The battle between biological and synthetic meshes in ventral hernia repair

Department of Surgery, Institution of Clinical Science, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden, .
Hernia (Impact Factor: 2.09). 01/2013; 17(1). DOI: 10.1007/s10029-013-1043-5
Source: PubMed
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    ABSTRACT: Standard abdominoplasty rectus plication techniques may not suffice for severe cases of rectus diastasis. In the authors' experience, prosthetic mesh facilitates the repair of severe rectus diastasis with or without concomitant ventral hernias. A retrospective review of all abdominal wall surgery patients treated in the past 8 years by the senior author (G.A.D.) was performed. Patients with abdominoplasty and either rectus diastasis repair with mesh or a combined ventral hernia repair were analyzed. Thirty-two patients, 29 women and three men, underwent mesh-reinforced midline repair with horizontal or vertical abdominoplasty. Patient characteristics included the following: mean age, 53 years; mean body mass index, 26 kg/m; average width of diastasis or hernia, 6.7 cm; and average surgery time, 151 minutes. There were no surgical-site infections and two surgical-site occurrences-two seromas treated with drainage in the office. After an average of 471 days' follow-up, none of the patients had recurrence of a bulge or a hernia. For patients with significant rectus diastasis, with or without concomitant hernias, the described mesh repair is both safe and durable. Although this operation requires additional dissection and placement of prosthetic mesh in the retrorectus plane, it may be safely combined with standard horizontal or vertical abdominoplasty skin excision techniques to provide an aesthetically pleasing overall result. Therapeutic, IV.
    Plastic &amp Reconstructive Surgery 01/2015; 135(1):268-76. DOI:10.1097/PRS.0000000000000840 · 3.33 Impact Factor
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    ABSTRACT: Background This study was conducted to determine the efficacy and safety of the use of a partially absorbable large pore synthetic prophylactic mesh in emergent midline laparotomies for the prevention of evisceration and incisional hernia. Methods Retrospective analysis of all patients who underwent an emergency midline laparotomy between January of 2009 and July of 2010 was performed. Patients with complicated ventral hernia repair, postoperative death, and lack of follow-up were excluded. Results A total of 266 patients were included. Laparotomies were closed with a running suture of slow-reabsorbable material in 190 patients (Group S), and 50 patients within this group (26.3%) received additional retention sutures. In 76 patients (Group M), an additional partially absorbable lightweight mesh was placed in the Supra-aponeurotic space. Both groups presented similar complication rates (71.1% Group S vs 80.3% Group M, P = .97). There were no differences regarding surgical-site infection rates (17.9% Group S vs 26.3% Group M; P = .13) or postoperative mortality (13.7% Group S vs 18.3% Group M; P = .346). A total of 150 patients completed the follow-up (99 Group S; 51 Group M) at a mean time of 16.7 months. During follow-up, 36 cases of incisional hernia (24%) were diagnosed: 33 (33%) in Group S, whereas there were only three cases (5.9%) in Group M (P = .0001). Mesh removal for chronic infection was not required in any case. Conclusion The use of a partially absorbable, lightweight large pore prophylactic mesh in the closure of emergency midline laparotomies is feasible for the prevention of incisional hernia without adding a substantial rate of morbidity to the procedure, even if high contamination or infections are present.
    Surgery 11/2014; 156(5). DOI:10.1016/j.surg.2014.04.035 · 3.11 Impact Factor
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    ABSTRACT: In the Amazon rainforest region, Andiroba oil is an herbal oil that is widely used by the local population to treat several inflammatory diseases. The objective of this study was to test Andiroba oil as a mesh coating or by oral administration in a rat model of excisional abdominal wall defect as an alternative to modulate inflammatory response without impairing the ventral hernia repair. Thirty six animals were distributed into three groups (N=12). (1) In the control group (CONT), ventral hernia repair was done using polypropylene/polyglecaprone mesh. (2) In the Andiroba oil gavage group (AndG), animals were treated with the meshes and 0.63 ml/kg of Andiroba oil was given by oral administration for 7 days prior to the mesh placement. (3) In the Andiroba oil submersion group (AndS), animals were treated with meshes that were previously submersed in Andiroba oil. At the 7th, 14th, and 21st days, macroscopic and microscopic analyses were done. AndG had fewer adhesions, necrosis, and lymphocytes, as well as similar collagen fiber formation and fibrosis areas as CONT. AndS showed a higher number of macrophages, fibrosis area, and less collagen fiber formation. Oral administration of Andiroba oil modulated inflammatory response, reduced abdominal adhesion formation, and did not impair tissue healing. Key words: Abdominal wall, wound healing, Andiroba, herbal, cicatrization.
    Journal of medicinal plant research 05/2014; 8(19):709-714. DOI:10.5897/JMPR2013.5321 · 0.88 Impact Factor


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