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Hernia repair with porcine small-intestinal submucosa

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Abstract

Purpose

Although at present nonabsorbable meshes are the preferred material for tension-free hernioplasty, some problems with their use have yet to be addressed (i.e., chronic pain and infections). In order to address these disadvantages, a collagen-based material, the porcine small-intestinal submucosa mesh (Surgisis Inguinal Hernia Matrix, Cook Surgical, Bloomington, IN, USA), has recently been developed for hernia repair.

Methods

With the aim of investigating the clinical safety and effectiveness of Surgisis IHM inguinal hernia repair, we report our experience of 45 consecutive hernioplasties with a medium-term follow-up. The surgical technique for the use of this material in hernioplasty is described in detail.

Results

Although some local (i.e., seromas) and general (i.e., hyperpyrexia), complications appeared in the immediate postoperative period (all of them disappeared spontaneously), no rejection or infection was observed after operations. At the 2-year follow-up, a low degree of pain and discomfort and no recurrences were observed.

Conclusions

We conclude that the Surgisis IHM hernioplasty is feasible with promising results and, from a clinical perspective, seems safe and effective.

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References

  1. Sachs M, Damm M, Encke A (1997) Historical evolution of inguinal hernia repair. World J Surg 21:218–223

    Article  PubMed  CAS  Google Scholar 

  2. Wantz GE (1999) Abdominal wall hernias. In: Shwarth SI, Shires GT, Spencer FC, Daly JM, Fisher JE, Galloway AC (eds) Principles of surgery, 7th ed. McGraw-Hill, New York

    Google Scholar 

  3. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157:188–193

    Article  PubMed  CAS  Google Scholar 

  4. Shulman AG, Amid PK, Lichtenstein IL (1992) The safety of mesh repair for primary inguinal hernias: results of 3,019 operations from five diverse surgical sources. Am Surg 58:255–257

    PubMed  CAS  Google Scholar 

  5. Janu PG, Sellers KD, Mangiante EC (1997) Mesh inguinal herniorrhaphy: a ten-year review. Am Surg 63:1065–1069

    PubMed  CAS  Google Scholar 

  6. McGillicuddy JE (1998) Prospective randomized comparison of the Shouldice and Lichtenstein hernia repair procedures. Arch Surg 133:974–978

    Article  PubMed  CAS  Google Scholar 

  7. Prior MJ, Williams EV, Shukla HS, Phillips S, Vig S, Lewis M (1998) Prospective randomized controlled trial comparing Lichtenstein with modified Bassini repair of inguinal hernia. J R Coll Surg Edinb 43:82–86

    PubMed  CAS  Google Scholar 

  8. Collaboration EH (2000) Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg 87:854–859

    Article  PubMed  CAS  Google Scholar 

  9. Heise CP, Starling JR (1998) Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg 187:514–518

    Article  PubMed  CAS  Google Scholar 

  10. Taylor SG, O’Dwyer PJ (1999) Chronic groin sepsis following tension-free inguinal hernioplasty. Br J Surg 86:562–565

    Article  PubMed  CAS  Google Scholar 

  11. Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, Juul P, Callesen T (2001) Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358:1124–1128

    Article  PubMed  CAS  Google Scholar 

  12. Condon RE (2001) Groin pain after hernia repair. Ann Surg 233:8

    Article  PubMed  CAS  Google Scholar 

  13. Falagas ME, Kasiakou SK (2005) Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 11:3–8

    Article  PubMed  CAS  Google Scholar 

  14. Dayton MT, Buchele BA, Shirazi SS, Hunt LB (1986) Use of an absorbable mesh to repair contaminated abdominal-wall defects. Arch Surg 121:954–960

    PubMed  CAS  Google Scholar 

  15. Kropp BP, Eppley BL, Prevel CD, Rippy MK, Harruff RC, Badylak SF, Adams MC, Rink RC, Keating MA (1995) Experimental assessment of small intestinal submucosa as a bladder wall substitute. Urology 46:396–400

    Article  PubMed  CAS  Google Scholar 

  16. Kropp BP, Sawyer BD, Shannon HE, Rippy MK, Badylak SF, Adams MC, Keating MA, Rink RC, Thor KB (1996) Characterization of SIS regenerated canine detrusor: assessment of reinnervation, in vitro compliance and contractility. J Urol 156:599–607

    Article  PubMed  CAS  Google Scholar 

  17. Vaught JD, Kropp BP, Sawyer BD, Rippy MK, Badylak SF, Shannon HE, Thor KB (1996) Detrusor regeneration in the rat using porcine SIS graft: functional innervation and receptor expression. J Urol 155:374–378

    Article  PubMed  CAS  Google Scholar 

  18. Ansaloni L, Bonasoni P, Cambrini P, Catena F, De Cataldis A, Gagliardi S, Gazzotti F, Peruzzi S, Santini D, Taffurelli M (2006) Experimental evaluation of Surgisis as scaffold for neointestine regeneration in a rat model. Transplant Proc 38:1844–1848

    Article  PubMed  CAS  Google Scholar 

  19. Record RD, Hillegonds D, Simmons C, Tullius R, Rickey FA, Elmore D, Badylak SF (2001) In vivo degradation of 14C-labeled small intestinal submucosa (SIS) when used for urinary bladder repair. Biomaterials 22:2653–2659

    Article  PubMed  CAS  Google Scholar 

  20. Hodde J (2002) Naturally occurring scaffolds for soft tissue repair and regeneration. Tissue Eng 8:295–308

    Article  PubMed  CAS  Google Scholar 

  21. Hodde JP, Record RD, Tullius RS, Badylak SF (2002) Retention of endothelial cell adherence to porcine-derived extracellular matrix after disinfection and sterilization. Tissue Eng 8:225–234

    Article  PubMed  CAS  Google Scholar 

  22. Hodde J, Hiles M (2002) Virus safety of a porcine-derived medical device: evaluation of a viral inactivation method. Biotechnol Bioeng 79:211–216

    Article  PubMed  CAS  Google Scholar 

  23. Parker DM, Armstrong PJ, Frizzi JD, North JH (2006) Porcine dermal collagen (Permacol) for abdominal wall reconstruction. Curr Surg 63:255–258

    PubMed  Google Scholar 

  24. Ma SZ, Li XH, Hu J (2006) Acellular extracellular matrix for inguinal hernia repair. Hernia 10:229–231

    Article  PubMed  CAS  Google Scholar 

  25. Buinewicz B, Rosen B (2004) Acellular cadaveric dermis (AlloDerm): a new alternative for abdominal hernia repair. Ann Plast Surg 52:188–194

    Article  PubMed  Google Scholar 

  26. Hodde J, Record R, Tullius R, Badylak S (2002) Fibronectin peptides mediate HMEC adhesion to porcine-derived extracellular matrix. Biomaterials 23:1841–1848

    Article  PubMed  CAS  Google Scholar 

  27. Voytik-Harbin SL, Brightman AO, Kraine MR, Waisner B, Badylak SF (1997) Identification of extractable growth factors from small intestinal submucosa. J Cell Biochem 67:478–491

    Article  PubMed  CAS  Google Scholar 

  28. Hodde JP, Record RD, Liang HA, Badylak SF (2001) Vascular endothelial growth factor in porcine derived extracellular matrix. Endothelium 8:11–24

    PubMed  CAS  Google Scholar 

  29. Raeder RH, Badylak SF, Sheehan C, Kallakury B, Metzger DW (2002) Natural anti-galactose alpha1,3 galactose antibodies delay, but do not prevent the acceptance of extracellular matrix xenografts. Transpl Immunol 10:15–24

    Article  PubMed  CAS  Google Scholar 

  30. Allman AJ, McPherson TB, Badylak SF, Merrill LC, Kallakury B, Sheehan C, Raeder RH, Metzger DW (2001) Xenogeneic extracellular matrix grafts elicit a TH2-restricted immune response. Transplantation 71:1631–1640

    Article  PubMed  CAS  Google Scholar 

  31. Palmer EM, Beilfuss BA, Nagai T, Semnani RT, Badylak SF, Van Seventer GA (2002) Human helper T cell activation and differentiation is suppressed by porcine SIS. Tissue Eng 5:893–900

    Article  Google Scholar 

  32. Allman AJ, McPherson TB, Merrill LC, Badylak SF, Metzger DW (2002) The TH2-restricted immune response to xenogeneic small intestinal submucosa does not influence systemic protective immunity to viral and bacterial pathogens. Tissue Eng 8:53–62

    Article  PubMed  CAS  Google Scholar 

  33. Clarke KM, Lantz GC, Salisbury SK, Badylak SF, Hiles MC, Voytik SL (1996) Intestine submucosa and polypropylene mesh for abdominal wall repair in dogs. J Surg Res 60:107–114

    Article  PubMed  CAS  Google Scholar 

  34. Badylak S, Kokini K, Tullius B, Whitson B (2001) Strength over time of a resorbable bioscaffold for body wall repair in a dog model. J Surg Res 99:282–287

    Article  PubMed  CAS  Google Scholar 

  35. Badylak S, Kokini K, Tullius B, Simmons-Byrd A, Morff R (2002) Morphologic study of SIS as a body wall repair device. J Surg Res 103:190–202

    Article  PubMed  Google Scholar 

  36. Franklin ME, Gonzalez JJ, Glass JL (2004) Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up. Hernia 8:186–189

    PubMed  Google Scholar 

  37. Ueno T, Pickett LC, de la Fuente SG, Lawson DC, Pappas TN (2004) Clinical application of porcine small intestinal submucosa in the management of infected or potentially contaminated abdominal defects. J Gastrointest Surg 8:109–112

    Article  PubMed  Google Scholar 

  38. Edelman DS (2002) Laparoscopic herniorrhaphy with porcine SIS: a preliminary study. JSLS 6:203–205

    PubMed  Google Scholar 

  39. Oelschlager BK, Barreca M, Chang L, Pellegrini CA (2003) The use of small intestine submucosa in the repair of paraesophageal hernias: initial observations of a new technique. Am J Surg 186: 4–8

    Article  PubMed  Google Scholar 

  40. Ansaloni L, Catena F, D’Alessandro L (2003) Prospective randomized, double-blind, controlled trial comparing Lichtenstein’s repair of inguinal hernia with polypropylene mesh versus Surgisis gold soft tissue graft: preliminary results. Acta Biomed Ateneo Parmense 74(Suppl 2):10–14

    Google Scholar 

  41. Franklin ME, Gonzalez JJ, Glass JL (2004) Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up. Hernia 8:186–189

    PubMed  Google Scholar 

  42. Helton WS, Fisichella PM, Berger R, Horgan S, Espat NJ, Abcarian H (2005) Short-term outcomes with small intestinal submucosa for ventral abdominal hernia. Arch Surg 140:549–560

    Article  PubMed  Google Scholar 

  43. Catena F, Ansaloni L, Leone A, De Cataldis A, Gagliardi S, Gazzotti F, Peruzzi S, Agrusti S, D’Alessandro L, Taffurelli M (2005) Lichtenstein repair of inguinal hernia with Surgisis inguinal hernia matrix soft-tissue graft in immunodepressed patients. Hernia 9:29–31

    Article  PubMed  CAS  Google Scholar 

  44. Sakorafas GH, Halikias I, Nissotakis C, Kotsifopoulos N, Stavrou A, Antonopoulos C, Kassaras GA (2001) Open “tension-free” repair of inguinal hernias; the Lichtenstein technique. BMC Surg 1:3

    Article  PubMed  CAS  Google Scholar 

  45. Edelman DS, Selesnick H (2006) “Sports” hernia: treatment with biologic mesh (Surgisis): a preliminary study. Surg Endosc 20:971–973

    Article  PubMed  CAS  Google Scholar 

  46. Gupta A, Zahriya K, Mullens PL, Salmassi S, Keshishian A (2006) Ventral herniorrhaphy: experience with two different biosynthetic mesh materials, Surgisis and alloderm. Hernia 10:419–425

    Article  PubMed  CAS  Google Scholar 

  47. Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7

    Article  PubMed  CAS  Google Scholar 

  48. Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244:212–219

    Article  PubMed  Google Scholar 

  49. Bringman S, Wollert S, Osterberg J, Smedberg S, Granlund H, Heikkinen TJ (2006) Three-year results of a randomized clinical trial of lightweight or standard polypropylene mesh in Lichtenstein repair of primary inguinal hernia. Br J Surg 93:1056–1059

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This research was presented at the 3rd International Hernia Congress, Boston, MA, USA, 7–11 June 2006. We dedicate this work to Orazio Campione, Professor of Surgery and head of the Emergency Surgery Department of the St.Orsola-Malpighi Hospital (University of Bologna, Italy) from 1995, who passed away prematurely in August 2003.

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Authors and Affiliations

  1. Unit of General, Transplant and Emergency Surgery, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy

    L. Ansaloni, F. Catena, S. Gagliardi, F. Gazzotti, L. D’Alessandro & A. D. Pinna

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  1. L. Ansaloni
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  2. F. Catena
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Correspondence to L. Ansaloni.

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Ansaloni, L., Catena, F., Gagliardi, S. et al. Hernia repair with porcine small-intestinal submucosa. Hernia 11, 321–326 (2007). https://doi.org/10.1007/s10029-007-0225-4

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