The battle between biological and synthetic meshes in ventral hernia repair

Montgomery, Agneta

doi:10.1007/s10029-013-1043-5

Cited by 55 publications

(40 citation statements)

References 33 publications

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“…All meshes will introduce a foreign body type response that needs to be balanced in order to result in normal wound healing. Chemicals can remain within the mesh, causing both toxic and inflammatory reactions in the patient (Montgomery, 2013). AndG was the only group that showed reduced necrosis areas in all three time points analyzed, confirming that oral administration of Andiroba oil can modulate the inflammatory response secondary to VHR.…”

Section: Discussionmentioning

confidence: 54%

“…However, the best results are obtained through mesh reinforcement, in which the chances of recurrence vary between 3 and 17%. It is clear that the use of meshes has revolutionized the outcomes of VHR (Montgomery, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Polypropylene, polyester, and ePTFE are the most commonly used meshes, and they also exhibit different properties. The development of new synthetic meshes is also extensive and fast (Montgomery, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Retromuscular position seems to be the most commonly used and safe mesh placement site, and the mesh must be ideally separated from abdominal organs in order to avoid adhesion formation (Montgomery, 2013). However, in large abdominal wall defects, it is very difficult to avoid contact between abdominal organs and the mesh, leading to an increased number of adhesions and other complications such as fistula formation and intestinal obstruction (Dinsmore et al, 2000;Alimoglu et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

“…Synthetic meshes are usually designed to be positioned outside the abdominal cavity, unless a special coating has been applied for intraabdominal use (Montgomery, 2013). Several substances were tested, but there is not yet an ideal mesh coating that would show no adverse reactions, complications, or foreign body reaction that would be simple to use, easily accessible, and have a low cost (Toosie et al, 2000;Lontra et al, 2010;Zong et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

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Andiroba oil (Carapa guianensis) on ventral hernia repair

Yasojima

Costa²,

Houat³

et al. 2014

J. Med. Plants Res.

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In the Amazon rainforest region, Andiroba oil is an herbal oil that is widely used by the local population to treat several inflammatory diseases. The objective of this study was to test Andiroba oil as a mesh coating or by oral administration in a rat model of excisional abdominal wall defect as an alternative to modulate inflammatory response without impairing the ventral hernia repair. Thirty six animals were distributed into three groups (N=12). (1) In the control group (CONT), ventral hernia repair was done using polypropylene/polyglecaprone mesh. (2) In the Andiroba oil gavage group (AndG), animals were treated with the meshes and 0.63 ml/kg of Andiroba oil was given by oral administration for 7 days prior to the mesh placement. (3) In the Andiroba oil submersion group (AndS), animals were treated with meshes that were previously submersed in Andiroba oil. At the 7th, 14th, and 21st days, macroscopic and microscopic analyses were done. AndG had fewer adhesions, necrosis, and lymphocytes, as well as similar collagen fiber formation and fibrosis areas as CONT. AndS showed a higher number of macrophages, fibrosis area, and less collagen fiber formation. Oral administration of Andiroba oil modulated inflammatory response, reduced abdominal adhesion formation, and did not impair tissue healing.

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Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Andiroba oil (Carapa guianensis) on ventral hernia repair

Yasojima

Costa²,

Houat³

et al. 2014

J. Med. Plants Res.

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Biologic vs Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias

et al. 2022

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IMPORTANCE Biologic mesh is widely used for reinforcing contaminated ventral hernia repairs; however, it is expensive and has been associated with high rates of long-term hernia recurrence. Synthetic mesh is a lower-cost alternative but its efficacy has not been rigorously studied in individuals with contaminated hernias. OBJECTIVE To determine whether synthetic mesh results in superior reduction in risk of hernia recurrence compared with biologic mesh during the single-stage repair of clean-contaminated and contaminated ventral hernias. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, single-blinded randomized clinical trial was conducted from December 2012 to April 2019 with a follow-up duration of 2 years. The trial was completed at 5 academic medical centers in the US with specialized units for abdominal wall reconstruction. A total of 253 adult patients with clean-contaminated or contaminated ventral hernias were enrolled in this trial. Follow-up was completed in April 2021.INTERVENTIONS Retromuscular synthetic or biologic mesh at the time of fascial closure. MAIN OUTCOMES AND MEASURESThe primary outcome was the superiority of synthetic mesh vs biologic mesh at reducing risk of hernia recurrence at 2 years based on intent-to-treat analysis. Secondary outcomes included mesh safety, defined as the rate of surgical site occurrence requiring a procedural intervention, and 30-day hospital direct costs and prosthetic costs.RESULTS A total of 253 patients (median [IQR] age, 64 [55-70] years; 117 [46%] male) were randomized (126 to synthetic mesh and 127 to biologic mesh) and the follow-up rate was 92% at 2 years. Compared with biologic mesh, synthetic mesh significantly reduced the risk of hernia recurrence (hazard ratio, 0.31; 95% CI, 0.23-0.42; P < .001). The overall intent-to-treat hernia recurrence risk at 2 years was 13% (33 of 253 patients). Recurrence risk with biologic mesh was 20.5% (26 of 127 patients) and with synthetic mesh was 5.6% (7 of 126 patients), with an absolute risk reduction of 14.9% with the use of synthetic mesh (95% CI, −23.8% to −6.1%; P = .001). There was no significant difference in overall 2-year risk of surgical site occurrence requiring a procedural intervention between the groups (odds ratio, 1.22; 95% CI, 0.60-2.44; P = .58). Median (IQR) 30-day hospital direct costs were significantly greater in the biologic group vs the synthetic group

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Chitosan selectively promotes adhesion of myoblasts over fibroblasts

Iyer

Udpa

Gao

2014

J Biomedical Materials Res

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Treatment of ventral hernias frequently makes use of synthetic and biological meshes, often resulting in scar tissue formation and incomplete muscle regeneration. Chitosan has been shown to promote a regenerative response than a fibrotic response. The objective of this study is to determine the effects of chitosan on myoblast and fibroblast adhesion and the underlying mechanisms. Primary myoblast cells, embryonic fibroblasts, and 1:1 coculture of both cell types were seeded on chitosan-coated and uncoated tissue culture plates. The number of attached cells was measured at 5, 24, 48, and 72 h after seeding. At 5 h after seeding, expression and structural organization of actin, integrin β3, and integrin β1 were analyzed. With chitosan, primary fibroblasts had 2.7 times smaller F-actin fraction, and more primary myoblasts with higher expression of integrin β3 were seen. Moreover, a higher ratio of myoblasts to fibroblasts was seen with chitosan, with a ratio higher than one at 48 and 72 h after seeding and greater than a twofold increase in ratio when compared with uncoated plates. A higher organization of actin and integrin β3 network around nucleus of myoblasts was observed with chitosan, whereas reorganization in actin and integrin β1 network was observed in fibroblasts. In conclusion, chitosan promotes myoblast adhesion with higher expression of integrin β3 and inhibits fibroblast adhesion with reorganization of actin and integrin β1 network.

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The battle between biological and synthetic meshes in ventral hernia repair

Cited by 55 publications

References 33 publications

Andiroba oil (Carapa guianensis) on ventral hernia repair

Andiroba oil (Carapa guianensis) on ventral hernia repair

Biologic vs Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias

Chitosan selectively promotes adhesion of myoblasts over fibroblasts

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