Mesh expansion as the cause of bulging after abdominal wall hernia repair

Deerenberg, Eva B.; Verhelst, Joost; Hovius, Steven E.R.; Lange, Johan F.

doi:10.1016/j.ijscr.2016.09.051

Cited by 13 publications

(11 citation statements)

References 13 publications

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“…This can cause alterations in the mesh's linear dimensions . It was shown that mesh shrinkage or expansion is associated with the development of chronic pain and increased chance of the recurrent herniation . Moreover, mesh stiffening can lead to mechanical irritation of the surrounding tissues, thus provoking further excessive immune response…”

Section: Discussionmentioning

confidence: 99%

“…32 It was shown that mesh shrinkage or expansion is associated with the development of chronic pain and increased chance of the recurrent herniation. 33,34 Moreover, mesh stiffening can lead to mechanical irritation of the surrounding tissues, thus provoking further excessive immune response. 32 However, there is a lack of consensus regarding the mechanism of hernia repair mesh deterioration caused by oxidative stress.…”

Section: Discussionmentioning

confidence: 99%

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In vitro study on the deterioration of polypropylene hernia repair meshes

et al. 2017

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Despite the relative safety of the procedure, hernia repairs are often associated with chronic post-operative pain. Although this complication has been linked among others to mesh deterioration, details of the processes that lead this deterioration are still unknown. This work aims to bridge this gap by analyzing the chemical, physical and structural alterations in hernia repair meshes exposed to oxidative stress in vitro. Here, we developed a methodology to characterize effect of oxidation stress on structure and properties of polymeric hernia repair meshes. It was shown that structural changes in polypropylene meshes exposed to oxidative stress may involve formation of cross-links between the polymer chains, chain scissions, and hydrogen bonds between the carboxyl groups, which are formed in the material during the oxidation. These effects result in mesh stiffening, ultimately leading to chronic post-operative pain. Moreover, we demonstrated that Composix meshes are more vulnerable to the oxidative stress when compared with UltraPro meshes. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2225-2234, 2018.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In vitro study on the deterioration of polypropylene hernia repair meshes

et al. 2017

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“…This difference creates the feeling of foreign body sensation. 15 But the sensitivity will be over countered by the time postoperatively. In the present study, 10 patients experience the foreign body sensation post-operatively at 1 month follow up, 5 patients at 3 month follow up and only 2 patients at the end of 1 year follow up.…”

Section: Discussionmentioning

confidence: 99%

“…Int Surg J. 2019 Jan;6(1):[13][14][15][16] International Surgery Journal | January 2019 | Vol 6 | Issue 1 Page 16…”

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confidence: 99%

A clinical study of post operative complications of Lichtenstein’s hernioplasty for inguinal hernia

Vasu¹

2018

Int Surg J

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Background: Lichtenstein’s hernioplasty is the commonly done surgery for inguinal hernias. The study was done with the objective to evaluate the postoperative complications, and the recurrence rate associated with Lichtenstein’s hernioplasty.Methods: This was a prospective clinical study conducted at Sapthagiri Institute of Medical Science and Research Centre, Bangalore during the period from May 2015 to April 2016. A total of 50 patients with inguinal hernia were included in the study. All the patients underwent Lichtenstein’s hernioplasty. Outcome of the surgery was evaluated by the incidence of postoperative complications and recurrence rate of hernia after 1 year follow up.Results: Intraoperative complications were observed in 3 (6%) patients. Immediate postoperative complication was seen in 6 (12%) cases. Stiffness in lower abdomen was noticed in 13 (26%) cases. The average post-operative hospital stay was 4.06±1.43 days and the average post-operative ambulation time was 1.52±0.64 days. The average time taken to return to work post-operatively was 8.68±2.63 days. Long term complications included are foreign body sensation and chronic pain at operated site. After 1 year follow up the prevalence of both the complications was decreased to 4% and 6% respectively. No recurrence of hernia (0%) was noticed after 1 year follow up.Conclusions: Lichtenstein’s hernioplasty was considered as the best surgical procedure for inguinal hernia repair because of low recurrence rate (0%) and postoperative complications.

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“…If the implant behaves much more rigid than the original soft tissue, it gives rise to tensile stresses that may tear the tissue surrounding, provoking pain and discomfort in the patient and increasing the risk of tissue damage (Paajanen and Hemunen, 2004). On the other hand, if the implant behaves much softer than the muscles replaced, it may lead to an hernia recurrence or the presence of "bulging" of the prothesis due to its lack of strength (Schoenmaeckers et al, 2010;Deerenberg et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Mechanical behavior of surgical meshes for abdominal wall repair: In vivo versus biaxial characterization

Simón-Allué

Ortillés

Calvo

2018

Journal of the Mechanical Behavior of Biomedical Materials

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Despite the widespread use of synthetic meshes in the surgical treatment of the hernia pathology, the election criteria of a suitable mesh for specific patient continues to be uncertain. Thus, in this work, we propose a methodology to determine in advance potential disadvantages on the use of certain meshes based on the patient-specific abdominal geometry and the mechanical features of the certain meshes. To that purpose, we have first characterized the mechanical behavior of four synthetic meshes through biaxial tests. Secondly, two of these meshes were implanted in several New Zealand rabbits with a total defect previously created on the center of the abdominal wall. After the surgical procedure, specimen were subjected to in vivo pneumoperitoneum tests to determine the immediate post-surgical response of those meshes after implanted in a healthy specimen. Experimental performance was recorded by a stereo rig with the aim of obtaining quantitative information about the pressure-displacement relation of the abdominal wall. Finally, following the procedure presented in prior works (Simón-Allué et al., 2015, 2017), a finite element model was reconstructed from the experimental measurements and tests were computationally reproduced for the healthy and herniated cases. Simulations were compared and validated with the in vivo behavior and results were given along the abdominal wall in terms of displacements, stresses and strain. Mechanical characterization of the meshes revealed Surgipro as the most rigid implant and Neomesh SuperSoft® as the softer, while other two meshes (Neomesh Soft®, Neopore®) remained in between. These two meshes were employed in the experimental study and resulted in similar effect in the abdominal wall cavity and both were close to the healthy case. Simulations confirmed this result while showed potential objections in the case of the other two meshes, due to high values in stresses or elongation that may led to discomfort in real tissue. The use of this methodology on human surgery may provide the surgeons with reliable and useful information to avoid certain meshes on specific-patient treatment.

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Mesh expansion as the cause of bulging after abdominal wall hernia repair

Cited by 13 publications

References 13 publications

In vitro study on the deterioration of polypropylene hernia repair meshes

In vitro study on the deterioration of polypropylene hernia repair meshes

A clinical study of post operative complications of Lichtenstein’s hernioplasty for inguinal hernia

Mechanical behavior of surgical meshes for abdominal wall repair: In vivo versus biaxial characterization

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