Regeneration of Abdominal Wall Aponeurosis: New Dimension in Marlex Peritoneal Sandwich Repair of Incisional Hernia

Abstract

Loss of abdominal wall substance is a major cause of incisional hernia formation. It makes repair of this iatrogenic human ailment a difficult surgical problem. The abdominal wall substance loss has compelled the world's surgical community dealing with this condition to substantiate the repair with extra material such as skin, fascia, wire mesh, and lately biocompatible synthetic mesh. Even though the synthetic mesh is compatible and well tolerated by body tissues, it is not without complications. Regenerative repair in the region of the abdominal wall with substance loss is probably the best repair if it can be achieved. With reasonable success in animal experiments and the positive regenerative capacity of stem cells to transform the peritoneum into an aponeurotic layer, the new technique using a Marlex peritoneal sandwich for repair of large incisional hernias was attempted but was not reported in the article published in the World Journal of Surgery in 1991. The present study is based on experiments on seven mongrel dogs. A suitable embryonal segment of autogenous peritoneum was excised and transferred to the rectus sheath region. The gross appearance of the grafted membrane 3 months after operation revealed tough, thick tissue formation. The histology confirmed the presence of collagen fiber tissue in layers similar to the aponeurosis in the grafted peritoneal membrane. The use of this regeneration in the Marlex peritoneal sandwich technique of repair of large incisional hernias and the scientific rationale of tissue regeneration by desired metaplasia is discussed.

Análise das aderências resultantes da fixação de telas cirúrgicas com selantes de fibrina e sutura: modelo experimental intraperitoneal

“…Table 1 Table 1 Table 1 Table 1 Table 1 Adhesions requiring blunt dissection to be divided. 3 Firm adhesions where the lyses can only be done with application of significant strength, resulting in partial or total injury of the viscera involved. Fibrin glue used only in the center of both meshes promoted a proper attachment to the abdominal wall.…”

“…The only effective treatment is surgery. The main encountered complications are bowel obstruction, hernia incarceration and/or strangulation, inflammation, chronic pain, fistula, adhesions and infertility 3 .…”

Tratamento cirúrgico das hérnias incisionais: experiência pessoal usando a malha de polipropileno monofilamentar-márlex

“…Na Europa, quando há referência ao tratamento convencional das hérnias incisionais estima-se recidiva de 20% a 40% 3 . Na Índia, também registra-se recidiva em torno de 40% nas hernioplastias incisionais convencionais 4 . No Japão, o insucesso no tratamento das hérnias incisionais pelo método convencional incentivou os cirurgiões para o uso de próteses 5 .…”

“…Na Alemanha, trabalhos recentemente publicados 2,5,18 referem-se às altas taxas de recidiva nas hernioplastias incisionais, em torno de 40% a 53%, e enfatizam o uso da malha de polipropileno como solução para resolver esse problema 5,6,16 . Trabalho indiano se refere à formação de sanduíche, isto é, a malha de polipropileno é colocada entre os músculos e o peritônio 4 . Em torno de 2.000.000 de laparotomias realizadas nos EUA anualmente, cerca de 2% a 11% dão origem à hérnia incisional.…”

Tracking stem cells in the incisional hernial sac: a gaze beyond pure tissue repairs

“…It seems logical to assume then that the HS, like other native tissues, would have large amounts of these less differentiated cells, originating from the peritoneal layer and/or the supporting stroma. Therefore, it is likely that this recruitment would also improve wound healing, triggered by the multiple fibroblastic metaplasias 6 that occurred in these cells. This should happen with greater intensity in incisional hernia repairs that take full advantage of the HS, such as the hernial sac transposition (HST) technique, developed in Brazil in the early 1970s by Lazaro da Silva 7,8 .…”