Early imaging of integration response to polypropylene mesh in abdominal Wall by environmental scanning electron microscopy: Comparison of two placement techniques and correlation with tensiometric studies

Ferrando, José M.; Vidal, José Luis; Armengol, Manel; Huguet, Pedro; Gil, Javier; Manero, J. M.; Planell, J. A.; Segarra, Alfonso; Schwartz, Simón; Arbós, M.A.

doi:10.1007/s00268-001-0038-z

Cited by 24 publications

(16 citation statements)

References 18 publications

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“…1 It is estimated that 2 to 10% of all abdominal operations result in an incisional hernia. 2 Small hernias less than 2½cm in diameter are often successfully closed with primary tissue repairs. 3 However, larger ones (more than 2½cm) have a recurrence rate of up to 30-40% when a tissue repair alone is performed.…”

Section: Discussionmentioning

confidence: 99%

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Onlay versus sublay mesh repair for ventral hernia

Muralidhar

Shetty

et al. 2018

Int Surg J

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Background: Ventral hernia repair is one of the most common surgical operations performed all over the world. Onlay and sublay mesh repairs are the commonly performed techniques for the same. However, the debate still continues about the superiority of both techniques over each other. The aim of this study was to compare the outcome of the onlay versus sublay mesh repair for ventral hernia.Methods: A total of 100 patients with paraumbilical, epigastric, supraumbilical and incisional hernias (with defect size ≤4 inches) were divided into main two groups; A: onlay mesh repair and B: sublay mesh repair. Patients with uncontrolled diabetes and recurrent ventral hernia were excluded. Randomization was done using computer generated software. Patients were evaluated for operating time, postoperative seroma formation, wound infection, drain duration, post-op hospital stay and recurrence of symptoms. Ethical approval for this study was granted by the ethical review committee of Mysore Medical College, Mysore, Karnataka, India.Results: The incidence of post-operative seroma and wound infection was 6.52% and 4.35% in sublay group compared to 21.30% and 19.20% in onlay group which was statistically significant (p<0.05). Mean operating time was found to be more in sublay group than onlay group which was also statistically significant (72.3+9.23 vs. 65.25+10.58 minutes, p<0.05). Mean drainage duration (4.22+0.99 days vs. 5.97+1.24 days) and post-op hospital stay (4.8+1.51 days vs. 6.68+1.46 days) was low in sublay group compared to onlay group which was statistically significant (p<0.05). Recurrence in sublay group was 4.35% compared to 8.51% in onlay group which was not statistically significant (p>0.05).Conclusions: Even though operating time is longer, placement of mesh in sublay position is a better option than onlay placement in open ventral hernia repair because of lower complication rate and post-op morbidity.

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Section: Discussionmentioning

confidence: 99%

“…1 The estimated incidence of ventral hernias is 15-20%. 2 Despite the frequency of surgical repair, "Perfect results" continue to elude surgeons and the rate of surgical failure is humbling (10-30%). 3 True recurrence rates are probably underestimated.…”

Section: Introductionmentioning

confidence: 99%

Onlay versus sublay mesh repair for ventral hernia

Muralidhar

Shetty

et al. 2018

Int Surg J

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“…This is often related to the use of native tissues, which are believed to be deficient to start off [3]. In analogy to inguinal hernia repair, implants are used to reinforce the fascial defect [4,5]. The most widely used are synthetic macroporous polypropylene implants, which induce a strong chronic host response, contributing to the occurrence of undesired side effects such as intestinal adhesions, erosions, fibrosis and fistula formation.…”

Section: Introductionmentioning

confidence: 99%

Tensile strength and host response towards different polypropylene implant materials used for augmentation of fascial repair in a rat model

et al. 2006

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We compared inflammatory response, fibrosis and biomechanical properties of different polypropylene materials from one manufacturer (Tyco Healthcare) in a rat model for primary fascial repair. Full-thickness abdominal wall defects were primarily repaired using 'overlay' technique. Multifilament implants were Surgipro SPM and SPMW, the latter a wider-weave type of the former. Monofilament SPMM implants and polypropylene suture repair (Surgipro II) served as controls. Explants were evaluated macroscopically and changes in thickness, shrinkage and tensile strength were measured. Inflammatory and connective tissue response was assessed on haematoxylin-eosin and Movat stains. Immunohistochemistry was done to localise rat macrophages/monocytes. Multifilament materials induced a shorter acute inflammatory response and more pronounced chronic inflammatory reaction compared to monofilament implants. Macrophages could be found deep in interstices 7.5 by 12.5 microm. No difference in collagen deposition and neovascularisation was observed. At 90 days time point, explants reconstructed with tighter woven multifilament SPM were weaker than sutured or SPMM controls. Overall shrinkage of 10% was comparable for all groups.

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“…[5] Some studies show that meshes implanted on the abdominal aponeurotic layer showed better and early incorporation and increased tensile strength reflecting tighter anchorage to the abdominal wall. [6] Rives developed the sublay technique and reported good results with recurrence of 3. 4% and acceptable morbidity.…”

Section: Discussionmentioning

confidence: 99%

Incisional Hernia - Onlay vs Sublay Mesh Hernioplasty

A¹,

L²,

Vijayalaxmi³

et al. 2015

jemds

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BACKGROUND:Incisional hernia is a common surgical problem. Anatomical repair of hernia is now out of vogue. Polypropylene mesh repair has now become accepted. In open mesh repair of incisional hernia cases the site of placement of mesh is still debated. Some surgeons favour the onlay repair and others use sublay or retro-rectus plane for deployment of the mesh. AIM: The aim of the study is to examine the pros and cons of both the techniques and find the better one. METHODS: A prospective study was conducted of 37 cases of incisional hernia admitted in Govt. General Hospital Guntur from Jan 2012 to Dec 2013. 20 of the cases underwent open mesh repair by onlay method whereas 17 cases underwent open mesh repair by the sublay i.e. retrorectus placement of the mesh. Observations were made regarding time taken for both types of repairs, post-operative complications like flap necrosis, wound seroma, wound infecton, postoperative ileus etc., after discharge from the hospital the cases were followed up in the OPD upto Dec. 2014 and any complications and recurrences were noted. OBSERVATIONS AND RESULTS: Most of the cases (75%) were female and the incisional hernias were in the lower abdomen. The time taken for the surgery is more in the sublay group and the postoperative pain score is also more in the sublay group. But the wound complications like wound infection and flap necrosis were more (25-30%) in the onlay group. Also one case (5%) developed recurrence. Though the time taken for the surgery and the skill needed is more for the sublay group the wound complications are acceptable in the sublay group. Also there are no recurrences observed in the sublay group. But no statistically significant difference (p<0.7) is detected when all the post-operative complications are taken together between the sublay and onlay repair techniques. CONCLUSIONS: Although it can be argued, theoretically and by the wound complication rate, in favour of sublay placement of the mesh, still the quest continues for the ideal technique of hernia repair in the Indian scenario. A well-constructed randomised clinical trial is needed to find the best method of incisional hernia repair.

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Early imaging of integration response to polypropylene mesh in abdominal Wall by environmental scanning electron microscopy: Comparison of two placement techniques and correlation with tensiometric studies

Cited by 24 publications

References 18 publications

Onlay versus sublay mesh repair for ventral hernia

Onlay versus sublay mesh repair for ventral hernia

Tensile strength and host response towards different polypropylene implant materials used for augmentation of fascial repair in a rat model

Incisional Hernia - Onlay vs Sublay Mesh Hernioplasty

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