Metin YÜCEL, Gürhan BAS, Fatih BAŞAK, Adnan ÖZPEK, Ethem ÜNAL, Ali KILIÇ

Abdominal duvar hernilerinin tamirinde omega-3 yağ asidi kaplı polipropilen mesh: 30 hastanın prospektif analizi

Amaç: Abdominal duvar hernilerinin tedavisinde temel prensip gerilimsiz onarımdır. Polipropilen mesh nedeniyle oluşan adezyon riskini azaltmak için antiadeziv bariyerli meshler kullanıma girdi. Bu çalışmanın amacı, omega-3 yağ asidi kaplı polipropilen mesh kullanılarak ameliyat edilen hastaların postoperatif takip sonuçlarının analiz edilmesi idi.Gereç ve Yöntem: Bu çalışma, kasım 2010 – temmuz 2015 yılları arasında omega-3 yağ asidi kaplı polipropilen mesh kullanılarak opere edilen hastaların, digital veri bankasında taranması ile prospektif olarak yapıldı. Uygulanan ameliyat tekniğine göre hastalar iki gruba ayrıldı (grub 1: laparoskopi, grub 2: açık cerrahi). Mesh olarak omega-3 yağ asidi kaplı polipropilen mesh kullanıldı (C-QURTM Mesh, Atrium Medical Corporation, Hudson, NH, USA). Postoperatif komplikasyonlar irdelendi.Bulgular: Çalışmaya 30 hasta dahil edildi. Erkek- kadın oranı eşit olup yaş ortalaması 56.2±14.5 (aralık: 17-83) idi. Yirmi iki hastada (%73) primer sütur ile onarılamayan abdominal duvar hernisi (grub 2), 8 inde (%27) laparoskopik onarılan abdominal duvar hernisi (grub 1) vardı. Dokuz hastada (%30) komplikasyon gelişti. Yaş, cinsiyet ve uygulanan cerrahi tekniğin komplikasyon gelişimine etkisi istatistiksel olarak anlamlı bulunmadı. Komplikasyon gelişen hastalarda defekt boyutu istatistiksel olarak anlamlı derecede yüksekti.Sonuç: Antiadeziv bariyerli meshlerin uzun dönem sonuçları bilinmemektedir. Bu tip meshlerin de komplikasyon, sağlık problemi ve hatta ölüme bile neden olma potansiyeli olduğu unutulmamalıdır.

Anahtar Kelimeler:

Antiadeziv bariyerli mesh, omega-3 yağ asidi kaplı polipropilen mesh, abdominal duvar hernisi

Omega-3 fatty acid covered polypropylene mesh for abdominal wall hernia repair: a prospective analysis of 30 patients

Purpose: The main principle in abdominal wall hernia repair is achieving a tension free repair. To reduce adhesion risk caused by polypropylene mesh, meshes with anti-adhesive barrier have been introduced into clinical practice. The present study aimed to analyze postoperative outcomes in patients operated with omega-3 fatty acid covered polypropylene mesh for abdominal wall hernia repair.Materials and Methods: This study was prospective cohort conducted by examining the data of patients operated with omega-3 fatty acid covered polypropylene mesh between November 2010 and July 2015. The patients divided into two groups according to the operative technique. Primary parameters included complications, i.e., hernia recurrence, mesh adhesion, mesh infection and surgical site infection. Results: This study enrolled 30 patients (15 men, 15 women) with a mean age of 56.2±14.5 (range 17-83) years. Group 1 had eight patients (27%) who had laparoscopically repaired abdominal wall hernias, and group 2 included 22 (73%) patients who had abdominal wall hernias un-repairable by primary suture. Nine (30%) patients developed a complication. Age, sex and operative technique did not significantly affect complication rate. In patients who developed complication, defect size was significantly greater. Conclusion: The long-term effects of meshes with anti-adhesive barrier are unknown. It should be noted that this meshes have the potential to cause morbidity, serious health problems or even death.

Keywords:

Composite mesh mesh with anti-adhesive barrier, omega-3 fatty acid covered polypropylene mesh, abdominal wall hernia,

PDF

___

1. Schumpelick V, Klinge U, Welty G, Klosterhalfen B. Meshes within the abdominal wall. Chirurg. 1999;70:878-87.
2. Halm JA, de Wall LL, Steyerberg EW, Jeekel J, Lange JF. Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery. World J Surg. 2007;31:423-9.
3. Aguayo-Albasini JL, Moreno-Egea A, Torralba-Martínez JA. The labyrinth of composite prostheses in ventral hernias. Cir Esp. 2009;86:139-46.
4. Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet. 2003;362:1561-71.
5. Israelsson LA, Jonsson T. Incisional hernia after midline laparotomy: a prospective study. Eur J Surg. 1996;162:125-9.
6. BurgerJW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004; 240: 578-83.
7. Di Vita G, D'Agostino P, Patti R, Arcara M, Caruso G, Davì V et al. Acute inflammatory response after inguinal and incisional hernia repair with implantation of polypropylene mesh of different size. Langebecks Arch Surg. 2005;390:306-11.
8. Cassar K, Munro A. Surgical treatment of incisional hernia. Br.J.Surg. 2002;89:534-45.
9. Goldstein HS. Selecting the right mesh. Hernia. 1999;3:23-6.
10. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;10:392-8.
11. Leber GE, Garb JL, Alexander AI, Reed WP. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg. 1998;133:378-82.
12. de Vries Reilingh TS, van Geldere D, Langenhorst B, de Jong D, van der Wilt GJ, van Goor H et al. Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia. 2004;8:56-9.
13. Langer C, Schaper A, Liersch T, Kulle B, Flosman M, Füzesi L et al. Prognosis factors in incisional hernia surgery: 25 years of experience. Hernia. 2005;9:16-21.
14. Schulz DD, Czeczko NG, Malafaia O, Schulz GJ, Czeczko LE, Garcia LS et al. Evaluation of healing prosthetic materialspolyester mesh reasorbable film and collagen elastin matrix/polypropylene used in rabbits abdominal wall defects. Acta Cir Bras. 2009;24:476-83.
15. Johanet H, Coelio C. Laparoscopic ventral hernia repair using Parietex Composite mesh: prospective multicenter study. Ann Chir. 2004;129:6-8.
16. Brüggmann D, Tchartchian G, Wallwiener M, Münstedt K, Tinneberg HR, Hackethal A. Intra-abdominal adhesions definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int. 2010;107: 769-75.
17. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D et al. Adhesion-related hospital readmission after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353:1476-80.
18. Jamry A, Jalynski M, Piskorz T, Brocki M. Assessment of adhesion formation after laparoscopic intraperitoneal implantation of dynamesh IPOM mesh. Arch Med Sci. 2013;9:487-92.
19. van’t Riet M, de vos van Steenwijk PJ, Bonthuis F, Marquet RL, Steyerberg EW, Jeekel J et al. Prevention of adhesion to prosthetic mesh. Ann Surg. 2003;237:123-8.
20. Kist C, Manna BB, Montes JHM, Bigolin AV, Grossi JVM, Cavazzola LT. Comparative study of intraperitoneal adhesions associated with the use of meshes of polypropylene and polypropylene coated with omega-3 fatty acid. Rev Col Bras Cir. 2012;39:201-6.
21. Pierce RA, Perrone J, Nimeri A, Sexton J, Walcutt J, Frisella M et al. 120-Day comparative analysis of adhesion grade and quantity, mesh contraction, and tissue response to a novel omega-3 fatty acid bioabsorbable barrier macroporous mesh after intraperitoneal placement. Surg Innov. 2009;16:46-54.
22. Schreinemacher MHF, Emans PJ, Gijbels MJJ, Greve JWM, Beets GL, Bouvy ND. Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model. Br J Surg. 2009;96:305-13.