BACKGROUND Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a pa...BACKGROUND Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair via a combined laparoscopic and sacrococcygeal approach that has not been described,and discuss our experience in diagnosis and treatment with a review of the literature.CASE SUMMARY A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.CONCLUSION Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.展开更多
<strong>Rationale:</strong> The three-dimensional (3D) computer-made titanium mesh is widely used in the skull repair for those patients receiving decompression of the bone flap. It can restore normal anat...<strong>Rationale:</strong> The three-dimensional (3D) computer-made titanium mesh is widely used in the skull repair for those patients receiving decompression of the bone flap. It can restore normal anatomy to a greater extent and make a better appearance. <strong>Case Presentation: </strong>We reported two cases of patients admitted to our hospital who have experienced high scalp tension after skull repair. At first, these two patients underwent decompression of the bone flap, and the physical examination results showed a defect of skull. No neurological symptoms and signs were found. The 3D computed tomography (CT) reconstruction of skull was performed, and then the skull repair with 3D titanium mesh was conducted. But because of high scalp tension, they underwent a second operation, during which we re-trimmed and reduce the arc of the titanium mesh. The scalp incision of both patients healed well and no titanium mesh was exposed. Both patients have a good prognosis. <strong>Lessons:</strong> We highlight that the high tension of scalp due to overstretching after 3D titanium mesh repair for skull defect should be paid much attention to. Trimming and reducing the arc of titanium mesh is an effective treatment for this situation.展开更多
Objective: To report results of mesh repair vs. the modified Mayo’s suture overlap in the surgical treatment of adult umbilical and paraumbilcal hernias in our medical center. Patients & Methods: The study is a S...Objective: To report results of mesh repair vs. the modified Mayo’s suture overlap in the surgical treatment of adult umbilical and paraumbilcal hernias in our medical center. Patients & Methods: The study is a Saudi single center single surgeon trial composed of sixty two patients. It was performed in the Surgical Department of King Abdul-Aziz University Hospital at Jeddah. The patients were randomly assigned into 2 groups. Group A patients underwent onlay mesh repair while modified Mayo’s repair was used in group B patients. Median follow-up was 28 months, and data were collected regarding size of hernia, type of the operation, complications, length of follow-up and the recurrence rate. Chi square test was used to compare results at 0.05 levels. Results: Complication was reported in 17% in group A and 8% in group B .There was no difference in scar pain, cosmetic result, and overall patient satisfaction between both groups. The recurrence rate was 10% for mesh repair and 18.8% for suture repair. Conclusions: Despite higher complication rate, mesh repair is superior to suture repair due to lower recurrence rate. Suture repair still has a place under certain circumstances, also it is simple less costly and has insignificant infection rate.展开更多
Introduction: Umbilical hernia in adults poses a challenge to the surgeon. Understanding the anatomical and pathological intricacies of the hernia is pivotal in evolving a good repair. A multitude of repairs have been...Introduction: Umbilical hernia in adults poses a challenge to the surgeon. Understanding the anatomical and pathological intricacies of the hernia is pivotal in evolving a good repair. A multitude of repairs have been tried for repair of umbilical hernias. However none of them have withstood the test of time. Objective: The study aims at evolving a technique which provides mesh reinforced anatomical reconstruction of the defect. Materials and Methods: 20 patients underwent a combination repair for umbilical hernia. The results were tabulated and analysed. Results: None of the 20 patients developed any recurrence. Conclusion: A combined mesh reinforcement of tissue repair is advocated for umbilical hernias in adults.展开更多
In representing automobile parts with mesh in the field of reverse engineering or finite element generation, the mesh reconstruction and data exchanging between different CAD/CAM systems often introduce many invisible...In representing automobile parts with mesh in the field of reverse engineering or finite element generation, the mesh reconstruction and data exchanging between different CAD/CAM systems often introduce many invisible topological and geometrical errors into mesh. These artifacts can cause serious problems in subsequent operations such as finite element analysis, reverse engineering, animation, and simulation. In this study we propose a practical method for repairing topological and geometrical errors on mesh. First, coincident vertices during mesh input are removed, fol- lowed by the identification of non-manifold vertices and edges. The non-manifold vertices are modified, and the facets having non-manifold edges are removed. Finally, faces that have the wrong orientations in the mesh are re-oriented. Experiments show that our methods can eliminate most common mesh errors quickly and effectively. The refined mesh can be properly used in subsequent operations.展开更多
AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrenc...AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrence, wound and mesh infection, other complications, surgical techniques and mortality. Weighted pooled proportions （95%CI） were calculated using StatsDirect. Heterogeneity concerning outcome mea-sures was determined using Cochran’s Q test and was quantifed using I2. Random and fxed effects models were used. Meta-analysis was performed with Review Manager software with the statistical signifcance set at P ≤ 0.05.RESULTSForty-four studies were included： 5 reporting biologic mesh repairs; 21, synthetic mesh repairs; and 18, prophylactic mesh repairs. Most of the studies were retrospective cohorts of low to moderate quality. The hernia recurrence rate was higher after undergoing biologic compared to synthetic mesh repair （24.0% vs 15.1%, P = 0.01）. No significant difference was found concerning wound and mesh infection （5.6% vs 2.8%; 0% vs 3.1%）. Open and laparoscopic techniques were comparable regarding recurrences and infections. Prophylactic mesh placement reduced the occurrence of a parastomal hernia （OR = 0.20, P 〈 0.0006） without increasing wound infection [7.8% vs 8.2% （OR = 1.04, P = 0.91）] and without differences between the mesh types.展开更多
Objective:The objective of this article is to systematically analyse the randomized,controlled trials comparing transinguinal preperitoneal(TIPP)and Lichtenstein repair(LR)for inguinal hernia.Methods:Randomized,contro...Objective:The objective of this article is to systematically analyse the randomized,controlled trials comparing transinguinal preperitoneal(TIPP)and Lichtenstein repair(LR)for inguinal hernia.Methods:Randomized,controlled trials comparing TIPP vs LR were analysed systematically using RevMan®and combined outcomes were expressed as risk ratio(RR)and standardized mean difference.Results:Twelve randomized trials evaluating 1437 patients were retrieved from the electronic databases.There were 714 patients in the TIPP repair group and 723 patients in the LR group.There was significant heterogeneity among trials(P<0.0001).Therefore,in the random effects model,TIPP repair was associated with a reduced risk of developing chronic groin pain(RR,0.48;95%CI,0.26,0.89;z=2.33;P<0.02)without influencing the incidence of inguinal hernia recurrence(RR,0.18;95%CI,0.36,1.83;z=0.51;P=0.61).Risk of developing postoperative complications and moderate-to-severe postoperative pain was similar following TIPP repair and LR.In addition,duration of operation was statistically similar in both groups.Conclusion:TIPP repair for inguinal hernia is associated with lower risk of developing chronic groin pain.It is comparable with LR in terms of risk of hernia recurrence,postoperative complications,duration of operation and intensity of postoperative pain.展开更多
BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient como...BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient comorbidities,surgical complexity,and immunosuppression presents considerable challenges in hernia repair,often accompanied by substantial risks.AIM To assess the incidence,risk factors,and outcomes of IH repair in LT recipients.METHODS A systematic literature search was conducted across MEDLINE,EMBASE,Scopus,CINAHL,the Cochrane Library,Google Scholar,and PubMed,yielding 493 results.In accordance with PRISMA guidelines,39 studies reporting on IH following LT were included in the final analysis.Studies involving paediatric populations,hernias unrelated to transplant incisions,living liver donors,non-LT,and multiorgan transplants were excluded.Meta-analysis was performed using Cochrane RevMan software.The study has been registered with PROSPERO(CRD420-24563398).RESULTS A review of 39 studies revealed incidence of post-LT IH ranging from 1.7%to upto 42.8%.Pooled analysis showed comparable demographics among groups and post-LT IH incidence was higher in older age recipients[mean difference(MD)=2.39,95%CI:1.15-3.63,P<0.001],male gender(relative risk=1.42,95%CI:1.18-1.72,P<0.001),high body mass index(BMI)(MD=1.06,95%CI:0.82-1.29,P<0.001),Mercedez-Benz incision type[odds ratio(OR)=0.45,95%CI:0.21,0.96,P=0.04],and need for re-laparotomy(OR=2.49,95%CI:1.05-5.93,P=0.04).No significant differences were found in recurrence rates or wound complications between open and laparoscopic IH repairs.CONCLUSION Older recipient age,male gender,high BMI,Mercedes-Benz incision,and re-laparotomy after LT are significant risk factors for IH.In contrast,model for end-stage liver disease score,pre-LT ascites,acute rejection,and mammalian target of rapamycin inhibitor therapy do not appear to influence IH development.While open repair remains the predominant approach post-LT,no significant differences in recurrence or wound complication rates have been observed between open and laparoscopic repairs.However,open repair is associated with a shorter operative time.展开更多
Mesh migration and penetration into abdominal visce-ra rarely occur after laparoscopic inguinal hernia repair. We present the first case of mesh migration into the sigmoid colon identified as a colonic polyp at initia...Mesh migration and penetration into abdominal visce-ra rarely occur after laparoscopic inguinal hernia repair. We present the first case of mesh migration into the sigmoid colon identified as a colonic polyp at initial co-lonoscopic examination. The patient complained of mild abdominal distention in the lower abdomen over the previous year without changes in bowel habits or stool appearance and without weight loss. By complement-ary endoscopic ultrasonography, a cavity--like structure beneath the suspected polyp was further confirmed. Enhanced abdominal computed tomography merely re-vealed local bowel wall thickening and inflammation of the colosigmoid junction. The migrating mesh, which was lodged in the sigmoid colon and caused intra--abdomi-nal adhesion in the lower abdominal cavity, was finally identified via exploratory surgery. The components of inflammatory granulation tissue around the mesh mate-rial were diagnosed based on histological examination of the surgical specimen after sigmoidectomy. In this patient, nonspecific endoscopic and imaging outcomes during clinical work--up led to the diagnostic dilemma of mesh migration. Therefore, the clinical, radiological and endoscopic challenges specific to this case as well as the underlying reasons for mesh migration are discussed in detail.展开更多
Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and compris...Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery,divided into the polypropylene mesh(PPM)group and the mosquito net mesh(MNM)group each containing fifty patients.All cases were completed successfully and results revealed no difference in two groups.The results of the present study,in consistent with the published literature,reveal that the cheap indigenous mosquito mesh,which has similar properties of an imported mesh,can be safely used for tension-free inguinal hernia repair in adults.Further trials with a larger number of patients and longer follow-ups are justified and recommended.展开更多
Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, po...Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, posed a new set of postoperative problems with the mesh infection being the most morbid one. Laparoscopic surgery has been able to reduce the incidence of mesh infection as opposed to the open hernia repairs. The infection occurs mostly early but rarely does it present several years after the surgery. Herein we report our case of delayed mesh infection developing 6 years postoperatively. This is our first such case in a series of more than 1000 laparoscopic hernia repairs over a period of 6 years (2010-2016). The patient needed an open exploration which revealed a large preperitoneal cavity containing 770 ml of pus with a mesh floating in it. The mesh was removed and the thorough toileting of the wound was done.展开更多
Background: It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, and port-site hernia. We chose to fix it to the exterior reducing port size, cost and pain, at the same comparing th...Background: It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, and port-site hernia. We chose to fix it to the exterior reducing port size, cost and pain, at the same comparing this with traditional mesh stapling. Methods: We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 120 patients in which we fixed the mesh to the anterior abdominal wall using either two prolene threads that passed to the exterior and tied in place or traditional mesh stapling. Results: The operative time is ranged from 35 to 70 minutes for external fixation, 30 to 60 minutes for mesh stapling, and 4 to 51 months for follow-up, and no recurrence occurred in both groups during the procedure. Two cases with post TAPP pain in mesh stapling patients are discussed with reduction of the cost and port size in external fixation patients. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior and it is fixed only to the exterior allowing a reduction in size of the ports and considerable reduction in cost with elimination of TAPP associated post operative pain.展开更多
Background: Laparoscopic tension-free repair of inguinal hernia was presented in 1990s, promising less pain and short recovery period, but carrying the risk mesh bulging and migration. Objective: We have presented our...Background: Laparoscopic tension-free repair of inguinal hernia was presented in 1990s, promising less pain and short recovery period, but carrying the risk mesh bulging and migration. Objective: We have presented our technique in which central zone of mesh is fixed only after closure of hernial defect. Patients and Methods: This study included 27 males patients (14 indirect inguinal hernias, 9 direct inguinal hernias, 4 both direct and indirect inguinal hernias on the same side). These cases are undergoing tension-free mesh repair after closure of hernial defect, and the mesh is fixed only at its central zone using Gulbran 2, between April 2011 and March 2013. The follow-up period ranged from 6 to 30 months. The intra and postoperative complications were recorded. Results: Mean hospital stay was 1 day. The age of this group of patients ranged from 23 to 63 years (mean, 47 years). The operative time ranged from 30 to 100 minutes (mean, 45 minutes). The intraoperative complications were in form of mild bleeding in 7 patients (25.9%) during hernial sac dissection. Postoperative complications were mild inguinal pain in 4 patients (14.8%) for three weeks. Mild hydrocele in 3 patients (11%) was recorded. No recurrence or bulging at hernia site was noticed during the period of follow-up. Conclusion: Laparoscopic inguinal hernia repair with central mesh fixation after closure of hernial defect is effective, easy and free of complications.展开更多
Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in ...Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in 3 cases of bilateral inguinal hernia. Methods: Laparoscopic SPA-IPOM is done through a 10 mm trocar with one 10 mm instrument that has 5 mm optical lens and 5 mm channel for grasper. After inserting 10 mm trocar at umbilicus using semi-open technique, intraperitoneal anatomical landmark of inguinal her-nia is identified. A 10 × 15 cm pre-tied bioresorbable composite mesh is then placed to cover hernia defect and all three potential area of indirect, direct and femoral hernia. Using Endoclose? needle, each pair of pre-tied sutures is retrieved percutaneously through a needle wound and extracorporeal tied with knot in subcutaneous space. After the upper half of mesh is sutured to the posterior surface of abdominal wall, the lower half of mesh is fixed by hernia tacker to Symphysis Pubis, Cooper Ligament and Iliopubic tract. Re-sults: Three men, average 48 year olds were operated by laparoscopic 10 mm SPA-IPOM for bilateral in-guinal hernia repair using bioresorbable composite mesh. Average operative time was 36 minutes. No imme-diate complication. All patients were discharge on the 2nd post-operative day and average 6 months follow up has no recurrence. Conclusions: Laparoscopic SPA-IPOM is an optional operation and is much easier to be performed. Benefits include operative time saving, cosmesis, early discharge and early return to work. Bio-resorbable composite mesh prevents bowel adhesion, however, is much more expensive. Long term follow up study for complications and recurrence is needed.展开更多
Objective To explore the application of scalp rotation flap in reconstruction of infectious scalp defect with titanium mesh exposure. Methods Twelve patients were treated in this group including 4 males and 8 female. ...Objective To explore the application of scalp rotation flap in reconstruction of infectious scalp defect with titanium mesh exposure. Methods Twelve patients were treated in this group including 4 males and 8 female. S The defective size ranged from 2. 0 cm × 5. 0 cm to 0.展开更多
Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mese...Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal her-nia, volvulus, and gastroesophageal reflux.展开更多
BACKGROUND A meshoma formation and erosion to the small intestine is rare.Herein,we report one case of a meshoma that was not treated early;causing it to displace and erode the small intestine,with infection,complete ...BACKGROUND A meshoma formation and erosion to the small intestine is rare.Herein,we report one case of a meshoma that was not treated early;causing it to displace and erode the small intestine,with infection,complete control of symptoms was achieved after removal of the infected patch mass,no recurrence of hernia after 2 years of follow-up.CASE SUMMARY A 62-year-old male patient presented with recurrent abdominal pain repeatedly for 1 wk,which has worsened 2 d before admition,accompanied by fever.Five years before presentation he underwent right inguinal hernia Plug and patch repair approach.Two years ago,a computed tomography scan revealed a right lower abdominal mass with soft tissue density,measuring approximately 30 mm×17 mm,which was diagnosed as meshoma that was not treated.The patient had poorly controlled diabetes in the past year.CONCLUSION The formation of meshoma is rare,and that if not treated in time it might erode and require resection of the involved organ.展开更多
文摘BACKGROUND Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair via a combined laparoscopic and sacrococcygeal approach that has not been described,and discuss our experience in diagnosis and treatment with a review of the literature.CASE SUMMARY A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.CONCLUSION Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.
文摘<strong>Rationale:</strong> The three-dimensional (3D) computer-made titanium mesh is widely used in the skull repair for those patients receiving decompression of the bone flap. It can restore normal anatomy to a greater extent and make a better appearance. <strong>Case Presentation: </strong>We reported two cases of patients admitted to our hospital who have experienced high scalp tension after skull repair. At first, these two patients underwent decompression of the bone flap, and the physical examination results showed a defect of skull. No neurological symptoms and signs were found. The 3D computed tomography (CT) reconstruction of skull was performed, and then the skull repair with 3D titanium mesh was conducted. But because of high scalp tension, they underwent a second operation, during which we re-trimmed and reduce the arc of the titanium mesh. The scalp incision of both patients healed well and no titanium mesh was exposed. Both patients have a good prognosis. <strong>Lessons:</strong> We highlight that the high tension of scalp due to overstretching after 3D titanium mesh repair for skull defect should be paid much attention to. Trimming and reducing the arc of titanium mesh is an effective treatment for this situation.
文摘Objective: To report results of mesh repair vs. the modified Mayo’s suture overlap in the surgical treatment of adult umbilical and paraumbilcal hernias in our medical center. Patients & Methods: The study is a Saudi single center single surgeon trial composed of sixty two patients. It was performed in the Surgical Department of King Abdul-Aziz University Hospital at Jeddah. The patients were randomly assigned into 2 groups. Group A patients underwent onlay mesh repair while modified Mayo’s repair was used in group B patients. Median follow-up was 28 months, and data were collected regarding size of hernia, type of the operation, complications, length of follow-up and the recurrence rate. Chi square test was used to compare results at 0.05 levels. Results: Complication was reported in 17% in group A and 8% in group B .There was no difference in scar pain, cosmetic result, and overall patient satisfaction between both groups. The recurrence rate was 10% for mesh repair and 18.8% for suture repair. Conclusions: Despite higher complication rate, mesh repair is superior to suture repair due to lower recurrence rate. Suture repair still has a place under certain circumstances, also it is simple less costly and has insignificant infection rate.
文摘Introduction: Umbilical hernia in adults poses a challenge to the surgeon. Understanding the anatomical and pathological intricacies of the hernia is pivotal in evolving a good repair. A multitude of repairs have been tried for repair of umbilical hernias. However none of them have withstood the test of time. Objective: The study aims at evolving a technique which provides mesh reinforced anatomical reconstruction of the defect. Materials and Methods: 20 patients underwent a combination repair for umbilical hernia. The results were tabulated and analysed. Results: None of the 20 patients developed any recurrence. Conclusion: A combined mesh reinforcement of tissue repair is advocated for umbilical hernias in adults.
文摘In representing automobile parts with mesh in the field of reverse engineering or finite element generation, the mesh reconstruction and data exchanging between different CAD/CAM systems often introduce many invisible topological and geometrical errors into mesh. These artifacts can cause serious problems in subsequent operations such as finite element analysis, reverse engineering, animation, and simulation. In this study we propose a practical method for repairing topological and geometrical errors on mesh. First, coincident vertices during mesh input are removed, fol- lowed by the identification of non-manifold vertices and edges. The non-manifold vertices are modified, and the facets having non-manifold edges are removed. Finally, faces that have the wrong orientations in the mesh are re-oriented. Experiments show that our methods can eliminate most common mesh errors quickly and effectively. The refined mesh can be properly used in subsequent operations.
文摘AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrence, wound and mesh infection, other complications, surgical techniques and mortality. Weighted pooled proportions （95%CI） were calculated using StatsDirect. Heterogeneity concerning outcome mea-sures was determined using Cochran’s Q test and was quantifed using I2. Random and fxed effects models were used. Meta-analysis was performed with Review Manager software with the statistical signifcance set at P ≤ 0.05.RESULTSForty-four studies were included： 5 reporting biologic mesh repairs; 21, synthetic mesh repairs; and 18, prophylactic mesh repairs. Most of the studies were retrospective cohorts of low to moderate quality. The hernia recurrence rate was higher after undergoing biologic compared to synthetic mesh repair （24.0% vs 15.1%, P = 0.01）. No significant difference was found concerning wound and mesh infection （5.6% vs 2.8%; 0% vs 3.1%）. Open and laparoscopic techniques were comparable regarding recurrences and infections. Prophylactic mesh placement reduced the occurrence of a parastomal hernia （OR = 0.20, P 〈 0.0006） without increasing wound infection [7.8% vs 8.2% （OR = 1.04, P = 0.91）] and without differences between the mesh types.
文摘Objective:The objective of this article is to systematically analyse the randomized,controlled trials comparing transinguinal preperitoneal(TIPP)and Lichtenstein repair(LR)for inguinal hernia.Methods:Randomized,controlled trials comparing TIPP vs LR were analysed systematically using RevMan®and combined outcomes were expressed as risk ratio(RR)and standardized mean difference.Results:Twelve randomized trials evaluating 1437 patients were retrieved from the electronic databases.There were 714 patients in the TIPP repair group and 723 patients in the LR group.There was significant heterogeneity among trials(P<0.0001).Therefore,in the random effects model,TIPP repair was associated with a reduced risk of developing chronic groin pain(RR,0.48;95%CI,0.26,0.89;z=2.33;P<0.02)without influencing the incidence of inguinal hernia recurrence(RR,0.18;95%CI,0.36,1.83;z=0.51;P=0.61).Risk of developing postoperative complications and moderate-to-severe postoperative pain was similar following TIPP repair and LR.In addition,duration of operation was statistically similar in both groups.Conclusion:TIPP repair for inguinal hernia is associated with lower risk of developing chronic groin pain.It is comparable with LR in terms of risk of hernia recurrence,postoperative complications,duration of operation and intensity of postoperative pain.
文摘BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient comorbidities,surgical complexity,and immunosuppression presents considerable challenges in hernia repair,often accompanied by substantial risks.AIM To assess the incidence,risk factors,and outcomes of IH repair in LT recipients.METHODS A systematic literature search was conducted across MEDLINE,EMBASE,Scopus,CINAHL,the Cochrane Library,Google Scholar,and PubMed,yielding 493 results.In accordance with PRISMA guidelines,39 studies reporting on IH following LT were included in the final analysis.Studies involving paediatric populations,hernias unrelated to transplant incisions,living liver donors,non-LT,and multiorgan transplants were excluded.Meta-analysis was performed using Cochrane RevMan software.The study has been registered with PROSPERO(CRD420-24563398).RESULTS A review of 39 studies revealed incidence of post-LT IH ranging from 1.7%to upto 42.8%.Pooled analysis showed comparable demographics among groups and post-LT IH incidence was higher in older age recipients[mean difference(MD)=2.39,95%CI:1.15-3.63,P<0.001],male gender(relative risk=1.42,95%CI:1.18-1.72,P<0.001),high body mass index(BMI)(MD=1.06,95%CI:0.82-1.29,P<0.001),Mercedez-Benz incision type[odds ratio(OR)=0.45,95%CI:0.21,0.96,P=0.04],and need for re-laparotomy(OR=2.49,95%CI:1.05-5.93,P=0.04).No significant differences were found in recurrence rates or wound complications between open and laparoscopic IH repairs.CONCLUSION Older recipient age,male gender,high BMI,Mercedes-Benz incision,and re-laparotomy after LT are significant risk factors for IH.In contrast,model for end-stage liver disease score,pre-LT ascites,acute rejection,and mammalian target of rapamycin inhibitor therapy do not appear to influence IH development.While open repair remains the predominant approach post-LT,no significant differences in recurrence or wound complication rates have been observed between open and laparoscopic repairs.However,open repair is associated with a shorter operative time.
基金Supported by Zhejiang Provincial Natural Science Foundation of China,No.LQ16H030001
文摘Mesh migration and penetration into abdominal visce-ra rarely occur after laparoscopic inguinal hernia repair. We present the first case of mesh migration into the sigmoid colon identified as a colonic polyp at initial co-lonoscopic examination. The patient complained of mild abdominal distention in the lower abdomen over the previous year without changes in bowel habits or stool appearance and without weight loss. By complement-ary endoscopic ultrasonography, a cavity--like structure beneath the suspected polyp was further confirmed. Enhanced abdominal computed tomography merely re-vealed local bowel wall thickening and inflammation of the colosigmoid junction. The migrating mesh, which was lodged in the sigmoid colon and caused intra--abdomi-nal adhesion in the lower abdominal cavity, was finally identified via exploratory surgery. The components of inflammatory granulation tissue around the mesh mate-rial were diagnosed based on histological examination of the surgical specimen after sigmoidectomy. In this patient, nonspecific endoscopic and imaging outcomes during clinical work--up led to the diagnostic dilemma of mesh migration. Therefore, the clinical, radiological and endoscopic challenges specific to this case as well as the underlying reasons for mesh migration are discussed in detail.
文摘Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair.The main limiting factor in the use of new meshes is the cost.We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery,divided into the polypropylene mesh(PPM)group and the mosquito net mesh(MNM)group each containing fifty patients.All cases were completed successfully and results revealed no difference in two groups.The results of the present study,in consistent with the published literature,reveal that the cheap indigenous mosquito mesh,which has similar properties of an imported mesh,can be safely used for tension-free inguinal hernia repair in adults.Further trials with a larger number of patients and longer follow-ups are justified and recommended.
文摘Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, posed a new set of postoperative problems with the mesh infection being the most morbid one. Laparoscopic surgery has been able to reduce the incidence of mesh infection as opposed to the open hernia repairs. The infection occurs mostly early but rarely does it present several years after the surgery. Herein we report our case of delayed mesh infection developing 6 years postoperatively. This is our first such case in a series of more than 1000 laparoscopic hernia repairs over a period of 6 years (2010-2016). The patient needed an open exploration which revealed a large preperitoneal cavity containing 770 ml of pus with a mesh floating in it. The mesh was removed and the thorough toileting of the wound was done.
文摘Background: It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, and port-site hernia. We chose to fix it to the exterior reducing port size, cost and pain, at the same comparing this with traditional mesh stapling. Methods: We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 120 patients in which we fixed the mesh to the anterior abdominal wall using either two prolene threads that passed to the exterior and tied in place or traditional mesh stapling. Results: The operative time is ranged from 35 to 70 minutes for external fixation, 30 to 60 minutes for mesh stapling, and 4 to 51 months for follow-up, and no recurrence occurred in both groups during the procedure. Two cases with post TAPP pain in mesh stapling patients are discussed with reduction of the cost and port size in external fixation patients. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior and it is fixed only to the exterior allowing a reduction in size of the ports and considerable reduction in cost with elimination of TAPP associated post operative pain.
文摘Background: Laparoscopic tension-free repair of inguinal hernia was presented in 1990s, promising less pain and short recovery period, but carrying the risk mesh bulging and migration. Objective: We have presented our technique in which central zone of mesh is fixed only after closure of hernial defect. Patients and Methods: This study included 27 males patients (14 indirect inguinal hernias, 9 direct inguinal hernias, 4 both direct and indirect inguinal hernias on the same side). These cases are undergoing tension-free mesh repair after closure of hernial defect, and the mesh is fixed only at its central zone using Gulbran 2, between April 2011 and March 2013. The follow-up period ranged from 6 to 30 months. The intra and postoperative complications were recorded. Results: Mean hospital stay was 1 day. The age of this group of patients ranged from 23 to 63 years (mean, 47 years). The operative time ranged from 30 to 100 minutes (mean, 45 minutes). The intraoperative complications were in form of mild bleeding in 7 patients (25.9%) during hernial sac dissection. Postoperative complications were mild inguinal pain in 4 patients (14.8%) for three weeks. Mild hydrocele in 3 patients (11%) was recorded. No recurrence or bulging at hernia site was noticed during the period of follow-up. Conclusion: Laparoscopic inguinal hernia repair with central mesh fixation after closure of hernial defect is effective, easy and free of complications.
文摘Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in 3 cases of bilateral inguinal hernia. Methods: Laparoscopic SPA-IPOM is done through a 10 mm trocar with one 10 mm instrument that has 5 mm optical lens and 5 mm channel for grasper. After inserting 10 mm trocar at umbilicus using semi-open technique, intraperitoneal anatomical landmark of inguinal her-nia is identified. A 10 × 15 cm pre-tied bioresorbable composite mesh is then placed to cover hernia defect and all three potential area of indirect, direct and femoral hernia. Using Endoclose? needle, each pair of pre-tied sutures is retrieved percutaneously through a needle wound and extracorporeal tied with knot in subcutaneous space. After the upper half of mesh is sutured to the posterior surface of abdominal wall, the lower half of mesh is fixed by hernia tacker to Symphysis Pubis, Cooper Ligament and Iliopubic tract. Re-sults: Three men, average 48 year olds were operated by laparoscopic 10 mm SPA-IPOM for bilateral in-guinal hernia repair using bioresorbable composite mesh. Average operative time was 36 minutes. No imme-diate complication. All patients were discharge on the 2nd post-operative day and average 6 months follow up has no recurrence. Conclusions: Laparoscopic SPA-IPOM is an optional operation and is much easier to be performed. Benefits include operative time saving, cosmesis, early discharge and early return to work. Bio-resorbable composite mesh prevents bowel adhesion, however, is much more expensive. Long term follow up study for complications and recurrence is needed.
文摘Objective To explore the application of scalp rotation flap in reconstruction of infectious scalp defect with titanium mesh exposure. Methods Twelve patients were treated in this group including 4 males and 8 female. S The defective size ranged from 2. 0 cm × 5. 0 cm to 0.
基金Supported by The Department of Surgery Fujita Health University School of Medicine and University Hospital
文摘Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal her-nia, volvulus, and gastroesophageal reflux.
文摘BACKGROUND A meshoma formation and erosion to the small intestine is rare.Herein,we report one case of a meshoma that was not treated early;causing it to displace and erode the small intestine,with infection,complete control of symptoms was achieved after removal of the infected patch mass,no recurrence of hernia after 2 years of follow-up.CASE SUMMARY A 62-year-old male patient presented with recurrent abdominal pain repeatedly for 1 wk,which has worsened 2 d before admition,accompanied by fever.Five years before presentation he underwent right inguinal hernia Plug and patch repair approach.Two years ago,a computed tomography scan revealed a right lower abdominal mass with soft tissue density,measuring approximately 30 mm×17 mm,which was diagnosed as meshoma that was not treated.The patient had poorly controlled diabetes in the past year.CONCLUSION The formation of meshoma is rare,and that if not treated in time it might erode and require resection of the involved organ.
