Aspects on the use of slowly degradable mesh in inguinal hernia surgery

Background: Synthetic non-degradable mesh used in inguinal hernia surgery can cause chronic inflammation, which in turn can lead to chronic post-operative pain (CPP). Theoretically, a degradable mesh could reduce the risk of chronic pain. Aims: Explore the possibility of keeping viable human peritoneum in contact with hernia meshes in an ex vivo model for several weeks. Evaluate the feasibility and the safety of a slowly degradable mesh in open and endoscopy inguinal hernia repair. Methods: Four publications are included in the doctoral thesis: an experimental method study with peritoneal tissue and three prospective clinical safety studies using a slowly degradable mesh in the repair of patients with inguinal hernias. Results: Ex-vivo model: Peritoneal tissue in contact with a mesh could be kept viable between 26 and 56 days. Safety Studies: At 3-year control, no patient experienced CPP. The recurrence rates in patients operated with the open technique were 44% for medial inguinal hernias and 0% for lateral inguinal hernias. In patients operated with the endoscopy technique, the recurrence rate for lateral inguinal hernias was 8.8%. Conclusions: Peritoneal tissue can be kept viable in contact with mesh during weeks in a human ex vivo model. Using slowly degradable mesh in the repair of medial inguinal hernia is not safe due to an increased recurrence risk. This mesh seems safe regarding the risk of chronic post-operative pain in patients with lateral inguinal hernias, but the risk of hernia recurrence should be further studied

Inguinal hernia repair using a synthetic long-term resorbable mesh: results from a 3-year prospective safety and performance study

PURPOSE: Conventional meshes for hernia repair and abdominal wall reinforcement are usually made from polypropylene, polyester or other synthetic plastic materials known to promote foreign body reactions and a state of chronic inflammation that may lead to long-term complications. A novel approach is to use long-term resorbable implants like TIGR(®) Matrix Surgical Mesh. Preclinical studies have shown that this mesh maintains mechanical integrity beyond the point in time where newly formed tissue is capable of carrying the abdominal loads. METHODS: This was a first-in-man, prospective, pilot study performed during 2009, at two sites in Sweden. Forty patients with primary inguinal hernias were enrolled for Lichtenstein repair using TIGR(®) Matrix Surgical Mesh. The primary endpoint was safety as assessed by monitoring the incidence of adverse events and serious adverse events (SAEs) both related and unrelated to the mesh. The secondary endpoint was pain or discomfort. Visual Analogue Scale (VAS) 0–10 and Inguinal Pain Questionnaire were used for scoring pain and discomfort. Included patients have been followed for 36 months using ultrasound in combination with clinical examination. RESULTS: All patients followed a normal early postoperative course. After 12 months no SAEs were reported. None of the patients with an isolated lateral inguinal hernia (LIH) had developed a recurrence but 4 (44 %) with medial and 4 (33 %) with combined hernias had recurred at 36-month follow-up. After 3-year follow-up none of the patients with LIH reported pain in the VAS-form and none of those patients could feel the sensation of a mesh in their groin. In the total study population 5 (16 %) patients experienced chronic pain in the form of mild sporadic pain and 3 (9.7 %) patients could feel the sensation of a mesh in their groin. CONCLUSION: The use of a synthetic long-term resorbable mesh (TIGR(®) Matrix Surgical Mesh) in Lichtenstein repair was found to be safe, without recurrences, and promising regarding pain/discomfort at 3-year follow-up in patients with LIH. However, patients with medial and combined inguinal hernias had high recurrence rates

An ex vivo model using human peritoneum to explore mesh-tissue integration

Biological compatibility, in terms of implantation of foreign mesh material in hernia surgery, still needs experimental investigation. Present study develops an experimental model using human peritoneum to study the integration between tissue and different mesh material. The ex vivo model using peritoneal tissue was studied with different mesh material, and integration was monitored over time using microscopy.It could be demonstrated that the peritoneal model may be kept viable in culture for several weeks. Cell migration was seen after 7-10 days in culture and could be further monitored over several weeks. The use of a human artificial model environment enabling the investigation of tissue/mesh integration has, to our knowledge, not been described previously.This proof-of-concept model was developed, for the investigation of peritoneal biology and the integration between tissue and different mesh material. It has the potential to be useful in studies on other important biological mechanisms involving the peritoneum

Pancreaticoduodenectomy for peri-ampullary neoplasia leads to specific micronutrient deficiencies

Background/Aims: After pancreaticoduodenectomy ( PD) patients may be deficient in essential micronutrients. This study was designed to determine if this is a consequence of surgery. Methods: Long-term survivors (> 6 months) of PD for peri-ampullary neoplasia and healthy controls ( patients' spouse/partner) were enrolled in the study. Specific clinical parameters were recorded, serum micronutrient levels were measured and subjects completed 7-day food diaries. Results: Thirty-seven patients were studied, 25 with paired controls. All were well nourished, as defined by body mass index and food diary analysis. Patients with paired controls were representative of all patients studied. Patients had raised transferrin ( median 2.60 vs. 2.16 g/l, p = 0.001) and low ferritin levels (34.9 vs. 119.0 g/ l, p < 0.001) indicating relative iron deficiency. Patients also demonstrated lower levels of the anti-oxidants selenium (0.77 vs. 0.93 mu mol/l, p < 0.001) and vitamin E (23.2 vs. 35.7 mu mol/ l, p < 0.001) with 57% of patients having frank selenium deficiencies. Patients had lower levels of vitamin D than controls (15.7 vs. 19.6 mu mol/l, p = 0.001) and 30% of patients had a raised parathyroid hormone level, suggesting compensatory mechanisms operate to maintain normocalcaemia. Conclusions: Long-term survivors of PD are relatively deficient in several micronutrients compared to non-operated controls taking the same diet. We recommend that micronutrient status should be regularly checked in these patients and treated where necessary

Mesh prophylaxis for hernia in abdominal incisions

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective of this review is to determine both the efficacy and safety of using primary mesh augmentation of abdominal incisions as a prophylaxis for incisional hernia. The secondary objective of this review is to determine whether the efficacy and safety of using primary mesh augmentation differs across prespecified subgroups (see Subgroup analysis and investigation of heterogeneity).</p