rimmed prolene mesh in ventral hernioplasty: a novel configuration for a better pro-peritoneal application

The development of abdominal wall defects is remarkable in surgical practice. Therefore, trials are never stopping to improve the methods of repair of such defects. Tension-free repairs using prosthetic materials are highly recommended, as long as a durable reconstruction is desirable. Debate always exists as regards the best prosthetic material; however polypropylene is the most commonly used one. Polypropylene mesh implants are available in many designs, configurations, thicknesses of weaves and strands, and sizes of pores. Is to revive the valuable sublay positioning of the prolene mesh by presenting a novel configuration of the mesh "rimmed prolene mesh", which is supposed to facilitate its application in the pro-peritoneal space, with comparison of the results to those of the commonly used onlay technique. Eighty nine patients with ventral hernia were enrolled into the study, during the period between January 2004 and October 2006. Seventy five cases were females, and 14 were males. They were randomly allocated between two groups of management, [A] and [B]. Group [A] was formed of 44 patients with a mean age of 40 years [30-57]. In this group, pro-peritoneal [sublay] rimmed prolene mesh [RPM] ventral hernioplasty was done. Group [B] included 45 patients with a mean age of 42 years [32-54]. This represented the cotrol group in which the common procedure of pro-parietal [onlay] flat mesh hernioplasty was applied. The method of preparation of the rimmed mesh and the technique of its application are described. Intra-operative and postoperative findings were recorded for both groups, and the results were compared. The presence of the rim configuration of the mesh had the following benefits in the pro-peritoneal application: It allowed fixation of the mesh to the edge of the fascial defect and obviated the need to close the defect over the mesh as in Rives Stoppa technique. Consequently, this insured a more tension-free repair. The 3-5 mm-height rim made it easier and faster to take the bites in the mesh during its fixation to the facial defect. The height of the rim also obviated the need to dip the needle down into the mesh that overlies the peritoneum, thus avoiding any event of a suture entangling a bowel loop, thus adding an element of safety. Otherwise, the comparison of results of the two groups of cases revealed shorter operative time and hospital stay in group A compared to B, being 92 [60-140] minutes and 1.86 [1-3] days for group A and 120 [75-180] minutes and 2.97 [4-9] days for group B. The overall rate of complications was also less in group [A], particularly the incidence of seroma. No recurrence was encountered in either group till the end of October 2006. The rimmed prolene mesh [RPM] is a novel configuration for a simple, rapid, efficient and safe pro-peritoneal application in treatment of ventral hernia. Further trials of application of the RPM are recommended to evaluate its effectiveness. A ready-made RPM may then be available, allowing its use at a wide scale

Tourniquet-free h and surgery

The use of tourniquet in h and surgery puts the patient, as well as the surgeon, under stress, with much consideration of the precautions necessary for its safe application, the possible inadvertent release of some pressure during surgery and the list of possible complications that may take place postoperatively. The use of a tourniquet is also sometimes inconvenient for a particular patient.Is to try an alternative method that may offer an almost bloodless field in h and surgery. Different surgical procedures were done for the h and s of 39 cases without the application of tourniquet, but alternatively with elevation of the out-stretched upper limb so that it makes 60with the horizontal plane. It was found that the surgical field was almost bloodless with no hindrance, but on the contrary with better identification of anatomical structures. In conclusion tourniquet-free h and surgery can be safely and accurately done if the out-stretched upper limb is elevated to make an angle of 60° with the horizontal plane, thus getting an almost bloodless field in the absence of tourniquet.