Mesh versus non-mesh for inguinal and femoral hernia repair

Lockhart, Kathleen; Teo, Edward; Teo, Shawn; Dhillon, Manvinder; Driel, Mieke van

doi:10.1002/14651858.cd011517.pub2

Cited by 93 publications

(84 citation statements)

References 72 publications

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“…On one hand, compared to nonmesh repairs, mesh repairs reduce the rate of hernia recurrence and involve a shorter operation time and faster return to normal activities. On the other hand, testicular complications probably occur slightly more often in mesh repairs and show nearly equivocal results 12 .…”

Section: ■ Discussionmentioning

confidence: 99%

Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats

Damous

Miranda³

et al. 2020

Acta Cir. Bras.

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Section: ■ Discussionmentioning

confidence: 99%

Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats

Damous

Miranda³

et al. 2020

Acta Cir. Bras.

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“…For example, Mitura et al showed that there are anatomical differences in the inguinal region between Africans and Caucasians and that therefore pure tissue repairs could be promising, especially for African patients [24]. A recent Cochrane analysis also recommends mesh-free methods for LICs [25].…”

Section: Discussionmentioning

confidence: 99%

Alterations in the mechanical, chemical and biocompatibility properties of low-cost polyethylene and polyester meshes after steam sterilization

Wiessner¹,

Lorenz²,

Gehring³

et al. 2020

Hernia

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Introduction In Africa and other Low Resource Settings (LRS), the guideline-based and thus in most cases mesh-based treatment of inguinal hernias is only feasible to a very limited extent. This has led to an increased use of low cost meshes (LCMs, mostly mosquito meshes) for patients in LRS. Most of the LCMs used are made of polyethylene or polyester, which must be sterilized before use. The aim of our investigations was to determine changes in the biocompatibility of fibroblasts as well as mechanical and chemical properties of LCMs after steam sterilization. Material and methods Two large-pored LCMs made of polyester and polyethylene in a size of 11 x 6 cm were cut and steam sterilized at 100, 121 and 134 °C. These probes and non-sterile meshes were then subjected to mechanical tensile tests in vertical and horizontal tension, chemical analyses and biocompatibility tests with human fibroblasts. All meshes were examined by stereomicroscopy, scanning electron microscopy (SEM), LDH (cytotoxicity) measurement, viability testing, pH, lactate and glycolysis determination. Results Even macroscopically, polyethylene LCMs showed massive shrinkage after steam sterilization, especially at 121 and 134 °C. While polyester meshes showed no significant changes after sterilization with regard to deformation and damage as well as tensile force and stiffness, only the unsterile polyethylene mesh and the mesh sterilized at 100 °C could be tested mechanically due to the shrinkage of the other specimen. For these meshes the tensile forces were about four times higher than for polyester LCMs. Chemical analysis showed that the typical melting point of polyester LCMs was between 254 and 269 °C. Contrary to the specifications, the polyethylene LCM did not consist of low-density polyethylene, but rather high-density polyethylene and therefore had a melting point of 137 °C, so that the marked shrinkage described above occurred. Stereomicroscopy confirmed the shrinkage of polyethylene LCMs already after sterilization at 100 °C in contrast to polyester LCMs. Surprisingly, cytotoxicity (LDH measurement) was lowest for both non-sterile LCMs, while polyethylene LCMs sterilized at 100 and 121 °C in particular showed a significant increase in cytotoxicity 48 hours after incubation with fibroblasts. Glucose metabolism showed no significant changes between sterile and non-sterile polyethylene and polyester LCMs. Conclusion The process of steam sterilization significantly alters mechanical and structural properties of synthetic hernia mesh implants. Our findings do not support a use of low-cost meshes because of their unpredictable properties after steam sterilization.

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“…Многолетнее использование сетчатых протезов не выя-вило доказательств канцерогенного потенциала грыжевых сеток [90]. Вместе с тем, использование протезирующих технологий в 2-4% осложняется развитием хирургической раневой инфекции и в 15% -хроническими болями [91][92][93][94][95]. Видеоэндоскопические операции сократили сроки пребывания больных в стационаре до суток.…”

Section: обзорные статьи Vol 4 № 3 2019 ®unclassified

Groin hernias: causes, diagnostics, and surgery

Подолужный¹,

Лесников²,

Шабалина³

2019

Fundamentalʹnaâ i kliničeskaâ medicina

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Groin hernias occur in 27–48% of men and 3–6% of women during lifetime. Among the causes are inherited or age-related connective tissue or muscular dysplasia, lack of diverticular obliteration in fetal parietal peritoneum, pre-peritoneal lipomas migrating into the hernia ring, and congenital, postpartum, or postoperation dilation of the femoral ring. Physical examination and examination of the preperitoneal space reveals hernia in 93% and 100%, respectively, yet ultrasound examination, computed tomographic peritoneography, magnetic resonance imaging are also employed to confirm the diagnosis. An established technique for the treatment of groin hernias includes opening the inguinal canal, high ligation of the hernia sac, and repair of the inguinal canal, altogether termed herniorrhaphy. Suprapubic or inguinal incision permits closure of the hernia sac without involving the inguinal canal (herniotomy). Implementation of synthetic meshes led to the increase in hernioplasty, i.e. reinforcement of the inguinal canal upon the inguinal canal repair. Laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) hernioplasty became widely used along with the development of endoscopic surgery. In these techniques, mesh is placed between the peritoneum and transversalis fascia, closing both inguinal canal and femoral ring. Overall, modern surgical techniques reduced the time of treatment, disability and disease recurrence to 1.4–2%.

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Mesh versus non-mesh for inguinal and femoral hernia repair

Cited by 93 publications

References 72 publications

Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats

Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats

Alterations in the mechanical, chemical and biocompatibility properties of low-cost polyethylene and polyester meshes after steam sterilization

Groin hernias: causes, diagnostics, and surgery

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