Ethicon

Ethicon

Novus Scientific

Abstract:

Although synthetic mesh has dramatically reduced recurrence in elective hernia repair, its use in contaminated surgical fields has been traditionally associated with complications such as wound sepsis, enterocutaneous fistulas, and chronic prosthetic infection. Biologic meshes emerged in the late 1990s with a rapid popularity fueled largely by the demand for an appropriate substitute in lieu of synthetic mesh in these complex cases; however, the high cost and rate of hernia recurrence have tempered the initial enthusiasm. Biosynthetic meshes were developed as a possible cost-effective alternative to both synthetic and tissue-derived products. Using biodegradable polymers instead of animal or cadaver tissue, they provide a temporary scaffold for deposition of proteins and cells necessary for tissue ingrowth, neovascularization, and host integration. Herein we review the current status of biosynthetic meshes for hernia repair.

Authors:

Mimi Kim, MD, FACS, Fellow, Minimally Invasive Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Bindhu Oommen, MD, MPH, Fellow, Minimally Invasive Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Samuel W. Ross, MD, MPH, Resident, General Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Amy E. Lincourt, PhD, MBA, Director of Research Division of Gastrointestinal and Minimally Invasive Surgery, Brent D. Matthews, MD, FACS, Professor of Surgery, Chairman, Department of Surgery, B. Todd Heniford, MD, FACS, Professor of Surgery, Chief, Division of Gastrointestinal and Minimally Invasive Surgery, Vedra A. Augenstein, MD, FACS, Clinical Assistant Professor of Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina

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Abstract:

Hernia repair remains one of the most common surgical procedures performed around the world. Over the past several decades, in response to various mesh-related complications and coinciding with the influx of laparoscopy into the field of general surgery, numerous advancements have been made in regards to the technology of mesh products being used in hernia repair today. Along these same lines, devices used for mesh fixation have evolved at a similar pace. The goal of this chapter is to review the various different materials and methods of mesh fixation being utilized in both ventral and inguinal hernia repair today.

Authors:

David Webb, M.D., Assistant Professor of Surgery, University of Tennessee Health Science Center, Memphis, TN, Nathaniel Stoikes, M.D., Assistant Professor of Surgery, University of Tennessee Health Science Center, Memphis, TN, Guy Voeller, M.D., Professor of Surgery, University of Tennessee Health Science Center, Memphis, TN

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Abstract:

The article reports the incidence of multiple inguinal protrusions in the same groin in a patient collect who underwent open hernia repair. Multiple ipsilateral inguinal hernias compose an almost neglected topic that, if not identified during hernia repair, could lead to unclear discomfort, pain, and reoperation. A collect of 100 consecutive open anterior inguinal hernia procedures was analyzed. The patients were divided into two subsets—A: patients with a single protrusion and B: patients with more than one protrusion simultaneously arising from the inguinal floor. The single hernias from cohort A and the multiple hernias from cohort B were further categorized using the Nyhus classification system. Eighty-eight single unilateral hernias were detected and 12 multiple inguinal hernias were ipsilaterally arising from the same groin. Nine percent of the multiple protrusions were double (three double indirect and six in combination direct + indirect). Three patients (3%) presented with triple protrusions; of those two individuals, one had a combination of double indirect, one had a direct hernia, and the third patient showed a tricomponent protrusion (hernia of the fossa supravescicalis + hernia of the fossa inguinalis media + indirect hernia). These numbers demonstrate that multiple ipsilateral inguinal hernias are more frequent than imagined. If undiscovered during a herniorrhaphy, the "forgotten" protrusion may generate unclear groin pain requiring reoperation. Consequently, is to envisage that many re-interventions will likely involve false "recurrences." Therefore, during hernia repair, more attention and adhesiolysis is essential during inspection of the inguinal floor. In fact, a careful exposure of the anatomical structures of the groin could be very advantageous in properly managing such conditions. This kind of surgical approach can help to prevent patient's discomfort and re-interventions.

Authors:

Amato Giuseppe, MD, Consultant Professor, Department of General Surgery and Emergency, Romano Giorgio, MD, Associate Professor, Department of General Surgery and Emergency, Agrusa Antonino, MD, Department of General Surgery, and Emergency, Di Buono Giuseppe, MD, Department of General Surgery and Emergency, Cocorullo Gianfranco, MD, Associate Professor, Department of General Surgery and Emergency, Gulotta Gaspare, MD, Professor - Head of Department, Department of General Surgery and Emergency, University of Palermo, Palermo, Italy

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Abstract:

Present available fixation devices in laparoscopic hernia repair include transfascial sutures, (permanent or absorbable) tacks, and fibrin or synthetic sealants, all of which have advantages and disadvantages. Tack fixation has been applied since the introduction of laparoscopic inguinal and ventral hernia repair during the end of the 1980s and the beginning of the 1990s, respectively. However, although this type of penetrating fixation offers a reliable method to keep the mesh in place, several negative aspects have been highlighted in recent years. Permanent metallic fixation devices such as helical titanium tacks (Protack™ ) provide greater fixation strength than absorbable fixation devices (AbsorbaTack™, Permasorb™, or SorbaFix™), but as the titanium tacks remain in the body permanently, they have been associated with serious adverse events. Dense adhesion formation and erosion of tacks in hollow viscera have been reported as well as the formation of so-called "tack hernias." However, the most clinically important negative aspect might be the increased acute and chronic postoperative pain. As pain and quality of life, rather than recurrence rate, gained the attention of clinicians, researchers, and patients, recent developments have been focusing on different types of absorbable materials. However, studies that investigated these issues comparing different tack materials for mesh fixation did not show any benefit from any type of fixation. Despite the postoperative short- and long-term sequellae, tack fixation is still the most widely applied technique for laparoscopic mesh fixation.

Authors:

Emmelie Reynvoet, MD, Surgical Resident, Department of General and Hepatobiliary Surgery, University Hospital, Ghent, Belgium, Frederik Berrevoet, MD, PhD, Consultant Surgeon, Department of General and Hepatobiliary Surgery, University Hospital, Ghent, Belgium

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