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A surgeon can do more for the community by operating on hernia cases and seeing that his recurrence rate is low than he can by operating on cases of malignant disease .
Sir Cecil Wakely, 1948 President Royal College of Surgeons
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Conventional Open Repair: The Herniorraphy Open Mesh Hernioplasty Laparoscopic Mesh repair
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Exogene
Sutures length of incision contamination Medication Type of incision
Others
emergency intra abdominal pressure
2012May-
After the Intra-abdominal pressure, another important factor in the abdominal wall repair plays a role, it is the
Mid City Hospital Lahore Pakistan Lahore Pakistan Mid City Hospital
2012May2012May-
Pressure
In humans the intra-abdominal pressure ranges from 0,2kPa (resting) to 20 kPa (maximum).
Dr. Shahzad Alam Shah Mid City Hospital Lahore Pakistan 2012May-
If we could artificially produce tissues of the density and toughness of fascia, the secret of the radical cure of hernia would be discovered. Theodore Billroth, 1857
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Burst Strength Compliance Foreign Body Response Degree of Shrinkage Increased Pore Size
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Polypropylene (Prolene) Mersilene Vypro Ultrapro Gore-Tex Teflon Some other polymer
Types of Meshes
Dr. Shahzad Alam Shah Mid City Hospital Lahore Pakistan 2012May-
Polypropylene Mesh
Most Commonly used mesh Reports showed good initial healing but were fraught with long term complications
Those complications are chronic infection, fistula formation, erosion into bowels or through skin grafts
Dr. Shahzad Alam Shah Mid City Hospital Lahore Pakistan 2012May-
There is less infection complication, increase recurrence rate (satisfactory short term solution in infected hernias but not generally indicated when prolonged tensile strength is required)
2012May-
ePTFE
Micro porous, smooth texture minimizes tissue ingrowth and limits adhesion formation and bowel injury
Combined with a large pore second layer it can adhere well to the abdominal wall
Disadvantages Mesh infection is not well treated by antibiotics and requires mesh removal Does not integrate well into host tissue when not combined with a large pore mesh
2012May-
Ethicon Proceed
Multilayered tissue separating mesh comprised of: PROLENE* Soft polypropylene Mesh Designed for strength, durability, and adaptability Oxidized regenerated cellulose (ORC) fabric Creates a flexible, secure bond between the mesh and ORC layers
2012May-
Lightweight Monofilament Construction Less foreign mass Flexible scar tissue Strong tissue incorporation Excellent Handling Lightweight, macro porous, monofilament mesh structure Allows fluid flow-through Conforms to anatomy Readily customized
2012May-
Strong, Secure repair Clear Visualization of anatomy Excellent Handling 65% foreing materials Physiological compatible with abdominal wall
UltraPro Mesh
Dr. Shahzad Alam Shah Mid City Hospital Lahore Pakistan 2012May-
Mesh Placement
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The ideal mesh has yet to be developed and the management of complex ventral hernias remains a challenge
2012May-
Thanks:
Dr. Shahzad Alam Shah Mid City Hospital Lahore Pakistan 2012May-