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H Fernandez - One of the best experts on this subject based on the ideXlab platform.

  • trans vaginal cystocele repair using a tension free Polypropylene Mesh more than 5 years of follow up
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 2010
    Co-Authors: Vincent Letouzey, H Fernandez, X Deffieux, Amelie Gervaise, Gregoire Mercier, Renaud De Tayrac
    Abstract:

    Abstract Objectives Prospective randomized controlled trials, with 2 years’ follow-up, seem to lean in favour of anterior repair using synthetic Mesh. The goal of this study was to report on long-term (>5 years) follow-up. Study design Polypropylene Mesh was inserted in 63 women (in 1999–2001) from the retropubic space to under the bladder using a tension-free technique. Results At 79 months’ follow-up, 45 women were anatomically cured (76%). Four (7%) were lost to follow-up and 14 (24%) presented with stage 2 or 3 cystocele recurrences. None of them required surgery for cystocele recurrence. Vaginal extrusion was reported in 10 (16%) patients (in four cases after 4 years of follow-up) and all required partial surgical removal of the Mesh ( n  = 10, 16%). Conclusion Cystocele repair using tension-free Polypropylene Mesh is associated with a low long-term rate of repeat surgery for cystocele recurrence.

  • Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free Polypropylene Mesh.
    International Urogynecology Journal, 2006
    Co-Authors: Renaud De Tayrac, Amelie Gervaise, X Deffieux, Aurélia Chauveaud-lambling, H Fernandez
    Abstract:

    We report a case series of 63 women with cystocele who underwent the same trans-vaginal procedure between October 1999 and October 2002. The Polypropylene Mesh (GyneMesh, Gynecare, Ethicon, France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. Patients were followed up for 24 to 60 months, with a mean follow-up of 37 months. Fifty-five patients returned for follow-up (87.3%). At follow-up, 49 women were anatomically cured (89.1%), five women had stage 2 anterior vaginal wall prolapse (9.1%), and one had a recurrent stage 3 (1.8%). Functional results and sexual function were also investigated. Fifty-three women had significant improvement in their quality of life (96.4%). There were a total of three cases of local pain around a Mesh shrinkage (5.5%) and five vaginal erosions of the Mesh (9.1%). Four out of 24 patients had dyspareunia (16.7%). In conclusion, the vaginal repair of anterior vaginal wall prolapse reinforced with a Polypropylene Mesh was efficient at 2 to 5 years follow-up. However, the first generation of Polypropylene Mesh we used was responsible for high rates of local complications and dyspareunia. Therefore, the Polypropylene Mesh has to be improved (lower weight) and the technique has to be documented by a randomized controlled trial before we could recommend its use in clinical practice.

  • A 2-year anatomical and functional assessment of transvaginal rectocele repair using a Polypropylene Mesh
    International Urogynecology Journal, 2006
    Co-Authors: Renaud De Tayrac, Aurélia Chauveaud-lambling, Olivier Picone, H Fernandez
    Abstract:

    This study reports the 2-year results of an original technique for rectocele repair by the vaginal route, using a combined sacrospinous suspension and a Polypropylene Mesh. Twenty-six women were successively operated between October 2000 and February 2003. Mean age was 63.7 years [range 35–92]. 19 women had had previous pelvic surgery for prolapse and/or urinary incontinence (73.1%), but none had had a previous rectocele repair. Patients underwent physical examination staging of prolapse in the international pelvic organ prolapse staging system. Eleven women had stage 2 posterior vaginal wall prolapse (42.3%), seven had stage 3 (26.9%) and eight had stage 4 (30.8%). The procedure included a bilateral sacrospinous suspension and a Polypropylene Mesh (GyneMesh, Gynecare, Ethicon France) attached from the sacrospinous ligaments to the perineal body. We did not perform any associated posterior fascial repair, nor myorraphy. Patients were followed up for 10–44 months, with a median follow-up (±SD) of 22.7±9.2 months. Functional results and sexual function were evaluated using the PFDI, the PFIQ and the PISQ-12 self-questionnaires. Twenty-five women returned for follow-up (96.2%). At follow-up, 24 women were cured (92.3%) and one had asymptomatic stage 2 rectocele. All the patients but one had symptoms and impact on quality of life improved. No postoperative infection of the Mesh or rectovaginal fistula was found, but there were three vaginal erosions (12%) and one out of 13 had de novo dyspareunia (7.7%).

  • tension free Polypropylene Mesh for vaginal repair of anterior vaginal wall prolapse
    Journal of Reproductive Medicine, 2005
    Co-Authors: Renaud De Tayrac, Amelie Gervaise, Aurelia Chauveaud, H Fernandez
    Abstract:

    Objective To study the ongoing results of the repair of anterior vaginal wall prolapse reinforced with tension-free Polypropylene Mesh (GyneMesh, Gynecare, Ethicon, Issy-Les-Moulineaux, France). Study design A case series of 87 consecutive women with anterior vaginal wall prolapse who underwent a transvaginal procedure using Polypropylene Mesh between October 1999 and August 2002. The mean age (+/-SD) was 62.4+/-13.4 years. Before the operation, patients underwent physical examination staging of the prolapse with the International Pelvic Organ Prolapse staging system. Thirteen women had stage 2 anterior vaginal wall prolapse (14.9%), 59 had stage 3 (67.9%), and 15 had stage 4 (17.3%). The Polypropylene Mesh was placed from the retropubic space to the inferior part of the bladder in a tension-freefashion. Patients were followed for 9-43 months, with a median follow-up (+/-SD) of 24+/-9.6 months. We defined "cure" as satisfactory (stage 1) or optimal (stage 0) outcome for point Ba in the staging system. Results Eighty-four patients returned for follow-up (96.6%). At follow-up, 77 women were cured (91.6%), 5 women had asymptomatic stage 2 anterior vaginal wall prolapse, and 2 had a recurrent stage 3 (2.4%). There were no postoperative infections. There were a total of 7 vaginal erosions of the Mesh (8.3%); 4 necessitated a second procedure for partial excision of the Mesh. Conclusion Vaginal repair of anterior vaginal wall prolapse reinforced with tension-free Polypropylene Mesh is effective and relatively safe. Vaginal erosion occurred in 8.3% of the study population but was easily manageable, with no sequelae.

  • combined genital prolapse repair reinforced with a Polypropylene Mesh and tension free vaginal tape in women with genital prolapse and stress urinary incontinence a retrospective case control study with short term follow up
    Acta Obstetricia et Gynecologica Scandinavica, 2004
    Co-Authors: Renaud De Tayrac, Amelie Gervaise, Aurelia Chauveaudlambling, H Fernandez
    Abstract:

    Background. To evaluate the tension-free vaginal tape (TVT) in both stress urinary incontinence (SUI) and occult SUI as an associated procedure at the time of tension-free Polypropylene Mesh repair for the treatment of genitourinary prolapse. Methods. Forty-eight consecutive women undergoing surgery for genital prolapse and concurrent SUI from November 1999 to September 2002. Preoperatively, SUI was symptomatic in 29 women and occult in 19, with a positive stress test during repositioning of the prolapse. All patients had urethral hypermobility and none had intrinsic sphincter deficiency. The cystocele repair was performed in all patients according to the technique of tension-free Polypropylene Mesh. Twenty-six women had an associated TVT and 22 had no associated procedure for SUI (control group). The main outcome measures were postoperative SUI, voiding dysfunction, and recurrence of prolapse. Results. The median follow-up was 20 ± 10.1 months (range 7-41). Patient characteristics and preoperative urodyn...

Renaud De Tayrac - One of the best experts on this subject based on the ideXlab platform.

  • trans vaginal cystocele repair using a tension free Polypropylene Mesh more than 5 years of follow up
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 2010
    Co-Authors: Vincent Letouzey, H Fernandez, X Deffieux, Amelie Gervaise, Gregoire Mercier, Renaud De Tayrac
    Abstract:

    Abstract Objectives Prospective randomized controlled trials, with 2 years’ follow-up, seem to lean in favour of anterior repair using synthetic Mesh. The goal of this study was to report on long-term (>5 years) follow-up. Study design Polypropylene Mesh was inserted in 63 women (in 1999–2001) from the retropubic space to under the bladder using a tension-free technique. Results At 79 months’ follow-up, 45 women were anatomically cured (76%). Four (7%) were lost to follow-up and 14 (24%) presented with stage 2 or 3 cystocele recurrences. None of them required surgery for cystocele recurrence. Vaginal extrusion was reported in 10 (16%) patients (in four cases after 4 years of follow-up) and all required partial surgical removal of the Mesh ( n  = 10, 16%). Conclusion Cystocele repair using tension-free Polypropylene Mesh is associated with a low long-term rate of repeat surgery for cystocele recurrence.

  • Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free Polypropylene Mesh.
    International Urogynecology Journal, 2006
    Co-Authors: Renaud De Tayrac, Amelie Gervaise, X Deffieux, Aurélia Chauveaud-lambling, H Fernandez
    Abstract:

    We report a case series of 63 women with cystocele who underwent the same trans-vaginal procedure between October 1999 and October 2002. The Polypropylene Mesh (GyneMesh, Gynecare, Ethicon, France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. Patients were followed up for 24 to 60 months, with a mean follow-up of 37 months. Fifty-five patients returned for follow-up (87.3%). At follow-up, 49 women were anatomically cured (89.1%), five women had stage 2 anterior vaginal wall prolapse (9.1%), and one had a recurrent stage 3 (1.8%). Functional results and sexual function were also investigated. Fifty-three women had significant improvement in their quality of life (96.4%). There were a total of three cases of local pain around a Mesh shrinkage (5.5%) and five vaginal erosions of the Mesh (9.1%). Four out of 24 patients had dyspareunia (16.7%). In conclusion, the vaginal repair of anterior vaginal wall prolapse reinforced with a Polypropylene Mesh was efficient at 2 to 5 years follow-up. However, the first generation of Polypropylene Mesh we used was responsible for high rates of local complications and dyspareunia. Therefore, the Polypropylene Mesh has to be improved (lower weight) and the technique has to be documented by a randomized controlled trial before we could recommend its use in clinical practice.

  • A 2-year anatomical and functional assessment of transvaginal rectocele repair using a Polypropylene Mesh
    International Urogynecology Journal, 2006
    Co-Authors: Renaud De Tayrac, Aurélia Chauveaud-lambling, Olivier Picone, H Fernandez
    Abstract:

    This study reports the 2-year results of an original technique for rectocele repair by the vaginal route, using a combined sacrospinous suspension and a Polypropylene Mesh. Twenty-six women were successively operated between October 2000 and February 2003. Mean age was 63.7 years [range 35–92]. 19 women had had previous pelvic surgery for prolapse and/or urinary incontinence (73.1%), but none had had a previous rectocele repair. Patients underwent physical examination staging of prolapse in the international pelvic organ prolapse staging system. Eleven women had stage 2 posterior vaginal wall prolapse (42.3%), seven had stage 3 (26.9%) and eight had stage 4 (30.8%). The procedure included a bilateral sacrospinous suspension and a Polypropylene Mesh (GyneMesh, Gynecare, Ethicon France) attached from the sacrospinous ligaments to the perineal body. We did not perform any associated posterior fascial repair, nor myorraphy. Patients were followed up for 10–44 months, with a median follow-up (±SD) of 22.7±9.2 months. Functional results and sexual function were evaluated using the PFDI, the PFIQ and the PISQ-12 self-questionnaires. Twenty-five women returned for follow-up (96.2%). At follow-up, 24 women were cured (92.3%) and one had asymptomatic stage 2 rectocele. All the patients but one had symptoms and impact on quality of life improved. No postoperative infection of the Mesh or rectovaginal fistula was found, but there were three vaginal erosions (12%) and one out of 13 had de novo dyspareunia (7.7%).

  • tension free Polypropylene Mesh for vaginal repair of anterior vaginal wall prolapse
    Journal of Reproductive Medicine, 2005
    Co-Authors: Renaud De Tayrac, Amelie Gervaise, Aurelia Chauveaud, H Fernandez
    Abstract:

    Objective To study the ongoing results of the repair of anterior vaginal wall prolapse reinforced with tension-free Polypropylene Mesh (GyneMesh, Gynecare, Ethicon, Issy-Les-Moulineaux, France). Study design A case series of 87 consecutive women with anterior vaginal wall prolapse who underwent a transvaginal procedure using Polypropylene Mesh between October 1999 and August 2002. The mean age (+/-SD) was 62.4+/-13.4 years. Before the operation, patients underwent physical examination staging of the prolapse with the International Pelvic Organ Prolapse staging system. Thirteen women had stage 2 anterior vaginal wall prolapse (14.9%), 59 had stage 3 (67.9%), and 15 had stage 4 (17.3%). The Polypropylene Mesh was placed from the retropubic space to the inferior part of the bladder in a tension-freefashion. Patients were followed for 9-43 months, with a median follow-up (+/-SD) of 24+/-9.6 months. We defined "cure" as satisfactory (stage 1) or optimal (stage 0) outcome for point Ba in the staging system. Results Eighty-four patients returned for follow-up (96.6%). At follow-up, 77 women were cured (91.6%), 5 women had asymptomatic stage 2 anterior vaginal wall prolapse, and 2 had a recurrent stage 3 (2.4%). There were no postoperative infections. There were a total of 7 vaginal erosions of the Mesh (8.3%); 4 necessitated a second procedure for partial excision of the Mesh. Conclusion Vaginal repair of anterior vaginal wall prolapse reinforced with tension-free Polypropylene Mesh is effective and relatively safe. Vaginal erosion occurred in 8.3% of the study population but was easily manageable, with no sequelae.

  • combined genital prolapse repair reinforced with a Polypropylene Mesh and tension free vaginal tape in women with genital prolapse and stress urinary incontinence a retrospective case control study with short term follow up
    Acta Obstetricia et Gynecologica Scandinavica, 2004
    Co-Authors: Renaud De Tayrac, Amelie Gervaise, Aurelia Chauveaudlambling, H Fernandez
    Abstract:

    Background. To evaluate the tension-free vaginal tape (TVT) in both stress urinary incontinence (SUI) and occult SUI as an associated procedure at the time of tension-free Polypropylene Mesh repair for the treatment of genitourinary prolapse. Methods. Forty-eight consecutive women undergoing surgery for genital prolapse and concurrent SUI from November 1999 to September 2002. Preoperatively, SUI was symptomatic in 29 women and occult in 19, with a positive stress test during repositioning of the prolapse. All patients had urethral hypermobility and none had intrinsic sphincter deficiency. The cystocele repair was performed in all patients according to the technique of tension-free Polypropylene Mesh. Twenty-six women had an associated TVT and 22 had no associated procedure for SUI (control group). The main outcome measures were postoperative SUI, voiding dysfunction, and recurrence of prolapse. Results. The median follow-up was 20 ± 10.1 months (range 7-41). Patient characteristics and preoperative urodyn...

Amelie Gervaise - One of the best experts on this subject based on the ideXlab platform.

  • trans vaginal cystocele repair using a tension free Polypropylene Mesh more than 5 years of follow up
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 2010
    Co-Authors: Vincent Letouzey, H Fernandez, X Deffieux, Amelie Gervaise, Gregoire Mercier, Renaud De Tayrac
    Abstract:

    Abstract Objectives Prospective randomized controlled trials, with 2 years’ follow-up, seem to lean in favour of anterior repair using synthetic Mesh. The goal of this study was to report on long-term (>5 years) follow-up. Study design Polypropylene Mesh was inserted in 63 women (in 1999–2001) from the retropubic space to under the bladder using a tension-free technique. Results At 79 months’ follow-up, 45 women were anatomically cured (76%). Four (7%) were lost to follow-up and 14 (24%) presented with stage 2 or 3 cystocele recurrences. None of them required surgery for cystocele recurrence. Vaginal extrusion was reported in 10 (16%) patients (in four cases after 4 years of follow-up) and all required partial surgical removal of the Mesh ( n  = 10, 16%). Conclusion Cystocele repair using tension-free Polypropylene Mesh is associated with a low long-term rate of repeat surgery for cystocele recurrence.

  • Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free Polypropylene Mesh.
    International Urogynecology Journal, 2006
    Co-Authors: Renaud De Tayrac, Amelie Gervaise, X Deffieux, Aurélia Chauveaud-lambling, H Fernandez
    Abstract:

    We report a case series of 63 women with cystocele who underwent the same trans-vaginal procedure between October 1999 and October 2002. The Polypropylene Mesh (GyneMesh, Gynecare, Ethicon, France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. Patients were followed up for 24 to 60 months, with a mean follow-up of 37 months. Fifty-five patients returned for follow-up (87.3%). At follow-up, 49 women were anatomically cured (89.1%), five women had stage 2 anterior vaginal wall prolapse (9.1%), and one had a recurrent stage 3 (1.8%). Functional results and sexual function were also investigated. Fifty-three women had significant improvement in their quality of life (96.4%). There were a total of three cases of local pain around a Mesh shrinkage (5.5%) and five vaginal erosions of the Mesh (9.1%). Four out of 24 patients had dyspareunia (16.7%). In conclusion, the vaginal repair of anterior vaginal wall prolapse reinforced with a Polypropylene Mesh was efficient at 2 to 5 years follow-up. However, the first generation of Polypropylene Mesh we used was responsible for high rates of local complications and dyspareunia. Therefore, the Polypropylene Mesh has to be improved (lower weight) and the technique has to be documented by a randomized controlled trial before we could recommend its use in clinical practice.

  • tension free Polypropylene Mesh for vaginal repair of anterior vaginal wall prolapse
    Journal of Reproductive Medicine, 2005
    Co-Authors: Renaud De Tayrac, Amelie Gervaise, Aurelia Chauveaud, H Fernandez
    Abstract:

    Objective To study the ongoing results of the repair of anterior vaginal wall prolapse reinforced with tension-free Polypropylene Mesh (GyneMesh, Gynecare, Ethicon, Issy-Les-Moulineaux, France). Study design A case series of 87 consecutive women with anterior vaginal wall prolapse who underwent a transvaginal procedure using Polypropylene Mesh between October 1999 and August 2002. The mean age (+/-SD) was 62.4+/-13.4 years. Before the operation, patients underwent physical examination staging of the prolapse with the International Pelvic Organ Prolapse staging system. Thirteen women had stage 2 anterior vaginal wall prolapse (14.9%), 59 had stage 3 (67.9%), and 15 had stage 4 (17.3%). The Polypropylene Mesh was placed from the retropubic space to the inferior part of the bladder in a tension-freefashion. Patients were followed for 9-43 months, with a median follow-up (+/-SD) of 24+/-9.6 months. We defined "cure" as satisfactory (stage 1) or optimal (stage 0) outcome for point Ba in the staging system. Results Eighty-four patients returned for follow-up (96.6%). At follow-up, 77 women were cured (91.6%), 5 women had asymptomatic stage 2 anterior vaginal wall prolapse, and 2 had a recurrent stage 3 (2.4%). There were no postoperative infections. There were a total of 7 vaginal erosions of the Mesh (8.3%); 4 necessitated a second procedure for partial excision of the Mesh. Conclusion Vaginal repair of anterior vaginal wall prolapse reinforced with tension-free Polypropylene Mesh is effective and relatively safe. Vaginal erosion occurred in 8.3% of the study population but was easily manageable, with no sequelae.

  • combined genital prolapse repair reinforced with a Polypropylene Mesh and tension free vaginal tape in women with genital prolapse and stress urinary incontinence a retrospective case control study with short term follow up
    Acta Obstetricia et Gynecologica Scandinavica, 2004
    Co-Authors: Renaud De Tayrac, Amelie Gervaise, Aurelia Chauveaudlambling, H Fernandez
    Abstract:

    Background. To evaluate the tension-free vaginal tape (TVT) in both stress urinary incontinence (SUI) and occult SUI as an associated procedure at the time of tension-free Polypropylene Mesh repair for the treatment of genitourinary prolapse. Methods. Forty-eight consecutive women undergoing surgery for genital prolapse and concurrent SUI from November 1999 to September 2002. Preoperatively, SUI was symptomatic in 29 women and occult in 19, with a positive stress test during repositioning of the prolapse. All patients had urethral hypermobility and none had intrinsic sphincter deficiency. The cystocele repair was performed in all patients according to the technique of tension-free Polypropylene Mesh. Twenty-six women had an associated TVT and 22 had no associated procedure for SUI (control group). The main outcome measures were postoperative SUI, voiding dysfunction, and recurrence of prolapse. Results. The median follow-up was 20 ± 10.1 months (range 7-41). Patient characteristics and preoperative urodyn...

Gregory A. Dumanian - One of the best experts on this subject based on the ideXlab platform.

  • reliable complex abdominal wall hernia repairs with a narrow well fixed retrorectus Polypropylene Mesh a review of over 100 consecutive cases
    Surgery, 2016
    Co-Authors: Steven T Lanier, Jennifer E Fligor, Kyle R Miller, Gregory A. Dumanian
    Abstract:

    Background Our objective was to determine outcomes for complex ventral hernia repairs in a large cohort of patients utilizing an operative construct employing retrorectus placement of a narrow, macroporous Polypropylene Mesh with up to 45 suture fixation points for force distribution. No consensus exists on the optimal technique for repair of complex ventral hernias. Current trends emphasize large Meshes with wide overlaps and minimal suture fixation, though reported complications and recurrence remain problematic. Methods A retrospective review was performed for all patients undergoing ventral hernia repair with retrorectus placement of midweight, uncoated, soft Polypropylene Mesh by a single surgeon (GAD) between the years of 2010 and 2015. Patient characteristics, operative history, operative data, and postoperative course were reviewed. Results A total of 101 patients with a mean age of 56 years and a mean body mass index of 29 m/kg2 (range 18–51 m/kg2) underwent hernia repair. Patients had a median of 3 prior abdominal operations (range 0–9), with 44 patients presenting with recurrent hernias. A total of 42 patients were Ventral Hernia Working Group grade 1, 40 grade 2, 17 grade 3, and 2 grade 4. There were no recurrences at a mean follow-up of almost 400 days for the 93 patients with long-term follow-up. The surgical site occurrence rate was 7.9% (3 surgical site infections, 2 seromas, 2 hematomas, and 4 instances of delayed wound healing in 8 patients). One patient required reoperation for hematoma drainage; 5 patients required readmission within 30 days. Conclusion An operative construct employing a retrorectus placement of a narrow, macroporous Polypropylene Mesh with up to 45 suture fixation points for force distribution can achieve significantly better outcomes across a spectrum of Ventral Hernia Working Group grade, risk-stratified patients compared to rates reported in the literature for current strategies that employ wide Meshes with minimal fixation.

  • routine use of bioprosthetic Mesh is not necessary a retrospective review of 100 consecutive cases of intra abdominal midweight Polypropylene Mesh for ventral hernia repair
    Surgery, 2013
    Co-Authors: Jason M Souza, Gregory A. Dumanian
    Abstract:

    Background The Ventral Hernia Working Group (VHWG) recently proposed a grading system to assist surgeons in selecting the appropriate Mesh based on an individual patient's risk of developing a postoperative complication. The VHWG grading scale was used to evaluate the incidence of surgical-site complications in 100 consecutive midline ventral hernias repaired with uncoated mid-weight Polypropylene Mesh. Methods A retrospective review was conducted of 100 consecutive cases of midline ventral hernia repair using an intra-abdominal Mesh underlay between July 2005 and May 2010. The median duration of follow-up was 23 months. Results Using the VHWG scale, 50 percent of cases were considered Grade 2 (“Co-morbid”) and 28 percent considered Grade 3 (“Potentially Contaminated”). The remaining cases were Grade 1 (“Low-risk”). Overall, there was a 5.6 percent rate of hernia recurrence, with a mean time to recurrence of 17 months. There were no enterocutaneous fistulae or infections requiring Mesh removal. Conclusion The use of uncoated mid-weight Polypropylene Mesh for reinforcement of midline ventral hernia repairs was not associated with increased rates of infection, fistula formation, or clinically significant adhesions. These findings challenge the recommendation by the VHWG to avoid synthetic repair material in patients with comorbidities or in “potentially contaminated” fields.

  • soft Polypropylene Mesh but not cadaveric dermis significantly improves outcomes in midline hernia repairs using the components separation technique
    Plastic and Reconstructive Surgery, 2009
    Co-Authors: Jason H Ko, David M Salvay, Benjamin C Paul, Edward Wang, Gregory A. Dumanian
    Abstract:

    Background: The search continues for the “ideal” repair of the midline ventral hernia, and the components separation technique has a low, but still concerning, hernia recurrence rate. The authors hypothesize that adding prosthetic or bioprosthetic Meshes to the midline closure during components separation would reduce recurrence rates with minimal added morbidity. Methods: Over a 3-year period, patients had a components separation procedure where either acellular cadaveric dermis (n = 26) or soft Polypropylene Mesh (n = 28) was used as an intraperitoneal underlay for reinforcement of the midline repair, but not as a “bridging material.” In 36 operations, the Mesh or cadaveric dermis was placed at the time of the components separation, and in the remaining cases (n = 18), the underlay was used to treat a recurrence after components separation. Results: Cadaveric dermis was associated with a 46 percent “true” recurrence rate that required reoperation (mean follow-up, 17.3 months), whereas soft Polypropylene Mesh had a significantly lower recurrence rate of 11 percent (p = 0.0057) during a follow-up period of 16 months. Because of a higher incidence of concomitant bowel surgery and contamination in the cadaveric dermis group, additional subset analysis of uncontaminated cases was performed, demonstrating a 61 percent recurrence rate for cadaveric dermis compared with 12 percent for soft Polypropylene (p = 0.0017). No significant differences in major and minor complications were seen between groups. Conclusion: Soft Polypropylene Mesh, but not acellular dermis, demonstrates acceptably low complication and hernia recurrence rates when used as a reinforcement of the midline ventral hernia closure in conjunction with components separation.

J Jeekel - One of the best experts on this subject based on the ideXlab platform.

  • intraperitoneal Polypropylene Mesh hernia repair complicates subsequent abdominal surgery
    World Journal of Surgery, 2007
    Co-Authors: Jens A Halm, L L De Wall, Ewout W Steyerberg, J Jeekel, Johan F Lange
    Abstract:

    Prosthetic incisional hernia repair (PIHR) is superior to primary closure in preventing hernia recurrence. Serious complications have been associated with the use of prosthetic material. Complications of subsequent surgical interventions after prior PIHR in relation to its anatomical position were the objectives of this study. Patients who underwent subsequent laparotomy/laparoscopy after PIHR between January 1992 and February 2005 at our institution were evaluated. Intraperitoneal and preperitoneal Mesh was related to complication rates after subsequent surgical interventions. Sixty-six of 335 patients underwent re-laparotomy after PIHR. The perioperative course was complicated in 76% (30/39) of procedures with intraperitoneal placed grafts compared to 29% (8/27) of interventions with preperitoneally positioned Meshes (P < 0.001). Small bowel resections were necessary in 21% of the intraperitoneal group (8/39) versus 0% in the preperitoneal group. Surgical site infection rates were higher in the intraperitoneal group (10/39, 26%, versus 1/27, 4%). Enterocutaneous fistula formation was rare and occurred in two patients after subsequent laparotomy (5%). Re-laparotomy after PIHR with Polypropylene Meshes are associated with more preoperative and postoperative complications when the Mesh is placed intraperitoneally. Therefore 0intraperitoneal positioning of Polypropylene Mesh at incisional hernia repair should be avoided if possible.

  • prevention of adhesion formation to Polypropylene Mesh by collagen coating a randomized controlled study in a rat model of ventral hernia repair
    Surgical Endoscopy and Other Interventional Techniques, 2004
    Co-Authors: M Van T Riet, J Jeekel, Jacobus W A Burger, Fred Bonthuis, H J Bonjer
    Abstract:

    Introduction: In laparoscopic incisional hernia repair with intraperitoneal Mesh, concern exists about the development of adhesions between bowel and Mesh, predisposing to intestinal obstruction and enterocutaneous fistulas. The aim of this study was to assess whether the addition of a collagen coating on the visceral side of a Polypropylene Mesh can prevent adhesion formation to the Mesh. Method: In 58 rats, a defect in the muscular abdominal wall was created, and a Mesh was fixed intraperitoneally to cover the defect. Rats were divided in two groups; Polypropylene Mesh (control group) and Polypropylene Mesh with collagen coating (Parieten Mesh). Seven and 30 days postoperatively, adhesions and amount and strength of Mesh incorporation were assessed. Wound healing was studied by microscopy. Results: With Parieten Mesh, the Mesh surface covered by adhesions was reduced after 30 days (42% vs 69%, p = 0.01), but infection rate was increased after both 7 (p = 0.001) and 30 days (p = 0.03), compared to the Polypropylene group with no Mesh infections. If animals with Mesh infection were excluded in the analysis, the Mesh surface covered by adhesions was reduced after 7 days (21% vs 76%, p = 0.02), as well as after 30 days (21 vs 69%, p < 0.001). Percentage of Mesh incorporation was comparable in both groups. Mean tensile strength of Mesh incorporation after 30 days was higher with Parieten Mesh. Conclusion: Although the coated Parieten Mesh was more susceptible to Mesh infection in the current model, a significant reduction of adhesion formation was still seen with the Parieten Mesh after 30 days, with comparable Mesh incorporation in the abdominal wall.

  • prevention of adhesion formation to Polypropylene Mesh by collagen coating a randomized controlled study in a rat model of ventral hernia repair
    Surgical Endoscopy and Other Interventional Techniques, 2004
    Co-Authors: M Van T Rie, J Jeekel, Jacobus W A Urge, Fred Onthuis, H J Onje
    Abstract:

    Introduction In laparoscopic incisional hernia repair with intraperitoneal Mesh, concern exists about the development of adhesions between bowel and Mesh, predisposing to intestinal obstruction and enterocutaneous fistulas. The aim of this study was to assess whether the addition of a collagen coating on the visceral side of a Polypropylene Mesh can prevent adhesion formation to the Mesh.

  • intraperitoneal Polypropylene Mesh repair of incisional hernia is not associated with enterocutaneous fistula
    British Journal of Surgery, 2002
    Co-Authors: W W Vrijland, Ewout W Steyerberg, J Jeekel, P Den T Hoed, H J Bonjer
    Abstract:

    Background: Incisional hernia repair with prosthetic material is followed by fewer recurrences than primary repair. Polypropylene is the most commonly used prosthetic material but may cause enterocutaneous fistulas. The aim of this study was to determine whether enterocutaneous fistulas developed after incisional hernia repair with Polypropylene Mesh and to evaluate clinical outcome after incisional hernia repair. Methods: A retrospective analysis of the outcome of incisional hernia repair with Polypropylene Mesh between 1982 and 1998 was conducted. Follow-up data were obtained from medical records and questionnaires. Results: Polypropylene incisional hernia repair was performed in 136 patients. Median follow-up was 34 months. No enterocutaneous fistulas developed. Wound infection occurred in 6 per cent. Wound sinus formation occurred in two patients. No Mesh was removed because of infection and no persisting infection of the Mesh occurred. Conclusion: Enterocutaneous fistula formation appears to be very rare after incisional hernia repair with Polypropylene Mesh, regardless of intraperitoneal placement, omental coverage or closing of the peritoneum.