PMC:6705338 / 1573-7560
Annnotations
{"target":"http://pubannotation.org/docs/sourcedb/PMC/sourceid/6705338","sourcedb":"PMC","sourceid":"6705338","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6705338","text":"Introduction\nThe incisional abdominal hernia can be defined as a hernia protrusion that develops in the topography of a previous surgical incision or a traumatic injury to the abdominal wall. It is one of the most frequent complications after elective or emergency abdominal surgeries. The incidence is 10-20%, reaching a higher rate (30-40%) in patients with associated risk factors1-2. In the United States of America, approximately four to five million abdominal surgeries are performed annually, resulting in an approximate incidence of 500.000 new cases of incisional hernias1-3. About 365.000 incisional hernioplasties were performed in the US in 2006 at a cost of $ 3.2 billion4. Due to the increase in the survival of patients with traumatic and infectious abdominal catastrophes, the number of large incisional hernias has increased, as well as the complexity of their surgical management1,2-5. The repair of large abdominal wall hernias is technically challenging. It is associated with a long hospitalization, difficulties and complications in the healing process, intra-abdominal hypertension, high rate of re-operations, readmissions and hernia recurrences, with a consequent increase in overall costs of treatment1,6-7.\nThe use of meshes for the repair of abdominal wall hernias is a widely discussed concept, and is performed by conventional or videolaparoscopic tension-free techniques. The development and the clinical use of polypropylene meshes in hernia repair of the abdominal wall is considered a historical milestone in the treatment of hernias8. The prostheses used in abdominal hernioplasties may be biological or synthetic. The synthetic meshes are composed mostly of polypropylene or polyester, or expanded polytetrafluoroethylene (PTFEe), or polyvinylidene fluoride (PVDF). In turn, biological meshes (bioprostheses) are composed of bovine or porcine pericardium (xenogenic) and a human acellular dermal matrix (allogeneic)9-10. The use of synthetic meshes for the repair of abdominal wall hernias has become important because it is able to reduce failure rates and recurrence of hernia after surgical treatment, solidifying as a gold standard in the management of abdominal hernias1,6-11.\nSeveral biological, chemical and physical characteristics of meshes, synthetic and bioprosthetic, differentiate the prostheses used for the repair of hernia defects of the abdominal wall. Ideally, such prosthetic implants should be chemically inert, have an inflammatory and fibroplastic response that leads to the incorporation of the mesh, but not result in an intense foreign body-type reaction to the extent that it compromises the elasticity of the abdominal wall or limits its movement. It should also be biocompatible, strong, resistant to infection, nonimmunogenic or carcinogenic, minimally bioreactive, affordable, moldable, sterilizable, and easy to handle9-12. The availability of a variety of different types of meshes for the surgical treatment of abdominal hernias leads to an inevitable conclusion: the ideal mesh is not yet available. However, meshes made of polypropylene or polyester are the most commonly used for this purpose11.\nAlthough the use of meshes for the repair of abdominal wall hernia defects is widely accepted and widespread, and has a positive impact in reducing failure rates and relapses6, the intra-abdominal use of most available prostheses is restricted. After implantation intraperitoneally, they can determine important adhesions between the surface of the mesh and the intra-abdominal viscera, especially with the small intestine, the colon and the epiploon, favoring the appearance of chronic abdominal pain, intestinal obstruction, enterocutaneous fistulas, chronic infection of the mesh, and a consequent need for surgeries to treat such complications, or even complicating conventional or laparotomic and videolaparotomic approaches after hernioplasty, leading to a significant morbidity and additional costs13-15.\nThe videolaparoscopic treatment of incisional hernias is usually performed using intraperitoneally implanted meshes. Therefore, they come in direct contact with the abdominal viscera. In this scenario, the meshes are called tissue separators. They are a coated, composite, double face, bilayer, or anti-adherence barrier2-9. Tissue separating meshes present a reticulated parietal face that, in contact with the underlying muscle-aponeurotic and peritoneal plane, favors the fibroplasia process and the incorporation of the mesh, providing an adequate tensile strength to the tissue. It also has a visceral, laminar face that, in contact with the viscera, can enhance the process of mesothelialization (formation of the neoperitoneum), thus reducing the risk of developing adhesions and their deleterious effects13-16. Tissue separating meshes can be divided into two groups: meshes with a permanent barrier, in which the visceral face is not degraded or absorbed, and meshes with absorbable (temporary) barriers, in which the visceral surface has a transitory effect11-17. Usually, the components of these barriers determine a wide variety of inflammatory responses and fibroplasia, resulting in a diverse rate of adhesions between the mesh and intra-abdominal viscera. This suggests that experimental and clinical studies are needed to achieve a definitive clinical efficacy of tissue separating meshes.\nA comparative experimental study was carried out on three different types of synthetic prostheses commonly used for the repair of incisional hernias. A low weight polypropylene mesh was used with no non-stick barrier and two tissue-separating meshes, a light polypropylene composite associated with polyglecaprone and the other a polyester composite with porcine collagen. All meshes were implanted intraperitoneally aiming an analysis of the extent and intensity of adhesions formed between the mesh and the intra-abdominal anatomical structures determined by the three different types of prostheses.","divisions":[{"label":"title","span":{"begin":0,"end":12}},{"label":"p","span":{"begin":13,"end":1233}},{"label":"p","span":{"begin":1234,"end":2217}},{"label":"p","span":{"begin":2218,"end":3167}},{"label":"p","span":{"begin":3168,"end":3979}},{"label":"p","span":{"begin":3980,"end":5385}}],"tracks":[{"project":"2_test","denotations":[{"id":"31432994-26139480-396028","span":{"begin":385,"end":386},"obj":"26139480"},{"id":"31432994-26108024-396029","span":{"begin":582,"end":583},"obj":"26108024"},{"id":"31432994-21904861-396030","span":{"begin":684,"end":685},"obj":"21904861"},{"id":"31432994-26139480-396031","span":{"begin":899,"end":900},"obj":"26139480"},{"id":"31432994-26108024-396031","span":{"begin":899,"end":900},"obj":"26108024"},{"id":"31432994-21904861-396031","span":{"begin":899,"end":900},"obj":"21904861"},{"id":"31432994-24035075-396031","span":{"begin":899,"end":900},"obj":"24035075"},{"id":"31432994-15383785-396032","span":{"begin":1229,"end":1230},"obj":"15383785"},{"id":"31432994-28181089-396032","span":{"begin":1229,"end":1230},"obj":"28181089"},{"id":"31432994-13606360-396033","span":{"begin":1567,"end":1568},"obj":"13606360"},{"id":"31432994-26671827-396034","span":{"begin":1951,"end":1952},"obj":"26671827"},{"id":"31432994-29754616-396034","span":{"begin":1951,"end":1952},"obj":"29754616"},{"id":"31432994-15383785-396035","span":{"begin":2212,"end":2213},"obj":"15383785"},{"id":"31432994-28181089-396035","span":{"begin":2212,"end":2213},"obj":"28181089"},{"id":"31432994-13606360-396035","span":{"begin":2212,"end":2213},"obj":"13606360"},{"id":"31432994-26671827-396035","span":{"begin":2212,"end":2213},"obj":"26671827"},{"id":"31432994-29754616-396035","span":{"begin":2212,"end":2213},"obj":"29754616"},{"id":"31432994-23137644-396035","span":{"begin":2212,"end":2213},"obj":"23137644"},{"id":"31432994-26671827-396036","span":{"begin":2885,"end":2886},"obj":"26671827"},{"id":"31432994-29754616-396036","span":{"begin":2885,"end":2886},"obj":"29754616"},{"id":"31432994-23137644-396036","span":{"begin":2885,"end":2886},"obj":"23137644"},{"id":"31432994-26537141-396036","span":{"begin":2885,"end":2886},"obj":"26537141"},{"id":"31432994-23137644-396037","span":{"begin":3164,"end":3166},"obj":"23137644"},{"id":"31432994-15383785-396038","span":{"begin":3342,"end":3343},"obj":"15383785"},{"id":"31432994-20401733-396039","span":{"begin":3973,"end":3975},"obj":"20401733"},{"id":"31432994-29265400-396039","span":{"begin":3973,"end":3975},"obj":"29265400"},{"id":"31432994-26139480-396040","span":{"begin":4300,"end":4301},"obj":"26139480"},{"id":"31432994-26108024-396040","span":{"begin":4300,"end":4301},"obj":"26108024"},{"id":"31432994-21904861-396040","span":{"begin":4300,"end":4301},"obj":"21904861"},{"id":"31432994-24035075-396040","span":{"begin":4300,"end":4301},"obj":"24035075"},{"id":"31432994-15383785-396040","span":{"begin":4300,"end":4301},"obj":"15383785"},{"id":"31432994-28181089-396040","span":{"begin":4300,"end":4301},"obj":"28181089"},{"id":"31432994-13606360-396040","span":{"begin":4300,"end":4301},"obj":"13606360"},{"id":"31432994-26671827-396040","span":{"begin":4300,"end":4301},"obj":"26671827"},{"id":"31432994-20401733-396041","span":{"begin":4792,"end":4794},"obj":"20401733"},{"id":"31432994-29265400-396041","span":{"begin":4792,"end":4794},"obj":"29265400"},{"id":"31432994-23137644-396042","span":{"begin":5047,"end":5049},"obj":"23137644"},{"id":"31432994-26537141-396042","span":{"begin":5047,"end":5049},"obj":"26537141"},{"id":"31432994-20401733-396042","span":{"begin":5047,"end":5049},"obj":"20401733"},{"id":"31432994-29265400-396042","span":{"begin":5047,"end":5049},"obj":"29265400"},{"id":"31432994-21898010-396042","span":{"begin":5047,"end":5049},"obj":"21898010"}],"attributes":[{"subj":"31432994-26139480-396028","pred":"source","obj":"2_test"},{"subj":"31432994-26108024-396029","pred":"source","obj":"2_test"},{"subj":"31432994-21904861-396030","pred":"source","obj":"2_test"},{"subj":"31432994-26139480-396031","pred":"source","obj":"2_test"},{"subj":"31432994-26108024-396031","pred":"source","obj":"2_test"},{"subj":"31432994-21904861-396031","pred":"source","obj":"2_test"},{"subj":"31432994-24035075-396031","pred":"source","obj":"2_test"},{"subj":"31432994-15383785-396032","pred":"source","obj":"2_test"},{"subj":"31432994-28181089-396032","pred":"source","obj":"2_test"},{"subj":"31432994-13606360-396033","pred":"source","obj":"2_test"},{"subj":"31432994-26671827-396034","pred":"source","obj":"2_test"},{"subj":"31432994-29754616-396034","pred":"source","obj":"2_test"},{"subj":"31432994-15383785-396035","pred":"source","obj":"2_test"},{"subj":"31432994-28181089-396035","pred":"source","obj":"2_test"},{"subj":"31432994-13606360-396035","pred":"source","obj":"2_test"},{"subj":"31432994-26671827-396035","pred":"source","obj":"2_test"},{"subj":"31432994-29754616-396035","pred":"source","obj":"2_test"},{"subj":"31432994-23137644-396035","pred":"source","obj":"2_test"},{"subj":"31432994-26671827-396036","pred":"source","obj":"2_test"},{"subj":"31432994-29754616-396036","pred":"source","obj":"2_test"},{"subj":"31432994-23137644-396036","pred":"source","obj":"2_test"},{"subj":"31432994-26537141-396036","pred":"source","obj":"2_test"},{"subj":"31432994-23137644-396037","pred":"source","obj":"2_test"},{"subj":"31432994-15383785-396038","pred":"source","obj":"2_test"},{"subj":"31432994-20401733-396039","pred":"source","obj":"2_test"},{"subj":"31432994-29265400-396039","pred":"source","obj":"2_test"},{"subj":"31432994-26139480-396040","pred":"source","obj":"2_test"},{"subj":"31432994-26108024-396040","pred":"source","obj":"2_test"},{"subj":"31432994-21904861-396040","pred":"source","obj":"2_test"},{"subj":"31432994-24035075-396040","pred":"source","obj":"2_test"},{"subj":"31432994-15383785-396040","pred":"source","obj":"2_test"},{"subj":"31432994-28181089-396040","pred":"source","obj":"2_test"},{"subj":"31432994-13606360-396040","pred":"source","obj":"2_test"},{"subj":"31432994-26671827-396040","pred":"source","obj":"2_test"},{"subj":"31432994-20401733-396041","pred":"source","obj":"2_test"},{"subj":"31432994-29265400-396041","pred":"source","obj":"2_test"},{"subj":"31432994-23137644-396042","pred":"source","obj":"2_test"},{"subj":"31432994-26537141-396042","pred":"source","obj":"2_test"},{"subj":"31432994-20401733-396042","pred":"source","obj":"2_test"},{"subj":"31432994-29265400-396042","pred":"source","obj":"2_test"},{"subj":"31432994-21898010-396042","pred":"source","obj":"2_test"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"2_test","color":"#93c1ec","default":true}]}]}}