nitinol and Hernia--Inguinal

Numerous mesh materials are available for laparoscopic inguinal hernia repair. The role of fixation of mesh in laparoscopic inguinal hernia repair remains controversial. Mesh materials have been engineered to anatomically conform to the pelvis to potentially reduce or eliminate the need for fixation. This study evaluates the outcomes of laparoscopic inguinal hernia utilizing a device consisting of a lightweight polypropylene mesh with a nitinol frame (Rebound HRD) compared with repair with lightweight polypropylene mesh with permanent tack fixation.. A prospective randomized trial evaluating the outcomes of laparoscopic inguinal hernia repair with a lightweight polypropylene mesh with a nitinol frame (N-LWM) compared with standard lightweight polypropylene mesh (LWM) was conducted. Randomization was performed at an N-LWM to LWM ratio of 2:1. Repairs were standardized to a laparoscopic extraperitoneal approach without fixation for N-LWM and titanium tack fixation for LWM repairs. Follow-up assessments were performed at 7 days, 6 months, and 1 year. Outcome measures include visual analog pain scale (VAS), Short Form 36 (SF-36), Carolinas Comfort Scale (CCS), operative details, complications, and recurrences.. There were 47 patients that underwent laparoscopic inguinal hernia repair and adhered to study protocol (31 N-LWM, 16 LWM). The groups did not differ significantly in age, body mass index, ethnicity, or employment. The N-LWM group had bilateral mesh placed in 51.6% and LWM 43.8% (P = .76). Operative duration was similar, 59.6 ± 23.1 minutes for LWM and 62.4 ± 26.7 minutes for N-LWM (P = .705) as was mesh handling time was 5.4 ± 3.1 minutes LWM versus 7.3 ± 3.9 minutes N-LWM (P = .053). VAS, CCS, and SF-36 survey results were similar between groups. There was one recurrence (0.03%) in the N-LWM group.. Nitinol-framed lightweight polypropylene mesh may be safely used during laparoscopic inguinal hernia repair with outcomes comparable to LWM at 1 year. N-LWM does not impact operating room time, mesh handling time, pain, recurrences, or complications.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alloys; Hernia, Inguinal; Herniorrhaphy; Humans; Male; Middle Aged; Pain, Postoperative; Polypropylenes; Surgical Mesh; Treatment Outcome; Young Adult

To prospectively evaluate the use of a continuous Nitinol containing memory frame patch during a TIPP-technique in the open repair of inguinal and femoral hernias.. Over a 3-year period all consecutive adult patients that needed treatment for an inguinal or femoral hernia were treated by the TIPP repair using the Rebound Shield mesh. Intra-operatively the type and size of the hernia were evaluated according to the EHS classification, as well as the size of the mesh used. Baseline characteristics for all patients were evaluated considering age, gender, BMI and American society of Anesthesiologists score. Standard X-ray was performed to evaluate mesh position. All patients were evaluated for post-operative pain using the visual analogue scale (VAS 0-10 scale).. In total 289 groin hernias were operated using a nitinol containing patch in 235 patients. The mean operating time was 38 min for unilateral hernias and 59 min for bilateral hernias. The median follow-up is 21.2 months (14-33 months) during which three patients died, unrelated to the groin hernia repair. At the time of re-evaluation 12 patients (5.0 %) complained of chronic pain, with a VAS score higher than 3 after 3 months (range 3-10). Two of these patients already had severe pain pre-operatively. A total of 3 recurrences (2.9 %) were noted with strong correlation with X-ray findings.. A nitinol memory frame containing mesh is a valuable tool to achieve complete deployment of a large pore mesh in a TIPP repair for inguinal hernias with acceptable morbidity and a low recurrence rate.

Topics: Aged; Aged, 80 and over; Alloys; Body Mass Index; Chronic Pain; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Length of Stay; Male; Middle Aged; Operative Time; Pain Measurement; Pain, Postoperative; Surgical Mesh

The results of laparoscopic transabdominal (transabdominal preperitoneal--TAPP) hernioplasty, using conventional polypropylene nets in 28 patients (group I) and nets, manufactured by firm MMDI in 22 patients (group II), were analyzed. The operation duration in group I had constituted (56 +/- 18) min at average and in group II--(38 +/- 7) min. The pain syndrome severity was lesser in group II patients by 40-50%. The patients of group I were discharged in 24-48 h and of group II--in 12-18 h. While following up in 3, 6 and 12 months the recurrence of hernia was revealed in 2 patients of group I. Application of nets, manufactured by firm MMDI opens new perspectives in laparoscopic herniology. Cosy unfolding and installation in preperitoneal space without additional fixation constitutes their advantage.

Topics: Alloys; Female; Hernia, Inguinal; Humans; Laparoscopy; Male; Middle Aged; Polypropylenes; Postoperative Complications; Recurrence; Surgical Mesh; Treatment Outcome

For an inguinal hernia repair, meshes with a continuous memory frame made it more easy to position the mesh in the preperitoneal space by anterior approach. We present a case of a sigmoid perforation caused by a fractured nitinol ring of a Rebound HRD Shield mesh.. A 29-years old sports instructor presented to the Emergency Department (ED) with a gnawing abdominal pain in the left lower quadrant. His past medical history noted an inguinal hernia repair on this side. A computed tomography scan showed a broken metal ring of the inguinal mesh perforating the sigmoid, so a laparoscopy was performed. The sigmoid was attached to the abdominal wall partially overlying the preperitoneal mesh and a part of the broken nitinol frame was found perforating the colon.. The memory ring of the Rebound mesh is made of nitinol. An alloy well-known in vascular surgery for stenting arteries with high bending and compression forces. In this setting, fracture due to fatigue has already been described, but it is not known in abdominal wall reconstruction. Our patients groin was subject to daily bending and compression forces resulting in breakage of the nitinol ring.. Particularly in young athletic patients the nitinol ring will be subject to bending forces in the groin and prone to breakage. This can have potentially severe consequences given its location near abdominal organs and neurovascular structures. In our opinion, patients should be informed about the possibility of ring breakage and doctors should consider the risk-benefits well.

Topics: Adult; Alloys; Colon, Sigmoid; Hernia, Inguinal; Herniorrhaphy; Humans; Laparoscopy; Surgical Mesh

The use of a self-expanding nitinol framed prosthesis (ReboundHRD. All patients who underwent a TEP-IHR using the ReboundHRD. In total, 69 TEP-IHR procedures were performed in 54 patients (15 bilateral hernias). No perioperative and 5 (9%) postoperative complications occurred, all graded Clavien-Dindo I-II. The median length of stay was 1 day (range 0-3), with 78% of the operations performed in an ambulatory setting. Median VAS score decreased from 3 (range 0-4) on the day of surgery to 1 (range 0-2) on day 7. Patients were completely pain-free at a median time of 5 (range 1-60) days. The majority (80.4%, 37/46) of the active patients went back to work within 2 weeks (maximum 6 weeks). At a median follow-up of 19 months (range 16-26 months), no recurrences occurred.. TEP-IHR using a self-expanding nitinol framed hernia repair device is a safe technique in longterm follow-up. The technique is associated with a low incidence of postoperative pain, a short hospital stay and quick return to normal activities.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Postoperative Complications; Prospective Studies; Recurrence; Surgical Mesh

Topics: Aged; Alloys; Bile Duct Neoplasms; Cholestasis, Extrahepatic; Fatal Outcome; Follow-Up Studies; Foreign-Body Migration; Hepatic Duct, Common; Hernia, Inguinal; Humans; Intestinal Obstruction; Intestine, Small; Male; Prosthesis Failure; Radiography; Reoperation; Rupture; Stents