-
Ugeskrift For Laeger Jan 2023Incisional and parastomal hernias are frequent complications after abdominal surgery. Patients with relevant symptoms should be referred to the local surgical department... (Review)
Review
Incisional and parastomal hernias are frequent complications after abdominal surgery. Patients with relevant symptoms should be referred to the local surgical department for diagnosis and indication for surgery. Patients with giant and parastomal hernias are referred to one of the five Danish regional hernia centres. Patients with parastomal hernias often benefit from being referred to a stoma nurse. The most frequent complications after hernia repair are wound complications and recurrence. In case of severe wound infection, incarceration, or strangulation the patient must always be referred acutely, as argued in this review.
Topics: Humans; Treatment Outcome; Incisional Hernia; Hernia; Surgical Stomas; Herniorrhaphy; Denmark; Surgical Mesh; Hernia, Ventral
PubMed: 36629293
DOI: No ID Found -
International Urogynecology Journal Aug 2023The objective was to demonstrate the surgical procedure of laparoscopic mesh removal after sacrocolpopexy to aid clinicians facing mesh complications.
INTRODUCTION AND HYPOTHESIS
The objective was to demonstrate the surgical procedure of laparoscopic mesh removal after sacrocolpopexy to aid clinicians facing mesh complications.
METHODS
Video footage shows the laparoscopic management of mesh failure and mesh erosion after sacrocolpopexy with narrated video sequences of two patients.
RESULTS
Laparoscopic sacrocolpopexy represents the gold standard in advanced prolapse repair. Mesh complications occur infrequently but infections, failure of prolapse repair and mesh erosions necessitate mesh removal and repeat sacrocolpopexy if applicable. The video deals with two women referred to our tertiary referral urogynecology unit in the University Women's Hospital of Bern, Switzerland, after laparoscopic sacrocolpopexies that were carried out in remote hospitals. Both patients were asymptomatic more than 1 year after surgery.
CONCLUSIONS
Complete mesh removal after sacrocolpopexy and repeat prolapse surgery can be challenging but is feasible and is aimed at improving patients' complaints and symptoms.
Topics: Female; Humans; Gynecologic Surgical Procedures; Laparoscopy; Pelvic Organ Prolapse; Surgical Mesh; Treatment Outcome; Uterine Prolapse; Vagina
PubMed: 36897370
DOI: 10.1007/s00192-023-05494-5 -
Journal of Gastrointestinal Surgery :... Apr 2022The aim of this paper was to provide a narrative review of surgical site infection after hernia surgery and the influence of perioperative preventative interventions. (Review)
Review
AIM
The aim of this paper was to provide a narrative review of surgical site infection after hernia surgery and the influence of perioperative preventative interventions.
METHODS
The review was based on current national and international guidelines and a literature search.
RESULTS
Mesh infection is a highly morbid complication after hernia surgery, and is associated with hospital re-admission, increased health care costs, re-operation, hernia recurrence, impaired quality of life and plaintiff litigation. The American College of Surgeons National Surgical Quality Improvement Program is a particularly useful resource for the study and evidence-based practise of abdominal wall hernia repair.
DISCUSSION
The three major modifiable patient comorbidities significantly associated with postoperative surgical site infection in hernia surgery are obesity, tobacco smoking and diabetes mellitus. Preoperative optimization includes weight loss, cessation of smoking, and control of diabetes. Intraoperative interventions relate, in particular, to the control of fomite mediated transmission in the operating theatre and prevention of mesh contamination with S. aureus CFUs. Risk management strategies should also target the niche ecological conditions which enable bacterial survival and subsequent biofilm formation on an implanted mesh. Outcomes of mesh infection after hernia surgery are closely related to mesh type and porosity, patient smoking status, presence of MRSA, bacterial adhesion and biofilm production. The use of suction drains and the timing of drain removal are controversial and discussed in detail. Finally, the utility of the ACS-NSQIP Surgical Risk Calculator in predicting complications and outcomes in individual patients and the importance of quality improvement initiatives in surgical units are emphasized.
Topics: Hernia, Ventral; Herniorrhaphy; Humans; Quality of Life; Staphylococcus aureus; Surgical Mesh; Surgical Wound Infection
PubMed: 35064459
DOI: 10.1007/s11605-022-05248-6 -
CMAJ : Canadian Medical Association... Nov 2023
Topics: Female; Humans; Suburethral Slings; Urinary Incontinence, Stress; Surgical Mesh
PubMed: 38011928
DOI: 10.1503/cmaj.221592-f -
Current Opinion in Obstetrics &... Oct 2016Polypropylene mesh has been widely used in the surgical repair of pelvic organ prolapse. However, low but persistent rates of complications related to mesh, most... (Review)
Review
PURPOSE OF REVIEW
Polypropylene mesh has been widely used in the surgical repair of pelvic organ prolapse. However, low but persistent rates of complications related to mesh, most commonly mesh exposure and pain, have hampered its use. Complications are higher following transvaginal implantation prompting the Food and Drug Administration to release two public health notifications warning of complications associated with transvaginal mesh use (PHN 2008 and 2011) and to upclassify transvaginal prolapse meshes from Class II to Class III devices. Although there have been numerous studies to determine the incidence and management of mesh complications as well as impact on quality of life, few studies have focused on mechanisms.
RECENT FINDINGS
In this review, we summarize the current understanding of how mesh textile properties and mechanical behavior impact vaginal structure and function, as well as the local immune response. We also discuss how mesh properties change in response to loading.
SUMMARY
We highlight a few areas of current and future research to emphasize collaborative strategies that incorporate basic science research to improve patient outcomes.
Topics: Female; Humans; Pelvic Organ Prolapse; Polypropylenes; Prostheses and Implants; Quality of Life; Stress, Mechanical; Surgical Mesh; Textiles; Vagina
PubMed: 27517341
DOI: 10.1097/GCO.0000000000000313 -
The Canadian Journal of Urology Aug 2021
Topics: Humans; Surgical Mesh
PubMed: 34378505
DOI: No ID Found -
ANZ Journal of Surgery Oct 2022Mesh is frequently utilized intraoperatively for the repair of groin hernias. However, patients may request non-mesh hernia repairs owing to adverse events reported in... (Review)
Review
BACKGROUND
Mesh is frequently utilized intraoperatively for the repair of groin hernias. However, patients may request non-mesh hernia repairs owing to adverse events reported in other mesh procedures. To inform surgical safety, this study aimed to compare postoperative complications between mesh and non-mesh groin hernia repairs and identify other operative and patient-related risk factors associated with poor postoperative outcomes.
METHODS
Ovid MEDLINE and grey literature were searched to 9 June 2021 for studies comparing mesh to non-mesh techniques for primary groin hernia repair. Outcomes of interest were postoperative complications, recurrence of hernia, pain and risk factors associated with poorer surgical outcomes. Methodological quality was appraised using the AMSTAR 2 tool.
RESULTS
The systematic search returned 4268 results, which included seven systematic reviews and five registry analyses. Mesh repair techniques resulted in lower hernia recurrence rates, with no difference in chronic pain, seroma, haematoma or wound infection, compared to non-mesh techniques. Risk factors associated with increased risk of hernia recurrence were increased body mass index (BMI), positive smoking status and direct hernia. These were independent of surgical technique. Patients under 40 years of age were at increased risk of postoperative pain.
CONCLUSIONS
Surgical repair of primary groin hernias using mesh achieves lower recurrence rates, with no difference in safety outcomes, compared with non-mesh repairs. Additional risk factors associated with increased recurrence include increased BMI, history of smoking and hernia subtype.
Topics: Groin; Hernia, Inguinal; Herniorrhaphy; Humans; Postoperative Complications; Recurrence; Surgical Mesh
PubMed: 35451174
DOI: 10.1111/ans.17721 -
Taiwanese Journal of Obstetrics &... Sep 2022
Topics: Humans; Pelvic Floor; Pelvic Organ Prolapse; Plastic Surgery Procedures; Surgical Mesh
PubMed: 36088039
DOI: 10.1016/j.tjog.2022.06.001 -
European Review For Medical and... Dec 2022Many studies show that surgical hernia repair with the use of prosthetic meshes can result in pain, hernia recurrence, contraction and mesh rupture. Numerous... (Review)
Review
Many studies show that surgical hernia repair with the use of prosthetic meshes can result in pain, hernia recurrence, contraction and mesh rupture. Numerous experimental studies have been conducted to understand the effect of mesh stiffness, pore size and mesh patterns on mesh biocompatibility. The purpose of this mini review is to present an overview of the contracture, adhesion, tissue regrowth and histological response characteristics of permanent and absorbable mesh. Indeed, the mechanics of mesh-human tissue interaction is poorly understood in the literature. It has been shown that early integration of biological meshes is critical for sustained hernia repair. One of the emerging experimental approaches is to combine cell-based regenerative medicine with mesh materials. Studies in preclinical models show that the use of synthetic and biological meshes with autologous cell implantation improves the biocompatibility of biomaterials, promoting key tissue regeneration processes such as adhesion and vascularisation.
Topics: Humans; Surgical Mesh; Prostheses and Implants; Wound Healing; Biological Products; Hernia, Ventral
PubMed: 36591887
DOI: 10.26355/eurrev_202212_30791 -
International Urogynecology Journal Aug 2021Women with mesh-related complications in prolapse (POP) and stress-urinary incontinence (SUI) surgery may benefit from operative mesh resection to alleviate symptoms. We...
INTRODUCTION AND HYPOTHESIS
Women with mesh-related complications in prolapse (POP) and stress-urinary incontinence (SUI) surgery may benefit from operative mesh resection to alleviate symptoms. We hypothesized that mesh resection would alleviate symptoms and aimed to evaluate risks and benefits in these women.
METHODS
We carried out a cross-sectional study. Primary outcome was improvement specified as better, unchanged or worsened symptoms after mesh revision surgery. Secondary outcomes were health-related quality of life (HrQol) scores of validated questionnaires, surgical characteristics and physical findings at follow-up visits. Descriptive data were reported with mean and medians. Associations were calculated with Spearman correlation coefficient and chi-square test to determine statistical differences between groups.
RESULTS
Fifty-nine women who underwent mesh revision surgery between 2009 and 2016 were included. After a median follow-up of 1.7 (IQR: 1.1-2.4) years, 44 women (75%) reported improvement of symptoms. No significant surgical or patient characteristics were identified that could differentiate which patients did or did not experience cure or complications.A trend was observed to better HrQol scores in women who reported overall improvement after mesh revision surgery. Seventeen (29%) women needed a subsequent operation after mesh removal.
CONCLUSIONS
This cross-sectional study shows that mesh revision surgery alleviates symptoms in 75% of women with mesh-related complications. Type of revision surgery and individual characteristics did not seem to matter to the individual chance of cure or complications. These data can facilitate the counseling of women considering mesh revision surgery.
Topics: Cross-Sectional Studies; Female; Humans; Pelvic Organ Prolapse; Quality of Life; Reoperation; Suburethral Slings; Surgical Mesh; Urinary Incontinence; Urinary Incontinence, Stress
PubMed: 33034678
DOI: 10.1007/s00192-020-04543-7