“…In the Ventrio™ Hernia Patch, this PDO ring allows the flexible mesh to return to a flat position against the abdominal wall facilitating optimal positioning. Since the memory function is no longer necessary after the mesh is secured to the abdominal wall, the ring undergoes hydrolysis in vivo and is absorbed [29]. In effect, this decreases the amount of foreign material that remains in the abdomen over time.Fig.…”
Section: Discussionmentioning
confidence: 99%
“…The low infection rate seen likely is the result of multiple factors including surgical technique, coverage of the mesh, small incision, and selective drain placement. While drain placement in open ventral hernia repair has been associated with the development of wound infections [29], neither of the patients who developed wound infections had drains placed at the time of surgery. Other factors in these patients including obesity, smoking, and presence of significant medical comorbidities may have contributed to the development of postoperative surgical site infection.…”
PurposeComposite mesh prostheses incorporate properties of multiple materials for use in open ventral hernia repair (OVHR). This study examines clinical outcomes in patients who underwent OVHR with a polypropylene/expanded polytetrafluoroethylene (ePTFE) composite graft containing a novel polydioxanone (PDO) absorbable ring to facilitate placement and graft positioning.MethodsData were prospectively collected on consecutive patients undergoing OVHR using a synthetic composite mesh. Seven centers enrolled patients during the study period. All patients underwent a standardized surgical procedure consisting of OVHR with sublay intraperitoneal placement of mesh. Mesh fixation was accomplished with peripheral tacks and transfascial sutures.ResultsOne hundred and nineteen patients underwent OVHR with the composite mesh. Average age was 55.8 years; there were 71 (59.7 %) females and 48 (40.3 %) males with mean BMI of 33.5 ± 7.1 kg/m2. One hundred and two (85.7 %) patients presented with primary ventral hernias. Mean defect size was 13.6 cm2, and mean mesh size was 113.6 cm2. Most patients (67 %) were discharged the day of surgery. Twelve patients (10.1 %) experienced complications in the perioperative time period primarily consisting of seroma (4.2 %) and ileus (1.7 %). Two patients required reoperation and mesh removal in the early postoperative period for infection and herniorrhaphy site pain, respectively. There was a decline in pain and movement limitation scores between baseline and 1-year follow-up. Six-month (n = 109) and twelve-month (n = 99) follow-up revealed no hernia recurrences (95 % CI 0–3 %, and 0–4 %, respectively).ConclusionsThe use of this second-generation composite mesh was associated with no hernia recurrences and a low complication rate after open ventral hernia repair.
“…In the Ventrio™ Hernia Patch, this PDO ring allows the flexible mesh to return to a flat position against the abdominal wall facilitating optimal positioning. Since the memory function is no longer necessary after the mesh is secured to the abdominal wall, the ring undergoes hydrolysis in vivo and is absorbed [29]. In effect, this decreases the amount of foreign material that remains in the abdomen over time.Fig.…”
Section: Discussionmentioning
confidence: 99%
“…The low infection rate seen likely is the result of multiple factors including surgical technique, coverage of the mesh, small incision, and selective drain placement. While drain placement in open ventral hernia repair has been associated with the development of wound infections [29], neither of the patients who developed wound infections had drains placed at the time of surgery. Other factors in these patients including obesity, smoking, and presence of significant medical comorbidities may have contributed to the development of postoperative surgical site infection.…”
PurposeComposite mesh prostheses incorporate properties of multiple materials for use in open ventral hernia repair (OVHR). This study examines clinical outcomes in patients who underwent OVHR with a polypropylene/expanded polytetrafluoroethylene (ePTFE) composite graft containing a novel polydioxanone (PDO) absorbable ring to facilitate placement and graft positioning.MethodsData were prospectively collected on consecutive patients undergoing OVHR using a synthetic composite mesh. Seven centers enrolled patients during the study period. All patients underwent a standardized surgical procedure consisting of OVHR with sublay intraperitoneal placement of mesh. Mesh fixation was accomplished with peripheral tacks and transfascial sutures.ResultsOne hundred and nineteen patients underwent OVHR with the composite mesh. Average age was 55.8 years; there were 71 (59.7 %) females and 48 (40.3 %) males with mean BMI of 33.5 ± 7.1 kg/m2. One hundred and two (85.7 %) patients presented with primary ventral hernias. Mean defect size was 13.6 cm2, and mean mesh size was 113.6 cm2. Most patients (67 %) were discharged the day of surgery. Twelve patients (10.1 %) experienced complications in the perioperative time period primarily consisting of seroma (4.2 %) and ileus (1.7 %). Two patients required reoperation and mesh removal in the early postoperative period for infection and herniorrhaphy site pain, respectively. There was a decline in pain and movement limitation scores between baseline and 1-year follow-up. Six-month (n = 109) and twelve-month (n = 99) follow-up revealed no hernia recurrences (95 % CI 0–3 %, and 0–4 %, respectively).ConclusionsThe use of this second-generation composite mesh was associated with no hernia recurrences and a low complication rate after open ventral hernia repair.
“…Several studies have particularly evaluated the effect of COPD, diabetes mellitus, obesity, smoking and immunosuppression on SSO. Kaafarani et al 6 report the result of a prospective, randomized trail comparing laparoscopic versus open ventral hernia in much less complex group of patients than in our study over 85% of the patients in their study were ASA class 1, with a mean BMI of 30.9 and less than 5% were diabetics. Our study population consisted of comorbid patients with a median ASA of 3, 42% of patients being diabetic, 33% of patients being obese (Mean BMI, 31.4kg/m 2 ) and smokers.…”
Section: Discussionmentioning
confidence: 47%
“…4 The rate of wound complication is reported to be up to 27%. [5][6][7] These series represent a heterogenous group of patients without stratification of inherent risk factors for SSO, such as smoking, diabetes, immunosuppression and obesity limiting the universal application of these results. [8][9][10] The Ventral Hernia Working Group (VHWG) established a grading system for management of incisional ventral hernias and the risk of SSO.…”
BACKGROUND: The VHWG recommend synthetic mesh in Grade I, biologic mesh in Grade III and Grade IV. The use of synthetic mesh in Grade II comrbid patient is matter of consideration and debate. Our aim was to examine the outcome of synthetic mesh repair in open incisional ventral hernia repair in patients with comorbidities. METHODS: Retrospective review of all open, grade II VHR performed by single surgeon over 5 years was evaluated. RESULTS: Seventysix patients with grade II ventral hernia underwent open hernia repair with synthetic mesh during the study period. There were 40 males and 36 females in our study with mean age of 53 years (range 30-85). Comorbidities associated with these patients included obesity in 43 (56%), smoking in 25 (32%), COPD in 19 (25%), diabetes milletus in 32 (42%), and immunosuppression in 2 (2.6%). Surgical site occurrence as defined by VHWG was identified in 12 (16%) patients which included 8 (10%) surgical site infection (SSIs), 3 (4%) seroma and 1 (1%) wound dehiscence. One patient developed recurrence during the follow-up period. CONCLUSION: Synthetic macroporous mesh can be used in co morbid patients with no long term complications with recurrence of less than 1.3%. although surgical site occurrence in this cohort of patients is high (16%), they can be managed conservatively with antibiotics.
“…[1–3] Besides the reduced morbidity, postoperative pain and hospital stay duration are reduced in laparoscopic surgery and patients return to normal activities earlier. [45] Furthermore the aspect of cosmesis becomes more important in these days.…”
BACKGROUND:Numerous technical and surgical innovations took place in laparoscopic surgery in the recent past. It is debatable whether single-access surgery or natural orifice surgery (NOS) will establish for several standard procedures. Most of the NOS-procedures are controversial and single-access surgery still has to prove its equality in controlled trials. In the intention to reduce the ingress incisons and to facilitate instrumentation, we decided to test the barrier-free AirSeal®-trocar in clinical practice.MATERIALS AND METHODS:Laparoscopically we performed a cholecystectomy, gastric wedge-resection and a fundoplication using the barrier-free AirSeal® 12-mm-trocar. This trocar works without any mechanical barrier so that via this trocar the use of two instruments is possible.RESULTS:All three operations were successful.CONCLUSION:Laparoscopic standard procedures are feasible using this barrier-free trocar without a higher degree of difficulty. Because of the facilitated instrumentation, it is possible to work more efficiently and to maintain the focus on the surgical field.
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