Ultra-Fine Polyethylene Hernia Meshes Improve Biocompatibility and Reduce Intraperitoneal Adhesions in IPOM Position in Animal Models.

(1) Introduction: The intraperitoneal onlay mesh technique (IPOM) is widely used to repair incisional hernias. This method has advantages but suffers from complications due to intraperitoneal adhesion formation between the mesh and intestine. An ideal mesh minimizes adhesions and shows good biocompatibility.

Machine learning prediction model for postoperative outcome after perforated appendicitis.

Purpose: Appendectomy for acute appendicitis is one of the most common operative procedures worldwide in both children and adults. In particular, complicated (perforated) cases show high variability in individual outcomes. Here, we developed and validated a machine learning prediction model for postoperative outcome of perforated appendicitis.

3D-Printed Replica and Porcine Explants for Pre-Clinical Optimization of Endoscopic Tumor Treatment by Magnetic Targeting.

Background: Animal models have limitations in cancer research, especially regarding anatomy-specific questions. An example is the exact endoscopic placement of magnetic field traps for the targeting of therapeutic nanoparticles. Three-dimensional-printed human replicas may be used to overcome these pitfalls.

Incisional hernia repair by synthetic mesh prosthesis in patients with inflammatory bowel disease: a comparative analysis.

Background: Patients with inflammatory bowel disease (IBD) have a high-life time risk undergoing abdominal surgery and are prone to develop incisional hernias (IH) in the postoperative course. Therefore, we investigated the role of IBD as perioperative risk factor in open ventral hernia repair (OVHR) as well as the impact of IBD on hernia recurrence during postoperative follow-up.

Methods: The postoperative course of 223 patients (Non-IBD (n = 199) and IBD (n = 34)) who underwent OVHR were compared by means of extensive group comparisons and binary logistic regressions.

Two Polyurethane Adhesives for PVDF Fixation Show Superior Biocompatibility in a Rat Model.

Background: The current standard for open and laparoscopic repair of incisional hernia consist of an abdominal wall augmentation by mesh implantation. However, the ideal fixation method of the prothesis material remains under discussion, due to potential complications of conventional fixation methods such as chronic abdominal pain or intestinal obstruction. As the use of adhesive based mesh fixation is an option of growing interest, the aim of this experimental study was to investigate the strength and biocompatibility of two newly developed polyurethane-based adhesives in comparison to a cyanoacrylatic adhesive, which is currently in clinical use.

A peritoneal defect covered by intraperitoneal mesh prosthesis effects an increased and distinctive foreign body reaction in a minipig model.

Background: The incidence of incisional hernia is with up to 30% one of the frequent long-term complication after laparotomy. After establishing minimal invasive operations, the laparoscopic intraperitoneal onlay mesh technique (lap. IPOM) was first described in 1993.

Cross-section modified and highly elastic sutures reduce tissue incision and show comparable biocompatibility: in-vitro and in-vivo evaluation of novel thermoplastic urethane surgical threads.

Surgical sutures are indispensable for a vast majority of operative procedures. An ideal suture is characterized by high tissue compliance without cutting into the mended tissue and optimal biocompatibility. Therefore, we assessed these mechanical and biological properties for novel elastic thermoplastic polyurethane (TPU) and cross-sectional modified "snowflake" sutures.

Minimally Invasive Thoracoabdominal Esophagectomy Is Superior to Minimally Invasive Gastrectomy in Terms of Health-Related Quality of Life.

There are two operative approaches for adenocarcinomas of the esophagogastric junction: thoracoabdominal esophagectomy or transhiatal extended gastrectomy. Both procedures can be performed minimally invasively. Dependent on the exact localization of the tumor, both approaches are feasible.

Improved tissue integration of a new elastic intraperitoneal stoma mesh prosthesis.

Parastomal herniation is a frequent complication in colorectal surgery, occurring with a prevalence of 30-80%. The aim of the study was to create a new intraperitoneal colostoma mesh prosthesis (IPST) with enhanced elastic properties made with thermoplastic polyurethane (TPU) monofilaments. We performed open terminal sigmoid colostomies reinforced with either a 10 cm by 10 cm polyvinylidene fluoride (PVDF) or a new TPU/PVDF composite mesh in a total of 10 minipigs.

A new device to prevent fascial retraction in the open abdomen - proof of concept in vivo.

Background: An open abdomen is often necessary for survival of patients after peritonitis, compartment syndrome, or in damage control surgery. However, abdominal wall retraction relieves delays and complicates abdominal wall closure. The principle of the newly fascia preserving device (FPD) is the application of anteriorly directed traction on both fascial edges over an external support through a longitudinal beam to relieve increased abdominal pressure and prevent fascial retraction.

Improved biocompatibility of profiled sutures through lower macrophages adhesion.

The biocompatibility of a textile implant is determined by various parameters, such as material composition and surface chemistry. However, little is known about the influence of geometry of sutures on biocompatibility. To elucidate this factor we focused on geometry-modification resulting in ultrafine polyethylene terephthalate (UFPET) suture and a snowflake like shaped polyvenylidenfluorid (PVDF) suture.

Incisional Hernia Repair of Medium- and Large-Sized Defects: Laparoscopic IPOM Versus Open SUBLAY Technique.

Small incisional hernias can be repaired laparoscopically with low morbidity and reasonable recurrence rates. The aim of this study was to compare laparoscopic with open technique in medium- and large-sized defects regarding postoperative complications and recurrence rates. Between 2012 and 2016, 102 patients with medium- or large-sized defects according to EHS classification underwent incisional hernia repair.

Influence of suture technique on anastomotic leakage rate-a retrospective analyses comparing interrupted-versus continuous-sutures.

Purpose: While many hospitals consider a continuous sutured colonic anastomosis with monofilamental fiber the current state of the art, others have advocated for interrupted sutures as the gold standard. The aim of the study was to evaluate the influence of suture technique on leakage rate (primary endpoint), wound infections, postoperative stay, and mortality.

Methods: Retrospective analyses of 347 patients (273 elective, 74 urgent) over 6 years with a handsewn colonic anastomosis (190 interrupted, 157 continuous), excluding sigma and rectum anastomosis.

Influence of Telomere Length in Hepatocytes on Liver Regeneration after Partial Hepatectomy in Rats.

Background: The aim of this study was to investigate telomere length in hepatocytes as a biomarker for liver regeneration after partial hepatectomy (PH) in rats.

Materials And Methods: Sixty male Wistar rats underwent a 70% PH. One-month-old rats were assigned to group Y (n = 30) and 4-month-old rats were assigned to group O (n = 30).

Impact of liver volume and liver function on posthepatectomy liver failure after portal vein embolization- A multivariable cohort analysis.

Background: Liver failure remains a life-threatening complication after liver resection, and is difficult to predict preoperatively. This retrospective cohort study evaluated different preoperative factors in regard to their impact on posthepatectomy liver failure (PHLF) after extended liver resection and previous portal vein embolization (PVE).

Methods: Patient characteristics, liver function and liver volumes of patients undergoing PVE and subsequent liver resection were analyzed.

AK03, a new recombinant fibrinogenase prevents abdominal adhesions in a rat model without systemic side effects.

Background: Abdominal adhesions are one of the most common complications after abdominal surgery, and fibrin is suspected to be a crucial component. The aim of the current study was an in vivo evaluation of a new recombinant fibrinogenase (AK03) in two animal models.

Methods: Sixty-four rats were randomly divided into four groups (sodium chloride [NaCl], icodextrin, AK03 low dose, and AK03 high dose) and evaluated at two time endpoints.

Impact of obesity on postoperative complications after laparoscopic and open incisional hernia repair - A prospective cohort study.

Background: Obese patients are often required to lose weight prior to incisional hernia repair as obesity is thought to increase postoperative complications and recurrence rates. The aim of this study was to determine the impact of BMI on the outcome after laparoscopic and open incisional hernia repair.

Materials And Methods: In a cohort study from May 2012 to August 2016, 178 patients underwent incisional hernia repair: 90 patients open SUBLAY and 88 patients laparoscopic intraperitoneal onlay mesh (IPOM).

Biocompatibility and biomechanical analysis of elastic TPU threads as new suture material.

High suture tension is one of the causes for many wound-healing problems. Constriction of tissue within the suture loops of nonelastic sutures can lead to cutting of the suture through tissues and necrosis of the tissue within these loops. The use of elastic materials in new suture types could give the material the ability to adapt tension to the tissue requirements and subsequently lead to more vital tissue within its loops.

Influence of gentamicin-coded PVDF suture material on the healing of intestinal anastomosis in a rat model.

Purpose: Intestinal anastomosis is a fundamental procedure in general surgery and required to restore intestinal continuity following resection. The aim of this study was to evaluate whether a gentamicin-coated polyvinylidene fluoride (PVDF) suture material has beneficial effect on anastomotic healing.

Methods: Ninety Sprague-Dawley rats were divided into three groups: a PVDF-suture group, a gentamicin-coated PVDF (GPVDF)-suture group and a control group using Maxon® (polyglycolid-co-trimethylene carbonate).

Video-assisted hepatic abscess debridement.

Background: Pyogenic liver abscesses are currently treated by either percutaneous computer tomography (CT)-guided drainage or by laparoscopic and a conventional liver resection when conservative treatment fails but may be associated with substantial morbidity and mortality.

Methods: A minimally invasive technique involving debridement of right liver abscesses was employed using a minimally invasive video-assisted hepatic abscess debridement (VAHD) after unsuccessful percutaneous CT-guided drainage. Clinical data, complication rates and outcomes of patients were recorded retrospectively.

Presurgical assessment of bariatric patients with the Patient Health Questionnaire (PHQ)--a screening of the prevalence of psychosocial comorbidity.

Background: Bariatric surgery has gained increasing relevance due to the dramatic rise in morbid obesity prevalence. A sound body of scientific literature demonstrates positive long-term outcome of bariatric surgery in decreasing mental and physical health morbidity. Still, there is a need for a manageable presurgical screening to assess major mental disorders.

Functional Liver Recovery After Bariatric Surgery--a Prospective Cohort Study with the LiMAx Test.

Background: Bariatric surgery provides long-term weight loss and improvement of obesity-associated diseases such as nonalcoholic steatohepatitis (NASH). Histologic improvement of NASH has been reported in some studies after bariatric surgery. This study was designed to assess the liver function in obese patients as well as its recovery after bariatric surgery with a noninvasive test method.

Polyvinylidene Fluoride as a Suture Material: Evaluation of Comet Tail-Like Infiltrate and Foreign Body Granuloma.

Background: Biocompatibility and tissue integration of a surgical suture are decisive factors for wound healing and therefore for the success of sutures. The optimal suture material is still under discussion. Polyvinylidene fluoride (PVDF) is described to have superior properties of biocompatibility and is therefore frequently used as a mesh component.

Elastic mesh with thermoplastic polyurethane filaments preserves effective porosity of textile implants.

In hernia surgery, meshes with small pores tend to be filled by fibrous tissue, which reduces their stretchability and causes patient complaints. Because of the inelasticity of current meshes, mechanical strain might cause pores to collapse even in large-pore mesh constructions. In this study, a mesh with elastic thermoplastic polyurethane (TPU) filaments was constructed to prevent pore size changes even under mechanical strain, and its biocompatibility in comparison with polyvinylidene fluoride (PVDF) was evaluated.

Laser-induced drug release for local tumor control--a proof of concept.

Background: The systemic palliative chemotherapy of locally extended gastrointestinal and hepatobiliary tumors is associated with a considerable burden for the patient. The aim of this project was to develop a new drug release system to improve the local stent therapy in these patients as a proof of concept study. For this purpose, polymer filaments were modified with drug-loaded polymer microgels that allow selective release of the active substance by photochemical triggering using laser radiation.