Laparoscopic management of ventral hernia repair using intraperitoneal synthetic mesh: A 10-year retrospective observational study

Objective:Ventral hernia is an anterior abdominal wall hernia,with an incidence of 2%-13%.Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique proven to be an effective treatment option.This study aims to assess the long-term outcomes of laparoscopic management of ventral hernia repair using intraperitoneal onlay mesh(IPOM)or intraperitoneal onlay mesh with defect closure(IPOM PLUS)technique with the usage of variety of synthetic meshes intraperitoneally.Methods:A retrospective study of 821 patients of a single institution for a decade was conducted.Longterm outcomes such as pain,mesh infections,enterocutaneous fistula,bowel adhesions and recurrence were assessed.Results:There were 801 primary,12 incisional,and 8 recurrent hernia cases,including 532 females and 289 males with a mean age of 45.62±9.37 years.IPOM PLUS were underwent in 674(82.10%)cases.Polypropylene,dual,titanium,composite meshes were applied in 473(57.61%),208(25.33%),82(9.99%),and 58(7.06%)cases respectively.Intraoperative bleeding occurred in 3(0.37%)cases,seroma in 8(0.97%),wound infection in 4(0.49%),stitch abscess in 2(0.24%).Recurrence was found in 8(0.97%)cases,with 5 used polypropylene mesh and 3 used dual mesh.Mesh infections were discovered in 6(2.88%)cases used dual,and foreign body sensation in 4(0.85%)cases used polypropylene.Three(0.37%)patients had suture site hernia,and 3(0.37%)had chronic sinus.Conclusion:IPOM or IPOM PLUS holds good in small or medium sized ventral hernias.The safety and efficacy of intraperitoneal polypropylene mesh is comparable to that of other synthetic meshes.A mesh overlap of minimum 5 cm beyond defect edge is must to minimise hernia recurrence.Absorbable suture can be considered as alternative to tackers.

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.

Biomechanical Properties of Synthetic Mesh Reconstructed Glenohumeral Joint Capsule

Synthetic mesh is often used in soft tissue reconstruction after artificial prosthesis replacement for patients with proximal humeral bone tumors.We carried out biomechanical and histological tests on two amputated extremities to test the stability of the joint and the biocompatibility of the synthetic meshes.

Characteristic of involute slope modification of asymmetric spur gear

The meshing characteristic of asymmetric involute spur gear was studied, the equations of the geometric shape of the asymmetric gear for both sides were deduced, and the equations of contact ratio and the key points of contact were also obtained.Meanwhile, an involute slope modification method considering the effects of static transmission errors was proposed based on the meshing properties. The characteristic of the involute slope modification was analyzed by changing different modification parameters.The mesh stiffness and synthetic mesh stiffness of unmodified and modified asymmetric spur gears were investigated. Furthermore,the spectrums of synthetic mesh stiffness under different modification parameters were compared. Research results showed that the modification parameters influence the meshing performance of gear pairs, and the proposed modification method was feasible to improve the transmission performance of gear pairs with appropriate modification parameters.

Mesh and plane selection: a summary of options and outcomes

Abdominal wall reconstruction is a relevant and important topic not only in plastic and reconstructive surgery,but in the practice of general surgeons.The ideal anatomic location for mesh placement during the repair of ventral hernias has been debated;however,the most common anatomic locations include onlay,inlay,sublay-retromuscular,sublaypreperitoneal,and sublay-intraperitoneal techniques,as defined by the European Hernia Society.Additionally,the availability of numerous synthetic and biologic meshes on the market provides for several options for the practicing surgeon.In this review,we provide a summary of the available literature of both the ideal mesh plane and the appropriate opportunities to use both synthetic and biologic meshes.

A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse

Background:It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time.The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse(POP)over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.Methods:A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1,2004 and September 30,2018 were included from 22 tertiary academic medical centers.The data were reported voluntarily and obtained from a database.We compared the proportion of each procedure in the 7 years before and 7 years after September 30,2011.The data were analyzed by performing Z test(one-sided).Results:The number of different procedures during October 1,2011-September 30,2018 was more than twice that during October 1,2004-September 30,2011.Regarding pelvic floor surgeries related to POP,the rate of synthetic mesh procedures increased from 38.1%(5298/13,906)during October 1,2004-September 30,2011 to 46.0%(14,107/30,688)during October 1,2011-September 30,2018,whereas the rate of non-mesh procedures decreased from 61.9%(8608/13,906)to 54.0%(16,581/30,688)(Z=15.53,P<0.001).Regarding synthetic mesh surgeries related to POP,the rates of transvaginal placement of surgical mesh(TVM)procedures decreased from 94.1%(4983/5298)to 82.2%(11,603/14,107)(Z=20.79,P<0.001),but the rate of laparoscopic sacrocolpopexy(LSC)procedures increased from 5.9%(315/5298)to 17.8%(2504/14,107).Conclusions:The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly.The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.Trial registration number:NCT03620565,https://register.clinicaltrials.gov.

Parastomal hernia repair

Despite significant advances in abdominal wall reconstruction,parastomal hernias remain a complex problem,with a high risk of recurrence following repair.While a number of surgical hernia repair techniques have been proposed,there is no consensus on optimal management.Several clinical variables must be considered when developing a comprehensive repair plan that minimizes the likelihood of hernia recurrence and surgical site occurrences.In this review,we describe the incidence of parastomal hernias and discuss pertinent risk factors,medical history findings,physical examination findings,supplementary diagnostic modalities,parastomal hernia classification systems,surgical indications,and repair techniques.Special consideration is given to the discussion of mesh reinforcement,including available biomaterials,anatomic plane selection,and the extent of mesh reinforcement.Although open repairs are the primary focus of this article,minimally invasive laparoscopic and robotic approaches are also briefly described.It is our hope that the provided surgical outcome data will help guide surgical management and optimize outcomes for affected patients.