[Surgery for Echinococcus cysts in the liver]. / Chirurgische Therapie bei Echinococcus-Zysten der Leber.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus, and the most frequently affected organ is the liver. Diagnosis is usually based on radiological and serological findings. Even though percutaneous drainage and medical therapies are suggested for selected cases, for the most part surgery is required. The surgical strategy consists of killing the cyst, removing its contagious elements from the liver, obliterating the cystic cavity, and preventing recurrence and complications. A large spectrum of operations - from simple drainage to liver transplantation - has been proposed for reaching these objectives. Laparoscopic surgery is used increasingly for hydatid disease. This article reviews the current status of hydatid disease surgery, with special emphasis on liver cysts.

Titanium coating of a polypropylene mesh for hernia repair: effect on biocompatibilty.

Titanium and its alloys are used worldwide in surgery. The favorable characteristics that make this material desirable for implantation are corrosion resistance and biocompatibility. Concerning hernia repair, a mesh modification has been developed using titanium layering of a polypropylene mesh implant, which is said to lead to an improved biocompatibility compared to commercially available mesh materials. To analyze the pure effect of titanium coating, two different mesh structures were studied using a standardized animal model. The titanium-coated monofilamentous, large porous, and lightweight mesh made of polypropylene and coated with titanium (PP+T) was compared to a pure polypropylene mesh manufactured with a similar structure and amount of material serving as a control (PP). In Sprague-Dawley rats, mesh samples were placed in a subcutaneuous position. Then 56, 84, and 182 days after mesh implantation, three animals from each group were sacrificed for morphological observations (amount of inflammatory and connective tissue formation, percentages of proliferating and apoptotic cells, percentage of macrophages). Both mesh modifications investigated showed an overall good biocompatibility. Macroscopic clinical observation after implantation of up to 182 days was uneventful. The tissue response to the PP as well as to the PP+T mesh was characterized by a moderate inflammatory tissue reaction limited to the perifilamentary region as is known for low weight, large porous, and monofilamentous mesh structures. No significant improvement of biocompatibility was found when analyzing the effect of titanium coating compared to the pure polypropylene mesh structure.

Pitfalls in retromuscular mesh repair for incisional hernia: the importance of the "fatty triangle".

Open retromuscular mesh repair has become a standard procedure in incisional hernia repair. This technique led to a significant decrease of recurrences. Recurrences after this technique typically occur at the upper mesh border and are a result of the technical complexity of reaching the postulated underlay of 5 cm in the region of the linea alba. We performed an anatomical study in human corpses to investigate the abdominal wall with its different structures, with emphasis on the overlap of the mesh under the linea alba. The overlap can be achieved by incision of the posterior lamina of the rectus sheath, on both sides close to the linea alba. The incision opens the preperitoneal space and appears in the shape of a "fatty triangle". The anterior lamina of the rectus sheath above the hernia defect remains intact and facilitates a sufficient thrust bearing for a retromuscular mesh implantation. Knowledge of the anatomy and preparation of the "fatty triangle" enables a mesh positioning according to the principles of retromuscular mesh repair.