Open inguinal hernia repair with the use of polyglycolic acid/trimethylene carbonate mesh: gross and pathologic assessment of the inguinal area at reoperation for recurrence.

PURPOSE: Our group tried to test the hypothesis of using a totally absorbable material for open inguinal hernia repair. However, the increased incidence of recurrences alleviated our initial enthusiasm regarding the technique. The purpose of the present study was to attain both gross and microscopic data that could at least in part justify the hernia repair failure from a patient included in our initial pilot study and was re-operated for recurrence. METHODS: A 65-year-old male patient was diagnosed clinically with a recurrence 24 months after open inguinal hernia repair with the use of polyglycolic acid/trimethylene carbonate mesh. The patient was operated for the recurrence upon our group on July 2012. The gross appearance of the inguinal area as well as the degree of chronic inflammation provoked by the used mesh as depicted by the pathologic analysis of specimens obtained intraoperatively were assessed. RESULTS: An open tension-free repair with the use of a non-absorbable mesh under spinal anesthetic was undertaken. Intraoperatively, after the division of the external oblique aponeurosis, only minor fibrotic reaction was observed a finding that was additionally confirmed pathologically. CONCLUSION: Polyglycolic acid/trimethylene carbonate mesh used for inguinal hernia repair was associated with a minimal inflammatory host reaction in the inguinal area at 3 years verified both grossly and microscopically.

Open inguinal hernia repair with the use of polyglycolic acid/trimethylene carbonate absorbable mesh: a critical update of the long-term results.

PURPOSE: Our group evaluated on a pilot basis open inguinal hernia repair with the use of a fully absorbable mesh aiming to take mesh inguinal hernia repair one step forward. The purpose of the present study was to assess the long-term results of the proposed technique. METHODS: Patients that were included in our previous report were followed up at 3 years after the initial operation. RESULTS: Ten patients underwent open inguinal hernia repair with the use of an absorbable polyglycolic acid/trimethylene carbonate mesh. 3 years after the procedure, from the total of ten patients, two were lost to follow-up (20 %). Three patients (37.5 %), one with direct and two with indirect hernia, were diagnosed clinically with a recurrence at the follow-up of 3 years. Recurrences were developed nearly 2 years--median 24 months (range 18-30)--after the initial operation. Among patients without recurrence none complained about chronic pain, foreign body sensation or numbness. On the other hand, chronic pain was a constant complain in the recurrence patient group. CONCLUSIONS: The results of the 3-year follow-up in the given patient sample alleviate the initial enthusiasm regarding the use of an absorbable mesh for inguinal hernia repair as an attractive alternative and causes skepticism about the generalized use of the procedure in its certain form.

Open inguinal hernia repair with the use of a polyglycolic acid-trimethylene carbonate absorbable mesh: a pilot study.

PURPOSE: Tension-free repair with mesh placement has become the gold standard for open inguinal hernia surgery. Traditionally, non absorbable materials have been used for mesh manufacture. The purpose of this pilot study was to evaluate the efficacy of using a totally absorbable prosthetic mesh for open inguinal hernia repair. METHODS: Ten patients with elective inguinal hernias were set to undergo open tension-free inguinal hernia repair with the use of polyglycolic acid-trimethylene carbonate absorbable mesh. In this pilot study, we looked primarily at recurrence and chronic pain assessed 1 year after the operation, while immediate postoperative complications were also recorded. RESULTS: All patients were discharged from the hospital the day after surgery. In three patients (30%), a Foley catheter was inserted to relieve symptoms of urinary retention. None of the patients had any immediate postoperative complication. At the 1st year follow up, none of the patients had clinical signs of recurrence. However, one patient experienced intermittent pain in the operated inguinal area. CONCLUSIONS: Open inguinal hernia repair with the use of polyglycolic acid-trimethylene absorbable mesh proved efficient in the given patient sample. Further studies with a larger number of patients and longer follow up are needed in order to confirm the possible favourable effects of this mesh type.

Comparative study of genetic activity of chlorambucil's active metabolite steroidal esters: the role of steroidal skeleton on aneugenic potential.

p-N,N-bis(2-chloroethyl)aminophenylacetic acid (PHE), a nitrogen mustard analogue and chlorambucil's active metabolite used as chemotherapeutic agent, has been shown that, in addition to its clastogenic activity, induces chromosome delay. In the present study an efford has been made (a) to investigate if the steroidal analogues of PHE (EA-92, EA-97, AK-333, AK-409 and AK-433) exert the same genetic activity as the parent compound, (b) to further analyze the aneugenic activity of nitrogen mustard analogues, (c) to investigate the mechanism by which they exert aneugenic potential and (d) to correlate the genetic activity with chemical structure. For this purpose the Cytokinesis Block Micronucleus (CBMN) assay was conducted in human lymphocytes in vitro and the micronucleus (MN) frequency was determined to investigate their genetic activity. The mechanism of micronucleation was determined in combination with Fluorescence In Situ Hybridization (FISH) using pancentromeric DNA probe. Since one of the mechanisms that chemicals cause aneuploidy is through alterations in the mitotic spindle, we also investigated the effect of the above compounds on the integrity and morphology of the mitotic spindle using double immunofluorescence of beta- and gamma-tubulin in C(2)C(12) mouse cell line. We found that PHE and its steroidal analogues, EA-92, EA-97, AK-333, AK-409 and AK-433, affect cell proliferation in human lymphocytes and C(2)C(12) mouse cells. All studied compounds are capable of inducing chromosome breakage events, as indicated by the enhanced C(-)MN frequencies. The less lipophilic compounds are the most genetically active molecules. PHE and only two of the studied analogues, AK-409 and AK-433, the most hydrophilic ones, showed aneugenic potential, by increasing the frequencies of MN containing a whole chromosome. The aneugenic potential of the above referred analogues is associated with amplification of centrosome number, since they caused high multipolar metaphase frequencies.

Aneugenic potential of the nitrogen mustard analogues melphalan, chlorambucil and p-N,N-bis(2-chloroethyl)aminophenylacetic acid in cell cultures in vitro.

Melphalan (MEL), chlorambucil (CAB) and p-N,N-bis(2-chloroethyl)aminophenylacetic acid (PHE) are nitrogen mustard analogues, which are clinically used as chemotherapeutic agents. They also exert carcinogenic activity. The aim of this study was to investigate the aneugenic potential of the above drugs and the possible mechanism responsible for this activity. The Cytokinesis Block Micronucleus (CBMN) assay in combination with fluorescence in situ hybridization (FISH) was used in human lymphocyte cultures to evaluate micronucleus (MN) frequency. Pancentromeric probe (alpha-satellite) was applied to identify chromosomes in micronuclei and an X-chromosome specific centromeric probe was used to asses micronucleation and non-disjunction of this chromosome in binucleated cells. The effect of the above compounds on the organization of mitotic apparatus, as a possible target of chemicals with aneugenic potential, was investigated in C(2)C(12) mouse cell line by double immunofluorescence of alpha- and gamma-tubulin. We found that the studied drugs increased MN frequency in a linear dose-dependent manner primarily by chromosome breakage and in a lesser extent by an aneugenic mechanism. Non-disjunction and micronucleation of X-chromosome were also induced. Abnormal metaphase cells were linearly increased with concentration and characterized by abnormal centrosome number. Interphase cells with micronuclei and abnormal centrosome number were also observed. Since nitrogen mustards are highly reactive agents, with low selectivity and form covalent bonds with different nucleophilic sites in proteins and nucleic acids, it is reasonable to consider that one possible pathway for nitrogen mustard analogues to exert their aneugenic activity is through reaction with nucleophilic moieties of proteins or genes that are involved in the duplication and/or separation of centrosomes, resulting in abnormal centrosome number. Based on our results the carcinogenicity of nitrogen mustard analogues studied may be attributed not only to their activity to trigger gene mutation and chromosome breakage, but also to their aneugenic potential. Further studies are warranted to clarify the above two hypotheses.