Article

Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation.

Department of Visceral Surgery and Medicine, University of Bern, 3010, Bern, Switzerland.
Surgical Endoscopy (impact factor: 4.01). 03/2011; 25(3):749-55. DOI:10.1007/s00464-010-1246-0 pp.749-55
Source: PubMed

ABSTRACT Mesh fixation during laparoscopic ventral hernia repair can be performed using transfascial sutures or metal tacks. The aim of the present study is to compare mesh shrinkage and pain between two different techniques of mesh fixation in a prospective randomized trial.
A randomized trial was performed. Patients with ventral hernia of maximal diameter 8 cm were assigned to mesh fixation using either transfascial nonabsorbable sutures or metal tacks for fixation of a parietene composite mesh. The borders of the mesh were marked using clips, and radiological images in prone position were used for assessment of mesh size and location. The primary endpoint was mesh shrinkage; secondary endpoints included postoperative pain, mesh dislocation, and surgical morbidity.
Demographic parameters were similar in both groups. A total of 40 patients were randomized, and 36 patients were available for follow-up. There was one hernia recurrence in each group. Pain was significantly higher following suture fixation after 6 weeks, but no difference was found after 6 months. Mesh shrinkage after 6 months was significantly higher using tacks for mesh fixation.
Transfascial sutures are associated with more pain within the first 6 postoperative weeks and less mesh shrinkage after 6 months compared with mesh fixation using metal tacks.

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    Article: Comparative study of shrinkage, inflammatory response and fibroplasia in heavyweight and lightweight meshes.
    L Zogbi, E N Trindade, M R M Trindade
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    ABSTRACT: PURPOSE: In this manuscript, the authors describe an animal study comparing shrinkage, inflammatory response and fibroplasia in heavyweight (HW-PP) and lightweight polypropylene (LW-PP) meshes. METHODS: Both meshes were fixed on abdominal fascia of 25 Wistar rats (epifascial onlay placement). They were killed at 7, 28 and 90 days to measure the prostheses. Histological analysis was performed with hematoxylin-eosin for cellular counting and immunohistochemistry to measure collagen types I and III. RESULTS: The authors found that the LW-PP mesh presented greater median shrinkage than HW-PP mesh at 7 (P = .036), 28 (P = .674) and 90 days (P = .038) postoperatively. There were more neutrophils on LW-PP mesh (P = .008) at 7 days, gradually diminishing in both prostheses. Lymphocytes were similar between the implants at 7 days, diminishing about 50 % on LW-PP mesh (P < .001) at 90 days. Macrophages and giant cells diminished on LW-PP and increased on HW-PP meshes (P < .001). Collagen I/III ratio presented a progressive, almost fivefold rise at 90 days, on both mesh types (P < .001). The collagen I/III ratio was similar between LW-PP and HW-PP meshes at the three times studied. CONCLUSIONS: It is concluded that LW-PP showed more shrinkage than HW-PP mesh at 7 and 90 days, despite the fact that HW-PP presented more lately foreign body reaction. The collagen I/III ratio was similar between the prostheses and increased during the postimplant period.
    Hernia 01/2013; · 1.84 Impact Factor
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    Chapter: Laparoscopic Incisional Hernia Repair
    Anita Kurmann, Guido Beldi
    11/2011; , ISBN: 978-953-307-773-4
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Keywords

36 patients
 
40 patients
 
6 months
 
6 weeks
 
different techniques
 
first 6 postoperative weeks
 
hernia recurrence
 
laparoscopic ventral hernia
 
maximal diameter 8 cm
 
mesh
 
mesh dislocation
 
mesh fixation
 
Mesh shrinkage
 
mesh size
 
parietene composite mesh
 
prospective randomized trial
 
randomized trial
 
surgical morbidity
 
transfascial nonabsorbable sutures
 
ventral hernia