Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia

Korenkov, Michael; Sauerland, Stefan; Arndt, M.; Bograd, L; Neugebauer, E.; Troidl, H.

doi:10.1046/j.0007-1323.2001.01974.x

Cited by 242 publications

(193 citation statements)

References 19 publications

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“…6,17 Large trials have shown that hernia repair should be performed by mesh placement and no longer by primary resuturing of the hernia because of unacceptably high recurrence rates. 7,19 Mesh repair, however, is not free from complications, with significant factors being technical failure such as insufficient fixation of the mesh to the abdominal wall and complications which are a result of the mesh biomaterial itself. The latter is especially true if the biomaterial provokes inflammation, or if its surface is prone to bacterial infection.…”

Section: Discussion and Concluding Remarksmentioning

confidence: 99%

Polypropylene Meshes to Prevent Abdominal Herniation. Can Stable Coatings Prevent Adhesions in the Long Term?

et al. 2008

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Abstract-Abdominal surgery is associated with a significant risk for incisional herniation. Hernia repair is routinely performed by implantation of synthetic meshes. Such meshes may cause serious adhesions between the implanted material and organs leading to intestinal obstruction or enterocutaneous fistulas. This study compares three knitted meshes for their capacity to prevent adhesion formation in an in vivo study. The meshes evaluated are polypropylene (Prolene Ò ), polypropylene coated with oxygenated regenerated cellulose-in principle-a biodegradable biomaterial (Proceed Ò ), and Prolene Ò coated with a nondegradable copolymer of the hydrophilic building block N-vinyl pyrrolidone (NVP) and the hydrophobic building block n-butylmethacrylate (BMA). The meshes were implanted in the abdomen of rats (followup 7 or 30 days). After 7 days, the formation of adhesions decreased in the order: Prolene Ò > NVP/BMA-coated Prolene Ò > Proceed Ò ; after 30 days, this order changed into: Proceed Ò > Prolene Ò > NVP/BMA-coated Prolene Ò . Both at 7 and at 30 days, Proceed Ò was the only mesh surrounded by macrophage cells that contained foreign materials, presumably degradation products of the (biodegradable) surface coating. The data indicate that long-term protection of implanted meshes against excessive adhesions may be achieved through stable biocompatible hydrogel surface coatings.

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Section: Discussion and Concluding Remarksmentioning

confidence: 99%

Polypropylene Meshes to Prevent Abdominal Herniation. Can Stable Coatings Prevent Adhesions in the Long Term?

et al. 2008

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“…Scores on the measure were also able to differentiate groups of gastrointestinal patients with different levels of function, as well as between those with gastrointestinal disease and those who were ostensibly normal. Responsiveness is obviously highest in gastroesophageal disorders, but the GIQLI has also been used with variable responsiveness in other abdominal operations [14,19,42,65,73]. The GIQLI is available on the Quality of Life Database developed by the nonprofit Mapi Research Institute.…”

Section: Gastrointestinal Quality Of Life Index (Giqli)mentioning

confidence: 99%

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

et al. 2004

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Background: Measuring health-related quality of life (QoL) after surgery is essential for decision making by patients, surgeons, and payers. The aim of this consensus conference was twofold. First, it was to determine for which diseases endoscopic surgery results in better postoperative QoL than open surgery. Second, it was to recommend QoL instruments for clinical research. Methods: An expert panel selected 12 conditions in which QoL and endoscopic surgery are important. For each condition, studies comparing endoscopic and open surgery in terms of QoL were identified. The expert panel reached consensus on the relative benefits of endoscopic surgery and recommended generic and disease-specific QoL instruments for use in clinical research. Results: Randomized trials indicate that QoL improves earlier after endoscopic than open surgery for gastroesophageal reflux disease (GERD), cholecystolithiasis, colorectal cancer, inguinal hernia, obesity (gastric bypass), and uterine disorders that require hysterectomy. For spleen, prostate, malignant kidney, benign colorectal, and benign non-GERD esophageal diseases, evidence from nonrandomized trials supports the use of laparoscopic surgery. However, many studies failed to collect long-term results, used nonvalidated questionnaires, or measured QoL components only incompletely.

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“…In the literature, several studies have assessed the body's reaction to polypropylene mesh implantation, which is widely used for the repair of abdominal wall defects of different etiologies. However, most studies seek to assess the rates of recurrence, infection and inflammatory response, and the presence of adhesions associated with the use of different mesh types available in the market [7][8][9] . According to the literature, since polypropylene mesh acts as a foreign body in the surgical wound, it could cause a prolonged inflammatory response (chronic inflammatory reaction) retarding progression to the proliferative phase of healing, which is responsible for the tensile strength of the scar 8,22,23 .…”

Section: Discussionmentioning

confidence: 99%

“…Currently there are several synthetic materials available, but polypropylene mesh is definitely the most widely used, with the most recorded experience 6,7 . The main characteristic of these meshes are that they are inert when infection occurs, that they maintain the tensile strength of the abdominal wall and have an excellent capacity for integration 2 , besides being low cost and malleable, and they have already been tested for years.…”

Section: Introductionmentioning

confidence: 99%

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Fibroplasia after polypropylene mesh implantation for abdominal wall hernia repair in rats

et al. 2009

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RESUMOObjetivo: Avaliar o tempo de fibroplasia em tela de polipropileno na correção de hérnias incisionais da parede abdominal, em ratos, através da quantidade de colágeno, correlacionando-o com a resposta inflamatória local. Métodos: Trinta e seis ratos machos da linhagem Wistar foram submetidos à ressecção longitudinal de um segmento músculo-aponeurótico e peritoneal (3x2 cm) da parede abdominal, seguida por reforço com tela de polipropileno, em forma de ponte sobre a aponeurose. Os animais foram distribuídos em seis grupos, de acordo com o tempo de fibroplasia a ser estudado (1, 2, 3, 7, 21 e 30 dias de pós-operatório). Após os prazos estabelecidos para estudo da fibroplasia, os animais foram submetidos à eutanásia, e a área de fixação da tela de polipropileno foi avaliada histologicamente quanto à reação inflamatória e à percentagem de colágeno pela técnica videomorfométrica assistida por computador. Resultados: Houve aparecimento de colágeno total junto à tela no 3º dia pós-implante, com aumento progressivo na sua proporção em todos os dias subseqüentes até o 21º dia, quando atingiu sua proporção máxima (p<0,001). A partir do dia 3, o colágeno III sofreu um aumento progressivo até o dia 21, quando atingiu sua proporção máxima (p<0,001), e no 30º dia apresentou uma redução significativa (p<0,001). O colágeno tipo I surgiu entre o 7º e o 21º dia, apresentou sua máxima proporção no 21º dia e manteve-se inalterado até o final do período de observação. A relação colágeno tipo I/tipo III aumentou progressivamente e inverteu-se no 30º dia de observação (p<0,001). Os neutrófilos foram identificados no 1º dia pós-implante, mantendo-se junto à tela até o 21º dia. Os macrófagos, gigantócitos e linfócitos foram identificados no 2º dia. Trinta dias após a implantação da tela, desapareceram os neutrófilos e mantiveram-se estáveis as proporções de macrófagos, gigantócitos e linfócitos (p<0,001). Conclusões: Os resultados do presente estudo evidenciaram a presença de colágeno no 3º dia pós-implante, com predomínio do colágeno tipo I ao final do período de observação. O prolongamento da resposta inflamatória da cicatrização e a persistência do processo inflamatório crônico junto à tela não interferiram no tempo da fibroplasia. Descritores: Parede Abdominal. Colágeno. Hérnia. Telas Cirúrgicas. Polipropilenos. Neutrófilos. Ratos. ABSTRACT Purpose:This study assessed the collagen deposition and correlated it with local inflammatory responses to evaluate the length of time required for fibroplasia when polypropylene meshes are used to repair incisional abdominal wall hernias in rats. Methods: Thirty-six male Wistar rats underwent longitudinal resection of a peritoneal and musculoaponeurotic tissue segment (3x2 cm) of the abdominal wall followed by defect reconstruction with polypropylene mesh bridging over aponeurosis. The animals were divided into 6 groups according to the time points for the analysis of fibroplasia: 1, 2, 3, 7, 21 and 30 days post-implantation. Animals were sacrificed at each time point, and the site where th...

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Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia

Abstract: Suture repair was safe for small incisional hernias. Both autoplastic and alloplastic hernia repair yielded comparably low recurrence rates, but led to a high rate of wound infection.

Cited by 242 publications

References 19 publications

Polypropylene Meshes to Prevent Abdominal Herniation. Can Stable Coatings Prevent Adhesions in the Long Term?

Polypropylene Meshes to Prevent Abdominal Herniation. Can Stable Coatings Prevent Adhesions in the Long Term?

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

Fibroplasia after polypropylene mesh implantation for abdominal wall hernia repair in rats

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