Design strategies and applications of biomaterials and devices for Hernia repair

Kalaba, Surge; Gerhard, Ethan; Winder, Joshua S.; Pauli, Eric M.; Haluck, Randy S.; Yang, Jian

doi:10.1016/j.bioactmat.2016.05.002

Cited by 118 publications

(139 citation statements)

References 178 publications

(211 reference statements)

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“…Researchers (Kalaba et al, ) propose that the future of hernia repair involves development of a biomaterial to which the acute and chronic foreign body response would be low and that promotes tissue ingrowth and vascularization and prevents or controls postoperative infection. Here, we present our work examining meshes manufactured with PCL and alginate for hernia repair, and the histology results showed their good behaviour regarding acute and chronic inflammation reduction and the promotion of new vascularization and fibrotic foci.…”

Section: Discussionmentioning

confidence: 99%

Proof of concept, design, and manufacture via 3‐D printing of a mesh with bactericidal capacity: Behaviour in vitro and in vivo

Castro

Yuste

Pereira

et al. 2019

J Tissue Eng Regen Med

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Currently, hernia treatment involves implantation of a mesh prosthesis, usually made of polypropylene, and the primary complication is infection of the device, which leads to an exponential increase in morbidity. Three-dimensional printing offers a method of dealing with complications of this magnitude. Therefore, in this study, the bactericidal properties and effectiveness of three-dimensional-printed meshes with polycaprolactone (PCL) and gentamicin were evaluated in vitro in Escherichia coli cultures, and their histological behaviour was examined in vivo. Different PCL meshes were implanted into four groups of rats, with 10 rats in each group: PCL meshes, PCL meshes with alginate and calcium chloride, PCL meshes with gentamicin, and PCL meshes with alginate and gentamicin. Thirty-six microporous meshes were manufactured, and their bactericidal properties were assessed. When the meshes did not include an antibiotic, an inhibition halo was not observed; when the gentamicin was free, an asymmetric inhibition area of 5.65 ± 0.46 cm 2 was present; when the gentamicin was encapsulated, a rectangular area of 5.40 ± 0.38 cm 2 was observed. In the rats, macroporous and microporous mesh implants produced mild inflammation and substantial fibrosis with collagen and neovascular foci. A significant difference was observed in fibroblastic activity between the PCL with alginate group and the PCL with alginate and gentamicin group microporous meshes (p = .013) and in collagen deposits between the macroporous and microporous meshes in the PCL mesh group (p = .033). The feasibility of manufacturing drug-doped printed PCL meshes containing alginate and gentamicin was verified, and the meshes exhibited bactericidal effects and good histopathological behaviour.

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Section: Discussionmentioning

confidence: 99%

Proof of concept, design, and manufacture via 3‐D printing of a mesh with bactericidal capacity: Behaviour in vitro and in vivo

Castro

Yuste

Pereira

et al. 2019

J Tissue Eng Regen Med

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“…Desde que la técnica sin tensión con malla, se convirtió en el procedimiento de elección para el tratamiento de la hernia inguinal (3), se ha buscado la malla ideal, con las siguientes características: inerte, de monofilamento, con poros mayores de 75µ de diámetro, resistente a la infección, estimulante de la fibroplasia, fácilmente moldeable, que pueda cortarse sin que pierda su integridad estructural, con adaptabilidad a la anatomía de la región inguinal, que no se modifique por los líquidos orgánicos, no ser alergénica ni carcinogénica, que no produzca adherencias intestinales y que sea económica (6). Para satisfacer los criterios mencionados, se han utilizado prótesis de muy variados tipos y que van desde tejidos autólogos, como fascia en sus inicios, hasta materiales de diferentes elementos como plata, alambre, poliéster, polipropileno, vicryl y politetrafluoroetileno expandido (PT-FEe); como parte del proceso continuo en la búsqueda de la prótesis idónea (8,9).…”

Section: Discussionunclassified

“…El costo de una malla puede llegar a representar hasta un 40% del costo total del procedimiento (4). Las mallas de baja densidad "tipo mosquitero", han sido evaluadas con diferentes resultados (5,6), por lo que el objetivo de este trabajo fue evaluar la eficacia reportada en términos de dolor mediante la escala visual análoga (EVA), infección del sitio operatorio, rechazo y recurrencia, de la malla de polietileno de baja densidad (PEBD) en comparación con la malla de polipropileno (PP), en la plastia inguinal abierta con malla sin tensión, en un país con condiciones socio-económicas y sanitarias diferentes a países desarrollados.…”

Section: Introductionunclassified

Utilidad de la malla de polietileno de baja densidad, en la plastia inguinal sin tensión

2018

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Palabras clave: hernia inguinal; plastia inguinal; malla de polietileno.Resumen. La malla de polietileno de baja densidad (PEBD) tipo mosquitero, se ha utilizado como una alternativa barata a la de polipropileno (PP) para la reparación de hernias inguinales sin tensión. El objetivo fue comparar ambas en términos de dolor, infección, rechazo y recurrencia. Se realizaron 31 plastias inguinales con técnica de Liechtenstein en 28 pacientes, utilizando en forma aleatoria 1) malla de PEBD ó 2) malla PP. Se registró en forma ciega infección y dolor en el postoperatorio, a los 7 y 30 días, y rechazo o recurrencia a 3, 6 y 18 meses. No existieron diferencias significativas entre los grupos de PEBD y PP, en dolor, infección, rechazo o recurrencia. El costo por procedimiento fue 58% menor en el grupo de PEBD. Se concluye que la malla de PEBD es una alternativa segura y económica para la plastia inguinal abierta sin tensión ya que es 500 veces más económica que la de polipropileno.Malla de polietileno en plastia inguinal sin tensión 319 Abstract. The low-density polyethylene (LDPE) mesh mosquito-net type has been used as an economical alternative to the polypropylene (PP) mesh for the repair of inguinal hernias without tension. The objective of this work was to compare both materials in terms of resulting pain, infection, rejection and recurrence of the hernia. We performed 31 inguinal hernioplasties with the Lichtenstein technique in 28 patients, randomly using the 1) LDPE mesh or the 2) PP mesh. Postoperative infection and pain were recorded at seven and 30 days, and rejection or recurrence at three, six and 18 months. There were no statistically significant differences between the groups of LDPE and PP, with respect to infection, recurrence and rejection frequency. Measured pain was similar in both groups. The cost per procedure in the LDPE group was 58% lower compared to the PP group. We concluded that the properties of the LDPE mesh are similar to those of the PP mesh. There were no differences in infection, rejection and recurrence, and LDPE mesh is 500 times cheaper than the polypropylene mesh.

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“…Hernia repair by prosthetic meshes involves the processes of inflammation, followed by cellular and vascular infiltration and finally of matrix remodeling. 38 These processes are prone to effects originating from hernia meshes and can result in excessive scaring, graft encapsulation, and degradation. In general, two types of meshes have been developed to ameliorate/repair hernia: synthetic and biologic meshes.…”

Section: Discussionmentioning

confidence: 99%

Collagen‐inducing biologization of prosthetic material for hernia repair: Polypropylene meshes coated with polyP/collagen

Ackermann

Wang

et al. 2017

J Biomed Mater Res

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Prostethic mesh material such as nonabsorbable polypropylene used in open and laparoscopic hernia repair are characterized by controllable mechanical properties but may elicit undesirable physiological reactions due to the nonphysiological inert polymer material. We succeeded in developing a biocompatible coating for these meshes, based on a physiological inorganic polymer, polyphosphate (polyP) that is morphogenetically active and used as a metabolic energy source, and a collagen matrix. The polyP/collagen hydrogel material was prepared by a freeze-extraction method, with amorphous Ca-polyP microparticles. Electron microscopy (SEM and REM) studies revealed that the polyP/collagen coats are built up of ≈50 nm-sized microparticles deposited onto the collagen matrix which forms a continuous layer around the polypropylene fibers that also spans the mesh pores. This bioresorbable inorganic/organic hybrid coat was found to be degraded during three days of incubation in medium/serum. The biomechanical properties of the coated meshes are comparable to those of the unmodified polypropylene meshes, with a higher toughness in longitudinal orientation and a more pronounced extensibility in the transverse orientation. The polyP/collagen coating improved cell attachment to the polypropylene meshes and strongly increase the growth of fibroblasts (MC3T3-E1 cells). Furthermore, those mats upregulate the expression of the gene encoding the stromal cell-derived factor-1α (SDF-1), a mesenchymal stem cells attracting chemokine in the fibroblasts. We conclude that coating of inert polymer meshes with a biocompatible, collagen-inducing polyP/collagen inorganic/organic hybrid layer may improve tissue integration of the meshes and the outcome of surgical hernia repair and may redudce the foreign body reaction in contaminated field. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2109-2121, 2018.

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Design strategies and applications of biomaterials and devices for Hernia repair

Cited by 118 publications

References 178 publications

Proof of concept, design, and manufacture via 3‐D printing of a mesh with bactericidal capacity: Behaviour in vitro and in vivo

Proof of concept, design, and manufacture via 3‐D printing of a mesh with bactericidal capacity: Behaviour in vitro and in vivo

Utilidad de la malla de polietileno de baja densidad, en la plastia inguinal sin tensión

Collagen‐inducing biologization of prosthetic material for hernia repair: Polypropylene meshes coated with polyP/collagen

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