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Andy Maleachi
Why it is important to be discussed
Advantage :
Decrease the incidence of hernia recurrence
compared with sutured repair
Open
Anterior approach
- Lichtenstein
- Sutureless, presheped mesh
hernioplasty
- Plug repair
Posterior approach
- Kugel approach
- Stoppa (GPRVS)
- Ugahary
Laparoscopic
TEPP
TAPP
IPOM
Mesh
If we could artificially produce tissues of the density
and toughness of fascia and tendon, the secret of the
radical cure of hernia would be discovered
Disadvantage
N : 614
At D7 work not resumed = 344
Reasons : Pain 60,2 %
Wound complication 17,2 %
Other reason 12,2 %
Unrelated 2,0 %
Not specified 28,2 %
At D30 work not resumed = 44
Reasons : Pain 50 %
Wound complication 27,3 %
Other reason 16,2 %
Unrelated 13,6 %
Not specified 11,4 %
Absorbable
- Polyglycolic acid (Dexon)
- Polyglactic acid (Vicryl)
Non absorbable
- Polypropylene
- Polyethylene terephthalete (polyester)
- Expanded polytetra-fenosethylene (ePTFE)
Surgical mesh
Combination
- Polypropylene + multifilamented polyglactin
(Vypro).
- Polypropylene + monofilamented
polyglecaprone (ultrapro)
- Polypropylene + Polydioxanone + Oxidized
regenerated cellulose fabric (Proceed)
Polypropylene
Mersilene (Ethicon)
Parietex ( Sofradim)
e PTFE
Teflon
Gone-Tex
Which mesh ?
Monofilament multifilament
Large pores small pores
Heavy-weight - lightweigth
Difference between burst strength
Difference between thickness
Monofilament - multifilament
Monofilament
- might reduce the attachment of bacteria
- usually increases the stiffness of the abdominal
wall
Multifilament
- elevated pliability
- may cause problems in case of bacterial
infection
Large pores small pores
Dog model.
Heavyweight polypropylene mesh vs lightweight
polypropylene with absorbable polyglactin ( large
pores). Shrinkage : 46% vs 34%
Cobb WS, Kercher KW, Heniford BT. The argument for lightweight
polypropylene mesh in hernia repair. Surg.Innovation 2005,12 :63-9
Heavyweight lightweight
Atrium 0,048
Marlex 0,066
Prolene 0,065
Amid.
The mesh should extend 2 cm across the pubic
tubercle, 3 4 cm above Hesselbachs triangle, and 5
6 cm lateral to the internal ring