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Surgical Endoscopy Nov 2013The use of mesh is becoming more popular for large hiatal hernia (type II-IV) repair to reduce the recurrence rate. The aim of this study was to outline the currently... (Review)
Review
BACKGROUND
The use of mesh is becoming more popular for large hiatal hernia (type II-IV) repair to reduce the recurrence rate. The aim of this study was to outline the currently available literature on the use of mesh in laparoscopic large hiatal hernia repair, emphasizing objective outcome.
METHODS
A structured search of the literature was performed in the Medline, Embase, and Cochrane Central Register of Controlled Trials databases.
RESULTS
A total of 26 studies met the inclusion criteria. There were three randomized controlled trials, seven prospective and five retrospective cohort studies, and five prospective and one retrospective case-control study. The study design was not reported in the remaining studies. In the included studies, laparoscopic hiatal hernia repair was performed with mesh in 924 patients (mesh group) and without mesh in 340 patients (nonmesh group). The type of mesh used was very different: polypropylene in six, biomesh in nine, polytetrafluoroethylene (PTFE) in two, expanded PTFE (ePTFE) in two, and composite polypropylene-PTFE in another two. At least two different kinds of mesh were used in five studies. Radiological and/or endoscopic follow-up was performed after a mean (± SEM) period of 25.2 ± 4.0 months. There was no or only a small recurrence (recurrent hiatal hernia <2 cm) in 385 of the 451 available patients (85.4 %) in the mesh group and in 182 of 247 (73.7 %) in the nonmesh group.
CONCLUSIONS
The use of mesh in the repair of large hiatal hernias is promising with respect to the reduction of anatomical recurrences. However, many different kinds and configurations of mesh are available. This systematic review of the literature is a basis for high-quality randomized controlled trials to obtain the most effective and safe mesh in the long term.
Topics: Diaphragm; Hernia, Hiatal; Herniorrhaphy; Humans; Laparoscopy; Polypropylenes; Polytetrafluoroethylene; Prostheses and Implants; Secondary Prevention; Surgical Mesh; Treatment Outcome
PubMed: 23793804
DOI: 10.1007/s00464-013-3036-y -
Archives of Dermatological Research Jun 2024Fast gut cutaneous sutures have become more prominent due to their low tissue reactivity, rapid absorption, and elimination of suture removal visits. It is not known how... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Fast gut cutaneous sutures have become more prominent due to their low tissue reactivity, rapid absorption, and elimination of suture removal visits. It is not known how fast gut sutures compare to other closure modalities.
METHODS
A comprehensive literature review was conducted to identify randomized controlled trials comparing fast gut sutures to alternative closure methods during dermatologic surgery. Data collected included patient and physician assessed cosmetic outcome as well as standardized complication rates.
RESULTS
Six studies were included in final analysis and reported on 208 patients. Fast gut sutures were associated with lower physician opinions of final scar when compared to polypropylene sutures (SMD 0.438; 95% CI 0.082 to 0.794). No differences existed between physician opinion of fast gut sutures and cyanoacrylate tissue adhesive (SMD - 0.024; 95% CI - 0.605 to 0.556). Complications with fast gut suture placement were rare, and included infection, dehiscence, and hematomas. Fast gut sutures were less likely to experience wound dehiscence than tissue adhesive (p = 0.01).
CONCLUSION
If no contraindications to polypropylene sutures exist, they may provide superior cosmetic outcomes compared to fast gut sutures. Further research is required to better quantify cosmetic outcomes and optimal use of fast gut sutures.
Topics: Humans; Sutures; Dermatologic Surgical Procedures; Suture Techniques; Tissue Adhesives; Polypropylenes; Cicatrix; Randomized Controlled Trials as Topic; Cyanoacrylates; Wound Healing
PubMed: 38850366
DOI: 10.1007/s00403-024-02973-7 -
International Journal of Surgery... 2011To systematically analyse the effectiveness of delayed-absorbable (Polydioxanone; PDS) versus non-absorbable (Polypropylene; Prolene, and Nylon) for abdominal fascial... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To systematically analyse the effectiveness of delayed-absorbable (Polydioxanone; PDS) versus non-absorbable (Polypropylene; Prolene, and Nylon) for abdominal fascial closure in patients undergoing laparotomy.
METHODS
Randomised trials evaluating PDS versus Prolene/Nylon for abdominal fascial closure were selected and analysed by using the statistical tool RevMan where summative data was expressed as odds ratio (OR).
RESULTS
Eight randomised trials encompassing 4261 patients undergoing laparotomy closure with either PDS or Prolene/Nylon were retrieved. There was no statistically significant heterogeneity among trials. In the fixed effect model PDS was comparable to Prolene/Nylon in terms of risk of incisional hernia (OR, 1.10; 95% CI, 0.87, 1.37; z = 0.79; p = 0.43), wound dehiscence (OR, 1.04; 95% CI, 0.67, 1.62; z = 0.19; p = 0.85), peri-operative complications (OR, 0.94; 95% CI, 0.66, 1.33; z = 0.37; p = 0.71), suture sinus formation (OR, 0.58; 95% CI, 0.33, 1.04; z = 1.84; p = 0.07) and surgical site infection (OR, 0.98; 95% CI, 0.68, 1.39; z = 0.14; p = 0.89). Subgroup analysis separately comparing Prolene and Nylon with PDS supported same outcome.
CONCLUSION
PDS and Prolene/Nylon are equally effective for the closure of abdominal fascia following laparotomy. Given that there are no significant differences between two suture materials, further studies may be conducted to evaluate their cost-effectiveness and measurement of health-related quality of life instead of analysing their effectiveness in laparotomy closure.
Topics: Abdominal Wound Closure Techniques; Absorbable Implants; Hernia, Abdominal; Humans; Laparotomy; Nylons; Polydioxanone; Polypropylenes; Postoperative Complications; Surgical Wound Dehiscence; Surgical Wound Infection; Sutures
PubMed: 22061310
DOI: 10.1016/j.ijsu.2011.09.006 -
Hernia : the Journal of Hernias and... May 2024Use of mesh is essential in hernia repair. A common complication after hernia repair is surgical site infection (SSI), which poses a risk in spreading to the mesh,... (Review)
Review
PURPOSE
Use of mesh is essential in hernia repair. A common complication after hernia repair is surgical site infection (SSI), which poses a risk in spreading to the mesh, possibly causing mesh infection. Topical antimicrobial pretreatment of mesh may potentially reduce SSI risk in hernia repair and has shown promising results in in vitro and in vivo studies. Clinical evidence, however, is more important. This systematic review aims to provide an overview of available clinical evidence for antimicrobial pretreated mesh in hernia repair surgery to reduce SSI.
METHODS
We report in accordance with PRISMA guidelines. CENTRAL, EMBASE, CINAHL and PubMed were searched up to October 2023 for studies that investigated the use of antimicrobial pretreated mesh on SSI incidence in adults undergoing hernia repair. The primary outcome was SSI incidence. We also collected data on pathogen involvement, hernia recurrence, and mesh infection. A meta-analysis on SSI risk and GRADE-assessment was performed of eligible studies.
RESULTS
We identified 11 eligible studies (n = 2660 patients); 5 randomized trials and 6 cohort studies. Investigated interventions included pre-coated mesh, antibiotic carriers, mesh soaked or irrigated with antibiotic or antiseptic solution. Meta-analysis showed no significant reduction in SSI for antibiotic pretreated polypropylene mesh (RR 0.76 [95% CI 0.27; 2.09]; I 50%).
CONCLUSION
Data on topical mesh pretreatment to reduce SSI risk after hernia repair is limited. Very low certainty evidence from randomized trials in hernia repair surgery shows no significant benefit for antibiotic mesh pretreatment for SSI reduction, but data are imprecise due to optimal information size not being met.
PubMed: 38722398
DOI: 10.1007/s10029-024-02987-0 -
BJU International Jan 2021To provide an update on the literature regarding the management of complications secondary to synthetic mesh placed to treat stress urinary incontinence (SUI).
OBJECTIVE
To provide an update on the literature regarding the management of complications secondary to synthetic mesh placed to treat stress urinary incontinence (SUI).
METHODS
We performed a systematic review of the literature using a multi-database structured search within OVID, the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE) and Cochrane library databases; using the keywords: urology, incontinence, mesh and surgery.
RESULTS
Several million synthetic polypropylene meshes have been inserted into women worldwide to manage SUI. Unfortunately, a significant number of women have now reported life-changing complications. We found a paucity of studies, heterogeneity of cohorts, poor long-term follow-up, and lack of evidence on the effective management of mesh-related complications.
CONCLUSIONS
The contemporary evidence is low-level and often contradictory, which prevents robust recommendations regarding treatment. A prospective registry will be required to generate meaningful outcome data and help in the complex management of patients who have mesh-related complications.
Topics: Autoimmunity; Female; Humans; Polypropylenes; Suburethral Slings; Surgical Mesh; Urinary Incontinence, Stress; Urologic Diseases; Vaginal Diseases
PubMed: 32981191
DOI: 10.1111/bju.15260 -
Colorectal Disease : the Official... Jun 2013Laparoscopic ventral mesh rectopexy (VMR) is a surgical option for internal and external rectal prolapse with low perioperative morbidity and low recurrence rates. Use... (Comparative Study)
Comparative Study Review
AIM
Laparoscopic ventral mesh rectopexy (VMR) is a surgical option for internal and external rectal prolapse with low perioperative morbidity and low recurrence rates. Use of synthetic mesh in the pelvis may be associated with complications such as fistulation, erosion and dyspareunia. Biological meshes may avoid these complications, but the long-term outcome is uncertain. Debate continues as to which type of mesh is optimal for laparoscopic VMR.
METHOD
A literature search was performed of electronic databases including MEDLINE, Embase and Scopus (2000-12). Studies describing outcomes relating to the mesh were included for review. Only English language studies were included.
RESULTS
Thirteen observational studies reported the outcome of 866 patients following laparoscopic VMR. Eleven reported the outcome using synthetic mesh with a median follow-up ranging from 7 to 74 months. Two studies reported the outcome with biological mesh with a median follow-up of 12 months. Pooled analysis of the studies demonstrated that 767 patients had a repair with synthetic mesh and 99 with a biological implant. There was no difference in recurrence (3.7 vs 4.0%, P = 0.78) or mesh complications (0.7 vs 0%, P = 1.0%) between synthetic and biological mesh repair.
CONCLUSION
Biological meshes appear to be as effective as synthetic meshes in the short term for laparoscopic VMR. Mesh complication rates are low in both groups. Long-term follow-up is required to ascertain if these findings persist.
Topics: Biocompatible Materials; Collagen; Humans; Laparoscopy; Polyesters; Polypropylenes; Postoperative Complications; Rectal Prolapse; Rectum; Recurrence; Surgical Mesh; Treatment Outcome
PubMed: 23517144
DOI: 10.1111/codi.12219 -
ANZ Journal of Surgery Oct 2022Mesh infection is the most feared postoperative complication after abdominal wall hernia repair, often needs mesh removal. Negative pressure wound therapy (NPWT) has... (Review)
Review
BACKGROUND
Mesh infection is the most feared postoperative complication after abdominal wall hernia repair, often needs mesh removal. Negative pressure wound therapy (NPWT) has been used in these situations with diverse results. The aim of this study was to investigate the efficacy of the NPWT in the treatment of mesh infection, the primary outcome was the mesh salvage rates of different type of meshes and mesh positions.
METHODS
Major databases were searched using the keywords negative pressure wound therapy, VSD, vacuum assisted, hernia, mesh infection, including various combinations of the terms. All relevant articles and reference lists in these original studies were also obtained from the above databases.
RESULTS
Ten articles containing 265 patients on the treatment of mesh infection after hernia repair with the use of NPWT method were included. The general infected mesh salvage rate with NPWT was 76.2%. The highest mesh salvage rate was achieved in polypropylene mesh (93.5%), followed by Proceed mesh (83.3%), and the mesh salvage rate was lower in polyester mesh (PCO) (0%) and the ePTFE mesh (14/3%). The salvage rate was higher when mesh placed in the onlay position (82.6%) or retromuscular/sublay position (98.5%), but lower in the IPOM position (55.6%).
CONCLUSION
The treatment of mesh infection after hernia repair should be individualized according to the mesh type, mesh position and the severity of infection. Infected mesh with favourable mesh materials (large pore and monofilament polypropylene) and favourable positions (onlay or sublay/retromuscular) can be salvaged with the use of NPWT based conservative method.
Topics: Herniorrhaphy; Humans; Negative-Pressure Wound Therapy; Polyesters; Polypropylenes; Surgical Mesh
PubMed: 36106686
DOI: 10.1111/ans.18040 -
Environmental Pollution (Barking, Essex... May 2024Microplastics in drinking water captured widespread attention following reports of widespread detection around the world. Concerns have been raised about the potential... (Review)
Review
Microplastics in drinking water captured widespread attention following reports of widespread detection around the world. Concerns have been raised about the potential adverse effects of microplastics in drinking water on human health. Given the widespread interest in this research topic, there is an urgent need to compile existing data and assess current knowledge. This paper provides a systematic review of studies on microplastics in drinking water, their evidence, key findings, knowledge gaps, and research needs. The data collected show that microplastics are widespread in drinking water, with large variations in reported concentrations. Standardized methodologies of sampling and analysis are urgently needed. There were more fibrous and fragmented microplastics, with the majority being <10 μm in size and composed of polyester, polyethylene, polypropylene, and polystyrene. Little attention has been paid to the color of microplastics. More research is needed to understand the occurrence and transfer of microplastics throughout the water supply chain and the treatment efficiency of drinking water treatment plants (DWTPs). Methods capable of analyzing microplastics <10 μm and nanoplastics are urgently needed. Potential ecological assessment models for microplastics currently in use need to be improved to take into account the complexity and specificity of microplastics.
Topics: Humans; Microplastics; Plastics; Drinking Water; Water Pollutants, Chemical; Environmental Monitoring
PubMed: 38537794
DOI: 10.1016/j.envpol.2024.123857 -
Hernia : the Journal of Hernias and... Apr 2019This study reviewed the literature regarding mesh migration in abdominal hernia repair. The aim of this study is to interrogate incidence, common type of abdominal...
PURPOSE
This study reviewed the literature regarding mesh migration in abdominal hernia repair. The aim of this study is to interrogate incidence, common type of abdominal hernia repair leading to migration, patterns of mesh migration, and materials associated with migration.
METHODS
A comprehensive literature review was conducted. PubMed and MEDLINE were searched for relevant articles in the English literature. We employed Ovid syntax from 1949 to January 2010, the Cochrane Library, Google and Google Scholar. The clinical trial database Clinicaltrials.gov was reviewed. Letters to the editor were reviewed to extract cross-references. Multiple keywords were used alone and in combination to extract all relevant articles.
RESULTS
In total, 287 unique English citations were reviewed. Of these, 84 articles were selected and consisted of 3 case series, 77 case reports, 2 literature reviews, 1 retrospective study, and 1 prospective, observational study. In an analysis of available cases, the average age was 59.8 ± 13.8 years with a male predominance (76.2%). The index hernia repair was inguinal in 62.9%, incisional/ventral in 28.1%, umbilical in 6.7%, and other in 2.2%. Within the inguinal hernia group, 51.8% were open repairs, 42.9% were laparoscopic, and 1.8% were robotic. Implicated mesh materials included polypropylene, PTFE, and composite mesh. Migration commonly affected multiple organs (31.5%).
CONCLUSIONS
It is likely that more cases of mesh migration will appear in the literature. Reports are heterogeneous and highlight the diversity of this complication. A standardized method of reporting is needed to develop guidelines and recommendations for this presentation.
Topics: Foreign-Body Migration; Hernia, Abdominal; Herniorrhaphy; Humans; Surgical Mesh
PubMed: 30701369
DOI: 10.1007/s10029-019-01898-9 -
Plastic and Reconstructive Surgery Nov 2012There are numerous randomized controlled trials examining biological materials in urogynecologic surgery. For prolapse surgery, the addition of a biological graft adds... (Review)
Review
There are numerous randomized controlled trials examining biological materials in urogynecologic surgery. For prolapse surgery, the addition of a biological graft adds no benefit compared with native tissue repairs for rectocele repair. Conflicting data exist regarding cystocele repair. Synthetic mesh repairs provide superior anatomical support for sacral colpopexy and cystocele repair compared with biologic grafts. However, biological and synthetic mesh slings have equivalent success rates for the treatment of stress urinary incontinence. Contrary to prior assumptions that biologic grafts add tissue strength without graft-related complications, there appears to be no benefit to the use of biological materials for prolapse and incontinence surgery.
Topics: Acellular Dermis; Biocompatible Materials; Bioprosthesis; Cystocele; Double-Blind Method; Female; Gynecologic Surgical Procedures; Humans; Male; Pelvic Organ Prolapse; Polypropylenes; Randomized Controlled Trials as Topic; Plastic Surgery Procedures; Rectocele; Suburethral Slings; Surgical Mesh; Urinary Incontinence; Urologic Surgical Procedures
PubMed: 23096979
DOI: 10.1097/PRS.0b013e31826154e4