Gore

Acell

Abstract:

Management of all types of hernias continues to evolve as technology evolves. Prosthetic options continue to play a pivotal role in selection of techniques for hernia repair. There are 3 broad categories of prosthetics including synthetic, biologic, and the new absorbable biosynthetics. Paralleling prosthetic technology is the evolution of fixation for laparoscopic and open hernia techniques. Evaluations of new permanent and absorbable fixation methods are ongoing by multiple companies. There is a great interest in adhesives for mesh fixation as well as self-adhering prosthetics. Studies in fixation revolve around understanding the compromise between fixation strength and pain caused by different fixation methods. Understanding of the biomechanical properties of fixation options coupled with the understanding of the thresholds of force created by the functional abdominal wall are key to optimizing surgical technique. The clinical ramifications of furthering our understanding of all of these technologies will impact perspectives on future technique selection for hernia repair.

Authors:

Nathaniel Stoikes, MD, Assistant Professor of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, Guy R. Voeller, MD, Professor of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

PMID: 23700182

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Abstract:

The aim of the current prospective study was to show the results of a new type of medium-weight monofilament polypropylene mesh covered with a hydrogel barrier on the visceral side. Between July 2011 and April 2013 prospectively collected data on 30 consecutive patients who underwent abdominal wall hernia repair using a medium-weight mesh covered with carboxymethylcellulose-sodiumhyaluronate coating (Ventralight™ ST mesh, Davol Inc, Subsidary of C. R. Bard, Inc. Warwick, RI) were analyzed. Out of these patients, those who had a follow-up of at least 12 months were selected. Short- and long-term outcomes were described. Meanwhile, registration continues up to completion of a series with 100 included patients. A total of 17 patients were selected (men/women ratio 11/6). Median follow-up was 12 months (range 12–21). Mean hernia diameter was 7 cm x 5 cm (craniocaudal x laterolateral) (range 1.5 x 1.5 to 20 x 15). Mean length of hospital stay was 6.1 days. Postoperative Visual Analogue Scale (VAS) at last follow-up was significantly lower than the preoperative VAS (P = 0.017) There were no intraoperative complications. Four patients (23%) developed minor complications. Two patients had mild discomfort, another two patients developed a seroma. No recurrences were observed. This intermediate study shows good results using a biofilm coated mesh and confirm the positive results obtained in the Sasse clinical trial.

Authors:

Tim Tollens, MD, Consultant, Halit Topal, MD, Surgical Trainee, Sander Ovaere, BSc, Apprentice, Anthony Beunis, MD, Fellow, Koen Vermeiren, MD, Consultant, Chris Aelvoet, MD, Consultant, Department of General and Abdominal Surgery, Imelda Hospital, Bonheiden, Belgium

PMID: 23982980

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Abstract:

The repair of complex abdominal wall defects in contaminated fields often presents a dilemma for general surgeons. Synthetic mesh, although strong, may lead to chronic infection or even visceral erosion. Leaving the abdomen open presents challenges for ward management and delays definitive care, as well as allowing the musculature to retract over time. Numerous biological mesh alternatives have arisen over the previous decade, which may make primary closure in this setting a practical alternative, although durability may prove the downside. Here we present our local experience with PermacolTM mesh (Porcine Acellular Dermal Matrix - PADM; Covidien, Mansfield, MA) in four challenging cases and discuss the role this relatively new mesh may have for these and other applications.

Authors:

Bee Meng Lee, MD, MBBS, Medical Officer, Department of General Surgery, Patrick Moore, MD, MBBS, FRACS, Consultant Surgeon, Department of General Surgery, Peter Grossberg, MD, MBBS, FRACS, FACS, Consultant Surgeon, Head of Department of General Surgery, Anthony Clough, MD, MBBS, FRACS, GradCert (Health Stats), Consultant Surgeon, Department of General Surgery, Boxhill Hospital, Eastern Health, Melbourne, Victoria, Australia

PMID: 23686799

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Abstract:

This study was conducted to compare laparoscopic inguinal hernia repair with or without mesh fixation regarding recurrence rate and duration of operation time. A sample of 73 patients who underwent laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair from January 2002 to January 2010 were derived from the medical records of university hospitals including Ekbatan, Beasat, and Shaheed Beheshti, as well as private hospitals. MERSILENE™ Mesh (Johnson & Johnson Medical GmbH, Norderstedt, Germany) fixation was performed for 23 cases and polypropylene mesh without fixation for the rest. The recurrence rate was followed in both groups for two years. The patients ages were from 7 to 64 years, 70 patients (95%) were male. Operation time for mesh fixation and nonfixation was 68.09 and 21.10 minutes, respectively (P < 0.001). Two recurrences occurred in the mesh fixation group versus no recurrence in the nonfixation group (P = 0.096). The results of this study revealed that laparoscopic TAPP inguinal hernia repair without mesh fixation is safe and feasible with no increase in recurrence rate. In addition, it offers a significantly shorter operation time than TAPP mesh fixation. However, we need more evidence based on randomized clinical trials to compare the benefits and harm of the two methods.

Authors:

Mohammad Ali Amirzargar, MD, Associate Professor of Urology, Department of Urology, School of Public Medicine, Hamadan University of Medical Sciences, Hamadan, Iran, Maede Mohseni, MD, Resident of Urology, Department of Urology, School of Public Medicine, Hamadan University of Medical Sciences, Hamadan, Iran, Jalal Poorolajal, MD, PhD, Assistant Professor of Epidemiology, Research Center for Health Sciences and Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

PMID: 23975444

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