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      The Argument for Lightweight Polypropylene Mesh in Hernia Repair

      1 , 1 , 2
      Surgical Innovation
      SAGE Publications

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          Long-term complications associated with prosthetic repair of incisional hernias.

          To determine whether the type of prosthetic material and technique of placement influenced long-term complications after repair of incisional hernias. Retrospective cohort analytic study. University-affiliated hospital. Two hundred patients undergoing open repair of abdominal incisional hernias with prosthetic material between 1985 and 1994. Four types of prosthetic material were used and placed either as an onlay, underlay, sandwich, or finger interdigitation technique. The materials were monofilamented polypropylene mesh (Marlex, Davol Inc, Cranston, RI), double-filamented mesh (Prolene, Ethicon Inc, Somerville, NJ), expanded polytetrafluroethylene patch (Gore-Tex, WL Gore & Associates, Phoenix, Ariz) or multifilamented polyester mesh (Mersilene, Ethicon Inc). The incidence of recurrence and complications such as enterocutaneous fistula, bowel obstruction, and infection with each type of material and technique of repair were compared with univariate and multivariate analysis. On univariate analysis, multifilamented polyester mesh had a significantly higher mean number of complications per patient (4.7 vs 1.4-2.3; P<.002), a higher incidence of fistula formation (16% vs 0%-2%; P<.001), a greater number of infections (16% vs 0%-6%; P<.05), and more recurrent hernias (34% vs 10%-14%; P<.05) than the other materials used. The additional mean length of stay to treat complications was also significantly longer (30 vs 3-7 days; P<.001) when polyester mesh was used. The deleterious effect of polyester mesh on long-term complications was confirmed on multiple logistic regression (P=.002). The technique of placement had no influence on outcome. Polyester mesh should no longer be used for incisional hernia repair.
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            Foreign body reaction to meshes used for the repair of abdominal wall hernias.

            To investigate the local tissue reactions to meshes that had been removed from humans. Open study Surgical department of the technical University, Aachen, Germany. Samples of 17 non-absorbable meshes (1 polyester, 10 polypropylene, 2 reduced polypropylene, and 4 polytetrafluorethylene, PTFE) and 1 absorbable mesh (polyglactin 910) that had been implanted for repair of abdominal wall defects. Light and transmission electron microscopy, immunohistochemistry, and histological examination. Signs of inflammatory response. Light microscopy showed chronic inflammatory tissue reaction, even after years, with pronounced differences among materials. Partial volume of inflammatory cells (%) varied from 32 in polypropylene, to 12 in expanded PTFE, 8 in polyester, and 7 in reduced polypropylene. Formation of connective tissue correlated significantly with the extent of the inflammatory reaction (p<0.01). In meshes implanted for long periods there were still numerous macrophages at the interface between tissue and polypropylene (45%), polyester (45%), expanded PTFE (25%), and reduced polypropylene (22%). There was no difference in time dependent tissue reactions (p = 0.19). Inflammation around alloplastic materials used to repair defects in the abdominal wall persists for many years. There was evidence of long term wound complications as a result of persistent foreign body reactions. Further studies are required to evaluate the long term tissue response to these materials.
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              The treatment of complicated groin and incisional hernias

              One hundred years ago, Edoardo Bassini said: "L'ernia é una malattia meccanica." Before that, Ambroise Paré (1598) and Joseph-Pierre Desault (1798) asserted the mechanical nature of strangulation. Beside strangulation, the most serious of all complications even today, I have studied huge hernias, which are natural complications, and recurrent hernias, which are the complications of suboptimal repairs. In this article, I consider the general features and diagnostic and technical consequences of the repair of groin and incisional hernias. The treatment of strangulating hernias, usually an emergency operation, has not seen any recent technical progress. Huge and recurrent hernias, however, usually allow time for adequate surgical preparation. These hernias are also amenable to modern prosthetic repairs. In prosthetic repairs, large pieces of polyester mesh are inserted beneath the muscular wall outside the peritoneum. They act as artificial, nonabsorbable endoabdominal fascia, making the abdominal wall instantly and definitively pressure tight. The state of hernial surgery has advanced to the point that one must consider the systematic surgical cure of all diagnosed hernias.
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                Author and article information

                Journal
                Surgical Innovation
                Surg Innov
                SAGE Publications
                1553-3506
                1553-3514
                June 30 2016
                March 2005
                June 30 2016
                March 2005
                : 12
                : 1
                : 63-69
                Affiliations
                [1 ]Carolinas Medical Center, Charlotte, NC
                [2 ]Carolinas Medical Center, 1000 Blythe Blvd, MEB #601, Charlotte, NC 28203 ()
                Article
                10.1177/155335060501200109
                1613a291-fd23-4d98-aa5c-6b4181adc737
                © 2005

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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