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Laycock J, Troller R, Hussain H, Hall NR, Joshi HM. A keyhole approach gives a sound repair for ileal conduit parastomal hernia. Hernia 2022; 26:647-651. [PMID: 35147828 DOI: 10.1007/s10029-021-02550-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report and evaluate a laparoscopic surgical technique for the treatment of parastomal hernia (PSH) after ileal conduit urinary diversion aiming to minimize PSH recurrence and perioperative complications. METHODS We retrospectively evaluated all patients who underwent a PSH (after ileal conduit urinary diversion) repair at Addenbrookes Hospital, Cambridge. As a surgical approach, a laparoscopic repair with mesh was utilized in all cases. Subsequently, we performed a voluntary follow-up of the patients to evaluate long-term recurrence and complication rates. In addition, we conducted a reassessment of the cross-sectional imaging available. RESULTS Between November 2008 and December 2019, 27 patients underwent hernia repair due to a clinically significant hernia. Out of those patients, one suffered from a post-operative wound infection. In total 23 patients participated in the follow-up with a median follow-up period of 91 months. Follow-up examination revealed two cases of recurrent PSH (8.7% of patients followed up), four patients suffered from minor complications (14.8%). CONCLUSION Repair of PSH associated with ileal conduit is particularly scarce. Our surgical approach presents the only laparoscopic case series of an effective method for treating a PSH from an ileal conduit with a low complication and recurrence rate.
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Affiliation(s)
- J Laycock
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - R Troller
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - H Hussain
- University of Cambridge Medical School, Cambridge, UK
| | - N R Hall
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - H M Joshi
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Gulmez M, Aktekin A, Aker F, Sanko V, Sezer S. Evaluation of In Vivo Adhesion Properties of New Generation Polyglactin, Oxidized Regenerated Cellulose and Chitosan-Based Meshes for Hernia Surgery. Cureus 2021; 13:e18755. [PMID: 34796054 PMCID: PMC8589341 DOI: 10.7759/cureus.18755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Composite meshes coated with anti-adhesive barriers have been developed by taking advantage of the robustness of polypropylene meshes for use in hernia repair. We aimed to evaluate the effects of composite meshes containing polyglactin, polycaprolactone, oxidized regenerated cellulose and chitosan on the adhesion formation. Methods Forty-two Sprague Dawley male rats were divided into six groups of seven rats according to the content of the meshes used. A defect was created on the right abdominal wall of the rats and an oval composite mesh of 2 cm in diameter was placed over the defect and fixed. The rats were sacrificed under anesthesia on the 7th postoperative day. Macroscopic and histopathological examination was performed and the incorporation of the mesh with the abdominal wall and the presence of intraabdominal adhesions were evaluated. Results When the macroscopic findings of the rats were evaluated, there was a statistically significant difference between the rat groups in terms of the distribution of peritoneal adhesion scores (p<0.05). There was no statistically significant difference between the rat groups in terms of the distribution of inflammation, fibrosis and macrophage levels (p>0.05). Conclusion It was evaluated that the development of intraabdominal adhesion and the strength of adhesion decreased when biocompatible adhesion barriers with anti-adhesive properties such as oxidized regenerated cellulose and chitosan were used in the structure of composite meshes used in hernia repair. Hemostatic and antibacterial properties of these substances are promising to create the ideal mesh.
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Affiliation(s)
- Mehmet Gulmez
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University Atakent Hospital, Istanbul, TUR
| | - Ali Aktekin
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Fugen Aker
- Department of Pathology, University of Health Sciences, Hamidiye Faculty of Medicine, Haydarpaşa Numune Health Application and Research Center, Istanbul, TUR
| | - Vildan Sanko
- Department of Chemistry, Gebze Technical University, Kocaeli, TUR
| | - Serdar Sezer
- Department of Pharmacology, Suleyman Demirel University Faculty of Medicine, Isparta, TUR
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Elbakry AA, Aldabek K, Crigger C, Trump T, Salkini MW. Robot-assisted laparoscopic repair of a huge sliding inguinal hernia of the urinary bladder, left ureter and sigmoid colon. UROLOGY VIDEO JOURNAL 2021. [DOI: 10.1016/j.urolvj.2021.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chalony C, Aguilar LE, Kim JY, Park CH, Kim CS. Development of electrospun core-shell polymeric mat using poly (ethyl-2) cyanoacrylate/polyurethane to attenuate biological adhesion on polymeric mesh implants. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 122:111930. [PMID: 33641922 DOI: 10.1016/j.msec.2021.111930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/28/2020] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
Poly (ethyl-2) cyanoacrylate was used to create an adhesion-free biocompatible non-woven material reinforced by polyurethane core via a co-axial electrospinning set-up. The effect of relative humidity (RH) of (18, 30, 40, 60, and 68) % on the electrospinning process was examined, and found that in order to achieve well defined core-shell fiber structure, the optimal RH was 18%. If the RH is >18%, a phenomenon called Taylor cone cyclic destabilization occurs, which results in unfavorable surface and mechanical properties of the mat. The developed composite electrospun mat has the potential to be used in medical devices, such as repairing the viscera layer for intraperitoneal hernia mesh implants, which require the attenuation of biological elements, and adequate mechanical properties.
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Affiliation(s)
- Carmen Chalony
- Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Republic of Korea
| | - Ludwig Erik Aguilar
- Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Republic of Korea
| | - Ju Yeon Kim
- Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Republic of Korea
| | - Chan Hee Park
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Republic of Korea; Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju City, 54001, Republic of Korea.
| | - Cheol Sang Kim
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Republic of Korea; Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju City, 54001, Republic of Korea.
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Aydemir Sezer U, Sanko V, Gulmez M, Aru B, Sayman E, Aktekin A, Vardar Aker F, Yanıkkaya Demirel G, Sezer S. Polypropylene composite hernia mesh with anti-adhesion layer composed of polycaprolactone and oxidized regenerated cellulose. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:1141-1152. [DOI: 10.1016/j.msec.2019.02.064] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/24/2019] [Accepted: 02/16/2019] [Indexed: 01/13/2023]
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Biomaterial Implants in Abdominal Wall Hernia Repair: A Review on the Importance of the Peritoneal Interface. Processes (Basel) 2019. [DOI: 10.3390/pr7020105] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Biomaterials have long been used to repair defects in the clinical setting, which has led to the development of a wide variety of new materials tailored to specific therapeutic purposes. The efficiency in the repair of the defect and the safety of the different materials employed are determined not only by the nature and structure of their components, but also by the anatomical site where they will be located. Biomaterial implantation into the abdominal cavity in the form of a surgical mesh, such as in the case of abdominal hernia repair, involves the contact between the foreign material and the peritoneum. This review summarizes the different biomaterials currently available in hernia mesh repair and provides insights into a series of peculiarities that must be addressed when designing the optimal mesh to be used in this interface.
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Bellón JM, Rodríguez M, Pérez-Köhler B, Pérez-López P, Pascual G. * The New Zealand White Rabbit as a Model for Preclinical Studies Addressing Tissue Repair at the Level of the Abdominal Wall. Tissue Eng Part C Methods 2017; 23:863-880. [PMID: 28756748 DOI: 10.1089/ten.tec.2017.0167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In this report, we review the use of the New Zealand White rabbit as the experimental animal for several models of abdominal wall repair. For the repair of an abdominal wall defect, such as a hernia in clinical practice, multiple types of prosthetic material exist. Before their marketing, each of these biomaterials needs to be tested in a preclinical setting to confirm its biocompatibility and appropriate behavior at the different tissue interfaces. For preclinical trials, we have always used the New Zealand White rabbit as the model owing to its ease of handling and suitable size. This size allows for laparoscopic studies designed to follow the behavior in real time of a biomaterial implanted at the peritoneal interface, a delicate interface that often gives rise to complications in human practice. The size of the rabbit also offers a sufficiently large number of implant samples to be harvested for a complete battery of tests at several time points postimplant. In this review, we first describe the models established and then provide the results obtained so far using these models to test the different types of biomaterial. We end our review with a discussion of the clinical implications of these results.
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Affiliation(s)
- Juan M Bellón
- 1 Department of Surgery, Medical, and Social Sciences, University of Alcalá , Alcalá de Henares, Madrid, Spain
| | - Marta Rodríguez
- 1 Department of Surgery, Medical, and Social Sciences, University of Alcalá , Alcalá de Henares, Madrid, Spain
| | - Bárbara Pérez-Köhler
- 1 Department of Surgery, Medical, and Social Sciences, University of Alcalá , Alcalá de Henares, Madrid, Spain
| | - Paloma Pérez-López
- 1 Department of Surgery, Medical, and Social Sciences, University of Alcalá , Alcalá de Henares, Madrid, Spain
| | - Gemma Pascual
- 2 Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), University of Alcalá , Alcalá de Henares, Madrid, Spain
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Greene C, Wu J, Rickard AH, Xi C. Evaluation of the ability of Acinetobacter baumannii to form biofilms on six different biomedical relevant surfaces. Lett Appl Microbiol 2016; 63:233-9. [PMID: 27479925 DOI: 10.1111/lam.12627] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 06/07/2016] [Accepted: 06/29/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED The human opportunistic pathogen, Acinetobacter baumannii, has the propensity to form biofilms and frequently cause medical device-related infections in hospitals. However, the physio-chemical properties of medical surfaces, in addition to bacterial surface properties, will affect colonization and biofilm development. The objective of this study was to compare the ability of A. baumannii to form biofilms on six different materials common to the hospital environment: glass, porcelain, stainless steel, rubber, polycarbonate plastic and polypropylene plastic. Biofilms were developed on material coupons in a CDC biofilm reactor. Biofilms were visualized and quantified using fluorescent staining and imaged using confocal laser scanning microscopy (CLSM) and by direct viable cell counts. Image analysis of CLSM stacks indicated that the mean biomass values for biofilms grown on glass, rubber, porcelain, polypropylene, stainless steel and polycarbonate were 0·04, 0·26, 0·62, 1·00, 2·08 and 2·70 μm(3) /μm(2) respectively. Polycarbonate developed statistically more biofilm mass than glass, rubber, porcelain and polypropylene. Viable cell counts data were in agreement with the CLSM-derived data. In conclusion, polycarbonate was the most accommodating surface for A. baumannii ATCC 17978 to form biofilms while glass was least favourable. Alternatives to polycarbonate for use in medical and dental devices may need to be considered. SIGNIFICANCE AND IMPACT OF THE STUDY In the hospital environment, Acinetobacter baumannii is one of the most persistent and difficult to control opportunistic pathogens. The persistence of A. baumannii is due, in part, to its ability to colonize surfaces and form biofilms. This study demonstrates that A. baumannii can form biofilms on a variety of different surfaces and develops substantial biofilms on polycarbonate - a thermoplastic material that is often used in the construction of medical devices. The findings highlight the need to further study the in vitro compatibility of medical materials that could be colonized by A. baumannii and allow it to persist in hospital settings.
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Affiliation(s)
- C Greene
- Department of Environmental Health and Science, University of Michigan, Ann Arbor, MI, USA
| | - J Wu
- Department of Environmental Health and Science, University of Michigan, Ann Arbor, MI, USA
| | - A H Rickard
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - C Xi
- Department of Environmental Health and Science, University of Michigan, Ann Arbor, MI, USA.
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Abid S, El-Hayek K. Which mesh or graft? Prosthetic devices for abdominal wall reconstruction. Br J Hosp Med (Lond) 2016; 77:157-8, 159-61. [PMID: 26961445 DOI: 10.12968/hmed.2016.77.3.157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reviews the ever-increasing number of prosthetic devices--both synthetic mesh and biologic grafts--now in use for abdominal wall reconstruction. It also introduces a novel hybrid synthetic/biologic graft (Zenapro) and suture passer device (Novapass).
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Affiliation(s)
- Shazia Abid
- Clinical Research Associate in the Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Kevin El-Hayek
- Assistant Professor of Surgery in the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University and Consultant General Surgeon in the Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States of America and Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Kelly M, Macdougall K, Olabisi O, McGuire N. In vivo response to polypropylene following implantation in animal models: a review of biocompatibility. Int Urogynecol J 2016; 28:171-180. [PMID: 27216918 PMCID: PMC5306078 DOI: 10.1007/s00192-016-3029-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/17/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Polypropylene is a material that is commonly used to treat pelvic floor conditions such as pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Owing to the nature of complications experienced by some patients implanted with either incontinence or prolapse meshes, the biocompatibility of polypropylene has recently been questioned. This literature review considers the in vivo response to polypropylene following implantation in animal models. The specific areas explored in this review are material selection, impact of anatomical location, and the structure, weight and size of polypropylene mesh types. METHODS All relevant abstracts from original articles investigating the host response of mesh in vivo were reviewed. Papers were obtained and categorised into various mesh material types: polypropylene, polypropylene composites, and other synthetic and biologically derived mesh. RESULTS Polypropylene mesh fared well in comparison with other material types in terms of host response. It was found that a lightweight, large-pore mesh is the most appropriate structure. CONCLUSION The evidence reviewed shows that polypropylene evokes a less inflammatory or similar host response when compared with other materials used in mesh devices.
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Affiliation(s)
- Michelle Kelly
- Devices Division, The Medicines and Healthcare products Regulatory Agency (MHRA), 151 Buckingham Palace Road, London, SW1W 9SZ, UK
| | - Katherine Macdougall
- Devices Division, The Medicines and Healthcare products Regulatory Agency (MHRA), 151 Buckingham Palace Road, London, SW1W 9SZ, UK
| | - Oluwafisayo Olabisi
- Devices Division, The Medicines and Healthcare products Regulatory Agency (MHRA), 151 Buckingham Palace Road, London, SW1W 9SZ, UK.
| | - Neil McGuire
- Devices Division, The Medicines and Healthcare products Regulatory Agency (MHRA), 151 Buckingham Palace Road, London, SW1W 9SZ, UK
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Anjum H, Bokhari SG, Khan MA, Awais M, Mughal ZU, Shahzad HK, Ijaz F, Siddiqui MI, Khan IU, Chaudhry AS, Akhtar R, Aslam S, Akbar H, Asif M, Maan MK, Khan MA, Noor A, Khan WA, Ullah A, Hayat MA. Comparative efficacy of Prolene and Prolene-Vicryl composite mesh for experimental ventral hernia repair in dogs. IRANIAN JOURNAL OF VETERINARY RESEARCH 2016; 17:78-83. [PMID: 27822231 PMCID: PMC5090135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 01/02/2016] [Accepted: 02/09/2016] [Indexed: 06/06/2023]
Abstract
In this study, efficacy of two hernia mesh implants viz. conventional Prolene and a novel Prolene-Vicryl composite mesh was assessed for experimental ventral hernia repair in dogs. Twelve healthy mongrel dogs were selected and randomly divided into three groups, A, Band C (n=4). In all groups, an experimental laparotomy was performed; thereafter, the posterior rectus sheath and peritoneum were sutured together, while, a 5 × 5 cm defect was created in the rectus muscle belly and anterior rectus sheath. For sublay hernioplasty, the hernia mesh (Prolene: group A; Prolene-Vicryl composite mesh: group B), was implanted over the posterior rectus sheath. In group C (control), mesh was not implanted; instead the laparotomy incision was closed after a herniorrhaphy. Post-operative pain, mesh shrinkage and adhesion formation were assessed as short term complications. Post-operatively, pain at surgical site was significantly less (P<0.001) in group B (composite mesh); mesh shrinkage was also significantly less in group B (21.42%, P<0.05) than in group A (Prolene mesh shrinkage: 58.18%). Group B (composite mesh) also depicted less than 25% adhesions (Mean ± SE: 0.75 ± 0.50 scores, P≤0.013) when assessed on the basis of a Quantitative Modified Diamond scale; a Qualitative Adhesion Tenacity scale also depicted either no adhesions (n=2), or, only flimsy adhesions (n=2) in group B (composite mesh), in contrast to group A (Prolene), which manifested greater adhesion formation and presence of dense adhesions requiring blunt dissection. Conclusively, the Prolene-Vicryl composite mesh proved superior to the Prolene mesh regarding lesser mesh contraction, fewer adhesions and no short-term follow-up complications.
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Affiliation(s)
- H. Anjum
- Ph.D. Scholar, Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - S. G. Bokhari
- Pet Centre, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - M. A. Khan
- Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - M. Awais
- Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - Z. U. Mughal
- Ph.D. Scholar, Pet Centre, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - H. K. Shahzad
- Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - F. Ijaz
- Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - M. I. Siddiqui
- Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - I. U. Khan
- Ph.D. Scholar, Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - A. S. Chaudhry
- Ph.D. Scholar, Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - R. Akhtar
- Department of Pathology, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - S. Aslam
- Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - H. Akbar
- Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - M. Asif
- Ph.D. Scholar, Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - M. K. Maan
- Ph.D. Scholar, Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - M. A. Khan
- Ph.D. Scholar, Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - A. Noor
- Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - W. A. Khan
- Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - A. Ullah
- Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - M. A. Hayat
- Ph.D. Scholar, Department of Clinical Medicine & Surgery, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
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Pore size and pore shape--but not mesh density--alter the mechanical strength of tissue ingrowth and host tissue response to synthetic mesh materials in a porcine model of ventral hernia repair. J Mech Behav Biomed Mater 2014; 42:186-97. [PMID: 25486631 DOI: 10.1016/j.jmbbm.2014.11.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/24/2014] [Accepted: 11/03/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Over 100 types of soft tissue repair materials are commercially available for hernia repair applications. These materials vary in characteristics such as mesh density, pore size, and pore shape. It is difficult to determine the impact of a single variable of interest due to other compounding variables in a particular design. Thus, the current study utilized prototype meshes designed to evaluate each of these mesh parameters individually. METHODS Five prototype meshes composed of planar, monofilament polyethylene terephthalate (PET) were evaluated in this study. The meshes were designed to focus on three key parameters, namely mesh density, pore size, and pore shape. The prototype meshes were implanted in the preperitoneal, retrorectus space in a porcine model of ventral incisional hernia repair, and tissue ingrowth characteristics were evaluated after 90 days. Mesh-tissue composite specimens were obtained from each repair site and evaluated via T-peel mechanical testing. Force-displacement data for each T-peel test were analyzed and five characteristics of tissue ingrowth reported: peak force (fp), critical force (fc), fracture energy (Γc), work (W), and work density (Wden). Hematoxylin and eosin (H&E) stained sections of explanted mesh-tissue composites were also assessed for characteristics of tissue response including cellular infiltration, cell types, inflammatory response, extracellular matrix deposition, neovascularization, and fibrosis, with a composite score assigned to represent overall tissue response. RESULTS The medium-weight, very large pore, hexagonal (MWVLH) mesh performed significantly better than the light-weight, medium pore, diamond (LWMD) mesh for all parameters evaluated (fp, fc, Γc, W, Wden) and trended toward better results than the medium-weight, medium pore, diamond (MWMD) mesh for the majority of the parameters evaluated. When the data for the five meshes was grouped to evaluate mesh density, pore size, and pore shape, differences were more pronounced. No significant differences were observed with respect to mesh density, however significant improvement in mechanical strength of tissue ingrowth occurred as pore size increased from medium to very large. In addition, the hexagonal pores resulted in the strongest tissue ingrowth, followed by the square pores, and finally the diamond pores. Scores for several histological parameters were significantly different for these prototype meshes. For example, the MWVLH mesh showed significantly greater tissue ingrowth by neovascularization histological score than MWMD and MWVLS meshes (p<0.05) and significantly less fibrosis than LWMD and MWVLS meshes (p<0.05). CONCLUSION Pore shape and pore size significantly altered the mechanical strength of tissue ingrowth and host-site integration in a porcine model of ventral hernia repair, while mesh density had no effect.
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Liu SQ, Lei P, Cui XH, Lv Y, Li JH, Song YL, Zhao G. Sutureless anastomoses using magnetic rings in canine liver transplantation model. J Surg Res 2013; 185:923-33. [DOI: 10.1016/j.jss.2013.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/04/2013] [Accepted: 07/11/2013] [Indexed: 01/16/2023]
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Hanna EM, Byrd JF, Moskowitz M, Mann JWF, Stockamp KT, Patel GN, Beneke MA, Millikan K, Iannitti DA. Outcomes of a prospective multi-center trial of a second-generation composite mesh for open ventral hernia repair. Hernia 2013; 18:81-9. [PMID: 23526091 PMCID: PMC3902081 DOI: 10.1007/s10029-013-1078-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 03/01/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Composite mesh prostheses incorporate properties of multiple materials for use in open ventral hernia repair (OVHR). This study examines clinical outcomes in patients who underwent OVHR with a polypropylene/expanded polytetrafluoroethylene (ePTFE) composite graft containing a novel polydioxanone (PDO) absorbable ring to facilitate placement and graft positioning. METHODS Data were prospectively collected on consecutive patients undergoing OVHR using a synthetic composite mesh. Seven centers enrolled patients during the study period. All patients underwent a standardized surgical procedure consisting of OVHR with sublay intraperitoneal placement of mesh. Mesh fixation was accomplished with peripheral tacks and transfascial sutures. RESULTS One hundred and nineteen patients underwent OVHR with the composite mesh. Average age was 55.8 years; there were 71 (59.7 %) females and 48 (40.3 %) males with mean BMI of 33.5 ± 7.1 kg/m(2). One hundred and two (85.7 %) patients presented with primary ventral hernias. Mean defect size was 13.6 cm(2), and mean mesh size was 113.6 cm(2). Most patients (67 %) were discharged the day of surgery. Twelve patients (10.1 %) experienced complications in the perioperative time period primarily consisting of seroma (4.2 %) and ileus (1.7 %). Two patients required reoperation and mesh removal in the early postoperative period for infection and herniorrhaphy site pain, respectively. There was a decline in pain and movement limitation scores between baseline and 1-year follow-up. Six-month (n = 109) and twelve-month (n = 99) follow-up revealed no hernia recurrences (95 % CI 0-3 %, and 0-4 %, respectively). CONCLUSIONS The use of this second-generation composite mesh was associated with no hernia recurrences and a low complication rate after open ventral hernia repair.
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Affiliation(s)
- E M Hanna
- Department of General Surgery, Division of Hepato-Pancreato-Biliary Surgery, Carolinas Medical Center, 1025 Moorehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA
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