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Hoffmann H, Kirchhoff P. Adhesions After Laparoscopic IPOM-How Serious Is the Problem? JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2025; 4:14126. [PMID: 40206847 PMCID: PMC11978498 DOI: 10.3389/jaws.2025.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 03/20/2025] [Indexed: 04/11/2025]
Abstract
Although laparoscopic IPOM is still the gold standard in ventral hernia repair, it is subject of a slow but constant decline, while new minimally invasive techniques are increasingly used, as well as open retromuscular repairs. One of the reasons are the intraperitoneal mesh position and its suspected higher risk for creating intraabdominal adhesions, compared to extraperitoneal mesh positions. In potential subsequent operations (e.g., in recurrent ventral hernia repair) adhesions usually must be taken down, which is a known risk factor for complications such as inadvertent enterotomies, surgical site infections and prolonged hospital stay. In this review we evaluate the incidence of intraabdominal adhesions after ventral hernia repair and their potential impact on surgical outcome in subsequent operations. Special attention is paid to the impact of mesh position in developing adhesions.
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Affiliation(s)
- Henry Hoffmann
- ZweiChirurgen GmbH, Center for Hernia Surgery and Proctology, Basel, Switzerland
- Faculty of Medicine, University Basel, Basel, Switzerland
- Merian Iselin Clinic, Clinic for Orthopedics and Surgery, Basel, Switzerland
| | - Philipp Kirchhoff
- ZweiChirurgen GmbH, Center for Hernia Surgery and Proctology, Basel, Switzerland
- Faculty of Medicine, University Basel, Basel, Switzerland
- Merian Iselin Clinic, Clinic for Orthopedics and Surgery, Basel, Switzerland
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Naraynsingh V, Cawich SO, Hassranah S. Alternative to mesh repair for ventral hernias: Modified rectus muscle repair. World J Surg Proced 2023; 13:14-21. [DOI: 10.5412/wjsp.v13.i3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections, adhesions, seromas, fistula formation and significant postoperative pain. The modified rectus muscle repair (RMR) is as an option to repair midline ventral hernias without mesh.
AIM To evaluate the short term outcomes when the modified RMR was used to repair ventral hernias.
METHODS This was a 5-year prospective study that examined the outcome of all consecutive patients with ventral abdominal wall hernias > 5 cm in maximal diameter who underwent repair using the modified RMR technique in a single surgeon unit. Patients were reviewed in an outpatient clinic at 3, 6 and 12 mo and evaluated for hernia recurrence on clinical examination. Each patient’s abdominal wall was also assessed with using ultrasonography at 24 mo to detect recurrences. All data were examined with SPSS ver 18.0.
RESULTS Over the 5-year study period, there were 52 patients treated for ventral hernias at this institution. Four patients were excluded and there were 48 in the final study sample, at a mean age of 56 years (range 28-80). The mean maximal diameter of the hernia defect was 7 cm (range 5-12 cm). There were 5 (10.4%) seromas and 1 recurrence (2.1%) at a mean of 36 mo follow-up.
CONCLUSION The authors recommend the modified RMR as an acceptable alternative to mesh repair of ventral hernias. The seroma rate can be further reduced with routine use of drains. The modified RMR also has the benefit of eliminating all mesh-specific complications.
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Affiliation(s)
- Vijay Naraynsingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Shamir O Cawich
- Department of Surgery, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Samara Hassranah
- Department of Surgery, Medical Associate Hospital, St. Joseph, Trinidad and Tobago
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Ding X, Zhu J, Liu A, Guo Q, Cao Q, Xu Y, Hua Y, Yang Y, Li P. Preparation and Biocompatibility Study of Contrast-Enhanced Hernia Mesh Material. Tissue Eng Regen Med 2022; 19:703-715. [PMID: 35612710 DOI: 10.1007/s13770-022-00460-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Meshes play a crucial role in hernia repair. However, the displacement of mesh inevitably leads to various associated complications. This process is difficult to be traced by conventional imaging means. The purpose of this study is to create a contrast-enhanced material with high-density property that can be detected by computed tomography (CT). METHODS The contrast-enhanced monofilament was manufactured from barium sulfate nanoparticles and medical polypropylene (PP/Ba). To characterize the composite, stress tensile tests and scanning electron microscopy (SEM) was performed. Toxicity and biocompatibility of PP/Ba materials was verified by in vitro cellular assays. Meanwhile, the inflammatory response was tested by protein adsorption assay. In addition, an animal model was established to demonstrate the long-term radiographic effect of the composite material in vivo. Subsequent pathological tests confirmed its in vivo compatibility. RESULTS The SEM revealed that the main component of the monofilament is carbon. In vitro cell experiments demonstrated that novel material does not affect cell activity and proliferation. Protein adsorption assays indicated that the contrast-enhanced material does not cause additional inflammatory responses. In addition, in vivo experiments illustrated that PP/Ba mesh can be detected by CT and has good in vivo compatibility. CONCLUSION These results highlight the excellent biocompatibility of the contrast-enhanced material, which is suitable for human abdominal wall tissue engineering.
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Affiliation(s)
- Xuzhong Ding
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong, 226000, China
| | - Jiachen Zhu
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-Innovation Center of Neuroregeneration, Nantong University, No. 19, Qixiu Road, Chongchuan District, Nantong, Jiangsu, China
| | - Anning Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong, 226000, China
| | - Qiyang Guo
- Chemistry and Chemical Engineering, Nantong University, Nantong, China
| | - Qing Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong, 226000, China
| | - Yu Xu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong, 226000, China
| | - Ye Hua
- Department of Imaging, Affiliated Hospital of Nantong University, Nantong, China
| | - Yumin Yang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-Innovation Center of Neuroregeneration, Nantong University, No. 19, Qixiu Road, Chongchuan District, Nantong, Jiangsu, China.
| | - Peng Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong, 226000, China.
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Favourable outcomes after Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Non-Complex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-Analysis. Ann Surg 2022; 276:55-65. [PMID: 35185120 DOI: 10.1097/sla.0000000000005422] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. SUMMARY BACKGROUND DATA Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For non-complex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. METHODS Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. RESULTS Ninety-three studies representing 12440 patients undergoing retro-rectus repair were included. Pooled hernia recurrence was estimated at 3.2% (95%CI: 2.2-4.2%, n = 11049) after minimally 12 months and 4.1%, (95%CI: 2.9-5.5%, n = 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2-6.4%, n = 4891) and 5.5% (95%CI: 4.4-6.8%, n = 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair (OR: 0.27, 95%CI: 0.15-0.51, p < 0.001) and equal recurrence rates compared to intraperitoneal onlay (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, p = 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03-3.14, p = 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7-2.3%, n = 849) and SSI (1.5%, 95%CI: 0.8-2.8%, n = 982), albeit based on non-randomized studies. CONCLUSIONS Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except surgical site infection. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.
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Limperg T, Chaves K, Jesse N, Zhao Z, Yunker A. Ultrasound Visceral Slide Assessment to Evaluate for Intra-abdominal Adhesions in Patients Undergoing Abdominal Surgery - A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021; 28:1993-2003.e10. [PMID: 34252609 DOI: 10.1016/j.jmig.2021.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Abdominal entry at the time of laparoscopy is a critical step with a risk of injury to underlying viscera owing to bowel adhesions. Ultrasound can be used as a preoperative tool to assess the slide of viscera underneath the abdominal wall to detect adhesion-free areas. The objective of this systematic review and meta-analysis was to determine the diagnostic accuracy of preoperative visceral slide assessment with ultrasound to detect intra-abdominal adhesions, compared with the gold standard of intraoperative findings. DATA SOURCES Using Cochrane, Medline PubMed, Embase, and Google Scholar electronic databases, 3737 articles were screened in April 2020 using a query that included variations of "adhesions" and "ultrasound." Reference lists of relevant articles were searched for further articles. METHODS OF STUDY SELECTION Prospective and cross-sectional studies in English that included patients at risk for intra-abdominal adhesions who underwent preoperative ultrasound visceral slide assessment and subsequent intraoperative assessment of adhesions were selected. Two reviewers independently selected 25 articles, extracted data, and assessed bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. TABULATION, INTEGRATION, AND RESULTS Twenty-five articles reported on 1609 patients and 5812 assessed abdominal areas, with considerable heterogeneity of described abdominal areas and degrees of adhesions. Meta-analysis was performed for 21 studies. The periumbilical area was assessed specifically for bowel adhesions in 890 patients in 12 studies, with a 12.0% bowel adhesion rate. Ultrasound assessment for periumbilical bowel adhesions had a combined sensitivity of 95.9% (95% confidence interval, 82.7%-99.1%), specificity of 93.1% (85.1%-96.9%), positive predictive value of 60.4% (44.2%-74.7%), and negative predictive value of 99.2% (97.9%-99.7%) with low heterogeneity (I2 = 16%). CONCLUSION Visceral slide assessment with ultrasound has a high negative predictive value for the absence of periumbilical bowel adhesions in patients at risk for adhesions and can function as a useful tool to detect adhesion-free areas to allow for safe laparoscopic entry.
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Affiliation(s)
- Tobias Limperg
- Department of Obstetrics & Gynecology (Drs. Limperg, Chaves, Jesse, and Yunker), Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Katherine Chaves
- Department of Obstetrics & Gynecology (Drs. Limperg, Chaves, Jesse, and Yunker), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicholas Jesse
- Department of Obstetrics & Gynecology (Drs. Limperg, Chaves, Jesse, and Yunker), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhiguo Zhao
- Department of Biostatistics (Mr. Zhao), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amanda Yunker
- Department of Obstetrics & Gynecology (Drs. Limperg, Chaves, Jesse, and Yunker), Vanderbilt University Medical Center, Nashville, Tennessee
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Yasemin A, Mehmet B, Omer A. Assessment of the diagnostic efficacy of abdominal ultrasonography and cine magnetic resonance imaging in detecting abdominal adhesions: A double-blind research study. Eur J Radiol 2020; 126:108922. [PMID: 32145598 DOI: 10.1016/j.ejrad.2020.108922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/21/2020] [Accepted: 02/28/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE This cohort aimed to determine the efficacy and safety of abdominal ulrasonography and cine-MRI by a double-blind study in the diagnosis of intraabdominal organs and abdominal wall adhesions in patients with previous abdominal operations. METHODS Between 2017 and 2019, 108 consecutive patients were prospectively included in the study. Visceral slide and induced visceral slide were measured during AU and cine-MRI. An abdominal map consisting of nine segments was created to document the location and extent of the adhesion. The degree and severity of the adhesions detected by the radiologist preoperatively and detected in surgery as the gold standard was recorded in the same abdominal zones. AU, c-MRI and intraoperative findings were correlated. RESULTS The mean age was 53.0 ± 10.3 years, body mass index was 30.4 ± 3.4, male (52.8 %) and female (47.2 %). According to the total nine zones, the sensitivity of AU was 91.4 %, specificity was 100 %, positive predictive value was 90.7 %, negative predictive value was 100 % and diagnostic accuracy was 87.9 %. Considering the total zones, the sensitivity of c-MRI was 90.8 %, specificity was 100 %, PPV was 90.7 %, NPV was 100 % and diagnostic accuracy was 91.7 %. A comparison of AU and c-MRI showed no significant difference in the detection of adhesions to the abdominal wall; however, c-MRI was superior in detecting intraabdominal organs adhesion. CONCLUSION We have demonstrated that AU and c-MRI are accurate for diagnosing adhesions in patients undergoing repeated surgery and may have a place on planning elective laparoscopic or open surgery to avoid bowel injury.
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Affiliation(s)
- Altıntas Yasemin
- Department of Radiology, Ozel Ortadogu Hospital, Adana, 01360, Turkey.
| | - Bayrak Mehmet
- Department of General Surgery, Ozel Ortadogu Hospital, Adana, 01360, Turkey.
| | - Alabaz Omer
- Department of General Surgery, Cukurova University Medicine Faculty, Adana, 01160, Turkey.
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Gerner-Rasmussen J, Donatsky AM, Bjerrum F. The role of non-invasive imaging techniques in detecting intra-abdominal adhesions: a systematic review. Langenbecks Arch Surg 2019; 404:653-661. [PMID: 30483880 DOI: 10.1007/s00423-018-1732-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intra-abdominal adhesions after surgery are highly prevalent. Adhesions implicate complications during subsequent surgery and can cause chronic abdominal pain. The objective of this review was to investigate the usefulness of non-invasive diagnostic methods for detection of adhesions. METHODS We searched the electronic databases: MEDLINE, Embase, and The Cochrane Central Register of Controlled Trials for studies investigating the use of non-invasive diagnostic imaging techniques for detecting adhesions. Main outcome was the sensitivity and specificity of each technique. We used the Quality Assessment of Diagnostic Accuracy studies tool to assess bias. RESULTS In total, 25 studies were included: 18 using ultrasound (US), 5 using magnetic resonance imaging (MRI), 1 using computed tomography (CT), and 1 using both US and MRI. A total of 2195 patients were included. Overall accuracy ranged between 76 and 100% for US studies and between 79 and 90% for MRI and was 66% for CT. Sensitivity ranged between 21 and 100% for US and between 22 and 93% for MRI and was 61% for CT. Specificity was 32-100% for US, 25-93% for MRI, and 63% for CT. Bias analysis revealed that in most studies, investigators were blinded to the reference standard but not to the index test and 11 of 25 studies had a high risk of selection bias. CONCLUSIONS Currently, abdominal US can be used to determine the presence of adhesions between bowel and the abdominal wall. MRI is also an accurate diagnostic modality and can in addition visualize adhesions between viscera, however, with a tendency to over diagnose adhesions. There is insufficient evidence to support CT as a diagnostic modality for adhesions.
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Affiliation(s)
- Jonas Gerner-Rasmussen
- Department of Surgery, Slagelse Hospital, University of Copenhagen, Faelledvej 11, 4200, Slagelse, Denmark.
| | | | - Flemming Bjerrum
- Department of Surgery, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Dehghani Firoozabadi MM, Alibakhshi A, Alaeen H, Zand S, Nazemian R, Rahmani M. Evaluation of the diagnostic potential of trans abdominal ultrasonography in detecting intra-abdominal adhesions: A double-blinded cohort study. Ann Med Surg (Lond) 2018; 36:79-82. [PMID: 30425829 PMCID: PMC6224334 DOI: 10.1016/j.amsu.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 08/31/2018] [Accepted: 09/15/2018] [Indexed: 12/12/2022] Open
Abstract
Background Intra-abdominal adhesion is one of the most important complications of abdominopelvic surgery. It increases morbidity and mortality for patients. Although laparoscopy is the gold standard of adhesion diagnosis, it can cause visceral damage during the operation. Therefore, surgeons prefer to use non-invasive methods for planning the operation. We designed this study to evaluate transabdominal ultrasonography ( TAU) accuracy for diagnosing Intra-abdominal Adhesions Material & methods This double-blinded cohort study was conducted on 47 patients with previous laparotomy who undergo another surgery. Spontaneous visceral slide (SVS) and induced visceral slide (IVS) were measured during TAU. Results The mean age and BMI of 47 patients were 43.21±10.3 and 27.545±5.76. The majority of the patients were female (76%). Mean SVS and IVS in patients with intra-abdominal adhesion were 8.73±1.60 and 44.84±11.60. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of TAU in intra-abdominal diagnosis were 83.33%, 51.72%, 51.72%, 83.33%, 63.83%. Conclusions Although TAU is an appropriate method for detecting the intra-abdominal adhesion, it isn't good enough for diagnosing free adhesion area. We recommended further researches with greater sample size and other non-invasive techniques.
Evaluation of accuracy, sensitivity, specificity, PPV, NPV for adhesion diagnosis. There are not a lot of studies on ultrasonography accuracy before. It’s an only double-blinded cohort study. Our study refers to high sensitivity and NPV for diagnosing the adhesion.
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Affiliation(s)
| | - Abbas Alibakhshi
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoorieh Alaeen
- Students' Research Scientific Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Zand
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ryan Nazemian
- Institute for Transformative Molecular Medicine, Case Western Reserve University, Cleveland, USA
| | - Maryam Rahmani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Department of Radiology, University of Medical Sciences, Tehran, Iran
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Alwahab A, AlAwadhi A, Nugud AAA, Nugud SAE. Worst Case Scenarios! Complications Related to Hernial Disease. HERNIA SURGERY AND RECENT DEVELOPMENTS 2018. [DOI: 10.5772/intechopen.76079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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10
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Berrevoet F, Doerhoff C, Muysoms F, Hopson S, Muzi MG, Nienhuijs S, Kullman E, Tollens T, Schwartz MR, LeBlanc K, Velanovich V, Jørgensen LN. A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the monofilament polyester composite ventral patch: interim results of the PANACEA study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:81-88. [PMID: 28553149 PMCID: PMC5440003 DOI: 10.2147/mder.s132755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study assessed the recurrence rate and other safety and efficacy parameters following ventral hernia repair with a polyester composite prosthesis (Parietex™ Composite Ventral Patch [PCO-VP]). Patients and methods A single-arm, multicenter prospective study of 126 patients undergoing open ventral hernia repair with the PCO-VP was performed. Patient outcomes were assessed at discharge and at 10 days, 1, 6, 12, and 24 months postoperative. Results All patients had hernioplasty for umbilical (n = 110, 87.3%) or epigastric hernia (n = 16, 12.7%). Mean hernia diameter was 1.8 ± 0.8 cm. Mean operative time was 36.2 ±15.6 minutes, with a mean mesh positioning time of 8.1 ± 3.4 minutes. Surgeons reported satisfaction with mesh ease of use in 95% of surgeries. The cumulative hernia recurrence rate at 1 year was 2.8% (3/106). Numeric Rating Scale (NRS) pain scores showed improvement from 2.1 ± 2.0 at preoperative baseline to 0.5 ± 0.7 at 1 month postoperative (P < 0.001), and this low pain level was maintained at 12 months postsurgery (P < 0.001). The mean global Carolina’s Comfort Scale® (CCS) score improved postoperatively from 3.8 ± 6.2 at 1 month to 1.6 ± 3.5 at 6 months (P < 0.001). One patient was unsatisfied with the procedure. Conclusion This 1-year interim analysis using PCO-VP for primary umbilical and epigastric defects shows promising results in terms of mesh ease of use, postoperative pain, and patient satisfaction. Recurrence rate is low, but, as laparoscopic evaluation shows a need for patch repositioning in some cases, an accurate surgical technique remains of utmost importance.
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Affiliation(s)
- Frederik Berrevoet
- Department of General and Hepatopancreaticobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - Carl Doerhoff
- General Surgery, Surgicare of Missouri, Jefferson City, MO, USA
| | - Filip Muysoms
- Department of Surgery, AZ Maria Middelares Ghent, Ghent, Belgium
| | - Steven Hopson
- Bon Secours Hernia Center, Mary Immaculate Hospital, Newport News, VA, USA
| | | | | | | | - Tim Tollens
- Imelda Hospital-General Surgery Imelda Hospital, Bonheiden, Belgium
| | | | - Karl LeBlanc
- Our Lady of Lakes Regional Medical Center, Baton Rouge, LA
| | - Vic Velanovich
- Tampa General Hospital, University of South Florida, Tampa, FL, USA
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Rastegarpour A, Cheung M, Vardhan M, Ibrahim MM, Butler CE, Levinson H. Surgical mesh for ventral incisional hernia repairs: Understanding mesh design. Plast Surg (Oakv) 2016; 24:41-50. [PMID: 27054138 DOI: 10.4172/plastic-surgery.1000955] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years.
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Affiliation(s)
- Ali Rastegarpour
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
| | - Michael Cheung
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
| | - Madhurima Vardhan
- Department of Biomedical Engineering, Duke University, Pratt School of Engineering, Durham, North Carolina
| | - Mohamed M Ibrahim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
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12
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Rastegarpour A, Cheung M, Vardhan M, Ibrahim MM, Butler CE, Levinson H. Surgical mesh for ventral incisional hernia repairs: Understanding mesh design. Plast Surg (Oakv) 2016. [DOI: 10.1177/229255031602400110] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years.
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Affiliation(s)
- Ali Rastegarpour
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael Cheung
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Madhurima Vardhan
- Department of Biomedical Engineering, Duke University, Pratt School of Engineering, Durham, North Carolina
| | - Mohamed M Ibrahim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Guillaume O, Teuschl AH, Gruber-Blum S, Fortelny RH, Redl H, Petter-Puchner A. Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio-Functionality to Meshes. Adv Healthc Mater 2015; 4:1763-89. [PMID: 26111309 DOI: 10.1002/adhm.201500201] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/12/2015] [Indexed: 12/19/2022]
Abstract
Abdominal wall hernia is a recurrent issue world-wide and requires the implantation of over 1 million meshes per year. Because permanent meshes such as polypropylene and polyester are not free of complications after implantation, many mesh modifications and new functionalities have been investigated over the last decade. Indeed, mesh optimization is the focus of intense development and the biomaterials utilized are now envisioned as being bioactive substrates that trigger various physiological processes in order to prevent complications and to promote tissue integration. In this context, it is of paramount interest to review the most relevant bio-functionalities being brought to new meshes and to open new avenues for the innovative development of the next generation of meshes with enhanced properties for functional abdominal wall hernia repair.
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Affiliation(s)
- Olivier Guillaume
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Andreas Herbert Teuschl
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- University of Applied Sciences Technikum Wien; Department of Biochemical Engineering; Höchstädtplatz 5 1200 Vienna Austria
| | - Simone Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - René Hartmann Fortelny
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Alexander Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
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Abstract
Results of this study suggest that ultrasound can be used to quantitatively estimate the degree of adhesions between intestine and the abdominal wall. Background and Objectives: Laparoscopic treatment of incisional hernias reduces surgical traumas and postoperative pain. It requires intraperitoneal placement of a foreign body that might cause adhesions, leading to postoperative complications. The aim of this study was to improve reliability of ultrasound in quantitatively estimating adhesions to exploit the other advantages of ultrasound, such as availability and versatility. Methods: The ultrasound examination was performed by using a hand-held 3.5MHz curved linear probe. The image data were analyzed prior to scan conversion. Two square regions of interest were defined, one in the abdominal wall and one in the underlying bowels. A cross correlation-based algorithm tracked each region by using a time span of 3 frames. Subtracting the 2 displacement functions from each other yielded a relative displacement function, indicating the degree of bowel adhesions. This was compared with the intraoperative findings. Results and Conclusions: The method was proven to be a rapid and robust method for quantitatively estimating the degree of bowel adhesions. It is limited to evaluation of adhesions between bowel and abdominal wall. However, this ultrasound technique could assist in the safe placement of ports prior to redo laparoscopic surgery.
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Affiliation(s)
- Sebastien Muller
- SINTEF Health Research, 7465 Trondheim, Norway, Research Scientist, Dept. Medical Technology, 7465 Trondheim, Norway.
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Zinther NB, Fedder J, Friis-Andersen H. Noninvasive detection and mapping of intraabdominal adhesions: a review of the current literature. Surg Endosc 2010; 24:2681-6. [PMID: 20512510 DOI: 10.1007/s00464-010-1119-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 04/20/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adhesions are a well-known and very common complication to surgery. Their extent and severity varies according to type and number of surgeries, use of intraabdominal mesh, and presence of peritonitis. Adhesions cause increased morbidity and mortality, with subsequent socioeconomic consequences. This review aimed to identify existing literature on noninvasive radiologic techniques for identification of intraabdominal adhesions. METHODS A structured literature search of medical databases was conducted. English literature published until September 2009 and relevant references were included and assessed. RESULTS The search identified transabdominal ultrasonography (TAU) and cine magnetic resonance imaging (cine MRI) as relevant tools matching the search criteria. In all, 12 publications concerning TAU and 4 publications concerning cine MRI were identified. All but one of these publications had the methodologic limitation of not being blinded, which influenced the final sensitivity, specificity, and accuracy. CONCLUSION Both TAU and cine MRI seem able to identify intraabdominal adhesions using visceral slide with accuracy of 76% to 92%. Unfortunately, the studies are biased by being nonblinded. Accordingly, a need exists for a systematic well-conducted double-blinded comparative study to validate these radiologic techniques.
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16
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Functional cine MRI and transabdominal ultrasonography for the assessment of adhesions to implanted synthetic mesh 5-7 years after laparoscopic ventral hernia repair. Hernia 2010; 14:499-504. [PMID: 20490585 DOI: 10.1007/s10029-010-0676-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 05/02/2010] [Indexed: 12/25/2022]
Abstract
BACKGROUND Laparoscopic ventral hernia repair (LVHR) has gained worldwide acceptance, due to its minimally invasive character, feasibility and low rate of complications. Animal experiments have shown marked adhesions to the intraperitoneal mesh (IPM), the clinical consequences being unclear. This study aimed to describe the extension of adhesions to the mesh, 5-7 years after LVHR, using two validated non-invasive radiologic methods. METHODS Real-time transabdominal ultrasonography (TAU) and cine magnetic resonance imaging (MRI) was applied to 30 patients with prior LVHR and implantation of IPM (Intramesh W3, Cousin Biotech, France). The visceral slide was measured in nine predefined abdominal segments. Values <or=1 cm were defined as an area with adhesion. RESULTS The mean time between LVHR and TAU/cine MRI was 67 months (range, 58-80 months). We found adhesion to the mesh in 90% of the patients using TAU and 100% of the patients using cine MRI. In the latter, 65% were between the bowel and IPM. CONCLUSIONS LVHR is known to reduce recurrences and postoperative complications, while improving patient outcome. The intraperitoneal placement of the mesh has been shown to induce adhesions; the amount and extension in the clinical setting is unclear. The present study showed a marked proportion of adhesions to the mesh with an average surgery to scan time of 5.6 years, despite an anti-adhesive barrier on the visceral surface of the mesh. Together with existing data, this result increases the concern related to the long-term consequences of an IPM. As a consequence, a comprehensive and comparable test system for medical devices, i.e. IPM, is needed.
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17
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Detection of abdominal wall adhesions using visceral slide. Surg Endosc 2010; 24:3161-6. [DOI: 10.1007/s00464-010-1110-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
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Piccolboni D, Ciccone F, Settembre A. High resolution ultrasound for pre-operative detection of intraperitoneal adhesions: An invaluable diagnostic tool for the general and laparoscopic surgeon. J Ultrasound 2009; 12:148-50. [PMID: 23396872 DOI: 10.1016/j.jus.2009.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The possibility of predicting the presence of intra-abdominal adhesions in post-surgical patients undergoing further laparotomy or laparoscopy is of great interest for the general and laparoscopic surgeon. Inadvertent enterotomy during re-laparotomy or trocar insertion is a feared complication with a significant associated morbidity and mortality occurring in 20% in open surgery and between 1% and 100% in laparoscopy. MATERIALS AND METHODS Sonographic study of the visceral slide (i.e. the "back and forth" movement of the peritoneal layer in rhythm with respiration in relation to the steady inner fascial layer) was the hallmark for free access to the peritoneal cavity. In 60 consecutive patients, aged 28-77, who had previously undergone open abdominal surgery, pre-operative ultrasound (US) was performed on Aloka 5.500 device (Aloka, Tokyo, Japan) using convex and linear multifrequency probes. RESULTS The possibility of safely performing trans-umbilical open laparoscopy (TUOL) was US evaluated in 35 (58.3%) patients scheduled for various abdominal laparoscopic procedures. This approach was successfully performed in 26 patients (74.3%). In 2 (5.7%) it was attempted but had to be changed due to the presence of previously undetected adhesions. In 7 patients (20%) pneumoperitoneum was induced by means of a Veress needle positioned in the upper left quadrant due to the presence of midline adhesions, which were confirmed after trocar insertion. Among the remaining 25 patients who underwent re-laparotomy (41.6%), incision was performed outside the midline in 8 patients (32%) due to the presence of suspected midline adhesions, which were confirmed in 6 patients (24%). CONCLUSIONS In this study, pre-operative US evaluation showed a diagnostic accuracy of 93.3%.
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Affiliation(s)
- D Piccolboni
- Department of General and Laparoscopic Surgery, Monaldi Hospital, Naples, Italy
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19
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Larciprete G, Valli E, Meloni P, Malandrenis I, Romanini ME, Jarvis S, Rossi F, Barbati G, Cirese E. Ultrasound Detection of the “Sliding Viscera” Sign Promotes Safer Laparoscopy. J Minim Invasive Gynecol 2009; 16:445-9. [DOI: 10.1016/j.jmig.2009.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 03/17/2009] [Accepted: 03/27/2009] [Indexed: 10/20/2022]
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Rosen MJ. Polyester-based mesh for ventral hernia repair: is it safe? Am J Surg 2009; 197:353-9. [PMID: 19245914 DOI: 10.1016/j.amjsurg.2008.11.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 11/12/2008] [Accepted: 11/12/2008] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The ideal prosthetic material for ventral hernia repair has yet to be described. Each prosthetic material has unique advantages and disadvantages in terms of tissue ingrowth, adhesion formation, and shrinkage profiles. Polyester-based mesh has shown minimal shrinkage and excellent tissue ingrowth in animal models. However, the macroporous, braided nature of this material has raised several concerns regarding the incidence of infections, fistulas, and bowel obstructions. We have reviewed our experience with polyester-based mesh for the repair of ventral hernias. METHODS All patients undergoing ventral hernia repair at the Case Comprehensive Hernia Center at University Hospitals of Cleveland from December 2005 to April 2008 were included. Laparoscopic cases underwent intraperitoneal placement of a polyester-based mesh with a collagen hydrogel anti-adhesive barrier. The mesh was sized for at least 4 cm of fascial overlap, and transfascial fixation sutures and titanium spiral tacks were used routinely to secure the mesh to the abdominal wall. Those cases deemed inappropriate for laparoscopic ventral hernia repair underwent open repair. Open ventral hernia repairs were performed using a retrorectus repair, placing the mesh in an extraperitoneal position. Unprotected polyester mesh was used in these cases. Pertinent data included patient demographics, surgical details, postoperative outcomes, and long-term follow-up evaluation. RESULTS During the study period 109 patients underwent ventral hernia repair with polyester mesh. Seventy-nine patients had a laparoscopic repair, and 30 patients had an open repair. The mean age was 57 years, with a mean body mass index of 33 kg/m(2), and American Society of Anesthesia score of 2.6. The patients had undergone 2.1 prior abdominal surgical procedures, and 42 patients had recurrent hernias. Surgical details for the laparoscopic repair and open repair were as follows: mean defect size, 116 versus 403 cm(2); mesh size, 367 versus 1,055 cm(2); and surgical times, 132 versus 170 minutes, respectively. The average hospital stay was 4.2 days for the laparoscopic repair and 5.8 days for the open repair groups. With a mean follow-up period of 14 months (range, 2-28 mo) in the laparoscopic repair group, 1 patient (1.4%) developed a mesh infection (with a history of a prior methicillin-resistant Staphylococcus aureus mesh infection), 1 patient (1.4%) developed a small-bowel obstruction remote to the mesh on re-exploration, and there were no fistulas. With a mean follow-up period of 11 months (range, 2-21 mo) in the open repair group, 3 wound infections (13%) occurred, 2 involved the mesh, which was salvaged with local wound care in 1, and required partial mesh resection in the other, and there were no bowel obstructions or fistulas during the follow-up evaluation. CONCLUSIONS This study shows that in this complex group of patients, polyester mesh placed during ventral hernia repair results in acceptable infection rates, and no direct bowel complications or fistulas. Given the macroporous nature of the mesh, each case of infection was treated successfully with local wound measures or partial mesh resection. Polyester-based meshes with an anti-adhesive barrier appear safe for intraperitoneal placement.
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Affiliation(s)
- Michael J Rosen
- Case Medical Center, University Hospitals of Cleveland, Department of General Surgery, Cleveland, OH 44106, USA
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Kirchhoff S, Ladurner R, Kirchhoff C, Mussack T, Reiser MF, Lienemann A. Detection of recurrent hernia and intraabdominal adhesions following incisional hernia repair: a functional cine MRI-study. ACTA ACUST UNITED AC 2009; 35:224-31. [PMID: 19305941 DOI: 10.1007/s00261-009-9505-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 02/08/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND To non-invasively identify incisional hernia repair implanted synthetic meshes with MRI, and also focusing on the evaluation of postsurgical complications such as adhesions. METHODS A total of 43 patients underwent either laparoscopic intraperitoneal onlay-mesh or open abdominal wall repair using preperitoneal layers. The patients were examined using a true-fast-imaging-with-steady-state-precession (trueFISP)-sequence in transverse/sagittal orientation with a section-by-section dynamic depiction of induced visceral slide. A 9-segment-abdominal-map was used to document the adhesion location/type. The MR-images were analysed regarding hernia relapse, layer-morphology, rectus-abdominis muscle-condition, and abdominal wall mobility. In 12 patients pre- and postsurgery-MRI was performed. RESULTS Time range between surgery and examination was 6-36 months. In all laparoscopy-patients the meshes were identified. For open surgery the mesh was not visualized in 20, but was seen in 6 cases. A total of 11 cases showed a recurrent hernia. Seventy intraabdominal adhesions were detected. Fifteen patients had restricted mobility. 20 patients showed an rectus-abdominis-muscle-asymmetry. Comparing pre- and post-op-MRI, 6 out of 8 patients with open repair showed thick scar-plaques. Three patients with open repair had new adhesion-formations postoperatively. CONCLUSION Functional cine MRI is suitable for follow-up studies in patients after hernia repair to detect and evaluate the implanted meshes. Typical complications like intestinal adhesions and abdominal wall dysmotility can be assessed as well.
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Affiliation(s)
- S Kirchhoff
- Department of Clinical Radiology, Hospital Grosshadern, Ludwig Maximilians University Munich, Munich, Germany.
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22
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Jamadar DA, Jacobson JA, Girish G, Balin J, Brandon CJ, Caoili EM, Morag Y, Franz MG. Abdominal wall hernia mesh repair: sonography of mesh and common complications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:907-917. [PMID: 18499850 DOI: 10.7863/jum.2008.27.6.907] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purposes of this study were (1) to review the sonographic in vitro and in vivo appearances of mesh for surgical repair of abdominal wall hernias, (2) to describe sonographic techniques and discuss the limitations of sonography in evaluation of mesh hernia repair, and (3) to illustrate common complications after mesh repair shown with sonography. METHODS We identified interesting cases from the musculoskeletal sonographic database as well as from the teaching files of the authors, with surgical or other cross-sectional imaging corroboration. RESULTS A compilation of the sonographic appearances of mesh used for anterior abdominal wall and inguinal hernia repair and complications diagnosable by sonography is presented. CONCLUSIONS Sonography can be effective for evaluation of mesh and complications after mesh repair of anterior abdominal wall and inguinal hernias.
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Affiliation(s)
- David A Jamadar
- Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA.
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Use of transabdominal ultrasound to identify intraabdominal adhesions prior to laparoscopy: a prospective blinded study. Am J Surg 2006; 192:843-7. [PMID: 17161105 DOI: 10.1016/j.amjsurg.2006.08.055] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Revised: 08/10/2006] [Accepted: 08/10/2006] [Indexed: 10/23/2022]
Abstract
OVERVIEW The aim of the current study was to assess the accuracy of transabdominal ultrasound (TAU) in identifying intra-abdominal adhesions (IAA) prior to laparoscopy in patients with previous abdominal surgery. METHODS Patients with previous open surgical procedures presenting for laparoscopic gastric bypass (LGB) underwent TAU by 1 radiologist. Attempts were made to identify IAA using TAU. The intended trocar sites were categorized as free movement (no adhesions), chaotic movement (omental adhesions), or no movement (frozen bowel). During LGB, adhesions at the 6 trocar sites were graded by 1 blinded surgeon. RESULTS A significant degree of agreement was found between the radiologist's predictions and the intraoperative findings with regards to identification of trocar sites free of adhesions versus omental adhesions and frozen bowel. CONCLUSIONS TAU can accurately identify IAA prior to laparoscopy. Widespread application of this technique may decrease trocar-related injuries during laparoscopic procedures in patients with previous abdominal surgery.
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Mussack T, Fischer T, Ladurner R, Gangkofer A, Bensler S, Hallfeldt KK, Reiser M, Lienemann A. Cine magnetic resonance imaging vs high-resolution ultrasonography for detection of adhesions after laparoscopic and open incisional hernia repair: a matched pair pilot analysis. Surg Endosc 2005; 19:1538-43. [PMID: 16247569 DOI: 10.1007/s00464-005-0092-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2005] [Accepted: 07/06/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intraabdominal adhesions represent nonspecific complications before or after laparoscopic or open incisional hernia repair. The objective of this matched control pilot study was to display long-term adhesions noninvasively by applying functional cine magnetic resonance (MR) imaging, as compared with applying high-resolution ultrasonography (US). METHODS The study group, composed of 17 consecutive patients (12 men and 5 women; mean age, 52 years), underwent laparoscopic intraperitoneal onlay mesh repair using expanded polytetrafluoroethylene (ePTFE) mesh. Their mean body mass index was 30 kg/m(2), and the size of the hernia was 95 cm(2). Another group, matched for age, gender, and type of hernia, was subjected to open abdominal wall repair using the preperitoneal sublay technique with a large-pore, low-weight polypropylene mesh. For cine MR imaging (1.5 T), section-by-section dynamic depiction of induced visceral slide throughout the entire abdomen was achieved by applying transverse or sagittal true fast imaging with steady-state precession sequences. The location and type of adhesions were compared with high-resolution ultrasonography using nine segments of the abdominal map. RESULTS The patients subjected to laparoscopic and open incisional hernia repair were examined 16 and 28 months after surgery. The findings showed functional cine MR imaging as superior to high-resolution ultrasonography for assessing the amount of intraabdominal adhesions (n = 53 vs n = 3; p < 0.01). Most frequently, adhesions were seen between small bowel loops and the abdominal wall (n = 22), followed by bowel-to-bowel adhesions (n = 19; p < 0.05). However, adhesions between small bowel loops and the abdominal wall occurred more frequently after open mesh repair (p < 0.05). Furthermore, a strong correlation was observed between patient complaints and findings with cine MR imaging (p < 0.05). Maximum pain correlated significantly with the region of the most distinctive adhesions (p < 0.05). CONCLUSIONS Functional cine MR imaging represents a reliable noninvasive technique for detecting long-term adhesions after open and laparoscopic incisional hernia repair. The study results suggest that this approach has distinct advantages over high-resolution ultrasonography.
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Affiliation(s)
- T Mussack
- Department of Surgery Innenstadt, Klinikum der Universität München, Nussbaumstrasse 20, 80336, München, Germany.
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Kayaoglu HA, Ozkan N, Hazinedaroglu SM, Ersoy OF, Erkek AB, Koseoglu RD. Comparison of adhesive properties of five different prosthetic materials used in hernioplasty. J INVEST SURG 2005; 18:89-95. [PMID: 16036777 DOI: 10.1080/08941930590926357] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This experimental study was designed to assess and to compare intra-abdominal adhesions following the use of five commercially available prosthetic mesh grafts in the repair if abdominal wall defects. Sixty Wistar albino rats were randomly divided into six groups (n = 10). A 2 x 1 cm defect at abdominal wall was created and defects were closed either primarily or with one of the following prosthetic mesh grafts: monofilament polypropylene, polytetrafluoroethylene, sodium hyaluronate/carboxymethylcellulose-coated polypropylene, polypropylene/polyglactin 910 composite, or resorbable hydrophilic collagen-coated multifiber polyester. The severity of adhesions was graded, tensile strengths of adhesions were measured, and histopathological grades of inflammation and fibrosis were evaluated. Polypropylene mesh resulted in more adhesion formation in comparison to primary repair and other grafts used in this study, except polypropylene/polyglactin 910 composite mesh. In addition, the highest tensile strength of omental adhesions was detected in the polypropylene group (chi2 = 26.249; p = .0001). Polyester composite mesh caused the least adhesion formation among the groups. Sodium hyaluronate/carboxymethylcellulose-coated polypropylene and polyester composite meshes revealed the highest fibrosis scores (chi2 = 50.776; p = .0001). The highest inflammatory activity was detected in the polytetrafluoroethylene mesh group (chi2 = 16.564; p = .005). Thus, sodium hyaluronate/carboxymethylcellulose-coated polypropylene and polytetrafluoroethylene meshes following polyester composite mesh were the minimal adhesion-forming grafts in this study. Disadvantages of the polytetrafluoroethylene mesh were lower fibrotic activity and higher inflammatory reaction to the graft.
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Duffy AJ, Hogle NJ, LaPerle KM, Fowler DL. Comparison of two composite meshes using two fixation devices in a porcine laparoscopic ventral hernia repair model. Hernia 2005; 8:358-64. [PMID: 15290611 DOI: 10.1007/s10029-004-0258-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Laparoscopic ventral hernia repair uses tacks to secure mesh. The mesh is designed to maximize tissue ingrowth while minimizing adhesions. We hypothesized: (1) a collagen-coated polyester mesh (PCO) will form fewer adhesions than an ePTFE-polypropylene composite (BC) and (2) absorbable tacks are equivalent to metal tacks. METHODS In a porcine model of adhesion formation, three pieces of 10x15-cm mesh were placed on the anterior abdominal wall. PCO was secured with absorbable (PLA) or metal tacks (PT), BC with PT. At 28 days, adhesion formation, abdominal-wall adherence, and tissue ingrowth were analyzed. RESULTS PCO induced fewer adhesions (14.5% vs 53.4%, P = 0.007). On an adhesion scale (0 5), BC scored 3.6 vs 1.75 for PCO (P < 0.03). There was no difference in adhesion strength, tack adhesions, or abdominal-wall peel force. Histology showed equal ingrowth. CONCLUSIONS PCO induces fewer adhesions than BC. There is no difference in the ingrowth of the two mesh types. The PLA achieves equivalent mesh incorporation to the PT.
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Affiliation(s)
- A J Duffy
- Minimal Access Surgery Center Department of Surgery, Weill Medical College of Cornell University, New York, NY, USA
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Lermite E, Pessaux P, Tuech JJ, Aubé C, Arnaud JP. [Visceral adhesion after intraperitoneal ventral hernia treatment: monocentric study comparative of protected versus unprotected meshes]. ACTA ACUST UNITED AC 2005; 129:513-7. [PMID: 15556581 DOI: 10.1016/j.anchir.2004.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 09/03/2004] [Indexed: 11/21/2022]
Abstract
AIM OF THE STUDY Intraperitoneal (IP) ventral hernia repair is advantageous because of reduced dissection, shorter operative time and less postoperative pain. However, the IP positioning of the mesh is suspected to increase the risk of visceral adhesion and induce complications. To overcome these drawbacks, an innovative mesh: Parietex Composite (RC) was developed with one side protected by a hydrophilic resorbable film. The purpose of this study was to compare using ultrasonography the rate of visceral adhesions after IP placement of a conventional mesh (RP) versus RC mesh. PATIENTS AND METHODS Twenty-six patients who received a Parietex Composite were prospectively compared to a retrospective series of 26 consecutive asymptomatic patients who received a non protected polyester mesh (RP). In order to objectively assess visceral adhesion toward the abdominal wall, an ultrasound specific examination was used after previous validation by comparison of preoperative ultrasonographic data with peroperative gross appearance in both groups. RESULTS With a mean follow up of 33 months, both groups were equivalent in term of inclusion criteria excepted for age which was older the RP group. US validation data were: sensitivity 72%, accuracy 69%, negative predictive value 67%. Using this procedure, 81% of the patients exhibit visceral adhesion to the mesh in the RP group, versus 27% in the PC group (P =0.0002, chi2). CONCLUSION US examination represents a suitable tool to evaluate postoperative adhesions to the abdominal wall. A significant reduction of visceral adhesion in the RC group was shown.
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Affiliation(s)
- E Lermite
- Service de chirurgie viscérale, CHU d'Angers, 4 rue Larrey, 49100 Angers, France
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Ott V, Groebli Y, Schneider R. Late intestinal fistula formation after incisional hernia using intraperitoneal mesh. Hernia 2004; 9:103-4. [PMID: 15616763 DOI: 10.1007/s10029-004-0271-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Accepted: 07/12/2004] [Indexed: 10/26/2022]
Abstract
Enteric fistulas are a rare but serious complication following the repair of an incisional hernia using a prosthesis. We report the case of a 52-year-old man who developed an enterocolocutaneus fistula after incisional hernia repair with intra-abdominal polyester mesh. This case shows that one may want to avoid placing the parietal prostheses in direct contact with intestinal loops.
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Affiliation(s)
- V Ott
- Département de Chirurgie, Hôpital des Cadolles, Avenue des Cadolles 14, 2000 Neuchâtel, Switzerland.
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