Predictors of recurrence in Veteran patients with umbilical hernia: single center experience

Background Different medical and social conditions have been associated with primary and recurrent hernias. Possible predictors of recurrence after elective umbilical hernia repair have not been defined clearly. The aim of this study was to determine factors that predict recurrence in patients after elective repair of umbilical hernias. Methods A 6-year retrospective review of patients with elective umbilical hernia repair at the Dallas VA Medical Center was performed. Clinical and pathologic data were evaluated by univariate analysis to identify predictive factors for recurrence. Results A total of 244 patients underwent elective hernia repair within the study period (male, 96%; mean age, 56 y; Caucasian, 74%; African American, 14%; Hispanic, 8%). Because 15 patients were not compliant with follow-up requirements, 229 were eligible for the study. Ninety-seven underwent suture repair (42.4%) and 132 underwent mesh repair (57.3%). Eleven recurrences were identified (4.8%): 7 in the suture repair group (7.7%) and 4 in the mesh repair group (3%). Univariate analysis showed that patients likely to develop recurrences were as follows: African American (15.6% vs. 3.5%; P = .017), type II diabetics (14.2% vs. 2.6%; P = .002), patients with hyperlipidemia (9.2% vs. 2.6%; P = .028), and human immunodeficiency virus–positive patients (66.6% vs. 3.9%; P = .000). Conclusions Smoking, obesity, size of hernia, type of repair, or chronic obstructive pulmonary disease do not seem to predict recurrence of hernias in our VA population. African Americans, patients with type II diabetes, hyperlipidemia, and positive for human immunodeficiency virus, may have a higher risk for recurrence after elective umbilical hernia repair.

Is testicular perfusion influenced during laparoscopic inguınal hernia surgery?

The influence of laparoscopic inguinal hernia surgery is still unclear. The aim of this study was to compare the possible early effects of laparoscopic and open inguinal hernia repair on testicular perfusion. In this prospective trial, 44 patients underwent mesh repair of a primary inguinal hernia assigned to one of two procedures: open anterior mesh repair (n = 29) or a laparoscopic totally extraperitoneal approach (n = 15). Doppler ultrasound was used to determine the hemodynamic characteristics of the testicular blood flow. No statistically significant differences were found between the two groups in terms of Doppler flow parameters for the preoperative, very early (day 1), and early postoperative (day 7) periods. When Doppler flow parameters of the testicular artery were compared in the conventional group, statistically significant differences were found between preoperative and very early postoperative values (p < 0.05). Meanwhile, comparison among flow parameters of the testicular, capsular, and intratesticular arteries of the laparoscopic group showed statistically significant differences between preoperative and very early postoperative and between preoperative and early postoperative values (p < 0.05). There were no statistically differences in postoperative complications between the two groups. Testicular blood flow is influenced during laparoscopic inguinal hernia surgery. Whether changes in flow parameters remain in the late postoperative period, and whether they have an impact on complications will be evaluated in further studies.

Inguinal Hernia Repair by Surgical Trainees at a Malaysian Teaching Hospital

To assess the outcome of inguinal hernia repaired by surgical trainees at Universiti Kebangsaan Malaysia Hospital. Retrospective review of 103 patients who underwent surgery between November 2001 and October 2002. The mean age of patients was 50 years and the male-to-female ratio was 20:1. Most hernias (60%) were right-sided inguinal hernias. Admissions consisted of 60% elective, 31% day-case and 9% emergency. General anaesthesia was administered in 66% of cases, spinal anaesthesia in 33% and local anaesthesia in 1%. Ten inguinal hernia repairs were performed by first-year trainees, 61 by third-year trainees and 19 by fourth-year trainees. First-year trainees did more darning (60%) and fewer mesh (40%) repairs. Third-year trainees still used darning (57%) but also performed more mesh repairs (43%). Fourth-year trainees performed 68% darning (mainly to teach the first-year trainees) and 32% mesh repairs. Senior surgeons assisted in 13 difficult cases where mesh repair was preferred (92%) to darning repairs (8%). Prophylactic antibiotic was more frequently used in patients undergoing mesh repair (p < 0.001). The mean operative time was the same for both types of repair. There were no significant differences in complications between the two types of repair. One hernia recurred after darning repair but none after mesh repair. Mesh repair of inguinal hernia is effective. Trainees easily acquire this skill and it becomes their preferred method of repair.