Table 3 - uploaded by Robert Bendavid
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The treatment of incisional hernias, on occasions, imposes the use of an intraperitoneal prosthesis. Though none of the available
biomaterials is entirely satifactory, the choice often reflects a compromise. Polypropylene and polyester have been associated
with bowel obstruction, fistulization and transmigration through a viscus. These problems are...
Context in source publication
Context 1
... were 30 patients in this series, 23 males and 7 females. Primary incisional hernias were identified in 20 cases (14 males, 6 females) and lO recurrent incisional her- nias (9 males, 1 female) (Table 3)-Ages were 32 to 72 for males and 37 to 74 in females. The sites of herniation and the nature of the original operations are seen in Table 2. ...
Citations
... Because it has various functions, it is a fluororesin that is widely used industrially in the chemical and medical fields [1][2][3][4][5][6][7]. In particular, PTFE has been used as an attractive membrane material owing to its superior chemical resistance, good thermal stability, and high mechanical strength, which makes it widely used in environmental protection, filtration, textiles, medicine, military, etc. [8][9][10][11][12][13][14][15][16][17][18]. However, PTFE exhibits both hydrophobic and oleophobic properties owing to its low surface energy. ...
Polytetrafluoroethylene (PTFE) is the most widely used fluoropolymer that has various functionalities such as heat resistance, chemical resistance, abrasion resistance, and non-adhesiveness. However, PTFE is difficult to dye because of its high water repellency. In this study, the PTFE surface was modified by a combination of gold sputtering and surface fluorination to improve dyeability. X-ray photoelectron spectroscopy indicated that, compared with the untreated sample, the gold-sputtered and acid-washed surface of PTFE had a negligible number of C–F terminals. Furthermore, the intensity of the C–C peak increased drastically. The polar groups (C=O and C–Fx) increased after surface fluorination, which enhanced the electronegativity of the surface according to the zeta potential results. Dyeing tests with methylene blue basic dye showed that the dye staining intensity on the surface of fluorinated PTFE samples was superior to other samples. It is due to the increased surface roughness and the negatively charged surface of fluorinated PTFE samples. The modified PTFE substrates may find broad applicability for dyeing, hydrophilic membrane filters, and other adsorption needs.
... The visceral contact component may be absorbable or non-absorbable. When nonabsorbable, this component is known as a physical barrier [110][111][112] and when absorbable as a chemical barrier [113][114][115][116][117][118][119][120][121][122][123][124][125][126] (Figure 5). ...
... The visceral contact component may be absorbable or non-absorbable. When nonabsorbable, this component is known as a physical barrier [110][111][112] and when absorbable as a chemical barrier [113][114][115][116][117][118][119][120][121][122][123][124][125][126] (Figure 5). The barriers used for visceral contact have always shared the structural characteristic of their smooth surface. ...
Biomaterials and their applications are perhaps among the most dynamic areas of research within the field of biomedicine. Any advance in this topic translates to an improved quality of life for recipient patients. One application of a biomaterial is the repair of an abdominal wall defect whether congenital or acquired. In the great majority of cases requiring surgery, the defect takes the form of a hernia. Over the past few years, biomaterials designed with this purpose in mind have been gradually evolving in parallel with new developments in the different surgical techniques. In consequence, the classic polymer prosthetic materials have been the starting point for structural modifications or new prototypes that have always strived to accommodate patients’ needs. This evolving process has pursued both improvements in the wound repair process depending on the implant interface in the host and in the material’s mechanical properties at the repair site. This last factor is important considering that this site—the abdominal wall—is a dynamic structure subjected to considerable mechanical demands. This review aims to provide a narrative overview of the different biomaterials that have been gradually introduced over the years, along with their modifications as new surgical techniques have unfolded.
... The first double mesh (polypropylene/ePTFE) which went on to become Composix ® saw the light of day in the same institution and was published in the first issue of HERNIA in 1997 [6]. ...
“The majority of hernias can be satisfactorily repaired by using the tissues at hand. The use of mesh prosthesis should be restricted to those few hernias in which tension or lack of good fascial structures prevents a secure primary repair. This group includes large direct inguinal hernias and incisional hernias in which the defect is too large to close primarily without undue tension. Most recurrent hernias, because of this factor are best repaired with mesh prosthesis”. These words, penned in 1960 by Francis Usher have reconfirmed what had been a mantra of the Shouldice Hospital (Usher in 81:847–854, 1960). The Shouldice Hospital has specialized in the treatment of abdominal wall hernias since 1945. It has, since its beginning, insisted on the fact that a thorough knowledge of anatomy coupled with large volumes of surgical cases would lead to unparalleled expertise. It was Cicero who taught us that “Practice, not intelligence or dexterity, will win the day”! Since the seminal contribution of Bassini (1844–1924), there have been no less than 80 procedures imitating his inguinal herniorrhaphy and much more since the introduction of mesh and mesh devices (Iason in Hernia. The Blakiston Company, Philadelphia, pp 475–604, 1940). All have failed to some extent and it appears that the common denominator for these failures was the inability to understand the importance of entering the preperitoneal space. Only Shouldice and McVay (Lotheissen, Narath) realized the shortcoming and have continued to thrive as a successful procedure. Entering the preperitoneal space eliminates any temptation to plicate the posterior inguinal wall, a layer normally deficient in direct inguinal hernias, but it also allows the identification of muscle layers rectus, transversus and internal oblique muscles which will go to reconstruct the posterior inguinal wall, without tension as reported by Schumpelick (Junge in 7(1):17–20, 2003).
... In two randomized trial of open mesh repair, recurrence rate with underlay repair were 20% and with onlay repair were 8% [7]. Intra-peritoneal mesh fixation by Original Article laparoscopy is another way of treating the incisional hernia but it requires special type of mesh [8,9] and highest degree of instrumental availability and operative dexterity [10,11]. The current literature of fixing the mesh as an Onlay technique describes suturing of mesh with a nonabsorbable suture in randomized and interrupted technique [7]. ...
Background: Irrespective of modern suturing technique of closure of abdominal wall, POIH(post-Op incisional hernia) is frequent complication of abdominal surgery, Repair of POIH with mesh has improved result & it has also reduced recurrence.
Aims: To observe and scrutinize the technique in the form of simplicity, post-Op complication and anatomical reconstruction.
Material &Methods: Patients having lower midline incisional hernia were operated upon by present technique of incisional hernia repair by reconstruction of meshed lineaalba were selected for the study. Patients were observed in Pre Op and Post-Op period & when they attend out-patient clinics. Data was collected in prescribed format& statistically analyzed to draw the conclusion.
Result: In our study of 20 patients, 95% of females (n= 19) outnumbered 5% males (n=1). The highest incidence was in the 5th& 6th decade of life. No patients were found having major wound infection, seroma formation, or recurrence of hernia. 20 patients (100%) attended our follow up which ranged from 3 months to 6 months. 15 patients (75%) attended the OPD personally for follow up. Remaining 5 patients (25%) were questioned over the telephone and their response recorded. The average hospital stay recorded was 5-6 days. No recurrence was encountered in the follow up group.
Conclusion: This technique of Reconstruction of meshed lineaalba was found to be technically simple, leading to least post op complications and attaining its goal of curing the lower abdominal incisional hernia.
... And we are neither slouches nor Johnniescome-lately in this discipline! We innovated the double mesh (Goretex-Marlex) in 1997 which had a memorable publication by being the very first article in the first issue of the Journal HERNIA [3]! Perhaps this type of surgery is the particular interest of "The Group"? ...
... The introduction of the composite bi-layered mesh (goretex-marlex) was also first designed and used at the Shouldice Hospital for intraperitoneal placement in difficult abdominal wall reconstructions [9]. It went on to become the Composix ® as industry renamed it at our expense! ...
... To avoid these adverse events, composites consist of two biomaterials one of which acts as a non-absorbable barrier [15]. Given its proven good peritoneal behaviour, one of the most used barrier components of composites is polytetrafluoroethylene (PTFE) [16,17]. Newer barrier materials for composites are absorbable conferring the advantage that when this component has been biodegraded, a reduced amount of foreign material is left in the host. ...
Composite biomaterials designed for the repair of abdominal wall defects are composed of a mesh component and a laminar barrier in contact with the visceral peritoneum. This study assesses the behaviour of a new composite mesh by comparing it with two latest-generation composites currently used in clinical practice.
Defects (7x5cm) created in the anterior abdominal wall of New Zealand White rabbits were repaired using a polypropylene mesh and the composites: Physiomesh(TM); Ventralight(TM) and a new composite mesh with a three-dimensional macroporous polyester structure and an oxidized collagen/chitosan barrier. Animals were sacrificed on days 14 and 90 postimplant. Specimens were processed to determine host tissue incorporation, gene/protein expression of neo-collagens (RT-PCR/immunofluorescence), macrophage response (RAM-11-immunolabelling) and biomechanical resistance. On postoperative days 7/14, each animal was examined laparoscopically to quantify adhesions between the visceral peritoneum and implant.
The new composite mesh showed the lowest incidence of seroma in the short term. At each time point, the mesh surface covered with adhesions was greater in controls than composites. By day 14, the implants were fully infiltrated by a loose connective tissue that became denser over time. At 90 days, the peritoneal mesh surface was lined with a stable mesothelium. The new composite mesh induced more rapid tissue maturation than Physiomesh(TM), giving rise to a neoformed tissue containing more type I collagen. In Ventralight(TM) the macrophage reaction was intense and significantly greater than the other composites at both follow-up times. Tensile strengths were similar for each biomaterial.
All composites showed optimal peritoneal behaviour, inducing good peritoneal regeneration and scarce postoperative adhesion formation. A greater foreign body reaction was observed for Ventralight(TM). All composites induced good collagen deposition accompanied by optimal tensile strength. The three-dimensional macroporous structure of the new composite mesh may promote rapid tissue regeneration within the mesh.
... This combination and selective positioning of polypropylene and ePTFE materials allows for manipulation of the host inflammatory response to favor rapid mesh incorporation at the parietal surface while suppressing complications that result from contact with abdominal viscera. Furthermore, multiple clinical studies have demonstrated the efficacy and safety of composite mesh materials used for ventral hernia repair [23][24][25]. ...
Purpose
Composite 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.
Methods
Data 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.
Results
One 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).
Conclusions
The use of this second-generation composite mesh was associated with no hernia recurrences and a low complication rate after open ventral hernia repair.
... Extended polytetrafluoroethylene meshes are also available. They have very low rates of adhesion formation but poor tissue ingrowth and high rates of seroma and infection that may require explantation [1,3,6,[10][11][12][13][14][15][16][17]. ...
Background:
Intraabdominal peritoneal onlay polypropylene (PP) mesh repair of incisional hernia has the potential risk of adhesions, bowel obstructions, and intestinal fistulae. Fresh or cryopreserved human amniotic membrane (HAM) has been tested as an antiadherent layer in animals, with excellent outcomes. However, it has disadvantages: it is difficult to handle, and it is expensive to store. Another processing method is available: drying in a laminar flow hood and gamma irradiation. Because this method impairs the membrane's cell viability, it may affect its antiadherent properties. However, such properties may also result from the collagen matrix and its basement membrane, which remain after drying. The aim of the present study was to asses dried irradiated HAM in adhesion prophylaxis in rats.
Methods:
Twenty-four female rats were randomized into two groups. In the first group (control group), PP meshes were placed in the intraabdominal space, and in the second group (treatment group), PP meshes coated with HAM were used. Animals were killed on day 30 after surgery. Adhesions and parietal prosthetic incorporation were assessed macroscopically and expressed as the average percentage of the covered area. The portion of the abdominal wall was then resected for histological testing.
Results:
The treatment group had a significantly higher percentage of adhesions and parietal incorporation compared with the control group (p = 0.003). Histological testing showed a higher inflammatory response in the treatment group, with an intense foreign body reaction.
Conclusions:
Dried irradiated HAM does not prevent adhesion formation in intraabdominal peritoneal onlay PP mesh repair in rats. Any use of this biomaterial in adhesion prophylaxis must be undertaken respecting graft cell viability as much as possible.
... Due to these specificities, it is only appropriate for intraperitoneal administration. Bendavid [16] advocated that adhesion with e PTFE is thinner and it is an advantage that the mesh is easily separated. Furthermore, the collagen density of e PTFE was found to be same as the control group in this study. ...
Objective:
The aim of this study was to determine the rate of collagen Type I/Type III for different meshes.
Method:
Fifty rats were used. Five groups were formed: prolene (n = 10), mersilene (n = 10), parietex (n = 10), e PTFE (n = 10) and control group (n = 10). In all animals, laparotomy was performed using a midline incision. After that four different kinds of meshes are placed into the retro-rectus plane and fixed with a non-absorbable suture. Rectus superficial fascia and skin are closed. In the control group, repairment is done primarily. Thirty days later, meshes are found through the incisions that were done previously. Scar tissues above and near by meshes and also in the control group are taken, and in these tissue samples, the ratio of Type I/III is evaluated histochemically.
Results:
The Prolene mesh was found to contain more collagen fibers than e PTFE. As a result of the histopathologic evaluation, it was seen that Group I contained statistically significantly more collagen density than the other four groups (p < 0.05). Moreover, the collagen Type I/III ratio in the specimen taken from the top part and the surrounding area of Group I was found significantly higher than the collagen Type I/III ratios of the rest of the groups (p < 0.05).
Conclusion:
As a conclusion, the ratio of collagen Type I/III is the highest in the prolene group.
