Editorial: Mesh Complications in Hernia Surgery

Kallinowski, F.; Fortelny, René H.; Köckerling, F.; Mayer, F; Morales-Conde, Salvador; Sandblom, Gabriel

doi:10.3389/fsurg.2022.841672

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…Mesh-related complications are well known following hernia repair in adults [ 40 ]. Data on long-term follow-up after mesh repair in adolescents are too sparse for any firm conclusions on this surgical approach [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

No Reason to Use Mesh in Groin Hernia Repair in Adolescents

Reistrup,

Fonnes,

Rosenberg

2024

J. Abdom. Wall Surg.

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Groin hernias are common and hernia repair is one of the most frequent surgical procedures performed worldwide. Despite this, there is no international guideline on the management of groin hernias in adolescents. Mesh reinforcement is used for repair in adults but not in young children. Adolescents, positioned between these age groups, pose unique challenges for surgeons due to their varying growth patterns. Placing a synthetic mesh in growing patients is a concern, particularly in relation to chronic pain. Traditionally, the hernia literature has defined adults as individuals aged 18 years and above. Considering that growth can continue until age 19, this review proposes a revised definition of adolescence for patients with groin hernias encompassing ages 10 to 19. Symptomatic groin hernias in adolescents should be repaired with an open non-mesh technique because of acceptable recurrence rates and the desire to avoid introducing synthetic foreign materials into young patients with ongoing growth potential. Watchful waiting is suggested for asymptomatic groin hernias, postponing repair until the adolescent has become a fully grown adult and symptoms from the hernia develop. Most groin hernias in adolescents are lateral hernias, but before pursuing a watchful waiting strategy in females, an ultrasound or magnetic resonance imaging scan is suggested to rule out the presence of a femoral hernia that may need repair.

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Section: Discussionmentioning

confidence: 99%

No Reason to Use Mesh in Groin Hernia Repair in Adolescents

Reistrup,

Fonnes,

Rosenberg

2024

J. Abdom. Wall Surg.

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“…According to many researchers [12,19,24,27], surgical trauma and the presence of an implant in the tissues lead to the occurrence of an inflammatory process, which prevents the delimitation of the implant, and contributes to the occurrence of postoperative complications. Long periods of alteration processes around implanted mesh endoprostheses lead to the development of complications in the early postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Comparative assessment of tissue response to a mesh implant made of polypropylene modified with carbon nanotubes and silver nanoparticles

Viltsaniuk,

Kravchenco,

Viltsaniuk

et al. 2024

Rep. of Morph.

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Treatment of abdominal hernias remains one of the most urgent problems of modern surgery. A large number of complications after hernia operations require the development of new types of implants for tissue plastic surgery. The purpose of the study is to carry out an experimental comparative assessment of tissue reaction to the implantation of the developed polypropylene mesh implant modified with carbon nanotubes and silver nanoparticles. Research was conducted on 105 sexually mature laboratory rats in three series of experiments (35 rats each). In the first series, polypropylene mesh implants were implanted in the tissues of the anterior abdominal wall, in the second – polypropylene implants coated with an antiseptic, and in the third – polypropylene implants modified with carbon nanotubes and silver nanoparticles. Animals were removed from the experiment after preliminary anesthesia 3, 5, 7, 14, 21, 30 and 90 days after the operation. The tissues of the abdominal wall were taken together with the implants, histological preparations were made, which were stained with hematoxylin and eosin and according to Van Gieson. We studied the composition and ratio of elements of cell infiltration in tissues with further statistical processing of the obtained data. It was established that during the implantation of mesh edoprostheses, regardless of their type, necrotic changes with reactive inflammation, the presence of inflammatory cell infiltrate, tissue swelling and microcirculation disorders were detected in the tissues 3-5 days after the operation. Under the condition of implantation of the developed mesh, a less pronounced exudative phase of inflammation and an earlier onset of the reparation phase were detected. Depending on the type of implant used, the subsequent reaction differed between the groups of experimental animals, which was evidenced by the regression of inflammatory phenomena in the tissues and the processes of formation of the fibrous capsule around the implants. During the implantation of nanomodified mesh implants by the 7th day of the experiment, the exudative phase of inflammation ended and the formation of a thin connective tissue capsule began, the formation of which was completed by the 21st day of observation, while when the mesh was implanted with polypropylene and polypropylene with an antimicrobial coating, the formation of the capsule lasted up to 30 days. Thus, it was established that the exudative phase of inflammation continues in the tissues around the implantation of classic polypropylene and polypropylene meshes with an antimicrobial coating up to the 14th day of the experiment, and the connective tissue capsule is formed up to the 30th day. At the same time, in the tissues around the mesh implants made of polypropylene modified with carbon nanotubes and silver nanoparticles, the exudative phase of inflammation ended by the 7th day of the experiment. This ensured the intensity of reparative regeneration processes and the separation of the implant from the surrounding tissues by a thin connective tissue capsule for up to 21 days of observation.

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“…An evolving dehiscence might not yet be visible under the skin and subcutaneous tissue. Weak scar tissue is formed, and a secure healing is impaired [ 9 , 10 , 14 ]. In clinical practice, fascia dehiscence greater than 12 mm is followed by hernia formation within 4 years in 94% of cases [ 10 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…A hernia occurs when the defect closure can no longer withstand the stress [ 8 , 9 ]. The failure starts by slackening of the suture line or by tearing of a stitch through the tissue [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Standardized suturing can prevent slackening or bursting suture lines in midline abdominal incisions and defects

Lesch

Uhr

Vollmer

et al. 2022

Hernia

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Purpose Incisional hernias often follow open abdominal surgery. A small-stitch–small-bite suture might close the incision durably. We analyzed specific details of this closure technique and assessed their influence on the closure stability. Methods The effects of cyclic loads, simulating coughs were investigated on a bench test. We prepared porcine bellies in the median line and bovine flanks parallel to the muscle fibers with 15 cm long incisions. Then we punched round or rhomboid defects with a diameter of 5–10 cm into the center of the incision. Monomax® 2–0 and Maxon® 1 and 2–0 were used as suture materials. We tested the durability of the closure with pressure impacts of 210 mmHg repeated 425 times. Throughout the experiments, we modified the suturing technique, the surgeon, the tissue tension, the defect size and shape and the suture diameter. Results Standardizing the suture technique improved the durability of the closure significantly. Any other variations showed minor influences after standardization. All incisions with round defects up to 7.5 cm width withstood 425 impacts using standardized suturing. Unstandardized sutures failed in all cases. When closing an incision with a 10 cm wide defect, the tissues ruptured frequently next to the suture line. We defined criteria to standardize this suturing technique. For the first time, we developed a suture factor related to the durability of a sutured tissue closure. We integrated the suture factor into the concept of biomechanically durable repairs. Conclusions Suturing the abdominal wall with a standardized suturing technique improves its durability significantly.

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Editorial: Mesh Complications in Hernia Surgery

Cited by 6 publications

References 21 publications

No Reason to Use Mesh in Groin Hernia Repair in Adolescents

No Reason to Use Mesh in Groin Hernia Repair in Adolescents

Comparative assessment of tissue response to a mesh implant made of polypropylene modified with carbon nanotubes and silver nanoparticles

Standardized suturing can prevent slackening or bursting suture lines in midline abdominal incisions and defects

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