A belgian multicenter prospective observational cohort study shows safe and efficient use of a composite mesh with incorporated oxidized regenerated cellulose in laparoscopic ventral hernia repair.

BACKGROUND: A variety of anti-adhesive composite mesh products have become available to use inside the peritoneal cavity. However, reimbursement of these meshes by the Belgian Governemental Health Agency (RIZIV/INAMI) can only be obtained after conducting a prospective study with at least one year of clinical follow-up. This -Belgian multicentric cohort study evaluated the experience with the use of Proceed®-mesh in laparoscopic ventral hernia repair. METHODS: During a 25 month period 210 adult patients underwent a laparoscopic primary or incisional hernia repair using an intra-abdominal placement of Proceed®-mesh. According to RIZIV/INAMI criteria recurrence rate after 1 year was the primary objective, while postoperative morbidity, including seroma formation, wound and mesh infections, quality of life and recurrences after 2 years were evaluated as secondary endpoints (NCT00572962). RESULTS: In total 97 primary ventral and 103 incisional hernias were repaired, of which 28 (13%) were recurrent. There were no conversions to open repair, no enterotomies, no mesh infections and no mortality. One year cumulative follow-up showed 10 recurrences (n = 192, 5.2%) and chronic discomfort or pain in 4.7% of the patients. Quality of life could not be analyzed due to incomplete data set. CONCLUSIONS: More than 5 years after introduction of this mesh to the market, this prospective multicentric study documents a favorable experience with the Proceed mesh in laparoscopic ventral hernia repair. However, it remains to be discussed whether reimbursement of these meshes in Belgium should be limited to the current strict criteria and therefore can only be obtained after at least 3-4 years of clinical data gathering and necessary follow-up.

Multicentric observational cohort study evaluating a composite mesh with incorporated oxidized regenerated cellulose in laparoscopic ventral hernia repair.

BACKGROUND: A variety of newly developed mesh products have recently become available to use inside the peritoneal cavity. This analysis reports the first clinical data evaluating the experience with the use of Proceed mesh in laparoscopic ventral hernia repair. PATIENTS AND METHODS: During a 6-month period, 114 adult patients underwent a laparoscopic ventral hernia repair using an intra-abdominal placement of a Proceed mesh. The operative procedure was stratified for all centers. Perioperatively, different parameters were evaluated considering the conversion rate to open procedure, complications such as seroma and hematoma, bowel lesions, urinary retention, acute, and chronic pain, mesh infection, and recurrences. RESULTS: The mean age of the patients was 45 years (range 19-84 years). There were no conversions to open repair and no mortality. Complications included 12 seromas/hematomas (four aspirated), chronic discomfort in two patients, and urinary retention in one patient. There have been four recurrences (3.5%), occurring 3, 4, 4, and 15 months after surgery, respectively. The mean follow-up period was 27 months (range 12-38 months). There have been no documented infections of the mesh. CONCLUSIONS: This multicentric study documents a favorable experience using large-pore mesh in laparoscopic ventral hernia repair. There were no major complications related to the mesh. Technical advantages considering mesh handling and long-term advantages considering chronic pain might be of interest with the use of this lightweight mesh for minimally invasive ventral hernia repair.

Use of the biomedicus pump in resection of renal carcinoma invading the vena cava.

The authors report a 7-year old boy suffering from a renal carcinoma with a tumoral thrombus invading the vena cava. The kidney and the tumoral thrombus were removed with the help of a Biomedicus pump. This paper shows how to avoid a cardiopulmonary bypass procedure in order to perform safely a tumoral thrombectomy with this relatively new technique.

A case against parathyroid autotransplantation.

The authors report about a recurrence in a uremic patient who underwent a subtotal parathyroidectomy with autotransplantation in the sternocleidomastoid muscle for hyperparathyroidism. Reexploration revealed an enlarged parathyroid graft. This paper illustrates the potential complication of parathyroid autografts in patients with chronic renal failure.