Advantages of new materials in fascia transversalis reinforcement for inguinal hernia repair.
OBJECTIVE
We investigated whether new absorbable materials can be used in the treatment of inguinal hernia with the same efficacy as the traditionally used polypropylene.


METHODS
We compared local tissue inflammation and fibrous reaction, postoperative complications (bleeding, wound haematoma, wound infection) and postoperative recovery time (time of mobilisation) in rats (Fischer strain) after implantation of a polypropylene mesh (PPM) (Prolene, Ethicon, Bracknell, UK) or a dual component fibrin mesh (DCFM) (Tachosil, Nycomed, Marlow, UK), between the muscle layer and the fascia transversalis defect. We further compared direct hernia repair methods using Lichtenstein's operation in humans after implantation of either PPM or DCFM for fascia transversalis reinforcement regarding postoperative pain and complications, time needed for patient mobilisation, and recurrence.


RESULTS
The results show that implantation of DCFM in rats resulted in milder inflammatory response and thicker fibrous tissue formation. Patients implanted with DCFM had significantly lower postoperative pain scores on a visual-analogue scale and lower analgesic use. The overall incidence of postoperative complications was significantly reduced with the use of DCFM. The incidence of recurrence after 24-month follow-up was the same in both groups.


CONCLUSIONS
This study has shown that DCFM has the same short-term efficacy in hernia treatment as the standard PPM, with a reduction in postoperative pain and analgesic use, and a decrease in overall postoperative complications. In the rat model, DCFM resulted in milder inflammatory response and thicker fibrous plate than the PPM. Further biomechanical testing and longer follow-up is necessary, but initial results are promising.
Arslani
N
N
Department of Surgery and Urology, Zabok General Hospital, Bračak 8, 49210, Zabok, Croatia. arslani.nuhi@gmail.com
Patrlj
L
L
Kopljar
M
M
Rajković
Z
Z
Altarac
S
S
Papeš
D
D
Stritof
D
D
D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000818:Animals; D004195:Disease Models, Animal; D000071938:Fasciotomy; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes; D051381:Rats; D011916:Rats, Inbred F344; D013526:Surgical Mesh; D014945:Wound Healing
D011126:Polypropylenes
Eur Urol. 2007 Oct;52(4):1156-63
17467884
J Surg Res. 2002 Apr;103(2):190-202
11922734
Chirurg. 2000 Jan;71(1):43-51
10663001
Eur Urol. 2007 Oct;52(4):1162-3
17467888
Am J Surg. 1970 Nov;120(5):610-4
4249908
Chir Ital. 2006 Nov-Dec;58(6):793-5
17190285
Br J Surg. 2002 Jan;89(1):50-6
11851663
Clin Appl Thromb Hemost. 2006 Oct;12(4):445-50
17000889
Interact Cardiovasc Thorac Surg. 2006 Jun;5(3):243-6
17670557
Acta Cir Bras. 2009 Jan-Feb;24(1):19-25
19169537
Ann Plast Surg. 2003 May;50(5):523-7
12792544
Ann Surg. 2005 Apr;241(4):553-8
15798455
Am J Surg. 2004 Dec;188(6A Suppl):9S-16S
15610887
J Invest Surg. 2005 Sep-Oct;18(5):273-8
16249170
Hernia. 2006 Mar;10(1):7-12
16362230
J Invest Surg. 2007 Nov-Dec;20(6):363-9
18097878
J Biomed Mater Res. 1999 Aug;46(2):203-11
10379998