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1.
Medicine (Baltimore) ; 100(9): e25007, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655970

RESUMO

ABSTRACT: Surgical site infection (SSI) is a costly postoperative complication with a decrease in the quality of life. We aimed to probe the predictive role of peripheral blood inflammation markers for SSI following mesh repair of groin hernia (GH).This retrospective study assessed the data of 1177 patients undergoing elective mesh repair of GH (open/laparoscopy) in the absence of antibiotic prophylaxis. The relation between demographics, surgical factors, pre-surgical laboratory results and the occurrence of SSI were investigated by univariate and multivariate analyses. Receiver operating characteristic analysis was performed to determine the optimal threshold of parameters and compare their veracity.The overall SSI rate was 3.2% with 1-year follow-up (38 superficial and 1 deep SSI). Patients with SSI had significant higher pre-surgical neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) than those without (P = .029 and P = .045, respectively); their NLR and PLR correlated positively with postoperative total days of antibiotic treatment for SSI (r = .689, P = .000; r = .493, P = .001; respectively). NLR and PLR had larger areas under the receiver operating characteristics curves than neutrophil (.875 vs. .601; P = .000; .726 vs. .601; P = .017). The combination of PLR and neutrophil/NLR raised the predictive sensitivity of PLR for SSI (sensitivity: PLR: 74.36%; PLR + neutrophil: 82.05%; PLR + NLR: 83.57%). On multivariate analyses, higher preoperative NLR (cut-off 2.44) and PLR (cut-off 125.42) were independent predictors for SSI.Higher pre-surgical NLR and PLR may be valuable predictors for SSI following elective mesh repair of GH.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Inflamação/sangue , Linfócitos/patologia , Neutrófilos/patologia , Telas Cirúrgicas/efeitos adversos , Infecção da Ferida Cirúrgica/sangue , Adulto , Idoso , Biomarcadores/sangue , Plaquetas/patologia , Feminino , Seguimentos , Humanos , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Qualidade de Vida , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia
2.
Int J Urol ; 28(3): 268-272, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33760315

RESUMO

OBJECTIVES: To evaluate the safety and efficacy of transvaginal mesh surgery using a polytetrafluoroethylene mesh to treat pelvic organ prolapse. METHODS: This prospective observational study included women undergoing transvaginal mesh surgery for pelvic organ prolapse that used new polytetrafluoroethylene mesh cut into a shape similar to that of Elevate. We evaluated the subjective and objective outcomes at 3 and 12 months, as well as postoperative complication rates. RESULTS: This study included 55 patients. The pelvic organ prolapse quantification scores improved significantly at 3 and 12 months after surgery compared with scores before surgery. In four patients (7.3%), a pelvic examination showed stage 2 objective recurrence without subjective symptoms. Clavien-Dindo grades 2 and 3 perioperative complications were observed in 9.1% and 1.8% of the patients, respectively. Vaginal mesh exposure occurred in one patient (1.8%) at the time of the 3-month follow-up evaluation. The mesh was exposed at the proximal midline of the anterior vaginal wall. CONCLUSIONS: These findings show the safe and effective use of the polytetrafluoroethylene mesh for transvaginal mesh surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico/cirurgia , Politetrafluoretileno/uso terapêutico , Telas Cirúrgicas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Complicações Pós-Operatórias , Resultado do Tratamento , Vagina/cirurgia
3.
Zhonghua Fu Chan Ke Za Zhi ; 56(2): 102-107, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33631881

RESUMO

Objective: To evaluate the short-term clinical efficacy and safety of transvaginal pelvic floor reconstruction with TiLOOP mesh, a titanized polypropylene lightweight mesh. Methods: From November 2017 to July 2019, 50 patients underwent surgery, who were with anterior vaginal prolapse stage Ⅲ-Ⅳ and (or) apical prolapse and posterior vaginal prolapse (stage Ⅰ-Ⅱ); 37 patients underwent self-cut TiLOOP mesh and 13 patients underwent pre-cut mesh-kit procedure. The subjective and objective parameters (including surgical success) of them were evaluated. Results: The mean follow-up time was (18±6) months. The overall surgical success rate was 90% (45/50). Prolapse recurrence rates were isolated anterior 2% (1/50), isolated apical 2% (1/50) and isolated posterior 6% (3/50). None of recurrent patients underwent re-treatment, including either surgery or use of a pessary at last follow-up. According to patient global impression of improvement (PGI-I), 46 patients (92%, 46/50) were very much better, and 4 patients (8%, 4/50) were much better. After the operation, pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire-short form 7 (PFIQ-7) scores were significantly lower than those before operation (all P<0.05); pelvic organ prolapse-urinary incontinence sexual questionnaire 12 (PISQ-12) score was no significant difference before and after operation (P>0.05), but without dyspareunia. The vaginal mesh erosion rate was 12% (6/50) and the stress urinary incontinence was observed in 2 cases (4%, 2/47). Conclusion: Transvaginal pelvic floor reconstruction with TiLOOP mesh is a safe and effective surgery, short-term efficacy is acceptable, how to reduce the mesh erosion still need to be explored.


Assuntos
Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/psicologia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
5.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542008

RESUMO

A 76-year-old man was referred to our clinic after a foreign body seen in his sigmoid colon during a colonoscopy. He had undergone three operations for a left inguinal hernia within the previous 8 years, and the first procedure was a laparoscopic totally extraperitoneal approach. Four years later, removal of migrated and infected mesh was conducted by open approach. He then had a positive stool occult blood test for routine check-up 4 years after the remnant mesh removal. An ill-defined lesion was identified on colonoscopy. CT revealed a 2.7 cm diameter enhancing lesion in the sigmoid colon. Laparoscopic sigmoidectomy was performed, and remnant mesh fragment was found in the sigmoid colon and removed. The migrated mesh could not be wholly removed by open abdominal approach and the remnant mesh fragment migrated to sigmoid colon. It suggests the importance of a laparoscopic approach to remove the entire mesh.


Assuntos
Colo Sigmoide/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Hérnia Inguinal/complicações , Herniorrafia , Laparoscopia , Telas Cirúrgicas/efeitos adversos , Idoso , Humanos , Masculino , Sangue Oculto , Complicações Pós-Operatórias/cirurgia
6.
Medicina (B Aires) ; 81(1): 24-30, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33611241

RESUMO

An adequate integration of the prosthetic materials used to repair abdominal wall defects is necessary for satisfactory outcomes. We aimed to evaluate, in an animal model, the biological behavior of meshes used for abdominal wall surgery. Four groups of 10 rats were separated. After laparotomy, intraperitoneal prostheses were placed: 1) Prolene® (polypropylene microporous, heavy-weight), 2) Ultrapro® (polypropylene + poliglecaprone, macroporous low-weight), 3) Proceed® (polypropylene + polidoxanone + regenerated oxidized cellulose, microporous medium-weight), 4) Physiomesh® (polypropylene + poliglecaprone, macroporous lowweight). Macroscopic and microscopic analyses were performed at 30 days. The results were evaluated by two independent observers and expressed in means with standard deviation. For statistical analysis p < 0.05 was considered significant. On macroscopic examination, mesh integration was greater than 75% in all cases. Microscopic analysis showed greater global inflammation and more multinucleated giant cells in Prolene® (p < 0.01). Less inflammatory cells were observed at the muscle-mesh interface in Physiomesh® vs. Ultrapro® (p < 0.05). Collagen fibers disposition was similar in all meshes, although, microporous meshes had higher collagen deposit in the interfilamentous spaces (p < 0.01). In conclusion, in our animal model, microporous and heavy-weight polypropylene meshes produce greater inflammatory and foreign body reaction. Thus, composite meshes would have greater biocompatibility and better tolerance by the host.


Assuntos
Parede Abdominal , Telas Cirúrgicas , Parede Abdominal/cirurgia , Animais , Teste de Materiais , Poliésteres , Próteses e Implantes , Ratos , Telas Cirúrgicas/efeitos adversos
7.
Khirurgiia (Mosk) ; (2): 73-79, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570358

RESUMO

OBJECTIVE: To evaluate the results of using titanium thread mesh implants in the treatment of anterior abdominal wall hernias. MATERIAL AND METHODS: This article evaluates the titanium thread mesh implant used by us in the treatment of 240 patients with anterior abdominal wall hernias; describes the features of this type of implants and the technical features of various types of operations using them. RESULTS: The overall rate of postoperative complications was 2.9%. Hernia recurrence was observed in 2.4% of patients after laparoscopic transabdominal preperitoneal hernioplasty. CONCLUSIONS: The use of a mesh implant made of titanium thread did not reveal any specific complications for this implant. At the stage of gaining experience with a mesh implant made of titanium thread, technical difficulties may occur when placing and fixing it, which increases the duration of surgery.


Assuntos
Hérnia Abdominal , Herniorrafia , Laparoscopia , Telas Cirúrgicas , Materiais Biocompatíveis , Hérnia Abdominal/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Laparoscopia/efeitos adversos , Recidiva , Telas Cirúrgicas/efeitos adversos , Titânio , Resultado do Tratamento
8.
Acta Cir Bras ; 35(12): e351205, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503218

RESUMO

PURPOSE: In laparoscopic incisional hernia repair, meshes with a tissue-separating barrier are positioned intraperitoneally. Despite this property, the close contact between mesh and viscera involves a risk of adhesion formation. Some natural products, such as red propolis (RP), could reduce these adhesions owing to their anti-inflammatory properties. This study aimed to compare two different intraperitoneal meshes with respect to their characteristics of adhesion formation, histological findings and evaluate the role of RP in the development of these adhesions. METHODS: 40 Wistar rats received placement of two different meshes (Symbotex and Dynamesh IPOM) on peritoneum. The animals were divided into two groups: control group (mesh) and treatment group (mesh and RP). After 7 and 14 days, 20 animals of each group underwent midline laparotomy to determine the adhesions and histological characteristics. RESULTS: Out of the 40 animals, there were two deaths in the test group and two in the control group. All animals in both groups developed adherence to the mesh. At postoperative day (POD) 7, two Symbotex meshes presented firm adhesions and at POD 14, two Dynamesh meshes had firm adhesions as well. The comparison between the meshes under the effect of RP in relation to the control group showed no statistical difference. CONCLUSIONS: Both meshes showed intraperitoneal adhesions in all evaluated samples with similar results on the characteristics of adhesions. RP showed no effect on the incidence or gradation of intraperitoneal adhesions with the mesh.


Assuntos
Produtos Biológicos , Hérnia Ventral , Animais , Anti-Inflamatórios/farmacologia , Polipropilenos , Ratos , Ratos Wistar , Telas Cirúrgicas/efeitos adversos , Aderências Teciduais/prevenção & controle
9.
BMJ Case Rep ; 14(1)2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397649

RESUMO

Rectal erosions after ventral rectopexy (VR) is an uncommon but challenging adverse event and can be associated with partial migration of the mesh into the intestinal cavity. Re-do surgery is difficult and often provides colostomy and/or anterior rectal resections. However, no alternative solutions are described in the available literature. An 82-year-old woman presented to our hospital for rectal erosion and intraluminal migration of the mesh placed at a 1-year laparoscopic VR. We performed an innovative totally endoscopic approach, using thulium laser and two endoscopes, that led to a successful removal of the mesh. The described mini-invasive technique can be an effective alternative to surgery in tertiary referral centres.


Assuntos
Endoscopia , Migração de Corpo Estranho/cirurgia , Terapia a Laser , Prolapso Retal/cirurgia , Reto/lesões , Telas Cirúrgicas/efeitos adversos , Idoso de 80 Anos ou mais , Feminino , Migração de Corpo Estranho/complicações , Humanos , Túlio
10.
Khirurgiia (Mosk) ; (1): 34-41, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395510

RESUMO

OBJECTIVE: To compare early and long-term results of various mesh prosthesis fixation methods in laparoscopic inguinal hernia repair. MATERIAL AND METHODS: It is a prospective clinical non-randomized trial. The study included 212 patients. Conventional stapler fixation (112 patients), self-gripping mesh implants (48 patients) and n-butyl cyanoacrylate adhesive fixation (52 patients) were compared. We estimated surgery time, pain syndrome severity in early and long-term postoperative period, postoperative morbidity and recurrence rate were evaluated. RESULTS: Early postoperative morbidity, activation of patients and hospital-stay were similar in all groups. Pain syndrome within 6 postoperative hours in the first group exceeded the same parameter in the second group by 1.23 times (95% CI 1.15-1.31, p<0.05) and by 1.19 times in the third group (95% CI 1.12-1.26, p<0.05). Within 12 hours, pain syndrome in the first group was 1.27 times more severe compared to the third group (95% CI 1.20-1.34, p<0.05). Pain syndrome in long-term period was similar in all groups. In the first group, one recurrence was detected (0.9%). CONCLUSION: There were no significant between-group differences. However, we found the correlation of postoperative pain syndrome with mesh implant fixation technique.


Assuntos
Hérnia Inguinal , Herniorrafia , Laparoscopia , Implantação de Prótese , Telas Cirúrgicas , Cianoacrilatos/administração & dosagem , Cianoacrilatos/efeitos adversos , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura/efeitos adversos , Procedimentos Cirúrgicos sem Sutura/efeitos adversos , Procedimentos Cirúrgicos sem Sutura/métodos , Fatores de Tempo , Adesivos Teciduais/administração & dosagem , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento
11.
J Urol ; 205(1): 183-190, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32749936

RESUMO

PURPOSE: We examined long-term risks and predictors of mesh erosion and reoperation following mid urethral sling procedure for stress urinary incontinence. MATERIALS AND METHODS: Women aged 18 years or older who received a mid urethral sling for stress urinary incontinence between 2008 and 2016 in outpatient surgical settings in New York State were included in our study. Those who underwent concomitant mesh pelvic organ prolapse repair were excluded. Primary outcomes were post-implantation time to erosion and reoperations. Kaplan-Meier analysis and Cox proportional hazard models were used to assess the risks of erosion diagnosis and reoperation. RESULTS: Our cohort included 36,195 women with a mean±SD age of 53.7±12.4 years. Estimated risks of erosions and reoperations at 7 years after sling procedures were 3.7% and 6.7%, respectively. Older age (≥65 vs <65: HR 0.83, 95% CI 0.70-0.99) and high volume facilities (high vs low: HR 0.79, 95% CI 0.68-0.92) were associated with a lower risk of erosion. History of hysterectomy was associated with a higher risk of erosion (HR 1.62, 95% CI 1.36-1.92). Predictors of reoperation included concurrent abdominal or native tissue transvaginal prolapse repair, previous hysterectomy and depression. CONCLUSIONS: One in 27 women had sling erosions and 1 in 15 had invasive reoperations at 7 years after sling procedures. The highest erosion cases were observed among younger White women treated at low volume facilities. Continued and vigilant surveillance of mesh in stress urinary incontinence repairs, the nature and burden of stress urinary incontinence recurrence, different types of re-treatment, patient reported outcomes and information about treating surgeons are crucial.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Estudos de Coortes , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , New York/epidemiologia , Prolapso de Órgão Pélvico/complicações , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recidiva , Reoperação/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária por Estresse/etiologia
12.
BJOG ; 128(1): 131-139, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32567211

RESUMO

OBJECTIVE: To understand health-related issues in women following mesh-augmented prolapse surgery. DESIGN: Inductive thematic analysis of free-text comments from participants in a cross-sectional study of laparoscopic mesh sacrohysteropexy. SETTING: Tertiary urogynaecology centres, United Kingdom. POPULATION: Women who underwent laparoscopic mesh sacrohysteropexy by surgeons based at two tertiary urogynaecology centres between 2010 and 2018. METHODS: A total of 1766 potential participants were contacted by post and invited to complete paper, online or telephone questionnaires containing a free-text comments section. Of 1121 participants (response proportion 63.5%), 752 (67.1%) provided such comments. These were analysed with a six-stage inductive thematic analysis, using NVivo 11® software. MAIN OUTCOME MEASURES: Themes developed from free-text comments. RESULTS: Following familiarisation, 29 codes and 189 sub-codes were identified. These defined six themes: pelvic floor symptoms, health status, treatment success, mesh, pain and care received. The majority of comments centred on the first of these six themes. There were concerns about mesh use and a desire for more information. A range of pain symptoms were mentioned, often associated with pelvic floor symptoms, prolapse surgery or mesh. CONCLUSIONS: Despite the mesh controversy, pelvic floor symptoms and their impact on quality of life remain the principle concern of women following mesh-augmented prolapse surgery. There is a need for quality, accessible and evidence-based information sources for those women with concerns, and for those considering such surgery in the future, particularly regarding mesh safety and postoperative recovery. The relationships between pain, prolapse, mesh and pelvic floor surgery require further study. TWEETABLE ABSTRACT: Following mesh-augmented prolapse surgery, pelvic floor symptoms remain women's main focus; pain deserves further research.


Assuntos
Medicina Baseada em Evidências , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Feminino , Humanos
13.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370975

RESUMO

A 52-year-old man presented with lower urinary tract symptoms and intermittent haematuria for the last 6 months. He had undergone totally extraperitoneal right inguinal hernia repair a decade ago. The ultrasonography and an X-ray of the pelvis suggested a large radio-opaque shadow in the bladder. However, CT revealed an encrusted intravesical extension of the migrated mesh along the right anterolateral wall. The entire intravesical part of the migrated mesh with encrustations was successfully retrieved by endourological approach using holmium laser. The patient symptomatically improved and at follow-up, cystoscopy showed a complete re-epithelisation of the bladder mucosa. The intravesical extension of migrated mesh is a rare but challenging complication following mesh hernioplasty and can be successfully managed with a complete endoscopic approach.


Assuntos
Remoção de Dispositivo/métodos , Migração de Corpo Estranho/cirurgia , Herniorrafia/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Falha de Prótese , Telas Cirúrgicas/efeitos adversos , Cistoscopia , Remoção de Dispositivo/instrumentação , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/diagnóstico , Hematúria/diagnóstico , Hematúria/etiologia , Hematúria/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia/instrumentação , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia
14.
Obstet Gynecol ; 136(5): 922-931, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030874

RESUMO

OBJECTIVE: We aimed to systematically review the literature to describe sexual activity and function before and after prolapse surgery. DATA SOURCES: We searched MEDLINE, EMBASE, and ClinicalTrials.gov databases from inception to April 2018. METHODS OF STUDY SELECTION: Prospective, comparative studies of reconstructive pelvic organ prolapse (POP) surgeries that reported sexual function outcomes were included. Studies were extracted for population characteristics, sexual function outcomes, and methodologic quality. Data collected included baseline and postoperative sexual activity, dyspareunia, and validated sexual function questionnaire scores. Change in validated scores were used to categorize overall sexual function as improved, unchanged, or worsened after surgery. TABULATION, INTEGRATION, AND RESULTS: The search revealed 3,124 abstracts and identified 74 articles representing 67 original studies. The overall quality of evidence was moderate to high. Studies reporting postoperative results found higher rates of sexual activity than studies reporting preoperative sexual activity in all POP surgeries except sacrospinous suspension, transvaginal mesh, and sacrocolpopexy. The prevalence of dyspareunia decreased after all prolapse surgery types. The risk of de novo dyspareunia ranged from 0% to 9% for all POP surgeries except posterior repair, which lacked sufficient data. Overall sexual function based on PISQ-12 (Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12) scores improved for mixed native tissue repairs, anterior repairs, uterosacral suspensions, sacrospinous suspensions, and sacrocolpopexy; scores were similar for posterior repairs, transvaginal mesh, and biologic grafts. Sexual function did not worsen after any POP surgeries. CONCLUSION: Sexual function improves or remains unchanged after all types of reconstructive POP surgeries and does not worsen for any surgery type. Prevalence of total dyspareunia was lower after all POP surgery types, and de novo dyspareunia was low ranging 0-9%. This information can help surgeons counsel patients preoperatively. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019124308.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Disfunções Sexuais Fisiológicas/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Prospectivos , Disfunções Sexuais Fisiológicas/etiologia , Telas Cirúrgicas/efeitos adversos
15.
Acta Chir Plast ; 62(1-2): 50-52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32911943

RESUMO

Some patients undergoing breast reconstruction with acellular dermal matrices (ADMs) develop postoperative erythema overlying their ADM grafts named red breast syndrome (RBS). To the best of our knowledge this entity has never been related to the use of a synthetic mesh. We present a case of a 61-year-old patient who underwent bilateral nipple-sparing prophylactic mastectomy because of BRCA-1 gene mutation. The patient was reconstructed with a direct-to-implant approach, and the implants were covered with a polyglycolic acid mesh. Twenty days after the reconstruction, she presented with a blanching erythema of both reconstructed breasts without signs of infection on the area covered by the mesh. The patient denied symptoms like fever or tenderness and presented with no clinical signs of infection. Her laboratory tests were within normal range. We decided to watch and wait. The patient continued strict controls in the outpatient setting. Gradually, the erythema begun to disappear and it resolved spontaneously. RBS has only been described with the use of ADMs, but since in this case the mesh was made of polyglycolic acid, we suggest RBS should be considered either with the use of biological or synthetic meshes. The importance of its differential diagnosis resides in distinguishing it from an infection.


Assuntos
Eritema/etiologia , Mamoplastia , Telas Cirúrgicas , Implante Mamário , Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia/efeitos adversos , Mastectomia , Pessoa de Meia-Idade , Polietilenoglicóis , Telas Cirúrgicas/efeitos adversos
19.
Int J Nanomedicine ; 15: 4991-5004, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764931

RESUMO

Introduction: Various materials and approaches have been used to reduce the mesh-induced inflammatory response and modify the mesh with tissue-matched mechanical properties, aiming to improve the repair of abdominal wall defects. Materials and Methods: In this study, we fabricated a polycaprolactone (PCL)/silk fibroin (SF) mesh integrated with amoxicillin (AMX)-incorporating multiwalled carbon nanotubes (MWCNTs) via electrospinning, grafting and crosslinking, developing a sustainable antibiotic and flexible mesh. AMX was loaded into the hollow tubular MWCNTs by physical adsorption, and a nanofibrous structure was constructed by electrospinning PCL and SF (40:60 w/w). The AMX@MWCNTs were then chemically grafted onto the surfaces of the PCL/SF nanofibers by treating with 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide/N-hydroxysuccinimide (EDC/NHS) solution for simultaneous crosslinking and coating. The incorporation of AMX into the MWCNTs (AMX@MWCNTs) and the integration of the AMX@MWCNTs with the PCL/SF nanofibers were characterized. Then, the functional mesh was fabricated and fully evaluated in terms of antibacterial activity, mechanical properties and host response. Results: Our results demonstrated that the PCL/SF nanofibrous structure was fabricated successfully by electrospinning. After integrating with AMX@MWCNT by grafting and crosslinking, the functional mesh showed undeformed structure, modified surface hydrophilicity and biocompatible interfaces, abdominal wall-matched mechanical properties, and a sustained-release antibiotic profile in E. coli growth inhibition compared to those of PCL/SF mesh in vitro. In a rat model with subcutaneous implantation, the functional mesh incited less mesh-induced inflammatory and foreign body responses than PCL/SF mesh within 14 days. The histological analysis revealed less infiltration of granulocytes and macrophages during this period, resulting in the loosely packed collagen deposition on the functional mesh and prominent collagen incorporation. Discussion: Therefore, this designed PCL/SF-AMX@MWCNT nanofibrous mesh, functionalized with antibacterial and tissue-matched mechanical properties, provides a promising alternative for the repair of abdominal wall defects.


Assuntos
Amoxicilina/química , Antibacterianos/química , Nanofibras/química , Nanotecnologia/métodos , Telas Cirúrgicas , Amoxicilina/farmacocinética , Amoxicilina/farmacologia , Animais , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Colágeno/química , Colágeno/metabolismo , Reagentes para Ligações Cruzadas/química , Escherichia coli/efeitos dos fármacos , Escherichia coli/crescimento & desenvolvimento , Fibroínas/química , Inflamação/etiologia , Masculino , Teste de Materiais , Camundongos , Nanotubos de Carbono/química , Poliésteres/química , Ratos Sprague-Dawley , Telas Cirúrgicas/efeitos adversos
20.
Niger J Clin Pract ; 23(7): 897-899, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620716

RESUMO

Background: The most important advantages of laparoscopic hernia repair include less postoperative pain, good cosmetic results, and early return to daily activities. Different methods and mesh types are used in inguinal hernia repair. Aims: The objective of this study was to evaluate the complications and recurrence rates in patients who underwent laparoscopic inguinal hernia repair with and without mesh fixation. Subjects and Methods: A total of 183 patients who underwent total extraperitoneal (TEP) inguinal hernia repair in the general surgery clinic between January 2012 and January 2015 patients operated due to inguinoscrotal hernia and those lost to follow-up were excluded from the study. Patients were divided into two groups. Group 1 consisted of patients in whom 3D (Bard 3D Max) mesh was used and fixed with symphysis pubis absorbable tucker, while group 2 included patients without mesh fixation. All statistical analyses were performed using SPSS 22.0 statistical package software. The differences were considered statistically significant if the P value was less than 0.05. Results: In the study, 178 patients were included. The median age was 48 years. Of all patients, 98 had right-sided, 72 left-sided, and eight bilateral hernias. The mean follow-up duration was 45 months. The demographic data between the groups were similar. Operation time was 51.82 ± 18.87 min in group 1 and 52 ± 19.92 in group 2 (P = 0.089). No statistically significant difference was found between both groups in terms of the development of early and late complications. Intraoperative complications, port-site hernia, and mortality were not seen in any patient. Conclusion: TEP seems to be a safe and effective surgical approach in inguinal hernia treatment with acceptable operation times and postoperative results. It was determined that not performing mesh fixation in the TEP application did not cause a statistical increase in morbidity and recurrence rates.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Próteses e Implantes/efeitos adversos , Recidiva , Resultado do Tratamento
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