Combined inguinal hernia in the elderly. Portraying the progression of hernia disease

Amato, Giuseppe; Agrusa, Antonino; Rodolico, Vito; Buono, Giuseppe Di; Amodeo, Silvia; Gulotta, Eliana

doi:10.1016/j.ijsu.2016.05.055

Cited by 24 publications

(11 citation statements)

References 21 publications

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“…It is evident that no other source of chronic compression exists in this area except the steady impact of the abdominal viscera against the groin. Therefore, the visceral impact could be identified as culprit of protrusion disease .…”

Section: Discussionmentioning

confidence: 99%

Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair

Amato

Puleio²,

Agrusa³

et al. 2018

Artificial Organs

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Despite undisputed improvements, prosthetics hernia repair continues to be affected by unacceptable rates of complications. Postoperative adverse events such as discomfort and chronic pain represent a subject of increasing concern among the surgical community. Poor quality biologic response, stiff scar plates, and mesh shrinkage, a typical effect of conventional static meshes and plugs, are all indicated as the main reasons for many of the complications related to inguinal hernia repair. Even the conventional concept of treatment based upon a supposed reinforcement of the groin consequent to the fibrotic incorporation of meshes, would appear to be inadequate in the light of the latest scientific evidence concerning the degenerative genesis of inguinal hernia. Following these recent studies, a newly conceived 3D dynamically responsive implant has been developed. It concerns a multilamellar shaped prosthesis, intended to be placed fixation‐free to obliterate the hernia defect. This 3D structure has already demonstrated to induce a probiotic biological response with development of viable tissue, instead of the fibrotic plaque typical of conventional meshes. Newly formed elastic fibers, neo‐angiogenesis, and neo‐nerve genesis in a surrounding of well perfused connective tissue are the typical elements of the biologic response in the newly conceived implant. In addition to these elements, muscle fibers have also been detected in the implant structure. The aim of this research was to determine the ingrowth of muscle fibers in the implant by assessing the quantity and quality of muscle development in the short, medium, and long term post‐implantation. Histological examination of biopsy samples excised from patients who underwent dynamic hernia repair with the 3D dynamic implant showed the presence of muscular elements that in the short term could be described as multiple spots of myocytes in the early stage of development. Over the mid‐ to long‐term, muscle fibers increased in number and level of maturation, assuming the typical aspect of standard muscle bundles in the final phase. Effectively, long term, myocytes histologically evidenced the distinctive arrangement of the muscle structure, with nuclei and striated elements being similar to normal muscle elements. The development of this highly specialized connective tissue in the 3D dynamic responsive implant seems to document the finalization of an enhanced biologic response leading to the ingrowth of typical tissue components of the groin. Reverting degenerative pathogenesis into effective regeneration recognized in the newly conceived 3D prosthesis would appear to represent a significant concept change in the repair of inguinal hernias.

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Section: Discussionmentioning

confidence: 99%

Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair

Amato

Puleio²,

Agrusa³

et al. 2018

Artificial Organs

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“…1. Возраст: пик распространённости ПГ приходится на детский (преобладают непрямые ПГ -у мальчиков, у недоношенных и маловесных детей) и пожилой возраст (прямые и двухсторонние ПГ) [6,7,8]. Роттердамское исследование, изучающее население старше 45 лет в 20-летний период (общая продолжительность наблюдения составила 50 802 человеко-года), показало, что кумулятивная заболеваемость ПГ за этот промежуток времени составила 14 %, при этом риск заболевания увеличивался с возрастом (отношение рисков (HR, hazard ratio) на 1 год увеличения возраста -1,03; 95%-й доверительный интервал (ДИ): 1,02-1,04; p < 0,001) [9].…”

Section: Surgery хирургияunclassified

Inguinal hernia – epidemiology, risk factors, treatment methods (literature review)

Ооржак¹,

Шост²,

Мозес

et al. 2021

Acta biomedica scientifica

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Inguinal hernias (IH) are widespread in the human population and occur in 27–43 % of men and 3–6 % of women. Many risk factors for IH have been overestimated in the last decade: male gender is considered the leading factor (the ratio between men and women is approximately 1:7), less significant factors are heredity (most significant for women), physical activity (more significant for men), age (peak prevalence of IH occurs at 5 years and 70–80 years), congenital or acquired connective tissue dysplasia, history of prostatectomy, low body mass index.Hernioplasty with the use of synthetic mesh prostheses remains the most popular technique for surgical correction of IH. Performing non-prosthetic hernioplasty is only recommended if mesh prostheses are not available, for example in poor countries. In open hernioplasty using mesh prostheses, different methods are used today: Plug & Patch, Prolene Hernia System, Parietene Progrip, sutureless plastic according to Trabucco, Stoppa, preperitoneal techniques TIPP (trans-inguinal pre-peritoneal), TREPP (transrectus pre-peritoneal), TEP (total extraperitoneal), however, none of them showed significant advantages over the gold standard of open hernioplasty – tensionfree repair according to Liechtenstein.Laparoscopic IH correction is represented by the TAPP (transabdominal preperitoneal) technique, performed through the abdominal cavity, and TEP (total extraperitoneal) – extraperitoneal prosthetic hernioplasty. None of them has a significant advantage in the treatment of IH; therefore, when choosing a treatment method, the surgeon should be guided by the cost of the operation and the level of proficiency in one or another hernioplasty technique.

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“…Mesh shrinkage is the effect of this graft-versus-host reaction [ 19 ]. Even though this poor quality fibrotic ingrowth could be reputed suitable for reinforcing a weakened area, this has nothing to do with what is expected for the cure of the degenerative source of hernia disease [ [20] , [21] , [22] , [23] , [24] , [25] , [26] ]. Stopping degeneration and inducing regeneration should be the target to resolve degenerative damage causing a hole in the muscular barrier of the groin.…”

Section: Discussionmentioning

confidence: 99%

First-in-man permanent laparoscopic fixation free obliteration of inguinal hernia defect with the 3D dynamic responsive implant ProFlor-E®. Case report

Amato

Calò

Buono

et al. 2020

International Journal of Surgery Case Reports

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Introduction In the case of inguinal hernia recurrence after primary anterior repair, international guidelines strongly suggest a posterior laparoscopic approach. The 3D dynamic-responsive prosthesis for inguinal hernia repair ProFlor-E® has recently been introduced to the market. The present report describes the results of the first-in-man laparoscopic inguinal hernia repair carried out with ProFlor-E®. Presentation of case A 71-year-old male Caucasian presented with recurrent inguinal hernia after primary anterior repair. A fixation free TAPP procedure with ProFlor-E® was planned. Implant delivery and placement to obliterate the defect was quick and safe. Postoperatively, starting from 2nd postop day, pain was practically absent allowing quick return to normal activities. During follow up, US and MRI scans confirmed the permanence of ProFlor-E® in the hernial gap. During 16-month follow-up no complications were reported. Discussion Flat meshes used to reinforce the herniated inguinal area is a well-established concept. Notwithstanding, such static and passive implants leave the defect patent and cause specific complications related to mesh fixation and uncontrolled poor quality fibrotic ingrowth. ProFlor-E® respects the inguinal physiology resolving these issues. Its centrifugal expansion and dynamic responsivity allows for fixation-free defect obliteration, thus avoiding complications, above all tissue tear, bleeding, mesh invagination, discomfort and chronic pain. In accord with the degenerative pathogenesis of hernia disease, by acting as a regenerative scaffold, ProFlor-E® restores the inguinal barrier promoting the regeneration of the typical inguinal components. Conclusion This initial experience seems to prove that ProFlor-E® can also be used with the laparoscopic approach achieving excellent results.

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Combined inguinal hernia in the elderly. Portraying the progression of hernia disease

Cited by 24 publications

References 21 publications

Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair

Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair

Inguinal hernia – epidemiology, risk factors, treatment methods (literature review)

First-in-man permanent laparoscopic fixation free obliteration of inguinal hernia defect with the 3D dynamic responsive implant ProFlor-E®. Case report

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