Kurgan Regional Clinical Hospital
Materials of IX conference “Actual issues of herniology” 2011
There was worked out and introduced into the clinical practice combined implant made of Titanium silk and mesh of non adhesive synthetic material.
The implant is used for intra peritoneal and sub lay plastic of the defects in patients with primary and recurrent middle ventral hernias.
Now days it’s known that intra peritoneal and sub lay technique of implantation in the abdominal wall repair lead to less number of wound complications in postoperative period. But the wide application is restricted by the high prize of implants. Sublay technique with the help of usual meshes have some difficulties while fixing.
The objective of the work: to invent a combined implant for operations of patients with primary ventral and recurrent hernias having comfortable working conditions, fixation safety and low prize.
Materials and methods: A combined implant for sub lay or intraperitoneal repair of abdominal wall defects has been worked out. A titanium or titanium nikelid mesh was sewed to the plate made of non adhesive material (repelen, RTFE) with 8-12 cm diameters with the help of polypropylene thread. The mesh had 0.3 mm cells, 8-12 cm diameters and 2 cm ho plate made of non adhesive material (repelen, RTFE) with 8-12 cm diameter hole in the center.
Operation technique: after the excision of hernia sack through the abdominal wall defect a combined implant is inserted to the abdominal cavity. Then the implant is straighten in the cavity with the spatula, the mesh location is in the direction of abdominal wall. In the implant hole a hernia stapler is inserted and the mesh is fixed to the abdominal wall in 8 different points of touching the non adhesive plate. The sheath defect is sewed with the metal mesh.
We also used a combined implant in sub lay plastics: for that abdominal membrane was separated from rectus muscle fascia, then peritoneum was repaired and the implant was fixed to the fascia with hernia stapler with the following sheath repair.
Results: in 2011 there were conducted 8 operations in patients with primary and recurrent middle ventral hernias with the help of implant described above (4 plastics with intraperitoneal implant location and 4 plastics with sublay location). At the end of operations drainages were not applied. Narcotics painkillers were not necessary during the postoperative period. Patients were discharged on the 5th or 6th day after operation.
Conclusions: A combined implant for abdominal wall defects’ repair by sublay and intraperitoneal technique have been worked out and put into practice. The worked out implant application is easy, comfortable to fix and quite low cost in comparison with foreign implants of the same purpose.
Particular Indications for the Titanium Silk mesh Usage
From our point of view the indications for the Titanium Silk mesh usage are the same as for the usage of synthetic materials meshes. For example the results of Titanium Silk applications in the cases of ventral and inguinal hernias are quite optimistic. But there are specific cases when Titanium Silk is the matter of choice.
- Presence of immune disorder in the case history, for example, bronchial asthma, psoriasis, allergic reactions. It’s quite natural in such cases to use the least allergic material.
- Polypropylene or other synthetic implants rejection. It’s understandable that the situation will reappear while using the same materials. So the material Titanium Silk is the matter of choice.
- Hernia relapse presence, especially if there was synthetic implants’ usage. It’s difficult to exclude the process of rejection.
- Oncological or systemic disease in the case history, as we can’t exclude specific treatment such as Gamma radiation therapy or chemotherapy. Some possible local tissue changes after chemotherapy and irradiation therapy:
- Scaring with shrinkage and contraction of the tissue.
- Danger of polymer itself destruction. At the point of irradiation some joints are destructed and some new ones are formed.
- Chemical interaction with anticancerous preparations and gold chemo preparations. As it’s known they are highly toxic materials having both immunosuppressive and destructive actions on the implant itself.
Development of immunosuppression of different genesis: due to diabetes mellitus specific treatment with gold and glucocorticosteroid medications, Immunodeficiency Syndrome.
Forming of combined implants for intra peritoneal insertion. In this case the material is suitable for forming the outer side of implant which is separated from the peritoneum.
Thus, we suggest using titanium silk as the most non reactive material in such cases when immune reaction and local tissues reaction is not predictable. This material also allows specific correction with antibiotics and anti cancerous medications without changes in the structure of the material. It helps to minimize the wound complications risk under such conditions.