Quality of life following laparoscopic totally extraperitoneal repair of a unilateral reducible inguinal hernia.

BACKGROUND: Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has become increasingly favored over open Lichtenstein tension-free mesh repair owing to its associated benefits, including reduced postoperative pain, early return to normal activities, and a comparable recurrence rate. In recent years, emphasis has been placed on patient-reported outcomes, particularly health-related quality of life (QOL), as a critical metric for evaluating surgical success. This study aimed to evaluate the overall QOL following laparoscopic TEP repair of unilateral inguinal hernia. METHODS: This prospective study enrolled patients aged 18 years or older who underwent elective laparoscopic TEP hernia repair for unilateral inguinal hernia from April 2020 to March 2022. Data collected include demographic details, hernia characteristics, postoperative complications, and postoperative QOL assessment. The Short Form 36 Health Survey Version 2 (SF-36v2), a validated general QoL questionnaire, was administered preoperatively and at 1 month, 6 months, and 1 year postoperatively. Statistical analysis utilized paired t-tests for comparisons, with significance set at a p-value <.05. RESULTS: A cohort of 49 patients, with a mean (standard deviation) age of 56.7 (14.0) years, predominantly comprising 47 men, was available for evaluation. Complications were observed in three (6.1%) of cases, with seroma/hematoma occurring in two patients and a wound infection necessitating antibiotic treatment in one patient. Notably, there were no instances of recurrence during the study period. Postoperative assessments revealed significant improvements in both physical and mental health at 1 month, with continued improvement noted up to 12 months. CONCLUSION: Laparoscopic TEP inguinal hernia repair has been shown to improve both physical and mental health in patients with unilateral reducible inguinal hernia, with the majority of the improvement typically occurring within the initial month following surgery. It is crucial to communicate these improvement trends to patients undergoing hernia repair to help manage their expectations effectively.

Polyurethane-based three-dimensional printing for biological mesh carriers.

Repair and reconstruction of the myopectineal orifice area using meshes is the mainstay of surgical treatment of inguinal hernias. However, the limitations of existing meshes are becoming increasingly evident in clinical applications; thus, the idea of using three-dimensionally (3D)-printed biological meshes was put forward. According to the current level of the 3D printing technology and the inherent characteristics of biological materials, the direct use of the 3D printing technology for making biological materials into finished products suitable for clinical applications is not yet supported, but synthetic materials can be first printed into 3D form carriers, compounded with biological materials, and finally made into finished products. The purpose of this study was to develop a technical protocol for making 3D-printed biomesh carriers using polyurethane as a raw material. In our study: raw material, polyurethane; weight, 20-30 g/m2; weaving method, hexagonal mesh; elastic tension aspect ratio, 2:1; diameters of pores, 0.1-1 mm; surface area, 8 × 12 cm2; the optimal printing layer height, temperature and velocity were 0.1 mm, 210-220 °C and 60 mm/s. Its clinical significance lies in: (1) applied to preoperative planning and design a detailed surgical plan; (2) applied to special types of surgery including patients in puberty, recurrent and compound inguinal hernias; (3) significantly improve the efficiency of doctor-patient communication; (4) it can shorten the operation and recovery period by about 1/3 and can save about 1/4 of the cost for patients; (5) the learning curve is significantly shortened, which is conducive to the cultivation of reserve talents.

3D-printed customised titanium mesh and bone ring technique for bone augmentation of combined bone defects in the aesthetic zone.

PURPOSE: Complex bone defects with a horizontal and vertical combined deficiency pose a clinical challenge in implant dentistry. This study reports the case of a young female patient who presented with a perforating bone defect in the aesthetic zone. MATERIALS AND METHODS: Based on prosthetically guided bone regeneration, virtual 3D bone augmentation was planned. A 3D printed customised titanium mesh and the autogenous bone ring technique were then utilised simultaneously to achieve a customised bone contour. After 6 months, the titanium mesh was removed and connective tissue grafting was performed. Finally, implants were placed and the provisional and definitive prostheses were delivered following a digital approach. Vertical and horizontal bone gain, new bone density, pseudo-periosteum type and marginal bone loss were measured. Planned bone volume, regenerated bone volume and regeneration rate were analysed. RESULTS: Staged tooth shortening led to a coronal increase in keratinised mucosa. The customised titanium mesh and bone ring technique yielded 14.27 mm vertical bone gain and 12.9 mm horizontal bone gain in the perforating area. When the titanium mesh was removed, the reopening surgery showed a Type 1 pseudo-periosteum (none or < 1 mm), and CBCT scans revealed a new bone density of ~550 HU. With a planned bone volume of 1063.55 mm3, the regenerated bone volume was 969.29 mm3, indicating a regeneration rate of 91.14%. The 1-year follow-up after definitive restoration revealed no complications except for 0.55 to 0.60 mm marginal bone loss. CONCLUSION: Combined application of customised titanium mesh and an autogenous bone ring block shows promising potential to achieve prosthetically guided bone regeneration for complex bone defects in the aesthetic zone.

Accuracy of semi-occlusive CAD/CAM titanium mesh using the reverse guided bone regeneration digital protocol: A preliminary clinical study.

PURPOSE: The reverse guided bone regeneration protocol is a digital workflow that has been introduced to reduce the complexity of guided bone regeneration and promote prosthetically guided bone reconstruction with a view to achieving optimal implant placement and prosthetic finalisation. The aim of the present study was to investigate the accuracy of this digital protocol. MATERIALS AND METHODS: Sixteen patients with partial edentulism in the maxilla or mandible and with vertical or horizontal bone defects were treated using the reverse guided bone regeneration protocol to achieve fixed implant rehabilitations. For each patient, a digital wax-up of the future rehabilitation was created and implant planning was carried out, then the necessary bone reconstruction was simulated virtually and the CAD/CAM titanium mesh was designed and used to perform guided bone regeneration. The computed tomography datasets from before and after guided bone regeneration were converted into 3D models and aligned digitally. The actual position of the mesh was compared to the virtual position to assess the accuracy of the digital project. Surgical and healing complications were also recorded. A descriptive analysis was conducted and a one-sample t test and Wilcoxon test were utilised to assess the statistical significance of the accuracy. The level of significance was set at 0.05. RESULTS: A total of 16 patients with 16 treated sites were enrolled. Comparing the virtually planned mesh position with the actual position, an overall mean discrepancy between the two of 0.487 ± 0.218 mm was achieved. No statistically significant difference was observed when comparing this to a predefined minimum tolerance (P = 0.06). No surgical complications occurred, but two healing complications were recorded (12.5%). CONCLUSION: Within the limitations of the present study, the reverse guided bone regeneration digital protocol seems to be able to achieve good accuracy in reproducing the content of the virtual plan. Nevertheless, further clinical comparative studies are required to confirm these results.

Laparoscopic repair of concurrent direct and indirect inguinal, femoral, and obturator hernias on the same side: A case report.

Concurrent direct and indirect inguinal, femoral, and obturator hernias are rare. This case report describes a rare case treated using the laparoscopic approach. A 68-year-old female patient presented with a moving left inguinal lump and pain. Physical examination and abdominal computed tomography scan revealed the coexistence of a left inguinal hernia or Nuck canal hydrocele and a left femoral hernia. The patient underwent laparoscopic transabdominal preperitoneal repair, and all four orifices were covered with one mesh. The patient was discharged on the second postoperative day without any complications. The concurrent presence of four hernias on the same side is rare and has not been previously reported. The laparoscopic approach is useful in such cases because it allows visualization of multiple hernia orifices from the intra-abdominal cavity.

Risk factors of recurrence after incisional hernia preperitoneal repair: a long-term retrospective single-center cohort study.

PURPOSE: To explore the risk factors for incisional hernia (IH) recurrence following open prepertioneal repair. METHODS: Patients diagnosed with primary IH who underwent open preperitoneal repair at our hospital were enrolled. Patients were assessed, and perioperative factors were collected. Recurrence surveys were performed at regular intervals throughout the long-term postoperative follow-up. The risk factors for IH recurrence were identified using univariate and multivariate analyses. RESULTS: This study included 145 patients. Significant differences were found between recurrence and non-recurrence patients regarding pulmonary ventilation function (PVT), age, body mass index (BMI), mesh materials, type of surgery (clean, clean-contaminated, or contaminated), surgical site infections (SSIs), maximum width of the hernia defect (MWHD), and site of incisional hernia (P < 0.01). The univariate survival analysis revealed that PVT abnormalities, age > 70 years, BMI > 27 kg/m2, porcine small intestine submucosal (PSIS) mesh, non-clean surgery, SSIs, MWHD > 10 cm, and location in the lateral zones were significant factors for IH recurrence after open preperitoneal repair. The multivariate survival analysis showed that PVT abnormalities, age > 70 years, BMI > 27 kg/m2, and PSIS mesh were independent risk factors for IH recurrence after open preperitoneal repair. CONCLUSIONS: We identified PVT abnormalities, age > 70 years, BMI > 27 kg/m2, and PSIS mesh as novel risk factors for IH recurrence after open preperitoneal repair.

[The results of clinical application of the mesh with anti-adhesive fluoropolymer coating in laparoscopic intraperitoneal repair of primary ventral hernia]. / Rezul'taty klinicheskogo primeneniya setchatogo endoproteza s antiadgezivnym ftorpolimernym pokrytiem pri laparoskopicheskoi intraperitoneal'noi plastike pervichnykh ventral'nykh gryzh.

OBJECTIVE: The purpose of the study was to evaluate the results of using fluoropolymer-coated mesh during intraperitoneal onlay mesh hernia repair in patients with primary ventral hernias. MATERIAL AND METHODS: The multicenter, non-randomized, controlled clinical study included 88 patients of both sexes who were operated on using a laparoscopic approach using the IPOM technique for a primary ventral hernia. The duration of observation ranged from 3 to 12 months. In the main group, 48 patients received fluoropolymer-coated meshes (Ftorex). A comparison was made with a retrospective group of 40 patients who were treated with anti-adhesive collagen-coated meshes (Parietene composite, Parietex Composite, Symbotex). RESULTS: The number of early and late postoperative complications in the groups did not have significant differences, at the same time, their number was lower in the group of patients in whom fluoropolymer-coated meshes were used. Most of the complications corresponded to Clavien-Dindo class I and II and did not pose a significant threat to health. There were no recurrences of hernias observed in patients included in the study. There were slightly more adhesions in the fluoropolymer-coated mesh group (35.4% vs. 25.0% in the collagen-coated mesh group). The quality of life of patients in the study groups did not differ. CONCLUSION: In laparoscopic IPOM hernia repair fluoropolymer-coated meshes are not inferior in effectiveness and safety to traditionally used collagen-coated meshes and can be recommended for use in patients with primary ventral hernias.

Bone Anchor Fixation in the Repair of Blunt Traumatic Abdominal Wall Hernias: A Western Trauma Association Multicenter Study.

BACKGROUND: Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair. METHODS: A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses. RESULTS: 176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P = .158), rate of hernia recurrence (9.8% vs 12.7%, P = .786), and surgical site infection (SSI) (12.5% vs 15.6%, P = .823) were all similar between cohorts. CONCLUSIONS: This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.

Durable and Robust Antibacterial Polypropylene Hernia Mesh for Abdominal Wall Defect Repair.

Polypropylene (PP) mesh is commonly used in repairing abdominal wall hernia (AWH). However, the use of synthetic prosthesis comes with the risk of developing a prosthetic infection, resulting in delayed healing, secondary surgery, and potentially increased mortality. To address these issues, a facile surface functionalization strategy for PP mesh based on phytic acid (PA) and polyhexamethylene guanidine (PHMG) was constructed through a one-step co-deposition process, referred to as the PA/PHMG coating. The development of PA/PHMG coating is mainly attributed to the surface affinity of PA and the electrostatic interactions between PA and PHMG. The PA/PHMG coating could be completed within 4 h under mild conditions. The prepared PA/PHMG coatings on PP mesh surfaces exhibited desirable biocompatibility toward mammalian cells and excellent antibacterial properties against the notorious "superbug" methicillin-resistant Staphylococcus aureus (MRSA) and tetracycline-resistant Escherichia coli (TRE). The PA/PHMG-coated PP meshes showed killing ratios of over 99% against MRSA in an infected abdominal wall hernia repair model. Furthermore, histological and immunohistochemical analysis revealed a significantly attenuated degree of neutrophil infiltration in the PA/PHMG coating group, attributed to the decreased bacterial numbers alleviating the inflammatory response at the implant sites. Meanwhile, the pristine PP and PA/PHMG-coated meshes showed effective tissue repair, with the PA/PHMG coating group exhibiting enhanced angiogenesis compared with pristine PP meshes, suggesting superior tissue restoration. Additionally, PP meshes with the highest PHMG weight ratio (PA/PHMG(3)) exhibited excellent long-term robustness under phosphate-buffered saline (PBS) immersion with a killing ratio against MRSA still exceeding 95% after 60 days of PBS immersion. The present work provides a facile and promising approach for developing antibacterial implants.

Managing female stress urinary incontinence in a post mesh era: What to do and when to refer.

BACKGROUND: Urinary incontinence is a common presentation in general practice and can significantly affect a patient's quality of life. Stress urinary incontinence (SUI) is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (eg sporting activities), or on sneezing or coughing'. There is a key role for primary care providers in the assessment and management of female SUI. OBJECTIVE: To highlight the key diagnostic and management principles of female SUI in general practice and discuss management options. DISCUSSION: SUI can usually be diagnosed based upon clinical history and targeted physical examination. Pelvic floor physiotherapy and lifestyle interventions, including weight modification and management of co-morbidities, are important first-line therapies. Surgical options for both persistent or complex SUI include urethral bulking agents, Burch colposuspension and pubovaginal fascial slings. Synthetic (mesh) mid-urethral slings remain a viable surgical option for women suffering SUI.

CAD/CAM Titanium Meshes for GBR: A Case Series with Preliminary Histologic Analysis.

Titanium has been proposed as a mesh material for guided bone regeneration (GBR) since the 1990s. To overcome difficulties in shaping and adapting meshes to the defect, digital techniques were introduced to digitally print meshes capable of fitting the bone perfectly, reproduced through the patient's CT scan. Five patients were included in this case series, and their CBCT data were acquired and sent to the producer of the titanium meshes. 3D regenerative surgery was performed with titanium meshes and a mix of demineralized bovine bone matrix (DBBM) and autogenous bone (1:1 ratio). Radiographic measures were evaluated on paraxial sections of the CBCT through a dedicated software. When possible, regenerated bone samples were obtained at implant insertion. Four out of five regenerated areas healed without local or systemic complications. One mesh was removed after 2 months and 2 weeks due to exposure. The mean vertical bone gain was 4.3 ± 1.5 mm (range: 2.5 to 7 mm). Two histologic samples were obtained. In sample 1, bone tissue area and graft material area were 44.4% and 12.5%, respectively; in sample 2, the same parameters were 15.6% and 16.9%, respectively.

Increasing Use of Prophylactic Open Abdomen Therapy With Vacuum Assisted Wound Closure and Mesh Mediated Fascial Traction After Repair of Ruptured Abdominal Aortic Aneurysm.

OBJECTIVE: Open abdomen therapy (OAT) is commonly used to prevent or treat abdominal compartment syndrome (ACS) in patients with ruptured abdominal aortic aneurysms (rAAAs). This study aimed to evaluate the incidence, treatment, and outcomes of OAT after rAAA from 2006 to 2021. Investigating data on resuscitation fluid, weight gain, and cumulative fluid balance could provide a more systematic approach to determining the timing of safe abdominal closure. METHODS: This was a single centre observational cohort study. The study included all patients treated for rAAA followed by OAT from October 2006 to December 2021. RESULTS: Seventy-two of the 244 patients who underwent surgery for rAAA received OAT. The mean age was 72 ± 7.85 years, and most were male (n = 61, 85%). The most frequent comorbidities were cardiac disease (n = 31, 43%) and hypertension (n = 31, 43%). Fifty-two patients (72%) received prophylactic OAT, and 20 received OAT for ACS (28%). There was a 25% mortality rate in the prophylactic OAT group compared with the 50% mortality in those who received OAT for ACS (p = .042). The 58 (81%) patients who survived until closure had a median of 12 (interquartile range [IQR] 9, 16.5) days of OAT and 5 (IQR 4, 7) dressing changes. There was one case of colocutaneous fistula and two cases of graft infection. All 58 patients underwent successful abdominal closure, with 55 (95%) undergoing delayed primary closure. In hospital survival was 85%. Treatment trends over time showed the increased use of prophylactic OAT (p ≤ .001) and fewer ACS cases (p = .03) assessed by Fisher's exact test. In multivariable regression analysis fluid overload and weight reduction predicted 26% of variability in time to closure. CONCLUSION: Prophylactic OAT after rAAA can be performed safely, with a high rate of delayed primary closure even after long term treatment.

The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair.

INTRODUCTION: Fixation of mesh during minimally invasive inguinal hernia repair is thought to contribute to chronic post-herniorrhaphy groin pain (CGP). In contrast to permanent tacks, absorbable tacks are hypothesized to minimize the likelihood of CGP. This study aimed to compare the rates of CGP after laparoscopic inguinal hernia repair between absorbable versus permanent fixation at maximum follow-up. METHODS: This is a post hoc analysis of a randomized controlled trial in patients undergoing laparoscopic inguinal hernia repair (NCT03835351). All patients were contacted at maximum follow-up after surgery to administer EuraHS quality of life (QoL) surveys. The pain and restriction of activity subdomains of the survey were utilized. The primary outcome was rate of CGP, as defined by a EuraHS QoL pain domain score ≥ 4 measured at ≥ 1 year postoperatively. The secondary outcomes were pain and restriction of activity domain scores and hernia recurrence at maximum follow-up. RESULTS: A total of 338 patients were contacted at a mean follow-up of 28 ± 11 months. 181 patients received permanent tacks and 157 patients received absorbable tacks during their repair. At maximum follow-up, the rates of CGP (27 [15%] vs 28 [18%], P = 0.47), average pain scores (1.78 ± 4.38 vs 2.32 ± 5.40, P = 0.22), restriction of activity scores (1.39 ± 4.32 vs 2.48 ± 7.45, P = 0.18), and the number of patients who reported an inguinal bulge (18 [9.9%] vs 15 [9.5%], P = 0.9) were similar between patients with permanent versus absorbable tacks. On multivariable analysis, there was no significant difference in the odds of CGP between the two groups (OR 1.23, 95% CI [0.60, 2.50]). CONCLUSION: Mesh fixation with permanent tacks does not appear to increase the risk of CGP after laparoscopic inguinal hernia repair when compared to fixation with absorbable tacks. Prospective trials are needed to further evaluate this relationship.

Advantages of Laparoscopic Treatment in Pelvic Static Disorders by Lateral Hystero/Colpopexy - A Single Center Experience.

Introduction: Pelvic organ prolapse is the most frequent and common health problem faced by most patients, representing the descent into the vagina or beyond the introitus of one or more pelvic organs, involving three compartments: anterior-bladder, apical-uterus and posterior-rectus. Lateral hystero/colpopexy is an alternative approach in the repair of symptomatic anterior and apical pelvic prolapse. The main objective is to correct pelvic floor defects, restore anatomy, relieve pressure and maintain normal sexual function. Material and Methods: Surgical intervention was applied to patients with prolapse greater than grade II according to the international prolapse quantification system (POP-Q). For apical, anterior prolapse, the bladder peritoneum is dissected and a polypropylene mesh is fitted to the round ligaments with suspension of the isthmus and cervix and fixation of the mesh with CapSure tacks followed by closure of the vaginal peritoneum. Results: During the performance of the technique I had no intraoperative or postoperative complications. Conservation of the uterus proved to be effective for prolapse correction, significant improvements in patient quality of life, frequency of nocturia, degree of dyspareunia and urgency symptoms were observed. Conclusion: Uterine preservation by lateral hystero/colpopexy is a new, feasible and successful method for treating prolapse.

Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates-a retrospective cohort study.

BACKGROUND: In elderly patients with external full-thickness rectal prolapse (EFTRP), the exact differences in postoperative recurrence and functional outcomes between laparoscopic ventral mesh rectopexy (LVMR) and perineal stapler resection (PSR) have not yet been investigated. METHODS: We conducted a retrospective multicenter study on 330 elderly patients divided into LVMR group (n = 250) and PSR (n = 80) from April 2012 to April 2019. Patients were evaluated before and after surgery by Wexner incontinence scale, Altomare constipation scale, and patient satisfaction questionnaire. The primary outcomes were incidence and risk factors for EFTRP recurrence. Secondary outcomes were postoperative incontinence, constipation, and patient satisfaction. RESULTS: LVMR was associated with fewer postoperative complications (p < 0.001), lower prolapse recurrence (p < 0.001), lower Wexner incontinence score (p = 0.03), and lower Altomare's score (p = 0.047). Furthermore, LVMR demonstrated a significantly higher surgery-recurrence interval (p < 0.001), incontinence improvement (p = 0.019), and patient satisfaction (p < 0.001) than PSR. Three and 13 patients developed new symptoms in LVMR and PSR, respectively. The predictors for prolapse recurrence were LVMR (associated with 93% risk reduction of recurrence, OR 0.067, 95% CI 0.03-0.347, p = 0.001), symptom duration (prolonged duration was associated with an increased risk of recurrence, OR 1.131, 95% CI 1.036-1.236, p = 0.006), and length of prolapse (increased length was associated with a high recurrence risk (OR = 1.407, 95% CI = 1.197-1.655, p < 0.001). CONCLUSIONS: LVMR is safe for EFTRP treatment in elderly patients with low recurrence, and improved postoperative functional outcomes. TRIAL REGISTRATION: Clinical Trial.gov (NCT05915936), retrospectively registered on June 14, 2023.

Lessons learned from revision procedures: a case series pleading for reinforcement of the anterior hiatus in recurrent hiatal hernia.

BACKGROUND: Hiatal Hernia (HH) is a common structural defect of the diaphragm. Laparoscopic repair with suturing of the hiatal pillars followed by fundoplication has become standard practice. In an attempt to lower HH recurrence rates, mesh reinforcement, commonly located at the posterior site of the esophageal hiatus, has been used. However, effectiveness of posterior mesh augmentation is still up to debate. There is a lack of understanding of the mechanism of recurrence requiring further investigation. We investigated the anatomic location of HH recurrences in an attempt to assess why HH recurrence rates remain high despite various attempts with mesh reinforcement. METHODS: A retrospective case series of prospectively collected data from patients with hiatal hernia repair between 2012 and 2020 was performed. In total, 54 patients with a recurrent hiatal hernia operation were included in the study. Video clips from the revision procedure were analyzed by a surgical registrar and senior surgeon to assess the anatomic location of recurrent HH. For the assessment, the esophageal hiatus was divided into four equal quadrants. Additionally, patient demographics, hiatal hernia characteristics, and operation details were collected and analyzed. RESULTS: 54 patients were included. The median time between primary repair and revision procedure was 25 months (IQR 13-95, range 0-250). The left-anterior quadrant was involved in 43 patients (80%), the right-anterior quadrant in 21 patients (39%), the left-posterior quadrant in 21 patients (39%), and the right-posterior quadrant in 10 patients (19%). CONCLUSION: In this study, hiatal hernia recurrences occured most commonly at the left-anterior quadrant of the hiatus, however, posterior recurrences were not uncommon. Based on our results, we hypothesize that both posterior and anterior hiatal reinforcement might be a suitable solution to lower the recurrence rate of hiatal hernia. A randomized controlled trial using a circular, bio-absorbable mesh has been initiated to test our hypothesis.

Computational analysis of electrical stimulation to promote tissue healing for hernia repair at varying mesh placement planes.

Development of a tear in the abdominal wall allowing for protrusion of intra-abdominal contents is known as a hernia. This can cause pain, discomfort, and may need surgical repair. Hernias can affect people of any age or demographic. In the USA, over 1 million hernia repair procedures are performed each year. During these surgeries, it is common for a mesh to be utilized to strengthen the repair. Different techniques allow for the mesh to be placed in different anatomical planes depending on hernia location and approach. The locations are onlay, inlay, and sublay, with sublay being split into retromuscular or preperitoneal with sublay being the most commonly used. The use of an electrically active hernia repair mesh is of interest to model as electrical stimulation has been shown to improve soft tissue healing which could reduce recurrence rates. Theoretical 3D COMSOL models were built to evaluate the varying electric fields of an electrically active hernia repair mesh at each of the different anatomical planes. Three voltages were chosen (10, 20, and 30 mV) for the study to simulate a low-level electrical signal and the electric field from a piezoelectric material at the tissue layers surrounding the mesh construct. Based on the model outputs, the optimal mesh placement location was the sublay-retromuscular as this location had the highest electric field values in the connective tissues and rectus abdominis muscle, which are the primary tissues of concern for the healing process and a successful repair.

Transverse patella fracture fixation: A cadaveric biomechanical comparison of cannulated screws and anterior tension band versus low-profile, multiplanar mesh plating.

INTRODUCTION: Multiplanar mesh plating of patella fractures has become more popular in recent years. It was the goal of this study to compare the biomechanical stability of cannulated screw with anterior tension band to multiplanar mesh plating for fixation of transverse patella fractures in cadaver specimens. MATERIALS AND METHODS: Eight matched pairs of fresh frozen cadaveric knees were obtained and soft tissues dissected leaving the extensor mechanism, joint capsule, and retinaculum intact. Transverse fractures were created at the mid-portion of the patella. For each pair, one specimen was repaired using cannulated screws with anterior tension band, and the second was repaired using multiplanar mesh plating. Each specimen underwent cyclic extension loading with loads increasing by 1.1 kg after every 50 cycles. Interfragmentary displacement was measured at the end of each interval at both 5° and 45° of knee flexion angle, with fixation failure defined by >2 mm displacement. RESULTS: The specimens fixed with multiplanar mesh plating survived more cycles and higher loads than the specimens fixed with cannulated screws with anterior tension band (p = 0.011 comparing survival plots). After 150 cycles of extension loading, 3 of 8 of the specimens fixed with screws/tension band had failed, whereas none of the mesh plated specimens had failed. After 400 cycles, 7 of 8 of the screws/tension band had failed, whereas half of the mesh plated specimens had failed. CONCLUSIONS: While a more technically challenging and expensive technique, mesh plating for patella fractures appears to offer greater durability than traditional cannulated screw with tension banding.

Restriction of Surgical Options for Pelvic Floor Disorders.

ABSTRACT: The purpose of this document is to update the 2013 AUGS Position Statement based on subsequent decisions made by the U.S. Food and Drug Administration, published clinical data, and relevant society and national guidelines related to the use of surgical mesh. Urogynecologists specialize in treating pelvic floor disorders, such as pelvic organ prolapse (POP) and urinary incontinence, and have been actively involved and engaged in the national and international discussions and research on the use of surgical mesh in the treatment of POP and stress urinary incontinence. In 2019, the U.S. Food and Drug Administration ordered manufacturers of transvaginally placed mesh kits for prolapse to stop selling and distributing their devices, stating that the data submitted did not provide a reasonable assurance of safety and effectiveness. Evidence supports the use of mesh in synthetic midurethral sling and abdominal sacrocolpopexy. The American Urogynecologic Society (AUGS) remains opposed to any restrictions that ban currently available surgical options performed by qualified and credentialed surgeons on appropriately informed patients with pelvic floor disorders. The AUGS supports the U.S. Food and Drug Administration's recommendations that surgeons thoroughly inform patients seeking treatment for POP about the risks and benefits of all potential treatment options, including nonsurgical options, native tissue vaginal repairs, or abdominally placed mesh. There are certain clinical situations where surgeons may assert that the use and potential benefit of transvaginal mesh for prolapse outweighs the risk of other routes/types of surgery or of not using mesh. The AUGS recommends that surgeons utilize a shared decision-making model in the decision-making process regarding surgical options, including use of transvaginally placed mesh.