Synthetic vs biologic mesh for the repair and prevention of parastomal hernia

AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrence, wound and mesh infection, other complications, surgical techniques and mortality. Weighted pooled proportions （95%CI） were calculated using StatsDirect. Heterogeneity concerning outcome mea-sures was determined using Cochran’s Q test and was quantifed using I2. Random and fxed effects models were used. Meta-analysis was performed with Review Manager software with the statistical signifcance set at P ≤ 0.05.RESULTSForty-four studies were included： 5 reporting biologic mesh repairs; 21, synthetic mesh repairs; and 18, prophylactic mesh repairs. Most of the studies were retrospective cohorts of low to moderate quality. The hernia recurrence rate was higher after undergoing biologic compared to synthetic mesh repair （24.0% vs 15.1%, P = 0.01）. No significant difference was found concerning wound and mesh infection （5.6% vs 2.8%; 0% vs 3.1%）. Open and laparoscopic techniques were comparable regarding recurrences and infections. Prophylactic mesh placement reduced the occurrence of a parastomal hernia （OR = 0.20, P 〈 0.0006） without increasing wound infection [7.8% vs 8.2% （OR = 1.04, P = 0.91）] and without differences between the mesh types.

Mesh repair of sacrococcygeal hernia via a combined laparoscopic and sacrococcygeal approach: A case report

BACKGROUND Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair via a combined laparoscopic and sacrococcygeal approach that has not been described,and discuss our experience in diagnosis and treatment with a review of the literature.CASE SUMMARY A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.CONCLUSION Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.

Delayed Mesh Infection: A Rare Complication of Laparoscopic Inguinal Hernia Repair (TEP—Totally Extra-Peritoneal Repair)

Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, posed a new set of postoperative problems with the mesh infection being the most morbid one. Laparoscopic surgery has been able to reduce the incidence of mesh infection as opposed to the open hernia repairs. The infection occurs mostly early but rarely does it present several years after the surgery. Herein we report our case of delayed mesh infection developing 6 years postoperatively. This is our first such case in a series of more than 1000 laparoscopic hernia repairs over a period of 6 years (2010-2016). The patient needed an open exploration which revealed a large preperitoneal cavity containing 770 ml of pus with a mesh floating in it. The mesh was removed and the thorough toileting of the wound was done.

High Scalp Tension after Three-Dimensional Titanium Mesh Repair for Skull Defect: 2 Case Reports

Rationale: The three-dimensional (3D) computer-made titanium mesh is widely used in the skull repair for those patients receiving decompression of the bone flap. It can restore normal anatomy to a greater extent and make a better appearance. Case Presentation: We reported two cases of patients admitted to our hospital who have experienced high scalp tension after skull repair. At first, these two patients underwent decompression of the bone flap, and the physical examination results showed a defect of skull. No neurological symptoms and signs were found. The 3D computed tomography (CT) reconstruction of skull was performed, and then the skull repair with 3D titanium mesh was conducted. But because of high scalp tension, they underwent a second operation, during which we re-trimmed and reduce the arc of the titanium mesh. The scalp incision of both patients healed well and no titanium mesh was exposed. Both patients have a good prognosis. Lessons: We highlight that the high tension of scalp due to overstretching after 3D titanium mesh repair for skull defect should be paid much attention to. Trimming and reducing the arc of titanium mesh is an effective treatment for this situation.

Mesh migration into the sigmoid colon after inguinal hernia repair presenting as a colonic polyp:A case report and review of literature

Mesh migration and penetration into abdominal visce-ra rarely occur after laparoscopic inguinal hernia repair. We present the first case of mesh migration into the sigmoid colon identified as a colonic polyp at initial co-lonoscopic examination. The patient complained of mild abdominal distention in the lower abdomen over the previous year without changes in bowel habits or stool appearance and without weight loss. By complement-ary endoscopic ultrasonography, a cavity--like structure beneath the suspected polyp was further confirmed. Enhanced abdominal computed tomography merely re-vealed local bowel wall thickening and inflammation of the colosigmoid junction. The migrating mesh, which was lodged in the sigmoid colon and caused intra--abdomi-nal adhesion in the lower abdominal cavity, was finally identified via exploratory surgery. The components of inflammatory granulation tissue around the mesh mate-rial were diagnosed based on histological examination of the surgical specimen after sigmoidectomy. In this patient, nonspecific endoscopic and imaging outcomes during clinical work--up led to the diagnostic dilemma of mesh migration. Therefore, the clinical, radiological and endoscopic challenges specific to this case as well as the underlying reasons for mesh migration are discussed in detail.

Cost effective use of mosquito net mesh in inguinal hernia repair

Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery,divided into the polypropylene mesh(PPM)group and the mosquito net mesh(MNM)group each containing fifty patients.All cases were completed successfully and results revealed no difference in two groups.The results of the present study,in consistent with the published literature,reveal that the cheap indigenous mosquito mesh,which has similar properties of an imported mesh,can be safely used for tension-free inguinal hernia repair in adults.Further trials with a larger number of patients and longer follow-ups are justified and recommended.

Transabdominal Pre-Peritoneal Mesh for Inguinal Hernia Repair with External Fixation versus Mesh Stapling

Background: It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, and port-site hernia. We chose to fix it to the exterior reducing port size, cost and pain, at the same comparing this with traditional mesh stapling. Methods: We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 120 patients in which we fixed the mesh to the anterior abdominal wall using either two prolene threads that passed to the exterior and tied in place or traditional mesh stapling. Results: The operative time is ranged from 35 to 70 minutes for external fixation, 30 to 60 minutes for mesh stapling, and 4 to 51 months for follow-up, and no recurrence occurred in both groups during the procedure. Two cases with post TAPP pain in mesh stapling patients are discussed with reduction of the cost and port size in external fixation patients. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior and it is fixed only to the exterior allowing a reduction in size of the ports and considerable reduction in cost with elimination of TAPP associated post operative pain.

A Long-term Follow-up: Suture versus Mesh Repair for Adult Umbilical Hernia in Saudi Patients. A Single Center Prospective Study

Objective: To report results of mesh repair vs. the modified Mayo’s suture overlap in the surgical treatment of adult umbilical and paraumbilcal hernias in our medical center. Patients & Methods: The study is a Saudi single center single surgeon trial composed of sixty two patients. It was performed in the Surgical Department of King Abdul-Aziz University Hospital at Jeddah. The patients were randomly assigned into 2 groups. Group A patients underwent onlay mesh repair while modified Mayo’s repair was used in group B patients. Median follow-up was 28 months, and data were collected regarding size of hernia, type of the operation, complications, length of follow-up and the recurrence rate. Chi square test was used to compare results at 0.05 levels. Results: Complication was reported in 17% in group A and 8% in group B .There was no difference in scar pain, cosmetic result, and overall patient satisfaction between both groups. The recurrence rate was 10% for mesh repair and 18.8% for suture repair. Conclusions: Despite higher complication rate, mesh repair is superior to suture repair due to lower recurrence rate. Suture repair still has a place under certain circumstances, also it is simple less costly and has insignificant infection rate.

Laparoscopic Inguinal Hernia Repair with Closure of Hernial Defect and Central Mesh Fixation Using Glubran 2

Background: Laparoscopic tension-free repair of inguinal hernia was presented in 1990s, promising less pain and short recovery period, but carrying the risk mesh bulging and migration. Objective: We have presented our technique in which central zone of mesh is fixed only after closure of hernial defect. Patients and Methods: This study included 27 males patients (14 indirect inguinal hernias, 9 direct inguinal hernias, 4 both direct and indirect inguinal hernias on the same side). These cases are undergoing tension-free mesh repair after closure of hernial defect, and the mesh is fixed only at its central zone using Gulbran 2, between April 2011 and March 2013. The follow-up period ranged from 6 to 30 months. The intra and postoperative complications were recorded. Results: Mean hospital stay was 1 day. The age of this group of patients ranged from 23 to 63 years (mean, 47 years). The operative time ranged from 30 to 100 minutes (mean, 45 minutes). The intraoperative complications were in form of mild bleeding in 7 patients (25.9%) during hernial sac dissection. Postoperative complications were mild inguinal pain in 4 patients (14.8%) for three weeks. Mild hydrocele in 3 patients (11%) was recorded. No recurrence or bulging at hernia site was noticed during the period of follow-up. Conclusion: Laparoscopic inguinal hernia repair with central mesh fixation after closure of hernial defect is effective, easy and free of complications.

Novel Technique Combining Tissue and Mesh Repair for Umbilical Hernia in Adults

Introduction: Umbilical hernia in adults poses a challenge to the surgeon. Understanding the anatomical and pathological intricacies of the hernia is pivotal in evolving a good repair. A multitude of repairs have been tried for repair of umbilical hernias. However none of them have withstood the test of time. Objective: The study aims at evolving a technique which provides mesh reinforced anatomical reconstruction of the defect. Materials and Methods: 20 patients underwent a combination repair for umbilical hernia. The results were tabulated and analysed. Results: None of the 20 patients developed any recurrence. Conclusion: A combined mesh reinforcement of tissue repair is advocated for umbilical hernias in adults.

Intestinal erosion caused by meshoma displacement:A case report

BACKGROUND A meshoma formation and erosion to the small intestine is rare.Herein,we report one case of a meshoma that was not treated early;causing it to displace and erode the small intestine,with infection,complete control of symptoms was achieved after removal of the infected patch mass,no recurrence of hernia after 2 years of follow-up.CASE SUMMARY A 62-year-old male patient presented with recurrent abdominal pain repeatedly for 1 wk,which has worsened 2 d before admition,accompanied by fever.Five years before presentation he underwent right inguinal hernia Plug and patch repair approach.Two years ago,a computed tomography scan revealed a right lower abdominal mass with soft tissue density,measuring approximately 30 mm×17 mm,which was diagnosed as meshoma that was not treated.The patient had poorly controlled diabetes in the past year.CONCLUSION The formation of meshoma is rare,and that if not treated in time it might erode and require resection of the involved organ.

Algorithms for mesh repairing to represent automobile parts

In representing automobile parts with mesh in the field of reverse engineering or finite element generation, the mesh reconstruction and data exchanging between different CAD/CAM systems often introduce many invisible topological and geometrical errors into mesh. These artifacts can cause serious problems in subsequent operations such as finite element analysis, reverse engineering, animation, and simulation. In this study we propose a practical method for repairing topological and geometrical errors on mesh. First, coincident vertices during mesh input are removed, fol- lowed by the identification of non-manifold vertices and edges. The non-manifold vertices are modified, and the facets having non-manifold edges are removed. Finally, faces that have the wrong orientations in the mesh are re-oriented. Experiments show that our methods can eliminate most common mesh errors quickly and effectively. The refined mesh can be properly used in subsequent operations.

Repair of infectious scalp defects with titanium mesh exposure by scalp rotation flap

Objective To explore the application of scalp rotation flap in reconstruction of infectious scalp defect with titanium mesh exposure. Methods Twelve patients were treated in this group including 4 males and 8 female. S The defective size ranged from 2. 0 cm × 5. 0 cm to 0.

A Technique of Bilateral Inguinal Hernia Repair Using 10 mm Single Port Access and Bioresorbable Composite Mesh Fixed with Endoclose Sutures: Three Cases Reported

Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in 3 cases of bilateral inguinal hernia. Methods: Laparoscopic SPA-IPOM is done through a 10 mm trocar with one 10 mm instrument that has 5 mm optical lens and 5 mm channel for grasper. After inserting 10 mm trocar at umbilicus using semi-open technique, intraperitoneal anatomical landmark of inguinal her-nia is identified. A 10 × 15 cm pre-tied bioresorbable composite mesh is then placed to cover hernia defect and all three potential area of indirect, direct and femoral hernia. Using Endoclose? needle, each pair of pre-tied sutures is retrieved percutaneously through a needle wound and extracorporeal tied with knot in subcutaneous space. After the upper half of mesh is sutured to the posterior surface of abdominal wall, the lower half of mesh is fixed by hernia tacker to Symphysis Pubis, Cooper Ligament and Iliopubic tract. Re-sults: Three men, average 48 year olds were operated by laparoscopic 10 mm SPA-IPOM for bilateral in-guinal hernia repair using bioresorbable composite mesh. Average operative time was 36 minutes. No imme-diate complication. All patients were discharge on the 2nd post-operative day and average 6 months follow up has no recurrence. Conclusions: Laparoscopic SPA-IPOM is an optional operation and is much easier to be performed. Benefits include operative time saving, cosmesis, early discharge and early return to work. Bio-resorbable composite mesh prevents bowel adhesion, however, is much more expensive. Long term follow up study for complications and recurrence is needed.

鲁棒的水密流形网格修复

针对未经修复的网格模型一般存在非流形结构,常带有孔洞、法向不一致、自交等缺陷,很难直接应用到后续基于网格的应用中的问题,提出一种保持输入网格特征的鲁棒水密流形网格修复算法.首先利用Manifoldplus算法和卷绕数(winding number)构建能够区分输入网格内外且逼近输入网格的水密流形引导曲面;然后利用引导曲面计算受限Voronoi图(restricted Voronoi diagram,RVD);再通过对偶得到受限三角剖分(restricted Delaunay triangulation,RDT);将非流形问题分解到RVD和RDT计算过程中,保证计算的RDT即为修复后的水密流形网格;最后在原始网格边中添加辅助点,保持原始网格特征.基于Windows 10平台,在ModelNet10公开数据集上进行实验的结果表明,所提算法在输出网格的平均精度为1.54×10^(-6),与Manifoldplus算法相当;但是当输入的模型包含孔洞时,Manifoldplus算法无法将孔洞合理地填补,而该算法能够合理地填补孔洞.

一种基于单接口多信道无线Mesh网路由协议改进

在无线Mesh网中,MCRP是一种单收发器多信道路由协议;通过对该协议的分析,针对协议中存在的缺陷,即在链路断开后触发链路修复或链路发现造成的较大网络开销,引入一种阀值估算算法对其进行改进,提出了一种基于链路预测的路由协议PRE-MCRP;并由NS2仿真实验证明,与标准的MCRP协议和AODV协议相比较,PRE-MCRP协议不仅有效地降低了控制开销和端到端的传输时延,而且增加了数据包的投递率,改善了网络性能。

腹腔镜疝修补术中补片固定方式的应用现状及研究进展

手术是治愈腹股沟疝的唯一手段。应用补片的疝修补术是当今标准腹股沟疝修补术,近年来随着微创技术的高速发展,大多倾向于腹腔镜下进行。随着该术式的广泛开展,诸如复发、疼痛、血清肿等一系列问题也日渐凸显。其中,补片固定方式的选择与应用与其密切相关,并在一定程度上决定疝修补的成败。本文对腹腔镜疝修补术中补片固定方式的应用现状进行综述。

自制负压封闭引流装置联合扩张头皮皮瓣修复钛网外露创面一例

目的探讨自制负压封闭引流装置联合扩张头皮皮瓣修复钛网外露创面的可行性。方法对颅骨修复术后钛网外露、钛网下窦道存在患者采用自制负压封闭引流装置培养肉芽肿组织,至创面感染控制后,行钛网外头皮皮瓣扩张术。待钛网下肉芽完全生长填塞,钛网外扩张皮瓣达到能够无张力覆盖钛网创面,再行扩张头皮皮瓣移植覆盖钛网创面,创面外VSD持续负压吸引,观察皮瓣存活情况,皮瓣张力以及切口恢复情况。结果术后扩张皮瓣完全无张力覆盖钛网创面,皮瓣无缺血淤血,皮瓣切口无明显张力,皮瓣存活良好。结论自制负压封闭引流装置联合扩张头皮皮瓣修复钛网外露创面效果较好,继续扩展病例数量,观察疗效,如能继续保持较好疗效,临床可以考虑推广使用。

颅骨缺损钛网修补术后钛网外露的整形外科处理策略

目的探讨颅脑外伤或肿瘤等颅骨缺损患者行颅骨钛网修补术后钛网外露的治疗策略选择及对应疗效分析。方法回顾性分析2011年3月至2023年10月空军军医大学西京医院整形外科收治的65例颅骨缺损修补术后钛网外露患者的临床资料。根据患者外露创面感染程度、外露发生时长、外露面积大小、局部分泌物及培养情况、患者本身存在的危险因素等,个体化决定是否保留钛网或去除钛网。若存在明显的大范围外露及周边区感染,则去除钛网并清除感染病灶,覆盖创面后待Ⅱ期再次行颅骨修补。以患者术后钛网外露区伤口愈合情况作为疗效指标。患者于出院后1、3、6、12个月分别进行门诊复诊,随访伤口愈合、外观修复、生活质量情况。结果65例患者中,53例(81.5%)患者植入物外露同时伴有明显感染。6例局部感染的钛网修补患者通过非手术治疗最终痊愈,59例行手术治疗。手术患者中,12例患者通过局部旋转头皮瓣成功保住了钛网,47例去除了钛网并行皮瓣覆盖缺损创面,其中11例在术后12个月随访时,再次进行了钛网修补颅骨缺损;所有患者伤口愈合良好,生活质量无影响。结论颅骨缺损钛网修补术后钛网外露常伴随感染发生,彻底的清创换药是愈合的基础。仅伤口轻微感染的患者可以考虑保留钛网的非手术治疗;对于外露区小范围感染的患者可以选择彻底清创后局部皮瓣转移覆盖创面以保留原有钛网,或剪除局部钛网,保留大部分钛网。而对于明显的大范围外露及合并严重感染者,则必须完整拆除钛网并行皮瓣覆盖创面,远期可再次行颅骨缺损修补。经个体化治疗,患者伤口愈合良好,且不影响生活质量。

三种不同腹股沟疝手术修补方案的临床有效性及安全性分析

目的 比较平片无张力疝修补术(Lichtenstein)、疝环充填式疝修补术(Rutkow)、腹膜前修补术(Kugel)三种修补方案治疗腹股沟疝的疗效及安全性。方法 60例成人腹股沟疝患者,根据修补方案的不同分为Lichtenstein组、Rutkow组、Kugel组,各20例。比较三组临床指标(手术时间、术后下床时间、住院时间)、术后早期并发症发生情况、术后不同时间疼痛程度及随访2年的术后复发率、异物感。结果 Lichtenstein组、Rutkow组、Kugel组手术时间分别为(65.2±10.3)、(58.6±9.5)、(72.1±11.2)min,术后下床时间分别为(12.8±3.1)、(10.4±2.6)、(14.2±3.5)h,住院时间分别为(5.6±1.2)、(4.9±1.0)、(6.2±1.4)d,三组比较有显著差异(P<0.05)。Kugel组术后早期并发症发生率5.00%略低于Lichtenstein组的10.00%和Rutkow组的10.00%,但并无显著差异(P>0.05)。术后1 d, Lichtenstein组、Rutkow组、Kugel组视觉模拟评分法(VAS)评分分别为(4.13±1.02)、(4.22±1.33)、(3.91±1.40)分,比较无显著差异(P>0.05)。术后1个月, Lichtenstein组、Kugel组VAS评分分别为(2.31±0.41)、(2.26±0.57)分,均低于Rutkow组的(3.16±0.92)分;术后6个月, Lichtenstein组、Kugel组VAS评分分别为(1.02±0.97)、(0.97±0.82)分,均低于Rutkow组的(1.91±1.55)分,有显著差异(P<0.05)。在术后2年的随访中,三组复发率比较,无显著差异(P>0.05);但Rutkow组的异物感占比60.00%明显高于Lichtenstein组的5.0%和Kugel组的10.0%,有显著差异(P<0.05)。结论 Lichtenstein、Rutkow、Kugel治疗腹股沟疝的疗效及并发症几乎接近,宜根据不同病例采用不同方案。