44 research outputs found
Infections associated with mesh repairs of abdominal wall hernias : Are antimicrobial biomaterials the longed-for solution?
The incidence of mesh-related infection after abdominal wall hernia repair is low, generally between 1 and 4%; however, worldwide, this corresponds to tens of thousands of difficult cases to treat annually. Adopting best practices in prevention is one of the keys to reduce the incidence of mesh-related infection. Once the infection is established, however, only a limited number of options are available that provides an efficient and successful treatment outcome. Over the past few years, there has been a tremendous amount of research dedicated to the functionalization of prosthetic meshes with antimicrobial properties, with some receiving regulatory approval and are currently available for clinical use. In this context, it is important to review the clinical importance of mesh infection, its risk factors, prophylaxis and pathogenicity. In addition, we give an overview of the main functionalization approaches that have been applied on meshes to confer anti-bacterial protection, the respective benefits and limitations, and finally some relevant future directions. (C) 2018 Elsevier Ltd. All rights reserved.Peer reviewe
META Score: An International Consensus Scoring System on Mesh-Tissue Adhesions
Background: Currently, the lack of consensus on postoperative mesh-tissue adhesion scoring leads to incomparable scientific results. The aim of this study was to develop an adhesion score recognized by experts in the field of hernia surgery. Methods: Authors of three or more previously published articles on both mesh-tissue adhesion scores and postoperative adhesions were marked as experts. They were queried on seven items using a modified Delphi method. The items concerned the utility of adhesion scoring models, the appropriateness of macroscopic and microscopic variables, the range and use of composite scores or subscores, adhesion-related complications and follow-up length. This study comprised two questionnaire-based rounds and one consensus meeting. Results: The first round was completed by 23 experts (82%), the second round by 18 experts (64%). Of those 18 experts, ten were able to participate in the final consensus meeting and all approved the final proposal. From a total of 158 items, consensus was reached on 90 items. The amount of mesh surface covered with adhesions, tenacity and thickness of adhesions and organ involvement was concluded to be a minimal set of variables to be communicated separately in each future study on mesh adhesions. Conclusion: The MEsh Tissue Adhesion scoring system is the first consensus-based scoring system with a wide backing of renowned experts and can be used to assess mesh-related adhesions. By including this minimal set of variables in future research interstudy comparability and objectivity can be increased and eventually linked to clinically relevant outcomes
Evaluation of crosslinked and non-crosslinked biologic prostheses for abdominal hernia repair
Recent Innovations & Daily Problems. A new prosthesis in inguinal hernia repair:preliminary results of a pilot study.
Introduction: Elective surgery for inguinal hernia is affected by very
low mortality « 1 per 10000 operation); in contrast, when surgery
is carried out for complicated inguinal hernia, risks of postoperative
complication are higher. TAPP is a world-wide accepted surgical practice
in the treatment of elective bilateral or recurrent inguinal hernia,
above all in young patients. Few exploratory studies were published on
laparoscopic approach in the treatment of urgent complicated inguinal
hernia. Aim of this study was to analyze feasibility (operative time,
conversion rate), safety (postoperative morbidity, length of hospital
stay) and quality of life (acute and chronic pain, return to work) of
trans-abdominal pre-peritoneal laparoscopic hernia repair in acute
incarcerated inguinal hernia. Rationale of laparoscopic trans-abdominal
approach is the easier hernia reduction under vision and a better
exploration of the abdominal cavity.
Methods: from September 2012 to September 2013, 15 consecutive
patients admitted in emergency at the Division of General Surgery of
University "Sapienza", Polo Pontino, for acute incarcerated inguinal
hernia were submitted to TAPP using 3 trocars (1 of 10 mm and 2 of
5mm) and polyester prosthesis fixed by fibrin glue. Exclusion criteria
for laparoscopic approach were age III, previous
abdominal surgery, signs of strangulated hernia. All of them were
evaluated for operative time, conversion rate, postoperative morbidity,
organ resection or other surgery required. All patients were scored for
pain by Visual Analogic Scale (VAS) during postoperative in hospital
stay at 7 days, 1,6 and 12 months after surgery.
Results: median follow-up was 16 months and 12 as minimum. In all
cases reduction of hernia was always possible and none conversion
to open surgery was recorded, median operative time was 89 minutes
(55-137 as range), omental resection was carried out in one patient
(6,6%), no other organ resections needed, whereas contralateral hernia
was diagnosed and repaired at the same time in 4 patients (26,6%). No
major complications were observed, median blood loss was 100 ml,
minor morbidity was contained to 18% represented by fever and
wound infection of surgical umbilical scar. Median in hospital stay
was 1,5 days with 1-5 days as range. Postoperative median acute pain,
measured by visual analogic scale (VAS), was 2 (range:0-4), none
patient referred any pain during follow-up. Median time of return to
work was 6,5 days, ranged between 3 to 15 days. Patients' compliance
to treatment and to follow-up was complete as well their satisfaction. Conclusions: In centres skilled for laparoscopy in emergency, TAPP
could be considered a feasible and safe technique. In well-selected
patients (especially if emolled in controlled clinical trial) TAPP could
represent an alternative surgical approach for complicated incarcerated inguinal hernia to conventional open surgery even in urgency. The
main advantages of laparoscopic approach are the ability to perform
surgical hernia reduction under vision, a better exploration and evaluation
of abdominal cavity and diagnosis and treatment of eventual
contralateral defect of wall, otherwise often missed. Finally, the good
control of acute and chronic pain, faster return to normal activity and
work, better aesthetic results contributed to total satisfaction and compliance
of the patients
The role of open abdomen in non-trauma patient : WSES Consensus Paper
The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.Peer reviewe