Innovations in Ventral Hernia Repair

Abstract:

There is a renewed interest in the surgical repair of ventral hernias due to new meshes and new techniques to use these meshes. The standard of care for ventral hernia repair, the Rives-Stoppa repair, is now more commonly done in the USA. Originally, only polypropylene mesh (PPM) or polyester meshes were available for this technique and they had to be placed extraperitoneally. With development of the laparoscopic approach for ventral hernia repair using expanded polytetrafluoroethylene (ePTFE), newer coated meshes for intraperitoneal placement were developed. Companies have also combined polypropylene mesh (PPM) and polytetrafluoroethylene (PTFE) into a unique mesh and numerous biologic meshes are being introduced. All of these meshes have led to several new methods for ventral hernia repair (including parastomal hernia) and in those cases where mesh is not indicated, one non-mesh repair, the components separation, has received renewed attention.

Authors:

Guy R. Voeller, M.D., F.A.C.S., University of Tennessee, Memphis, Memphis, Tennessee, USA

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Meshes in Hernia Repair

Abstract:

The search for safe and effective means of herniorrhaphies has been ongoing for more than a century. Evidence strongly supports tension-free hernia repairs in most patients, which result in a 50% reduction in a ten-year cumulative rate of hernia recurrence compared with tissue repairs. Polypropylene mesh revolutionized the field approximately 50 years ago; however, limitations of traditional polypropylene mesh have fueled the research and development of other prosthetic and biologic mesh products. Newer polyester and expanded polytetrafluoroethylene (ePTFE) products are designed to improve pliability and reduce adhesiogenic potential. Combination meshes capitalize on the ideal properties of biomaterials by strategically positioning particular mesh surfaces to selectively impede or promote tissue ingrowth. The most recent improvement in mesh products is the introduction of "lightweight" meshes. In response to mounting evidence that the traditional formulations of polypropylene meshes are over-engineered, lightweight meshes were designed with less polypropylene per surface area. Future research may prove that most meshes used currently are "mechanical overkill," which may lead to a widespread use of lightweight meshes to provide a durable repair, minimize chronic mesh-related discomfort, and improve the overall quality of life of hernia patients.

Authors:

Yuri W. Novitsky, M.D., Andrew G. Harrell, M.D., William W. Hope, M.D., Kent W. Kercher, M.D., F.A.C.S., B. Todd Heniford, M.D., F.A.C.S., Carolinas Hernia Center, Carolinas Medical Center, Charlotte, NC, USA

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Hernioplasty with Surgisis® Inguinal Hernia Matrix (IHM)™

Abstract:

Although at present nonabsorbable meshes are the preferred material for tension-free hernioplasty, some problems with their use are still to be addressed (i.e., chronic pain and infections). To address these disadvantages, a collagen-based material, the porcine small intestinal submucosa mesh, has recently been developed for hernia repair. The technique to use this material in performing an hernioplasty is described. A preshaped Surgisis® Inguinal Hernia Matrix (IHM)™ is fashioned as appropriate, with a slit 2 cm from its inferior edge to accommodate the spermatic cord, placed for at least 10 min into a dish with room-temperature normosaline to be rehydrated and then transferred to the already prepared and dissected inguinal region. After drawing its tails around the cord, the mesh is sutured to the inguinal ligament with a continuous suture of PDS II 2/0, starting from the pubic tubercle laterally up to the deep orifice. The fixation of the mesh to the internal oblique abdominal muscle and the rectus sheath is accomplished with interrupted stitches. An extra stitch is placed between the two tails to close the new deep orifice. We conclude that an hernioplasty using Surgisis® IHM™ is feasible with promising results.

Authors:

Stefano Gagliardi, M.D., Luca Ansaloni, M.D., Fausto Catena, M.D., Filippo Gazzotti, M.D., Luigi D'Alessandro, M.D., Antonio Daniele Pinna, M.D., F.A.C.S., St. Orsola-Malpighi University Hospital, Bologna, Italy

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