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Chan L, Moster MR, Bicket AK, Sheybani A, Sarkisian SR, Samuelson TW, Ahmed IIK, Miller-Ellis E, Smith OU, Cui QN. New Devices in Glaucoma. Ophthalmol Ther 2023; 12:2381-2395. [PMID: 37558818 PMCID: PMC10441989 DOI: 10.1007/s40123-023-00780-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/20/2023] [Indexed: 08/11/2023] Open
Abstract
Glaucoma remains a leading cause of blindness globally. Minimally invasive treatment techniques are rapidly expanding the availability of therapeutic options for glaucoma. These include devices aimed at enhancing outflow through the subconjunctival space, Schlemm's canal, and suprachoroidal space, sustained-release drug delivery devices, and extraocular devices aiming to reduce glaucomatous progression through other novel means. In this review, we provide an overview of several novel devices either newly available or in development for the medical and surgical management of glaucoma. Further studies are required to determine the long-term efficacy of these devices and how they will integrate into the current landscape of glaucoma management.
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Affiliation(s)
- Lilian Chan
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA
| | | | - Amanda K Bicket
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, 1000 Wall St, Ann Arbor, MI, 48105, USA
| | - Arsham Sheybani
- Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8096, St Louis, MO, 63110, USA
| | - Steven R Sarkisian
- Oklahoma Eye Surgeons, 5600 N Portland Ave, Oklahoma City, OK, 73112, USA
| | - Thomas W Samuelson
- Minnesota Eye Consultants, University of Minnesota, 909 Fulton St SE, Minneapolis, MN, 55455, USA
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Prism Eye Institute, Mississauga, Canada
- John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA
| | - Eydie Miller-Ellis
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA
| | - Oluwatosin U Smith
- Glaucoma Associates of Texas, 10740 N. Central Expy, Suite 300, Dallas, TX, 75231, USA
| | - Qi N Cui
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA.
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Rusli SM, Choo JM, Piozzi GN, Kim SH. Laparoscopic and robotic-assisted mesh pelvic closure for locally advanced and recurrent colorectal cancer. J Surg Case Rep 2021; 2021:rjab524. [PMID: 34858579 PMCID: PMC8634069 DOI: 10.1093/jscr/rjab524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022] Open
Abstract
Extensive resection that may be required in locally advanced and recurrent colorectal cancer result in formation of empty pelvic cavity that has the potential to cause small bowel descent into the pelvis. In patients with prior history of radiotherapy and multiple abdominal surgery, the risk of adhesion and subsequent small bowel obstruction can lead to increasing need for surgery and its resulting morbidity and mortality. We present five cases of locally advanced and recurrent colorectal cancer requiring laparoscopic and robotic-assisted pelvic closure with Gore-Tex Dual Mesh as prevention of small bowel descent into the pelvis. One out of the five cases had a history of small bowel obstruction after the surgery and wound-related infection occurred in one patient. There was no mesh-related complication or mortality. Pelvic closure using Gore-Tex Dual Mesh is feasible to prevent small bowel descent after surgery for locally advanced and recurrent colorectal cancer.
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Affiliation(s)
- Siti Mayuha Rusli
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jeong Min Choo
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Guglielmo Niccolò Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seon Hahn Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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Filipović-Čugura J, Misir Z, Hrabač P, Orešić T, Vidović D, Misir B, Filipović N, Kirac I, Mijić A. Comparison of Surgisis, Vypro II and TiMesh in contaminated and clean field. Hernia 2019; 24:551-558. [PMID: 30976937 DOI: 10.1007/s10029-019-01949-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 04/01/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The study aimed to evaluate the histologic properties and infection resistance of three different mesh materials in a rat model. METHODS Each mesh, in both infectious (n = 96) and non-infectious groups (n = 270), was positioned both in sublay (preperitoneally) and onlay (subcutaneously) locations. Properties of the biological (Surgisis; Cook Surgical), composite, partially resorbing (Vypro II mesh; Ethicon) and non-resorbing (TiMesh; GFE Medizintechnik GmbH) mesh were evaluated and compared. Animals were killed at 7, 21 and 90 days after implantation. The following parameters were evaluated to assess the host response to the mesh material: inflammation, vascularization, fibrosis, collagen formation, Ki67, and a foreign body reaction by granuloma formation (FBG). RESULTS Surgisis mesh produced more pronounced inflammation and cell proliferation, and less intense granuloma formation, as well as fibrosis, compared to the other two groups. When the infected materials were examined, we found signs of local infection to be more often present in Surgisis group of animals. CONCLUSIONS In the presence of bacterial contamination, no benefits were observed in the use of the Surgisis prosthesis over the use of TiMesh and Vypro II.
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Affiliation(s)
- J Filipović-Čugura
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Z Misir
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - P Hrabač
- Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Šalata 3, 10000, Zagreb, Croatia
| | - T Orešić
- University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Ilica 197, 10000, Zagreb, Croatia
| | - D Vidović
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - B Misir
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - N Filipović
- University of Zagreb, School of Medicine, Šalata 3, 10000, Zagreb, Croatia
| | - I Kirac
- University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Ilica 197, 10000, Zagreb, Croatia.
| | - A Mijić
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
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Earle D, Roth JS, Saber A, Haggerty S, Bradley JF, Fanelli R, Price R, Richardson WS, Stefanidis D. SAGES guidelines for laparoscopic ventral hernia repair. Surg Endosc 2016; 30:3163-83. [PMID: 27405477 DOI: 10.1007/s00464-016-5072-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/21/2016] [Indexed: 01/21/2023]
Affiliation(s)
- David Earle
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - J Scott Roth
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Alan Saber
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Steve Haggerty
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Joel F Bradley
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Robert Fanelli
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Raymond Price
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
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Bueno-Lledó J, Torregrosa-Gallud A, Sala-Hernandez A, Carbonell-Tatay F, Pastor PG, Diana SB, Hernández JI. Predictors of mesh infection and explantation after abdominal wall hernia repair. Am J Surg 2016; 213:50-57. [PMID: 27421189 DOI: 10.1016/j.amjsurg.2016.03.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/16/2016] [Accepted: 03/29/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The main objective was to identify predictive factors associated with prosthesis infection and mesh explantation after abdominal wall hernia repair (AWHR). METHODS This is a retrospective review of all patients who underwent AWHR from January 2004 to May 2014 at a tertiary center. Multivariate analysis identified predictors of mesh infection and explantation after AWHR. RESULTS From 3,470 cases of AWHR, we reported 66 cases (1.9%) of mesh infection, and 48 repairs (72.7%) required mesh explantation. Steroid or immunosuppressive drugs use (odds ratio [OR] 2.22; confidence interval [CI] 1.16 to 3.95), urgent repair (OR 5.06; CI 2.21 to 8.60), and postoperative surgical site infection (OR 2.9; CI 1.55 to 4.10) were predictive of mesh infection. Predictors of mesh explantation were type of mesh (OR 3.13; CI 1.71 to 5.21), onlay position (OR 3.51; CI 1.23 to 6.12), and associated enterotomy in the same procedure (OR 5.17; CI 2.05 to 7.12). CONCLUSIONS Immunosuppressive drugs use, urgent repair, and postoperative surgical site infection are predictive of mesh infection. Risk factors of prosthesis explantation are polytetrafluoroethylene mesh, onlay mesh position, and associated enterotomy in the same procedure.
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Affiliation(s)
- José Bueno-Lledó
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, Politecnic "La Fe" Hospital, University of Valencia, Valencia, 46008, Spain.
| | - Antonio Torregrosa-Gallud
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, Politecnic "La Fe" Hospital, University of Valencia, Valencia, 46008, Spain
| | - Angela Sala-Hernandez
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, Politecnic "La Fe" Hospital, University of Valencia, Valencia, 46008, Spain
| | - Fernando Carbonell-Tatay
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, Politecnic "La Fe" Hospital, University of Valencia, Valencia, 46008, Spain
| | - Providencia G Pastor
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, Politecnic "La Fe" Hospital, University of Valencia, Valencia, 46008, Spain
| | - Santiago B Diana
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, Politecnic "La Fe" Hospital, University of Valencia, Valencia, 46008, Spain
| | - José I Hernández
- Surgical Unit of Abdominal Wall, Department of Digestive Surgery, Politecnic "La Fe" Hospital, University of Valencia, Valencia, 46008, Spain
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LeBlanc K. Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair. Hernia 2015; 20:85-99. [DOI: 10.1007/s10029-015-1399-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 06/12/2015] [Indexed: 02/03/2023]
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Laparoscopic hernia complexity predicts operative time and length of stay. Hernia 2014; 18:791-6. [DOI: 10.1007/s10029-014-1250-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 04/06/2014] [Indexed: 11/26/2022]
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Meintjes J, Yan S, Zhou L, Zheng S, Zheng M. Synthetic, biological and composite scaffolds for abdominal wall reconstruction. Expert Rev Med Devices 2014; 8:275-88. [DOI: 10.1586/erd.10.64] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brown RH, Subramanian A, Hwang CS, Chang S, Awad SS. Comparison of infectious complications with synthetic mesh in ventral hernia repair. Am J Surg 2013; 205:182-7. [PMID: 23331984 DOI: 10.1016/j.amjsurg.2012.02.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/26/2012] [Accepted: 02/26/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Infection can be a devastating complication associated with prosthetic incisional hernia repair. It is unclear whether the type of mesh used affects the risk of infection. METHODS A retrospective review was performed of all patients who underwent elective incisional hernia repair with permanent prosthetic mesh between January 1, 2000, and August 1, 2007. RESULTS A total of 176 patients underwent elective incisional hernia repair with mesh. The overall infection rate with the use of goretex (Flagstaff, AZ, USA) was 12 of 86 (14%) and 2 of 90 (2.2%) in cases in which nongoretex material was used (P = .016). In the goretex group, infection rates were significantly higher in open versus laparoscopic cases (26.5% vs 5.8%, P = .030). Methicillin-resistant Staphylococcus aureus was the most common organism recovered. CONCLUSIONS The risk of mesh infection with the use of goretex was found to be higher than with the use of nongoretex mesh. Laparoscopic placement of goretex reduces this risk of infection. No significant differences in recurrence rates were found.
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Affiliation(s)
- Rodger H Brown
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
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Abstract
OBJECTIVE The objective of this review is to evaluate the results of laparoscopic treatment of ventral hernias using intra-peritoneal prosthetic mesh through a review of published surgical series. METHODS All large series of patients treated for an incisional hernia by laparoscopy and published between 2002 and 2011 were identified. The results of controlled randomized series comparing this technique with open surgical repair were analyzed. RESULTS Twenty-two series with a total of 7057 patients were analyzed (range 51-1242); the mean Body Mass Index (BMI) was 32 (range: 28.5-46), and the mean size of the hernia defect was 10.6 cm (range: 6-14.9 cm). The mean rate of conversion to open surgical repair was 2.7%. Mean operative duration was 90 ± 33 minutes. Mortality was 0.8%, usually due to an unrecognized intestinal injury (1.6%), which occurred more frequently with second or iterative hernia repairs. Hospital stay averaged 2.5 days. The infection rate was 0.3% and the rate of hernia recurrence was 4.6% (with a mean follow-up of 36 months). No statistically significant differences were found in terms of post-operative complications or hernia recurrence in the randomized studies comparing laparoscopic to open anterior abdominal surgical repair. However, duration of hospital stay was shorter after laparoscopy in some studies. CONCLUSION Laparoscopic repair of ventral incisional hernia is technically feasible and reliable for large hernia defects, even in obese patients. This approach should be reserved for patients with no history of previous hernia repair in order to avoid the risk of intestinal injury. It appears to allow for a shortened duration of hospitalization.
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Concomitant laparoscopic ventral hernia mesh repair and bariatric surgery: a retrospective study from a tertiary care center. Obes Surg 2012; 22:685-9. [PMID: 22328097 DOI: 10.1007/s11695-012-0614-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To analyze the safety in combing laparoscopic ventral hernia repair with a mesh and bariatric surgery. BACKGROUND Obesity is one of the important precipitating factors for primary and recurrent ventral hernias (incisional and umbilical) and it is not uncommon to find these hernias in patients opting for obesity surgery. But, with no consensus or recommendation and concern of mesh infection, surgeons fear in combining these procedures, especially Roux en Y gastric bypass and sleeve gastrectomy. METHODS In this study, we have retrospectively analyzed all patients who underwent concomitant bariatric procedure and mesh repair for ventral hernia at our institute. RESULTS A total of 36 out of 765 patients operated at our institute between 2003 and 2011 had concomitant procedures. Eleven patients had Roux en Y gastric bypass (group I) and remaining 25 had sleeve gastrectomy (group II) performed on them. The operating times were 149 min(120-210 min) in group I and 122 min (90-220min) in group II. No immediate complications or any incidence of mesh infection or recurrence in either of the groups. CONCLUSION Concomitant mesh repair for ventral hernias can be safely combined with bariatric procedures like Roux en Y gastric bypass and sleeve gastrectomy. But, for beginners, these should be done only in selected cases after fully informed consent from the patients.
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Lo Monte AI, Damiano G, Palumbo VD, Zumbino C, Spinelli G, Sammartano A, Bellavia M, Buscemi G. Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia. INT J GERONTOL 2011. [DOI: 10.1016/j.ijge.2011.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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SILS Incisional Hernia Repair: Is It Feasible in Giant Hernias? A Report of Three Cases. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2011; 2011:387040. [PMID: 21845023 PMCID: PMC3154386 DOI: 10.1155/2011/387040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 05/01/2011] [Accepted: 06/20/2011] [Indexed: 12/02/2022]
Abstract
Aim. Three incisional ventral abdominal wall hernias were repaired by placing a 20 × 30 cm composite mesh via single incision of 2 cm.
Methods. All three cases had previous operations and presented with giant incisional defects clinically. The defects were repaired laparoscopically via single incision with the placement of a composite mesh of 20 × 30 cm. Nonabsorbable sutures were needed to hang and fix the mesh only in the first case. Double-crown technique was used in all of the cases to secure the mesh to the anterior abdominal wall.
Results. The mean operation time was 120 minutes. The patients were mobilized and led for oral intake at the first postoperative day. No morbidity occurred.
Conclusion. Abdominal incisional hernias can be repaired via single incision with a mesh application in experienced centers.
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Brill JB, Turner PL. Long-Term Outcomes with Transfascial Sutures versus Tacks in Laparoscopic Ventral Hernia Repair: A Review. Am Surg 2011. [DOI: 10.1177/000313481107700423] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although most surgeons report using both transfascial sutures and laparoscopically placed tacks to secure prostheses in laparoscopic ventral hernia repair, a significant minority have reported large series in which sutures were omitted. A systematic review of the available literature was conducted for large case series and controlled trials documenting long-term follow-up. Forty-three articles were identified, including 6015 patients whose prostheses were secured with transfascial sutures (with or without tacks), and 2450 patients receiving tacks or staples alone. The mean follow-up time reported was 30.1 months. No significant difference was found in rates of hernia recurrence, mesh removal, prolonged postoperative pain, patient body mass index, or hernia defect size between the two groups. The suture group did experience a significantly higher rate of surgical site infection. Although suture tensile strength is greater than that of tacks, and despite numerous anecdotal reports of hernia recurrence secondary to suture failure or omission, the existing literature does not show superiority of one mesh fixation technique over the other for recurrence, whereas infection rates increase when transfascial suture is used.
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Affiliation(s)
- Jason B. Brill
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Patricia L. Turner
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Fortelny RH, Petter-Puchner AH, Glaser KS, Offner F, Benesch T, Rohr M. Adverse effects of polyvinylidene fluoride-coated polypropylene mesh used for laparoscopic intraperitoneal onlay repair of incisional hernia. Br J Surg 2010; 97:1140-5. [PMID: 20632284 DOI: 10.1002/bjs.7082] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Polyvinylidene fluoride-coated polypropylene meshes have been developed specifically for intraperitoneal onlay mesh repair. They combine a macroporous design with biomechanical characteristics compatible with the abdominal wall and are reported to have favourable antiadhesive properties. This retrospective study reports complications related to one of these materials, DynaMesh. METHODS Twenty-nine patients underwent intraperitoneal onlay mesh repair with DynaMesh at one of two hospitals. Patients characteristics, surgical procedures and postoperative analgesia were comparable at both sites. RESULTS Six patients developed DynaMesh-related complications that required surgical reintervention by laparotomy within 1 year of operation. Surgical reintervention was for adhesions in five patients and the mesh had to be explanted in three. One mesh was explanted because of early infection. Adhesions to DynaMesh were found in two patients who had surgery for unrelated reasons. CONCLUSION Laparoscopic intraperitoneal onlay DynaMesh repair was associated with a high rate of complications.
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Affiliation(s)
- R H Fortelny
- Second Department of Surgery, Wilhelminenspital, Vienna, Austria
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El laberinto de las prótesis composite en las eventraciones. Cir Esp 2009; 86:139-46. [DOI: 10.1016/j.ciresp.2009.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 01/09/2009] [Indexed: 11/21/2022]
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Stokes JB, Friel CM. Laparoscopic Ventral Hernia Repair: Mesh Options and Outcomes. SEMINARS IN COLON AND RECTAL SURGERY 2009. [DOI: 10.1053/j.scrs.2009.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gananadha S, Samra JS, Smith GS, Smith RC, Leibman S, Hugh TJ. Laparoscopic ePTFE mesh repair of incisional and ventral hernias. ANZ J Surg 2008; 78:907-13. [PMID: 18959647 DOI: 10.1111/j.1445-2197.2008.04690.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Incisional hernia is a relatively frequent complication of abdominal surgery. The use of mesh to repair incisional and ventral hernias results in lower recurrence rates compared with primary suture techniques. The laparoscopic approach may be associated with lower postoperative morbidity compared with open procedures. Long-term recurrence rates after laparoscopic ventral and incisional hernias are not well defined. A prospective study of the initial experience of a standardized technique of laparoscopic incisional and ventral hernia repair carried out in a tertiary referral hospital was undertaken between January 2003 and February 2007. Laparoscopic hernia repair was attempted in 71 patients and was successful in 68 (conversion rate 4%). The mean age of the patients identified was 63.1 years (39 men and 31 women). Multiple hernial defects were identified in 38 patients (56%), and the mean overall size of the fascial defects was 166 cm(2). The mean mesh size used was 403 cm(2). The mean operative time was 121 minutes. There were six (9%) major complications in this series, but there were no deaths. Hernia recurrence was noted in four patients (6%) at a mean follow up of 20 months. Our preliminary experience indicates that laparoscopic incisional and ventral hernia repair is technically feasible and has acceptable postoperative morbidity and low early recurrence rates.
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Affiliation(s)
- Sivakumar Gananadha
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, Sydney, New South Wales, Australia
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Pierce RA, Perrone JM, Nimeri A, Sexton JA, Walcutt J, Frisella MM, Matthews BD. 120-Day Comparative Analysis of Adhesion Grade and Quantity, Mesh Contraction, and Tissue Response to a Novel Omega-3 Fatty Acid Bioabsorbable Barrier Macroporous Mesh After Intraperitoneal Placement. Surg Innov 2008; 16:46-54. [DOI: 10.1177/1553350608330479] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. This study aimed to evaluate adhesion formation, mesh contraction, and tissue response to an omega-3 fatty acid barrier—coated lightweight polypropylene mesh (C-Qur) after intra-abdominal placement, and compare these properties to those of other commercially available meshes. Materials and methods. After randomization, 3 × 3 cm pieces of Atrium C-Qur, Mesh ProLite Ultra, Composix, Parietex, Proceed, Sepramesh, and DualMesh were sewn to the intact peritoneum on either side of a midline incision in 41 New Zealand white rabbits. Necropsy was performed at 120 days, and explants were evaluated for adhesion grade, adhesion amount, and mesh contraction. Histologic evaluation included extent of capsule formation, abdominal wall tissue ingrowth, degrees of inflammation and vascularization of the surrounding tissue, and the presence of mesothelialization. Results. There were no significant differences between the C-Qur mesh and the commercially available meshes tested with regard to adhesion grade or amount, although percentage adhesion coverage for the C-Qur mesh was much less than for Composix and Proceed. The C-Qur mesh contracted less than all meshes, significantly less ( P < .05) than DualMesh or Proceed. DualMesh exhibited the greatest amount of capsule formation and inflammation on its parietal side as compared with the other meshes. Conclusions. Placing lightweight polypropylene mesh with an omega-3 fatty acid barrier coating intraperitoneally results in more favorable adhesion characteristics compared with Composix and Proceed meshes at 120-day explantation after intraperitoneal placement. The minimal amount of contraction and favorable tissue response in comparison to other commercially available meshes makes C-Qur mesh a practical alternative for laparoscopic and open ventral hernia repair.
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Affiliation(s)
- Richard A. Pierce
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Juan M. Perrone
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Abdelrahman Nimeri
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Jennifer A. Sexton
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Julie Walcutt
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Margaret M. Frisella
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Brent D. Matthews
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, Missouri,
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Wassenaar EB, Schoenmaeckers EJP, Raymakers JTFJ, Rakic S. Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs. Surg Endosc 2008; 23:825-32. [PMID: 18813986 DOI: 10.1007/s00464-008-0146-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 07/13/2008] [Accepted: 07/31/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND All hernia recurrences in a series of 505 patients who underwent laparoscopic repair of a ventral hernia (n=291) or incisional hernia (n=214) were analyzed to identify factors responsible for the recurrence. METHODS In all laparoscopic repairs, an expanded polytetrafluoroethylene prosthesis overlapping the hernia margins by >or=3 cm was fixed with a double ring of tacks alone (n=206) or with tacks as well as sutures (n=299). During the mean follow-up time of 31.3 +/- 18.4 months, nine patients (1.8%) had a recurrence, eight of which were repaired laparoscopically. Operative reports and videotapes of all initial repairs and repairs of recurrences were analyzed. RESULTS All recurrences followed an incisional hernia repair (p<0.001). Five recurrences developed after mesh fixation with both tacks and sutures and four after mesh fixation with tacks alone (p=1.0). All recurrences were at the site of the apparently sufficient original incision scar: in eight patients, the recurrent hernia was attached to the mesh; in one, it developed in another part of the scar. All initial repairs had been performed without technical errors. Upon repair of the recurrences, a new, larger mesh was placed over the entire incision, not just the hernia. There were no re-recurrences during follow-up (mean 19.8+/-10.3 months). CONCLUSIONS Recurrence after incisional hernia repair appears to be due primarily to disregard for the principle that the whole incision--not just the hernia--must be repaired. Our experience supports the idea that the entire incision has a potential for hernia development. Insufficient coverage of the incision scar is a risk factor for recurrence after laparoscopic repair of ventral and incisional hernia.
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Affiliation(s)
- Eelco B Wassenaar
- Department of Surgery, Twenteborg Hospital, Postbox 7600, 7600 SZ Almelo, The Netherlands.
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22
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Ferrari GC, Miranda A, Sansonna F, Magistro C, Di Lernia S, Maggioni D, Franzetti M, Pugliese R. Laparoscopic management of incisional hernias > or = 15 cm in diameter. Hernia 2008; 12:571-6. [PMID: 18688567 DOI: 10.1007/s10029-008-0410-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 06/19/2008] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite good results in terms of safety and minimal recurrence ensured by laparoscopy in the management of incisional hernias, the use of minimally invasive techniques for large incisional wall defects is still controversial. METHODS Between 2002 and 2008 as many as 36 patients with abdominal wall defects > or = 15 cm were managed laparoscopically in our institution. The wall defects were > or = 20 cm in eight cases. The diameter of parietal defects was measured from within the peritoneal cavity. None had loss of domain. Body mass index (BMI) for 18 patients was > or = 30 kg/m(2). RESULTS The mean duration of operations was 195 +/- 28 min (range 75-540). One patient needed conversion for ileal injury and massive adhesions. Post-operative complications occurred in nine patients; there were six surgical complications. Morbidity in obese and non-obese patients was not statistically different (p > 0.05). There was no postoperative death. Mean hospital stay was 4.97 +/- 3.4 days (range 2-18). Mean follow up was 28 months (range 2-68) and only one hernia recurrence was observed. CONCLUSIONS Minimum-access procedures can provide good results in the repair of giant incisional hernia. Obesity is not a contraindication to laparoscopic repair. Further studies are expected to confirm our promising results.
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Affiliation(s)
- G C Ferrari
- Surgery and Videolaparoscopy Department, Niguarda Hospital, Milan, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
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23
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Berrevoet F, Fierens K, De Gols J, Navez B, Van Bastelaere W, Meir E, Ceulemans R. Multicentric observational cohort study evaluating a composite mesh with incorporated oxidized regenerated cellulose in laparoscopic ventral hernia repair. Hernia 2008; 13:23-7. [PMID: 18682886 DOI: 10.1007/s10029-008-0418-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 07/15/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND A variety of newly developed mesh products have recently become available to use inside the peritoneal cavity. This analysis reports the first clinical data evaluating the experience with the use of Proceed mesh in laparoscopic ventral hernia repair. PATIENTS AND METHODS During a 6-month period, 114 adult patients underwent a laparoscopic ventral hernia repair using an intra-abdominal placement of a Proceed mesh. The operative procedure was stratified for all centers. Perioperatively, different parameters were evaluated considering the conversion rate to open procedure, complications such as seroma and hematoma, bowel lesions, urinary retention, acute, and chronic pain, mesh infection, and recurrences. RESULTS The mean age of the patients was 45 years (range 19-84 years). There were no conversions to open repair and no mortality. Complications included 12 seromas/hematomas (four aspirated), chronic discomfort in two patients, and urinary retention in one patient. There have been four recurrences (3.5%), occurring 3, 4, 4, and 15 months after surgery, respectively. The mean follow-up period was 27 months (range 12-38 months). There have been no documented infections of the mesh. CONCLUSIONS This multicentric study documents a favorable experience using large-pore mesh in laparoscopic ventral hernia repair. There were no major complications related to the mesh. Technical advantages considering mesh handling and long-term advantages considering chronic pain might be of interest with the use of this lightweight mesh for minimally invasive ventral hernia repair.
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Affiliation(s)
- F Berrevoet
- Division of General and Hepatobiliary Surgery, Department of Surgery, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium.
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Ferrari GC, Miranda A, Di Lernia S, Sansonna F, Magistro C, Maggioni D, Scandroglio I, Costanzi A, Franzetti M, Pugliese R. Laparoscopic repair of incisional hernia: Outcomes of 100 consecutive cases comprising 25 wall defects larger than 15 cm. Surg Endosc 2007; 22:1173-9. [PMID: 18157568 DOI: 10.1007/s00464-007-9707-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 08/30/2007] [Accepted: 10/03/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Minimal access surgery for incisional hernia repair is still debated, especially for large and giant wall defects. This study was undertaken to analyze the results of the use of the laparoscopic technique in incisional hernias smaller and larger than 15 cm of diameter. METHOD From 2002 to 2007 a total of 100 patients with incisional hernia were operated on by laparoscopy and were included in this study. As much as 38 patients were obese, with a body mass index (BMI) > 30 kg/m(2). The mean follow-up span was 24 months (range = 2-58). The fascial defect was recurrent in 19 patients, in 13 after previous repair with mesh and in 6 after repair without mesh. The wall defect was larger than 15 cm in 25 patients and in 6 of them it was 20 cm or larger as measured from within the peritoneal cavity. RESULTS The mean operating time was 152 +/- 25 min (range = 45-275), and for defects larger than 15 cm it was 205 +/- 101 min (range = 85-540). Two patients with massive adhesions needed conversion to open surgery, one after an intraoperative injury of an intestinal loop. Postoperative complications occurred in 23 patients; local complications were 10. Pulmonary embolism caused death in one obese patient. Morbidity and hospital stay were similar in obese and nonobese patients and the differences were not statistically relevant (p > 0.05). The outcomes in patients with wall defects larger than 15 cm showed no significant difference with outcomes of the remaining patients with smaller defects (p > 0.05). Recurrence occurred in three cases, and in one case local infection led to removal of the mesh. CONCLUSIONS Minimal access procedures can provide good results in the repair of incisional hernia, even when the diameter is larger than 15 cm. Obesity is not a contraindication to laparoscopic repair. Further studies are expected to confirm these promising results.
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Affiliation(s)
- Giovanni Carlo Ferrari
- Surgery and Videolaparoscopy Department, Niguarda Hospital, Milan, Piazza Ospedale Maggiore 3, 20162, Milano, Italy
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25
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Eriksen JR, Gögenur I, Rosenberg J. Choice of mesh for laparoscopic ventral hernia repair. Hernia 2007; 11:481-92. [PMID: 17846703 DOI: 10.1007/s10029-007-0282-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 08/17/2007] [Indexed: 01/25/2023]
Abstract
BACKGROUND Surgical treatment of ventral hernias has changed dramatically over the past decades by the introduction of laparoscopy and prosthetic biomaterials for reinforcement of the abdominal wall. There are many meshes available on the market for laparoscopic ventral hernia repair (LVHR), and new meshes are introduced regularly. Experimental and clinical documentation for safety and efficacy are, however, often not available for the clinician. The choice of mesh may therefore be difficult in clinical practice. We present a review of the current literature regarding safety measures such as adhesions, fistulas, and infections as well as the available data on pain, recurrence, mesh shrinkage, and seroma formation after LVHR. METHODS The literature was searched systematically using PubMed/MEDLINE and EMBASE for controlled studies, prospective descriptive series and retrospective case series. RESULTS The literature clearly points in the direction of very few mesh-related complications after LVHR. Experimental studies and theoretical considerations may argue for using a covered mesh, i.e., a composite mesh, or ePTFE for LVHR in humans, although it is important to stress that there are no human data at the moment to support this. Concerns about using pure polypropylene mesh in the intraperitoneal position may be re-evaluated with the experience of lightweight macropore meshes from open surgery in mind. There is a tendency towards greater shrinkage in ePTFE-based meshes but no differences seems to exist between different mesh materials in other relevant outcome parameters from clinical series. CONCLUSIONS The literature cannot give general recommendations for choice of mesh based on randomized controlled trials. The final choice of mesh for LVHR will therefore typically be based on surgeons' preference and cost while we await further data from randomized controlled clinical trials.
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Affiliation(s)
- J R Eriksen
- Department of Surgical Gastroenterology D, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
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Fei L, Saviano C, Moccia F, del Genio G, Trapani V, Nunziale A, Lombardi G, Cecchi M. ePTFE soft tissue patch reconstruction of hemidiaphragmatic agenesis with late clinical presentation. Hernia 2007; 12:103-6. [PMID: 17598070 DOI: 10.1007/s10029-007-0254-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 05/25/2007] [Indexed: 10/23/2022]
Abstract
In this paper we describe a case of a 71-year-old man affected by left hemidiaphragm agenesis who presented an extensive enterothorax after an asymptomatic history for many years. The patient had late development of severe constipation and occasional episodes of bowel obstruction and vomiting. The surgical correction of this congenital anomaly consisted of restoring the continuity of the diaphragmatic barrier with a 2-mm-thick expanded polytetrafluoroethylene soft tissue patch(Gore-Tex) after the herniated viscera have been replaced into the abdominal cavity. At 26 months' follow-up no recurrence has been observed. We would suggest that this is the first known elderly patient surgically treated and the eighth case reported in the literature. The use of a single-layer ePTFE mesh allows a good anatomical and functional repair. An overview of the literature is also reported.
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Affiliation(s)
- L Fei
- Unit of General and Gastrointestinal Surgery, F. Magrassi-A. Lanzara Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, School of Medicine, Naples, Italy.
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27
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Barbaros U, Asoglu O, Seven R, Erbil Y, Dinccag A, Deveci U, Ozarmagan S, Mercan S. The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 2006; 11:51-6. [PMID: 17131072 DOI: 10.1007/s10029-006-0160-9] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 10/05/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND The laparoscopic approach has emerged in the search for a surgical technique to decrease the morbidity associated with conventional repair of ventral hernias. In this study we aimed to compare the results of our open and laparoscopic ventral hernia repairs prospectively. METHODS Between January 2001 and October 2005, a total of 46 patients diagnosed with ventral hernias (primary and incisional) who were admitted to our surgical unit and accepted to be included in this study group were examined. All patients were divided into laparoscopic repair (n = 23) and open repair (n = 23) subgroups in a randomized fashion. The patients' demographic characteristics, operation times, body mass indices, sizes of fascial defects, hernia locations, durations of hospital stay, presence and degrees of postoperative pain, and postoperative minor and major complications were analysed and compared. All the data were expressed as means +/- SDs. Chi-square and Wilcoxon tests were used for statistical analysis, and P < 0.05 was accepted as a significant statistical value (SPSS 11.0 for Windows). RESULTS The demographic characteristics of both groups were similar. Women predominated, especially in the laparoscopy group (P < 0.05). The comparison of the results revealed that the major advantage of laparoscopy was the shortened postoperative hospital stay and the reduced incidence of mesh infection (P < 0.05, P < 0.05). On the other hand, operation time was significantly longer in the laparoscopy group (P < 0.05). The major complications encountered in the laparoscopy group were ileus and a missed enterotomy. The most frequent minor complication was seroma, which was significantly more frequent in the laparoscopy group (P < 0.05). Postoperative pain assessment revealed similar results in both groups (P > 0.05). CONCLUSIONS The laparoscopic approach appears to be as effective as open repairs in the treatment of ventral hernias. Advanced surgical skill, laparoscopic experience and high technology are mandatory factors for successful ventral hernia repair.
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Affiliation(s)
- U Barbaros
- Department of General Surgery, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey.
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Champault G, Descottes B, Dulucq JL, Fabre JM, Fourtanier G, Gayet B, Johanet H, Samama G. [Laparoscopic surgery. The recommendations of specialty societies in 2006 (SFCL-SFCE)]. ACTA ACUST UNITED AC 2006; 143:160-4. [PMID: 16888601 DOI: 10.1016/s0021-7697(06)73644-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- G Champault
- Société Française de Chirurgie Laparoscopique (SFCL), Service de Chirurgie Digestive, CHU Jean Verdier, Bondy.
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29
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Hadi HIA, Maw A, Sarmah S, Kumar P. Intraperitoneal tension-free repair of small midline ventral abdominal wall hernias with a Ventralex hernia patch: initial experience in 51 patients. Hernia 2006; 10:409-13. [PMID: 16932846 DOI: 10.1007/s10029-006-0127-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 07/26/2006] [Indexed: 10/24/2022]
Abstract
Midline ventral hernias are common. Tension-free mesh repair of ventral hernias is becoming popular due to the high recurrence rate with conventional techniques. We have used an open intraperitoneal technique using the Bard Ventralex hernia patch in midline ventral hernias (<or=3 cm). Fifty-one patients were treated (34 males and 17 females) with a mean age of 52.4 years (range 18-82). Forty-three patients were day cases. Operative times, analgesic use, overnight hospital stay and postoperative complications were recorded prospectively. The mean operative time was 30 min (range 10-68). Thirty-six patients required mild/moderate postoperative analgesia. Two patients had minor wound infections and one had seroma. There was one recurrence. Our early experience suggests that Ventralex hernia patch repair of small midline ventral hernias can be performed as a day case with minimal postoperative complications.
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Affiliation(s)
- H I A Hadi
- Department of General Surgery, Glan Clwyd Hospital, Denbighshire, Rhyl, LL18 5UJ, UK
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30
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Champault G, Descottes B, Dulucq JL, Fabre JM, Fourtanier G, Gayet B, Johanet H, Samama G. [Laparoscopie surgery: guidelines of specialized societies in 2006, SFCL-SFCE]. ANNALES DE CHIRURGIE 2006; 131:415-20. [PMID: 16762309 DOI: 10.1016/j.anchir.2006.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- G Champault
- Service de Chirurgie Digestive, CHU Jean-Verdier, avenue du-14-juillet, 93140 Bondy, France.
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Fourtanier G, Muscari F, Duffas JP, Suc B. [Laparocopic repair of incisional hernias: a gold standard?]. ACTA ACUST UNITED AC 2006; 131:233-5. [PMID: 16580623 DOI: 10.1016/j.anchir.2006.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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