ObjectiveTo investigate the surgical skills and clinical effects of the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in treatment of recurrent inguinal hernia with plug prefix mesh.
MethodsThe clinical data such as operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications of 87 patients with recurrent inguinal hernia reoperated in laparoscopic TAPP after inguinal hernioplasty with plug prefix mesh (recurrent hernia group), in the Department of Gastroenterology and Hernia surgery of the First Affiliated Hospital of Kunming Medical University from January 2011 to December 2013, were retrospectively analyzed, which were compared with the 834 incipient inguinal hernia patients operated first by TAPP (incipient hernia group) at the same time.
ResultsThe operations were completed successfully in all of the 921 patients without conversion to open surgery. The operation time and intraoperative blood loss in the recurrent hernia group were significantly more than those in the incipient hernia group (P=0.000, P=0.000), the postoperative hospital stay had no signifcant difference between two groups (P=0.057). No recurrences were observed in the recurrent hernia group and incipient hernia group for following-up of (31±4) months and (28±6) months, respectively. Compared with the incipient hernia group, the rates of postoperative pain on day 30 and seroma on day 1 and 3 were higher in the recurrent hernia group (P=0.001, P=0.040, P=0.003, respectively). There were no severe complications such as collateral damage, foreign body sensation, incision infection, intestinal obstruction and so on in the two groups.
ConclusionsThe laparoscopic TAPP inguinal hernia repair is safe and effective for patients with recurrent inguinal hernia with plug prefix mesh. More skills are required to reduce the complications. The operation time and intraoperative blood loss in reoperated patients with recurrent inguinal hernia are more than those in patients with incipient inguinal hernia. The rates of seroma on day 1 and 3 are also higher.
Objective?To explore the method and effectiveness of laparoscopic bundled fastigiated mesh in repairing inguinal hernia.?Methods?Between January 2003 and December 2009, 1 215 patients (1 363 sides) with inguinal hernia were treated. There were 1 132 males (1 268 sides) and 83 females (95 sides), aged from 18 to 89 years (median, 58 years). The cases included 1 187 cases (1 329 sides) of primary hernia and 28 cases (34 sides) of recurrent hernia. There were indirect inguinal hernia in 728 cases (786 sides), direct inguinal hernia in 416 cases (499 sides), femoral hernia in 43 cases (45 sides), and unusual hernia in 28 cases (33 sides). According to the hernia classification criteria, there were 31 cases (38 sides) in type I, 683 cases (754 sides) of type II, 403 cases (452 sides) of type III, and 98 cases (119 sides) of type IV. The disease duration was 1 to 9 days with an average of 3.8 days. To repair the hernia, the bundled fastigiated mesh was patched through the internal inguinal ring and fixed on the internal inguinal fascia by three-point fixation. The mesh would be wrapped in the peritoneum by purse-string suture.?Results?The surgeries were performd successfully. The operative time ranged from 18-32 minutes (mean, 22 minutes). Postoperative tractional pain in the inguinal region occurred in 19 cases (21 sides), acute uroschesis in 8 cases, and far-end hernial sac effusion in 2 cases (2 sides); all were cured after symptomatic treatment. All incisions healed by first intention, and no complications of fever, infection, or hematoma occurred. A total of 1 095 cases (1 182 sides) were followed up 1 to 7 years (median, 3 years and 9 months). Five patients died of medical illnesses at 1-3 years after operation. Three cases recurred and then were cured by a second surgery. No intestinal adhesion or obstruction occurred.?Conclusion?The bundled fastigiated mesh in laparoscopic inguinal hernia repair has the advantages of minimal invasiveness, easy-to-operate, less complications, and lower recurrence rate.
Objective Mesh infection may occur after incisional hernia repair using prosthetic mesh. Preparation of antibiotics-bonded meshes to prevent infection is one of the solutions. To evaluate the anti-infection effect of polypropylene mesh bonded norvancomycin slow-release microsphere by preparing the rat model of incisional hernia repair contaminatedwith Staphylococcus aureus. Methods The norvancomycin slow-release microspheres were prepared by emulsion and solvent evaporation method and they were bonded to polypropylene mesh (50 mg/mesh). The appearance of the microspheres was observed using scanning electronic microscope (SEM). The content of norvancomycin in microspheres and the release rate of the norvancomycin in norvancomycin-bonded polypropylene mesh were detected using high performance l iquid chromatography method. The rat models of incisional hernia were developed in 40 healthy Sprague Dawley rats, aged 10-11 weeks and weighing 200-250 g. The rats were divided randomly into the experimental group (norvancomycin-bonded polypropylene mesh repair, n=20) and the control group (polypropylene mesh repair, n=20). And then the mesh was contaminated with Staphylococcus aureus. The wound heal ing was observed after operation. At 3 weeks after operation, the mesh and the tissue around the mesh were harvested to perform histological observation and to classify the inflammatory reaction degree. Results The norvancomycin microsphere had integrated appearance and smooth surface with uniform particle diameter, 64% of particlediameter at 60 to 100 μm, and the loading-capacity of norvancomycin was 19.79%. The norvancomycin-bonded polypropylene patch had well-distributed surface and the loading-capacity of norvancomycin was (7.90 ± 0.85) mg/cm2. The release time of norvancomycin in vitro could last above 28 days and the accumulative release rate was 72.6%. The rats of 2 groups all survived to experiment completion. Wound infection occurred in 2 rats of the experimental group (10%) and 20 rats of the control group (100%), showing significant difference (χ2=32.727 3, P=0.000 0). The inflammatory reaction in experimental group was not obvious, grade I in 16 rats and grade II in 4 rats, and numerous inflammatory cell infiltration occurred in the control group, grade II in 3 rats and grade III in 17 rats, showing significant difference (Z=32.314, P=0.000). Conclusion The polypropylene mesh bonded norvancomycin slow-release microsphere has definite anti-infection effect in rat model of incisional hernia repair contaminated by Staphylococcus aureus.
Test of tissue tolerance to domastic prosthetic materials (carbon fiber mesh, siliconized velvet, silk cloth and dacron cloth) as a subcutaneos transplant was performed in the adcominal wall of rabbit. These implants and their surroundding tissues were excied for studies at second , fourth, eighth and the twelfth weeks after operation. Ratio of fibroblast count to inflammatory cells count which is a common parameter of tissue tolerance was calculated in these four groups. The result shows that fibroblastic cell reaction elicited by carbon fiber mesh is the greates among the four prosthetic materials, the second one is dasron cloth. The inflammatory cell reaction elicited by silk is the greatest among the four materials, the second is carbon fiber mesh, and the dacron cloth the least. Tissure tolerance of dacron cloth is the best in the four prosthetic materials for implantation while sick is the worst.
ObjectiveTo compare the efficiency of total extraperitoneal inguinal herniorrhaphy with laparoscopic technique using an innovative self-gripping mesh and polypropylene mesh.
MethodsThe clinical data of 142 cases of unilateral inguinal hernia who underwent total extraperitoneal prosthesis (TEP) in our hospital form June 2012 to March 2015 were retrospectively analyzed. the operation type was total extraperitoneal inguinal herniorrhaphy with laparoscopic technique. Depending on the kind of mesh, all patients were divided into two groups from the self-gripping mesh group (n=60) and the polypropylene mesh group (n=82).
ResultsThere was no significant difference in the operation time, intraoperative blood loss, hospital stay, and The Visual Analogue Score of post-operative (at 12, 24, 48, and 72 hours after operation) between the 2 groups (P>0.05). On the post-operative complications, there was no significant difference in incidences of total complication, scrotal edema, seroma, bladder injury, vascular injury of abdominal, and urinary reten-tion too (P>0.05). All the patients were followed up for 3-36 months (the median time was 19-month), and no recurrence occurred during the follow-up period.
ConclusionInnovative self-gripping mesh is safe and effective, and maybe a good direction of mesh for material development.
Objective To evaluate the biomechanical characteristicsof titanium mesh with anterior plate fixation or ilium autograft in anterior cervical decompression.Methods Six fresh cervical spine specimens(C3-7) of young cadaver were used in the biomechanical test. After C5, C5,6 and C4-6 were given vertebrectomy,ilium autograft and titanium mesh with anterior plate fixation were performed. Their stabilities of flexion,bilateral axial rotation,the lateral bending and the extension were tested. Intact cervical spine specimens served as control group. Results Ilium autograft improved the stability of the unstable cervical vertebrae and decreased the flexion, the lateral bending or the extension, showing a significant difference when compared with control group(Plt;0.05). Whereas, axial rotational motion was decreased insignificantly(Pgt;0.05). Titanium meshwith anterior plate fixation improved the stability of the unstable spine and decreased the flexion,the bilateral axial rotation,the lateral bending or the extension, showing a significant difference when compared with control group(Plt;0.05). Conclusion The vertebrectomy and anterior cervical fusion by ilium autograft was the least stable construct of all modes tested,and the titanium mesh implantation is stabler than the intact cervical sample.
Objective
To review the application progress of non-biological meshes for breast reconstruction (BR).
Methods
The related home and abroad researches in BR were reviewed and summarized.
Results
Non-biological meshes can be divided into degradable and nondegradable. The former has many types, whether its degradation rate can match with the grow rate of repair tissue will significantly affect the wound healing and tissue intergradation. TiLOOP, on behalf of the latter, has a good postoperative performance due to its nano TiO2 layer, lightness and flexibility. Non-biological meshes have been gradually used to cover and fix implant in BR. Compared with biological meshes, non-biological meshes are cheaper and have a more positive postoperative performance generally, but definite comparison can’t be concluded due to the limited data.
Conclusion
As non-biological meshes are applied to BR preliminarily, their effectiveness are still needed to be observed further.
Objective To explore the effect of NaOH on the surface morphology of three-dimensional (3D) printed poly-L-lactic acid (PLLA) mesh scaffolds. Methods The 3D printed PLLA mesh scaffolds were prepared by fused deposition molding technology, then the scaffold surfaces were etched with the NaOH solution. The concentrations of NaOH solution were 0.01, 0.1, 0.5, 1.0, and 3.0 mol/L, and the treatment time was 1, 3, 6, 9, and 12 hours, respectively. There were a total of 25 concentration and time combinations. After treatment, the microstructure, energy spectrum, roughness, hydrophilicity, compressive strength, as well as cell adhesion and proliferation of the scaffolds were observed. The untreated scaffolds were used as a normal control. Results 3D printed PLLA mesh scaffolds were successfully prepared by using fused deposition molding technology. After NaOH etching treatment, a rough or micro porous structure was constructed on the surface of the scaffold, and with the increase of NaOH concentration and treatment time, the size and density of the pores increased. The characterization of the scaffolds by energy dispersive spectroscopy showed that the crystal contains two elements, Na and O. The surface roughness of NaOH treated scaffolds significantly increased (P<0.05) and the contact angle significantly decreased (P<0.05) compared to untreated scaffolds. There was no significant difference in compressive strength between the untreated scaffolds and treated scaffolds under conditions of 0.1 mol/L/12 h and 1.0 mol/L/3 h (P>0.05), while the compression strength of the other treated scaffolds were significantly lower than that of the untreated scaffolds (P<0.05). After co-culturing the cells with the scaffold, NaOH treatment resulted in an increase in the number of cells on the surface of the scaffold and the spreading area of individual cells, and more synapses extending from adherent cells. Conclusion NaOH treatment is beneficial for increasing the surface hydrophilicity and cell adhesion of 3D printed PLLA mesh scaffolds.
Objective To investigate and summarize preliminarily the clinical experiences of laparoscopic incisional hernia repair with intraperitoneal patch placement for the patients over 70 years old. Methods From July 2005 to July 2008, laparoscopic incisional hernia repair with intraperitoneal onlay meshes were applied in 8 patients, and whose clinical data were studied retrospectively. Results The procedures were performed successfully in all patients except one converted to open because of severe adhesion. The mean operative time was 105 min (ranged from 50 min to 180 min). One postoperative hypercapnia was resolved through mechanic ventilation for 24 h. One seroma and 1 prolonged postoperative pain over 1 month occurred, which were cured with conservative therapy. Mean postoperative hospital stay was 9.5 d (ranged from 7 d to 14 d). There was no recurrence or local discomfort during 12-36 months (average 26.5 months) follow-up.Conclusions Laparoscopic incisional hernia repair with intraperitoneal onlay mesh for the patients over 70 years old is safe and feasible, which has some advantages such as less trauma and rapid recovery. The perioperative management and operative technique are very important for the success of operation.
Glaucoma is the leading cause of irreversible blindness worldwide, with its primary risk factor arising from elevated intraocular pressure (IOP) due to an imbalance between aqueous humor production and outflow. This study aims to establish quantitative correlations among IOP, iris mechanical properties, channel microstructures, and aqueous humor dynamics through three-dimensional modeling and finite element analysis, overcoming the limitations of conventional experimental techniques in studying aqueous flow within the trabecular meshwork (TM) outflow pathway. A three-dimensional fluid-structure interaction (FSI) model incorporating the layered TM structure, Schlemm’s canal (SC), iris, and other anterior segment tissues was developed based on human ocular anatomy. FSI simulations were performed to quantify the effects of IOP variations and iris Young’s modulus on tissue morphology and aqueous humor dynamics parameters. The computational results demonstrated that axial iris deformation showed significant correlations with IOP and iris Young’s modulus. Although elevated IOP exhibited minimal effects on hydrodynamic parameters in the anterior and posterior chambers, it markedly suppressed aqueous flow velocity in the TM region. Additionally, wall shear stress in SC and collector channels displayed high sensitivity to IOP variations. These findings reveal that the tissue mechanics-FSI mechanism modulates outflow resistance by regulating aqueous humor dynamics, offering valuable references for developing clinical therapies targeting IOP reduction in glaucoma management.
