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: 2.05). 01/2013; 17(1). DOI: 10.1007/s10029-013-1043-5
Source: PubMed
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    • "On the other hand, when Andiroba oil as a mesh coating was tested, there was less collagen fibers ingrowth when compared with the other groups, exposing that there was worse tissue healing. There is unceasing search for an ideal mesh coating that would show no adverse reactions, complications, or foreign body reaction, and one that is simple to use, easily accessible, and affordable (Montgomery, 2013). However, this study shows that no substance, despite its anti-inflammatory or tissue healing activity, should be used in the clinical setting of VRH before a full basic research is done, because Andiroba oil used as a mesh coating showed greater fibrosis and less collagen fiber formation, leading to worse VHR outcome. "
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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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    ABSTRACT: Purpose: It is recognized that chronic inflammation can cause cancer. Even though most of the available synthetic meshes are considered non-carcinogenic, the inflammatory response to an infected mesh plays a constant aggression to the skin. Chronic mesh infection is frequently the result of misuse of mesh, and due to the challenging nature of this condition, patients usually suffer for years until the infected mesh is removed by surgical excision. Methods: We report two cases of squamous-cell carcinoma (SCC) of the abdominal wall, arising in patients with long-term mesh infection. Results: In both patients, the degeneration of mesh infection into SCC was presumably caused by the long-term inflammation secondary to infection. Patients presented with advanced SCC behaving just like the Marjolin's ulcers of burns. Radical surgical excision was the treatment of choice. The involvement of the bowel played an additional challenge in case 1, but it was possible to resect the tumor and the involved bowel and reconstruct the abdominal wall using polypropylene mesh as onlay reinforcement, in a single stage operation. He is now under adjuvant chemotherapy. The big gap in the midline after tumor resection in case 2 required mesh bridging to close the defect. The poor prognosis of case 2 who died months after the operation, and the involvement of the armpit, groin and mesenteric nodes in case 1 shows how aggressive this disease can be. Conclusion: Infected mesh must be treated early, by complete excision of the mesh. Long-standing mesh infection can degenerate into aggressive squamous-cell carcinoma of the skin.
    Hernia 04/2013; 18(6). DOI:10.1007/s10029-013-1083-x · 2.05 Impact Factor
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    ABSTRACT: Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel.
    World Journal of Emergency Surgery 12/2013; 8(1):50. DOI:10.1186/1749-7922-8-50 · 1.47 Impact Factor
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