The consequences of ventral hernia mesh repair. Analyses and interpretation of different aspects of outcome
Year: 2017
Type: dissertation
Abstract: A hernia located in the anterior abdominal wall can be spontaneous, caused by abdominal surgery or trauma. If treatment seems appropriate, this includes laparoscopic or open surgery and closure of the defect with mesh prostheses. The surgical treatment objective is to restore the integrity of the abdominal wall, whereas the principal outcome measure should be improved QoL and functionality.\nThe aim of this thesis was to bring knowledge to different aspects of ventral hernia mesh repair. We compared open and laparoscopic surgical technique with respect to equitable clinical measures concomitantly bringing patient reported outcome to the synthesis.\nIn paper I we focused on long term recurrence, pain and patient satisfaction after open or laparoscopic mesh repair. There was no difference between these two techniques with respect to these measures. Chronic pain is frequent and is therefore important for explaining dissatisfaction.\nIn paper II we investigated QoL and functionality long term after open or laparoscopic mesh repair comparing patients presenting with non-recurrent ventral hernia disease. Both surgical techniques reduce chronic pain and physical impairment and improve long-term QoL. Hernia recurrence and persistent pain reduce the beneficial effect of hernia surgery while dispotional optimism seems to modulate QoL reporting and functionality.\nBy performing MRI, paper III aimed at detecting intra-abdominal adhesions between viscera and the anterior abdominal wall after ventral hernia mesh repair with special attention to any association with pain. Adhesions are common after open and laparoscopic mesh repair, but are not associated with chronic pain.\nThe purpose of paper IV was to find evidence of bacterial biofilm in mesh implants from the anterior abdominal wall, analyze its bacterial diversity and look for possible resemblance with bacterial biofilm from the periodontal pocket. The results revealed great bacterial diversity including oral commensals and periodontopathogens. Other sites such as gut and skin however may also provide sources for mesh biofilm.
Author: Odd Langbach
Language: English
Topic: Hernia repair and management
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2626650837