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$175.00
Surgical Technology International XXI contains 40 articles with color illustrations.
Universal Medical Press, Inc.
San Francisco, September, 2011
ISBN: 1-890131-17-2
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STI XXI - Hernia Repair
ULTRAPRO® Hernia System: Toward an Ideal Solution? The Bonheiden Experience with a Partially Absorbable and Macroporous Bilayer Device
Tim Tollens, MD, Consultant Surgeon, Sabrina Speybrouck, MD, Consultant Surgeon, Catherine Terry, MD, Registrar in surgery, Kurt Devroe, MD, Registrar in Surgery, Chris Alevoet, MD, Consultant Surgeon Jean-Pierre Vanrykel, MD, Head of Department Department of General Surgery, Imelda Hospital, Bonheiden, Belgium
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Abstract
- In 1998, Gilbert introduced the Prolene Hernia System (PHS), a bilayer polypropylene mesh device composed of an onlay patch, a connector, and an underlay patch. The overall concept of its design was to include the best features of all currently available techniques while eliminating their undesirable features. This device is now available in a lightweight version, the Ultrapro® Hernia System (UHS; Johnson & Johnson, Somerville, NJ). We present the Bonheiden experience. From 2006 until 2009, we used 890 UHS devices in 712 patients. All patients were requested to join a prospective analysis with follow-up at one week and one month. Follow-ups at one and two years were organized using a telephone questionnaire. We were able to monitor 668 UHS implants in 526 patients. Bilateral primary hernias were repaired simultaneously in 142 patients and 6 hernias were a recurrence of a previous nonmesh repair. There were 472 men and 54 women in our cohort, with an average age of 57.5 years and average BMI of 24.79. No recurrences have occurred to date. Superficial wound infection presented in 3 patients. They were treated with antibiotics and no mesh needed to be removed. Seromas are much more common after this bilayer technique and are not considered a true complication. Whereas ecchymosis is very common, large hematomas were seen in 5 patients. One patient presented with a DVT of the iliac vein. She was treated with anticoagulation for three months, stockings, and early mobilization. The Ultrapro Hernia System is a good alternative to other preperitoneal hernia repairs, feasible in a day hospital under locoregional or general anesthesia. It has a very low recurrence rate but carries a more extensive dissection. We think the price paid for this extensive dissection is more than acceptable and is comparable to the Lichtenstein experience.
Update on Bioactive Prosthetic Material for the Treatment of Hernias
David S. Edelman, MD, FACS,
Department of Surgery,
Doctors Hospital
Miami, Florida, Jason P. Hodde, MS,
Clinical Affairs Manager,
Cook Biotech Incorporated,
West Lafayette, Indiana
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Abstract
- The use of mesh in the repair of hernias is commonplace. Synthetic mesh, like polypropylene, has been the workhorse for hernia repairs since the 1980s. Surgisis® mesh (Cook Surgical, Bloomington, IN), a biologic hernia graft material composed of purified porcine small intestinal submucosa (SIS), was first introduced to the United States in 1998 as an alternative to synthetic mesh materials. This mesh, composed of extracellular matrix collagen, fibronectin and associated glycosaminoglycans and growth factors, has been extensively investigated in animal models and used clinically in many types of surgical procedures. SIS acts as a scaffold for natural growth and strength. We reported our initial results in this publication in July 2006. Since then, there have been many more reports and numerous other bioactive prosthetic materials (BPMs) released. The object of this article is to briefly review some of the current literature on the use of BPM for inguinal hernias, sports hernias, and umbilical hernias.
Comparison of Recurrence Rates in Obese and Non-Obese Patients Undergoing Ventral Hernia Repair with Lighter-Weight, Partially Absorbable Mesh
Tim Tollens, MD , Consultant Surgeon, Imelda Hospital, Bonheiden, Belgium, Sabrina Speybrouck, MD, Registrar in Surgery, Imelda Hospital, Bonheiden, Belgium, Kurt Devroe, MD, Registrar in Surgery, Imelda Hospital, Bonheiden, Belgium, Catherine Terry, MD, Registrar in Surgery, Sint Nikolaus Hospital, Eupen, Belgium, Chris Aelvoet, MD, Consultant Surgeon, Imelda Hospital, Bonheiden, Belgium, L. Thomas Divilio, MD, Ethicon, Inc., Somerville, New Jersey, Bababhai Patel, PhD, Ethicon, Inc., Somerville, New Jersey, JP. Vanrykel, MD
Head of Department, Imelda Hospital, Bonheiden, Belgium
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Abstract
- Lighter-weight, large pore meshes with absorbable layers are designed for intra-abdominal placement in laparoscopic ventral hernia repair. This retrospective review of 86 patients who underwent ventral hernia repair with PROCEED™ Surgical Mesh (Ethicon, Inc., Somerville, NJ) represents an evaluation of a cohort of patients implanted with this mesh. All patients implanted with PROCEED Mesh for ventral hernia repair between October 2006 and December 2007 were contacted and asked to participate in an evaluation of their hernia repair. Patients were evaluated for pain, recurrence of their hernia and other potential complications. Eight patients underwent open repair; all others were performed laparoscopically. One patient continued to have pain at 1 year. Twelve developed seromas early on and 5 required drainage by a single puncture each. None persisted. There were 4 recurrences with none in patients with a Body Mass Index ³ 32. One case of abdominal wall cellulitis responded to antibiotics. There were no wound infections, mesh infections, bowel obstructions or enteric fistulas. This study demonstrates the utility of a lighter-weight, large pore, partially absorbable mesh for intraperitoneal use in laparoscopic ventral hernia repair and indicates this mesh is strong enough for use in obese patients.