Why we remove mesh

Fadaee, Negin; Zarrinkhoo, E; Towfigh, Shirin

doi:10.1007/s10029-018-1839-4

Cited by 31 publications

(27 citation statements)

References 14 publications

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“…Mesh is removed after hernia repair for a variety of indications, and the demand for this procedure is increasing. 2 However, there is no standard for how to handle the specimen after it is removed, or understanding of the clinical implications of the pathology findings. Although some researchers have analyzed explanted mesh microscopically, most have not correlated their pathology findings with clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis is challenging and only made after an extensive preoperative workup. 2 Patient symptoms are not typical; they present with a syndrome that can include chronic fatigue, joint pain, extremity edema, rash, headache, fevers, nausea, sleep difficulty, concentration difficulty ("brain fog"), bloating, erythema, and/or edema over the area of the implant. All potential causes of these symptoms, including autoimmune disorders, are ruled out preoperatively by blood tests, imaging, and evaluation by specialists, such as rheumatologists and allergists.…”

Section: Methodsmentioning

confidence: 99%

“…The indications for mesh removal are varied and include infection, chronic pain (eg due to meshoma, nerve entrapment, or mesh erosion), and incidental removal (eg at the time of recurrent hernia repair or unrelated operation). 1,2 A rare indication for mesh removal is serious allergic, immunogenic, or inflammatory reaction to the mesh product itself. We term these as mesh reactions.…”

mentioning

confidence: 99%

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Clinical Value of Hernia Mesh Pathology Evaluation

Fadaee

Mazer

Capati

et al. 2019

Journal of the American College of Surgeons

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BACKGROUND: Hernia mesh removal is growing in demand. Meanwhile, there is no standard for handling the mesh specimen or any consensus on the clinical value of the surgical pathology findings. STUDY DESIGN: All hernia mesh specimens gathered from 2013 to 2018 were analyzed. Patients were categorized based on indication for mesh removal. The "mesh reaction" group included those with clinical reaction deemed to be related to the mesh material. The "mesh nonreaction" group included patients who had mesh removed for a clinical indication unrelated to the mesh material. RESULTS: One hundred and one patients had 115 mesh specimens that were microscopically evaluated. Patients with clinical diagnosis of mesh reaction were significantly younger (39 vs 56 years; p ¼ 0.023) and more likely to be female (71% vs 39%; p < 0.001) than those without mesh reaction. Although the clinical symptoms were significantly different, the pathology findings were quite similar. CONCLUSIONS: There is no clinical value in submitting mesh specimens for microscopic surgical pathology evaluation, regardless of clinical indication for the mesh removal. Also, no clinical claims can be made based on pathology findings from explanted mesh. In addition, microscopic evaluation does incur additional costs to the consumer. We recommend explanted mesh be submitted for gross examination only for documentation purposes in the medical records.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical Value of Hernia Mesh Pathology Evaluation

Fadaee

Mazer

Capati

et al. 2019

Journal of the American College of Surgeons

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“…However, depending on the localization and fixation of the previous mesh, the problem could range from an asymptomatic patient to a patient with a solid mass and pain. Regarding mesh removal, most of the studies concern the removal of infected mesh [7][8][9][10][11][12]. Although some studies concern laparoscopic repair of recurrent ventral hernias, there is still a lack of data about mesh removal during the procedure [13].…”

Section: Discussionmentioning

confidence: 99%

“…The influence of mesh removal during laparoscopic repair of recurrent ventral hernias on the long-term outcome foreign body has not been comprehensively studied in the literature. Considering the removal of mesh, most of the studies concern mesh infections [ [7][8][9][10][11][12]. Data on the efficacy of mesh removal during laparoscopic repair remain missing.…”

Section: Introductionmentioning

confidence: 99%

The influence of mesh removal during laparoscopic repair of recurrent ventral hernias on the long-term outcome.

Sıkar

Çetin

2019

Videosurgery and Other Miniinvasive Techniques

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IntroductionRecurrent hernias can be treated by laparoscopy without the need for mesh removal. However, shrinkage of the mesh following recurrence affects most of the patients, and leaving a partially floating and rigid foreign body could be discussed.AimTo compare the outcomes of patients regarding the removal of previous mesh during laparoscopic repair of recurrent abdominal wall hernias.Material and methodsPatients who underwent laparoscopic repair for recurrent ventral hernias between August 2012 and March 2015 were included in the study. The patients with complete removal of the mesh were included in the MR group and the patients with partial removal or without removal of the previous mesh were included in the non-MR group. Patient characteristics and demographics, previous hernia repair, defect size, mesh size, operative time, mean hospital stay, complications, recurrences, numeric pain rating scale (NRS), early termination of analgesics and prolonged use of analgesics were compared.ResultsA total of 112 patients with a mean age of 53.2 and mean body mass index of 31.1 kg/m2 underwent laparoscopic repair. There were 47 patients in the MR group and 54 patients in the non-MR group. Operative time was shorter in the non-MR group (p < 0.05), whereas symptomatic seroma and NRS scores on postoperative day 10 and at the 6th week were higher in comparison with the MR group (p < 0.05).ConclusionsMesh removal during laparoscopic repair of recurrent ventral hernias has an association with the reduction of pain and symptomatic seroma. However, further prospective comparative studies are required to verify this view.

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3D‐Bioprinted Inflammation Modulating Polymer Scaffolds for Soft Tissue Repair

et al. 2020

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creates a defect that intra-abdominal contents may protrude through. [1] The most common types of hernias are incisional, inguinal, femoral, umbilical and hiatal hernias. [2] Hernia repair for many defects is performed by the surgical implantation of a prosthetic mesh to firmly support and reinforce the damaged abdominal wall and facilitate the healing process (Figure 1A,B). Each year, over 400 000 incisional hernia repair surgeries are performed with a cost of ≈$15 billion in US healthcare expenditures. [3-5] Prosthetic hernia mesh implants are developed using synthetic, biologic, and coated materials. [6,7] Despite their specific advantages, these mesh implants are not very effective in minimizing potential adverse postsurgical complications. [8] Surgical hernia repair with mesh implants mostly fail due to the formation of visceral adhesions, hardening, and shrinking of the mesh after its implantation. Visceral adhesions are fibrous tissues developed from the underlying serosal membrane of stomach, intestine or colon, that attach to the implanted mesh. [9] These adhesions are mainly composed of collagen and fibroblasts that grow on the mesh and adhere to the nearby tissue, nerves and organs. [10] The mesh shrinks as the adhesions grow and scar tissue hardens, thus forming a hard, fibrous mass that may cause chronic pain, bowel obstruction, enteric fistula, infertility, poor quality of life, and failure of the surgical hernia repair. [11-13] To remove the failed hernia mesh, a complicated surgery needs to be performed, wherein the mesh must be peeled off bladder, stomach, intestine, colon, or a major blood vessel, that may adversely affect the clinical outcomes. [14] To minimize adhesions formation, graft contraction, and foreign body reactions, absorbable and biological meshes have been developed. However, these meshes are not significantly effective because of very high hernia recurrence rates. [15-17] Causative factors for adverse complications arising due to surgical mesh implantation are chronic inflammatory responses, poor mesh-tissue integration, rapid degradation of the materials, surface chemistry and topochemical design of the mesh. [18,19] We herein present the development of an intrinsically inflammation modulating 3D-fabricated biomaterial scaffold (bioscaffold) for soft tissue repair and demonstrate its in vivo efficacy in a rat ventral hernia Development of inflammation modulating polymer scaffolds for soft tissue repair with minimal postsurgical complications is a compelling clinical need. However, the current standard of care soft tissue repair meshes for hernia repair is highly inflammatory and initiates a dysregulated inflammatory process causing visceral adhesions and postsurgical complications. Herein, the development of an inflammation modulating biomaterial scaffold (bioscaffold) for soft tissue repair is presented. The bioscaffold design is based on the idea that, if the excess proinflammatory cytokines are sequestered from the site of injury by the surgical implantation of a bioscaffold,...

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Why we remove mesh

Cited by 31 publications

References 14 publications

Clinical Value of Hernia Mesh Pathology Evaluation

Clinical Value of Hernia Mesh Pathology Evaluation

The influence of mesh removal during laparoscopic repair of recurrent ventral hernias on the long-term outcome.

3D‐Bioprinted Inflammation Modulating Polymer Scaffolds for Soft Tissue Repair

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