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.

Chest wall osteochondroma resection with biologic acellular bovine dermal mesh reconstruction in pediatric hereditary multiple exostoses:A case report and review of literature

BACKGROUND Hereditary multiple exostoses is a rare genetic disorder characterized by the growth of multiple osteochondromas affecting primarily long bones.Chest wall lesions may represent a challenge,particularly in pediatric patients.Pain is a common manifestation.However,life-threatening complications can result from direct involvement of adjacent structures.Surgical resection with appropriate reconstruction is often required.CASE SUMMARY A 5-year-old male who was diagnosed with hereditary multiple exostoses presented with significant pain from a large growing chest wall exostosis lesion.After appropriate preoperative investigations,he underwent surgical resection with reconstruction of his chest wall using a biologic bovine dermal matrix mesh.CONCLUSION Resection of chest wall lesions in children represents a challenge.Preoperative planning to determine the appropriate reconstruction strategy is essential.

Use of biological meshes for abdominal wall reconstruction in highly contaminated fields

Abdominal wall defects and incisional hernias represent a challenging problem. In particular, when a synthetic mesh is applied to contaminated wounds, its removal is required in 50%-90% of cases. Biosynthetic meshes are the newest tool available to surgeons and they could have a role in ventral hernia repair in a potential-ly contaminated field. We describe the use of a sheet of bovine pericardium graft in the reconstruction of abdominal wall defect in two patients. Bovine pericardium graft was placed in the retrorectus space and secured to the anterior abdominal wall using polypropylene sutures in a tension-free manner. We experienced no evidence of recurrence at 4 and 5 years follow-up.

Mesh safety in pelvic surgery:Our experience and outcome of biological mesh used in laparoscopic ventral mesh rectopexy

BACKGROUND Laparoscopic ventral mesh rectopexy(LVMR)continues to be a popular treatment option for rectal prolapse,obstructive defecation/faecal incontinence and rectoceles.In recent years there have been concerns regarding the safety of mesh placements in the pelvis.AIM To assess the safety of the mesh and the outcome of the procedure.METHODS Eighty-six patients underwent LVMR with Permacol(Biological)mesh from 2012 to 2018 at University Hospital Wishaw.Forty were treated for obstructive defecation secondary to prolapse,rectocele or internal rectal intussusception,38 for mixed symptoms obstructive defecation and incontinence,5 for pain and bleeding secondary to full thickness prolapse and 3 with symptoms of incontinence.Questionnaires for the calculation of Wexner scores for constipation and incontinence were completed by the patients who were followed up in the clinic 12 wk after surgery and again in 6-12 mo.The average review of their notes was 18.3±4.2 mo.RESULTS The median Wexner scores for constipation pre-operatively and post-operatively were 14.5[Interquartile range(IQR):10.5-18.5]and 3(IQR:1-6),respectively,while the median Wexner score for faecal incontinence was 11(IQR:7-15)and 2(IQR:0-5),respectively(P<0.01).There were 4(4.6%)recurrences,2 cases that presented with erosion of a suture through the rectum and one with diskitis.No mesh complications or mortalities were recorded.CONCLUSION LVMR using a Permacol mesh is a safe and effective procedure for the treatment of obstructive defecation/faecal incontinence,rectal prolapse,rectoceles and internal rectal prolapse/intussusception.

Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse

External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.

Type III/Type IV Giant Para-Oesophageal Herniae: Our Technique of Gastropexy with Biological Prosthesis

Objective: To present our technique of laparoscopic repair of giant para-oesophageal hernia with biological prosthesis (porcine dermis). Method: Our technique involves creating a pneumoperitoneum with standard port placement for anti-reflux surgery, mediastinal sac dissection and excision, crura-plasty, tension free placement of the biological prosthesis for hiatal reinforcement, fundoplication and gastropexy. Conclusion: Our technique of laparoscopic repair of giant para-oesophageal hernia with biological mesh is feasible and safe with acceptable morbidity and outcome.

Application of computer tomography-based 3D reconstruction technique in hernia repair surgery

BACKGROUND Hernia is a common condition requiring abdominal surgery.The current standard treatment for hernia is tension-free repair using meshes.Globally,more than 200 new types of meshes are licensed each year.However,their clinical applications are associated with a series of complications,such as recurrence(10%-24%)and infection(0.5%-9.0%).In contrast,3D-printed meshes have significantly reduced the postoperative complications in patients.They have also shortened operating time and minimized the loss of mesh materials.In this study,we used the myopectineal orifice(MPO)data obtained from preoperative computer tomography(CT)-based 3D reconstruction for the production of 3D-printed biologic meshes.AIM To investigate the application of multislice spiral CT-based 3D reconstruction technique in 3D-printed biologic mesh for hernia repair surgery.METHODS We retrospectively analyzed 60 patients who underwent laparoscopic tension-free repair for inguinal hernia in the Department of General Surgery of the First Hospital of Shanxi Medical University from September 2019 to December 2019.This study included 30 males and 30 females,with a mean age of 40±5.6 years.Data on the MPO were obtained from preoperative CT-based 3D reconstruction as well as from real-world intraoperative measurements for all patients.Anatomic points were set for the purpose of measurement based on the definition of MPO:A:The pubic tubercle;B:Intersection of the horizontal line extending from the summit of the inferior edge of the internal oblique and transversus abdominis and the outer edge of the rectus abdominis,C:Intersection of the horizontal line extending from the summit of the inferior edge of the internal oblique and transversus abdominis and the inguinal ligament,D:Intersection of the iliopsoas muscle and the inguinal ligament,and E:Intersection of the iliopsoas muscle and the superior pubic ramus.The distance between the points was measured.All preoperative and intraoperative data were analyzed using the t test.Differences with P<0.05 were considered significant in comparative analysis.RESULTS The distance between points AB,AC,BC,DE,and AE based on preoperative and intraoperative data was 7.576±0.212 cm vs 7.573±0.266 cm,7.627±0.212 cm vs 7.627±0.212 cm,7.677±0.229 cm vs 7.567±0.786 cm,7.589±0.204 cm vs 7.512±0.21 cm,and 7.617±0.231 cm vs 7.582±0.189 cm,respectively.All differences were not statistically significant(P>0.05).CONCLUSION The use of multislice spiral CT-based 3D reconstruction technique before hernia repair surgery allows accurate measurement of data and relationships of different anatomic sites in the MPO region.This technique can provide precise data for the production of 3D-printed biologic meshes.

Mine disaster survivor’s pelvic floor hernia treated with laparoscopic surgery and a perineal approach:A case report

BACKGROUND A pelvic floor hernia is defined as a pelvic floor defect through which the intraabdominal viscera may protrude.It is an infrequent complication following abdominoperineal surgeries.This type of hernia requires surgical repair by conventional or reconstructive techniques.The main treatments could be transabdominal,transperineal or a combination.CASE SUMMARY In this article,we present the case of a recurrent perineal incisional hernia,postresection of the left side of the pelvis,testis and lower limbs resulting from a mine disaster 18 years ago.Combined laparoscopic surgery with a perineal approach was performed.The pelvic floor defect was repaired by a biological mesh and one pedicle skin flap.No signs of recurrence were indicated during the 2 years of follow-up.CONCLUSION The combination of laparoscopic surgery with a perineal approach was effective.The use of the biological mesh and pedicle skin flap to restructure the pelvic floor was effective.

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.

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.