Effects of Ethylene oxide resterilisation and In- Vitro degradation on mechanical properties of partially absorbable composite hernia meshes

Background: Prosthetic mesh repair for abdominal wall hernias is widely used because of its technical simplicity and low hernia recurrence rates. The most commonly used material is pure polypropylene mesh, however newer  composite materials are recommended by some centers because of their advantages. However, these meshes are more expensive than pure polypropylene meshes. Resterilisation of a pure polypropylene mesh has been  shown to be quite safe, and many centers prefer slicing a large mesh into smaller pieces that suitable for hernia type or defect size. Nevertheless there is no data about the safety after resterilisation of the composite meshes.Objective: To search the effects of resterilisation and In vitro degradation in phosphate buffered saline solution on the physical structure and the mechanical properties of partially absorbable lightweigth meshes.Design: Laboratory-based research.Subjects: Two composite meshes were used in the study: One mesh is consisted of monofilament polypropylene and monofilament polyglecaprone -a copolymer of glycolide and epsilon (ε)-caprolactone- (Ultrapro®, 28 g/m2, Ethicon, Hamburg, Germany), and the other one consisted of multifilament polypropylene and multifilament polyglactine (Vypro II®, 30 g/m2, Ethicon, Hamburg, Germany). Two large meshes were cut into rectangular specimens sized 50x20 mm for mechanical testing and 20x20 mm for In vitro degradation experiments. Meshes were divided into control group with no resterilisation and gas resterilisation. Ethylene oxide gas sterilisation was performed at 55°C for 4.5 hours. In vitro degradation in 0.01 M phosphate buffered saline (PBS, pH 7.4) solution at 37 ± 1°C for 8  weeks was applied to one subgroup in each mesh group. Tensiometric measurements and scanning electron microscopyic evaluations were completed for control and resterilisation specimens.Results: Regardless of resterilisation, when meshes were exposed to In vitro degradation, all mechanical parameters decreased significantly. Highest reduction in mechanical properties was observed for Ultrapro due to the degradation of absorbable polyglecaprone and polyglactin parts of these meshes. It was observed that resterilisation by ethylene oxide did not have significant difference on the degradation characteristics and almost similar physical structures  were observed for resterilised and non-resterilised meshes. For Vypro II meshes, no significant mechanical  difference was observed between resterilised and non-resterilised meshes after degradation while resterilised Ultrapro meshes exhibited stronger characteristics than non-resterilised counterparts, after degradation

Effects of Ethylene Oxide Resterilization and In-vitro Degradation on Mechanical Properties of Partially Absorbable Composite Hernia Meshes*

Rezumat Efectele resterilizãrii cu oxid de etilen aei degradãrii in-vitro asupra proprietãåilor mecanice ale plaselor chirurgicale din material mixt paråial absorbabile Principiul aei scopul lucrãrii: Protezarea cu plase chirurgicale a herniilor de perete abdominal este o tehnicã extensiv utilizatã datoritã simplitãåii sale aei ratelor scãzute de recurenåã aferente. Cele mai utilizate materiale sunt plasele din polipropilenã, însã noi materiale mixte sunt recomandate de unele centre datoritã avantajelor pe care le prezintã. Aceste plase sunt, însã, mai costisitoare decât cele realizate exclusiv din polipropilenã. Resterilizarea unei plase de polipropilenã purã s-a dovedit a fi o procedurã destul de sigurã, iar multe centre preferã sã taie o plasã de dimensiuni mari în mai multe plase mai mici, ce pot fi folosite pentru orice tip de hernie sau orice dimensiune a defectului. Cu toate acestea, nu existã date privind gradul de siguranåã al resterilizãrii plaselor din material mixt. Studiul curent a fost desfãaeurat în vederea evaluãrii efectelor resterilizãrii aei degradãrii in-vitro cu fosfat tamponat cu soluåie salinã asupra structurii fizice aei a proprietãåilor mecanice ale plaselor chirurgicale uaeoare paråial absorbabile. Materiale aei metode: Douã tipuri de plase din material mixt au fost utilizate în acest studiu: o plasã alcãtuitã din monofilamente de polipropilenã aei monofilamente de poliglecapronã -un copolimer din glicolid aei epsilon (ε)-caprolactonã (Ultrapro®, 28 g/m 2 , Ethicon, Hamburg, Germania), iar cealaltã din multifilamente de polipropilenã aei multifilamente de poliglactinã (Vypro II®, 30 g/m 2 , Ethicon, Hamburg, Germania). Douã plase de dimensiuni mari au fost tãiate în probe rectangulare de 50x20 mm pentru testarea mecanicã aei de 20x20 mm pentru experimentele de degradare in-vitro. Plasele au fost distribuite în grupuri de control, fãrã sterilizare, aei de resterilizare cu gaz. Sterilizarea gazoasã cu oxid de etilen a fost efectiatã la 55°C timp de 4,5 ore. Câte un subgrup din fiecare grup de plase a fost supus degradãrii in-vitro cu 0,01 M fosfat tamponat cu soluåie salinã (PBS, pH 7,4) la 37 ± 1°C timp de 8 sãptãmâni. Mãsurãtorile tensiometrice aei de microscopie electronicã au fost efectuate pentru probele de control aei cele resterilizate. Rezultate: Indiferent de resterilizare, la expunerea plaselor la degradarea in-vitro, toåi parametrii mecanici au scãzut semnificativ. Cea mai mare scãdere în termeni de proprietãåi mecanice a fost observatã la plasele Ultrapro, din cauza degradãrii componentelor de poliglecapronã aei poliglactinã absorbabile ale acestor plase. S-a observat cã resterilizarea cu oxid de etilen nu a determinat diferenåe semnificative în ce Cuvinte cheie: plasã chirurgicalã, hernie, plasã din material mixt, resterilizare, degradare, proprietãåi mecanice, tensiometrie, rezistenåã la tracåiune, polipropilenã, poliglecapronã, poliglactinã Abstract Background and Aim: Prosthetic mesh repair for abdominal wall hernias is widely used because of its technical simplicity and low hernia recurrence rates. The most commonly used material is pure polypropylene mesh, although newer composite materials are recommended by some centers due to their advantages. However, these meshes are more expensive than pure polypropylene meshes. Resterilization of a pure polypropylene mesh has been shown to be quite safe, and many centers prefer slicing a large mesh into smaller pieces, suitable for any hernia type or defect size. Nevertheless there is no data about the safety after resterilization of the composite meshes. The present study was carried out to investigate the effects of resterilization and in vitro degradation in phosphate buffered saline solution on the physical structure and the mechanical properties of partially absorbable lightweight meshes. Methods: Two composite meshes were used in the study: One mesh consists of monofilament polypropylene and monofilament polyglecaprone -a copolymer of glycolide and epsilon (ε) -caprolactone -(Ultrapro®, 28 g/m 2 , Ethicon, Hamburg, Germany), and the other one consisted of multifilament polypropylene and multifilament polyglactine (Vypro II®, 30 g/m 2 , Ethicon, Hamburg, Germany). Two large meshes were cut into rectangular specimens sized 50 x 20 mm for mechanical testing and 20 x 20 mm for in vitro degradation experiments. Meshes were divided into control group with no resterilization and gas resterilization. Ethylene oxide gas sterilization was performed at 55°C for 4.5 hours. In vitro degradation in 0.01 M phosphate buffered saline (PBS, pH 7.4) solution at 37 ± 1°C for 8 weeks was applied to one subgroup in each mesh group. Tensiometric measurements and scanning electron microscopic evaluations were completed for control and resterilization specimens. Results: Regardless of resterilization, when the meshes were exposed to in vitro degradation, all mechanical parameters decreased significantly. Highest reduction in mechanical properties was observed for Ultrapro due to the degradation of absorbable polyglecaprone and polyglactin parts of these meshes. It was observed that resterilization by ethylene oxide did not determine significant difference on the degradation characteristics and almost similar physical structures were observed for resterilized and non-resterilized meshes. For Vypro II meshes, no significant mechanical difference was observed between resterilized and non-resterilized meshes after degradation while resterilized Ultrapro meshes exhibited stronger characteristics than non-resterilized counterparts, after degradation. Conclusion: Resterilization with ethylene oxide did not affect the mechanical properties of partially absorbable composite meshes. No important surface changes were observed in scanning electron microscopy after resterilization

Current options in inguinal hernia repair in adult patients

Inguinal hernia is a very common problem. Surgical repair is the current approach, whereas asymptomatic or minimally symptomatic hernias may be good candidate for watchful waiting. Prophylactic antibiotics can be used in centers with high rate of wound infection. Local anesthesia is a suitable and economic option for open repairs, and should be popularized in day-case setting. Numerous repair methods have been described to date. Mesh repairs are superior to "nonmesh" tissue-suture repairs. Lichtenstein repair and endoscopic/laparoscopic techniques have similar efficacy. Standard polypropylene mesh is still the choice, whereas use of partially absorbable lightweight meshes seems to have some advantages

Hernia, Mesh, and Topical Antibiotics, Especially Gentamycin: Seeking the Evidence for the Perfect Outcome…

Inguinal hernia repair is a clean surgical procedure and surgical site infection (SSI) rate is generally below 2%. Antibiotic prophylaxis is not routinely recommended, but it may be a good choice for institutions with high rates of wound infection (>5%). Typical prophylaxis is the intravenous application of first or second-generation cephalosporins before the skin incision. However, SSI rate remains more than 2% in many centers in spite of intravenous antibiotic prophylaxis. Even a 1% SSI rate may be unacceptable for the surgeons who specifically deal with hernia surgery. A hernia center targets to be a center of excellence not only in respect of recurrence rate but also for other postoperative outcomes, therefore a further measure is required for an excellent result regarding infection control. Topical gentamycin application in combination with preoperative single-dose intravenous antibiotic may be a useful to obtain this perfect outcome. Data about this subject are not complete and high-grade evidence has not been cumulated yet. Prospective randomized controlled trials can make our knowledge more solid about this subject and help the surgeons who seek perfect outcome regarding infection control in inguinal hernia surgery. © Copyright © 2015 Kulacoglu

A safety-based comparison of pure ligasure use and ligasure-tie technique in total thyroidectomy

PubMed: 24524472Background and Aim: Sutureless total thyroidectomy by using vessel sealing devices has been shown to be safe in some recent clinical studies. However, some surgeons are still concerned about the use of these energy devices in the vicinity of the recurrent laryngeal nerve and parathyroid glands. The objective of this study was to investigate the effects of the use of pure LigaSure on postoperative complications and to discuss the pertinent literature. Methods: A total of 456 patients having undergone a total thyroidectomy operation between June 2009 and March 2011 were included in the study. Data were prospectively collected and retrospectively evaluated. Patients were separated into 2 groups. Group L comprised of 182 patients where only LigaSure was used, and group LT consisted of 274 patients where ligation was used in the vicinity of the recurrent laryngeal nerve and parathyroid glands, and LigaSure was used in all other parts of the surgery. Patient's blood calcium values were checked preoperatively and at postoperative 24, 48, and 72 hours. Groups were assessed in terms of demographic properties, thyroid pathology, duration of operation, and postoperative complications. Results: Groups were similar in respect of demographic properties, operation duration, thyroid gland pathology. No mortality rate was recorded. Laboratory hypocalcemia rate was higher in group L (P>0.003), but no significant difference was identified between groups in terms of symptomatic hypocalcemia. No permanent hypocalcemia or recurrent laryngeal nerve injury developed in any of the patients in the two groups. Conclusions: Pure LigaSure for total thyroidectomy may increase laboratory hypocalcemia rate, but not symptomatic hypocalcemia. Hemorrhage related complications were similar and low in the two groups. Ligations in the places close to delicate anatomic structures did not cause longer operative times and may be a safer option in total thyroidectomy. © Celsius