Page 38 - herina surgery and possible lawsuits

P ro s th e tic m a te ria ls

From the beginning of modem anatomic hernia surgery m by Bassmi in 1887 recurrences

have frustrated surgeons. The need for a satisfactory prosthetic material to bridge or reinforce
defect of hernia required for more than a century. Various materials, including auto grafts
(the patient's own tissue) have been tried.

Autografts: The most successful of the auto grafts is fascia lata, which has been used as
suture material, a pedicle graft, and as a free transplanted graft. However, m addition to
requiring a second operation to harvest it, fascia lata weakens and fails over time and
dissolves m the presence of infection.

Metal Prosthetic Graft Materials:

Table 7: Metal Prosthetic Graft materials and its outcomes

Silver filigree mesh Became brittle and fractured and eventually extruded causing
(1900) Meyer & Bartlet multiple sinuses and fistulas.

Produces dense fibrosis infiltrating to surrounding structures -
Tantalum Gauze (1948) Irregularities m the abdominal wall contour,
Koontz, Douglas Seroma formation,
Fatigue fractures of the gauze mesh result in patient discomfort,

Stainless steel mesh Set up electrolyte reactions between ingredients if composition
(1928) Goepel varied. Rigidity and foreign body sensation, MR1 contraindicated

Nonmetallic synthetic vrostheses:
Most surgeons now use a nonmetallic synthetic prosthetic material in inguinal hernias
because techniques are comparatively easy to master and are associated with supenor
outcomes. The goals of treatment in the case of hernia are to relieve pain, cure the hernia to

prevent acute incarceration and successful long term outcome.
Polyester (Dacron) is polymer from ethylene glycol and terephthalic acid, developed m 1939.

Mesh wash prepared m 1950 and started its use in hernia surgery. The mesh has
advantages of adaptability, pliability and tolerance in tissues. It was the first
nonmetalhe mesh to stand test time for four decades and still in use, but its use has
decreased after polypropylene mesh become popular. [26]

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