Prosthetic Materials for Hernia Repair: Polyester

In addition to polypropylene and PTFE, polyester is a widely used synthetic for mesh repair of hernias. Polyester is somewhat easier to handle than polypropylene and PTFE as it sticks less to tissue and is softer. It is hydrophilic and produces less scar-tissue contraction than heavier materials.

Polyester performs well in a contaminated environment, although material that does not incorporate is usually removed. Granulation tissue will form through the pores even when exposed.

Polyester meshes are not typically used in inguinal hernia repair. They are occasionally used in ventral hernia repair as described below

Parietex – manufactured by Sofradim Corporation, composite mesh with polyester on one side and a combination of polyethylene glycol, glycerol, and oxidized collagen on the other side.


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Prosthetic Materials for Hernia Repair: Polypropylene

In the United States, general surgeons perform about 900,000 hernia repairs every year. There has been an explosion of new synthetic materials available to aid in closing these anatomic defects. These polymers fall into the following three categories – polypropylene, polyester, and polytetraflouroethylene (PTFE).

Polypropylene prosthetics are widely used. They can vary siginificantly in porosity, weave, and density. Products with lower density and larger pore size may cause less inflammatory response and less contracture because of the relatively thinner scar formed, with a comcomitant improvement in outcomes. However, this lesser inflammatory response must be balanced against rates of recurrence.

Some commonly used brands of polypropylene mesh for inguinal hernia repair are listed below:

Bard 3D Max – manufactured by Davol, Inc., relatively heavyweight material.

PerFix Plug – manufactured by Davol, Inc., prone to contracture and migration as a relatively large amount of scar tissue decreases its size.

Kugel Patch – manufactured by Davol, Inc, has a flat surface with an attached ring.

Prolene Hernia System – manufactured by Ethicon, heavyweight mesh that has an on-lay sheet with an attached plug that is placed in the preperitoneal position to reduce plug migration. Used only in open hernia repair.

Prolite Mesh and Plug – manufactured by Atrium Medical Corporation, this is relatively porous, lightweight material.

Proloop Mesh Plug – manufactured by Atrium Medical Corporation, relatively porous, lightweight material.

Surgipro – manufactured by US Surgical, comes in open-weave, and mono- and multi-filament.

Some commonly used brands of polypropylene mesh for ventral hernia repair are listed below:

Supramesh-IP - manufactured by Genzyme, composite material of polypropylene and polyglycolic acid woven together, also coated on one side with a gel mixture of sodium hyaluronate, carboxymethylcellulose, and polyethylene glycol.

Proceed – manufactured by Ethicon, coated with a proprietary cellulose based polymer.

C-Qur – manufactured by Atrium Medical, absorbs in 10-12 weeks, coated with processed fish oil on both sides

Primary Peritonitis

Peritonitis is defined as the presence of microorganisms in the normally sterile peritoneal sac. It is classified as primary, secondary, or tertiary.

In primary peritonitis, there is no identifiable source of infection. It is associated with peritoneal diaylysis, systemic lupus erythematosus, ascites, and cirrhosis.

It is often monomicrobial with the most common pathogen being Escherichia coli. Other common Gram-negative species identified include Klebsiella. Gram-positive species isolated include Streptococcus and Enterococcus.

These are considered serious infections and mortality can reach 50% in cases with cirrhosis.


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Scheduled Nebulizer Treatment in Paraplegics

Most physiatrists (rehab physicians) put patients with high spinal cord injuries on a scheduled regimen of nebulizer treatment to facilitate clearance of secretions.

These patients tend to have hyperactivity of the airway and the unopposed parasympathetic stimulation of albuterol stimulates increased ciliary function.


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Heparin-Induced Thrombocytopenia – Quick Fact

In the setting of heparin-induced thrombocytopenia type 2 long-term anticoagulation is usually prescribed, usually with coumadin. This should not be started until the platelet count has rebounded to 100,000/dl. No heparin should be given until the patient has been retested to rule out for the continuing presence of heparin antibodies.


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Five Causes of Wide QRS Complexes on Electrocardiogram

1. Ventricular tachycardia (V-tach)
2. Supraventricular tachycardia with aberrancy
3. Drug-induced intraventricular bundle branch block
4. Pacemaker generated heart beat
5. Wolff-Parkinson-White syndrome


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Dobutamine Quick Fact

Dobutamine is the cardiac “pressor” that causes the least the tachycardia (rapid heart rate) and experienced ICU physicians will often use this drug when they want to keep the heart rate less than 100 beats per minute.

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The Scaphoid Bone – where is this bone and what does it do?

Vitamin K (phytonadione) should never be given to patients with mechanical (prosthestic) heart valves. It causes an unacceptably high rate of clot formation on the valve, particularly on the hinges of the valve. These clots then can embolize to the brain and cause cerebral vascular incidents (strokes).


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Arterial Blood Supply to the First Part of the Duodenum

The arterial supply to the duodenum is confusing, even for experienced surgeons – in part because of the normal anatomic variability found in individuals.

The main arterial root is the common hepatic artery which branches off to form the gastroduodenal artery and the proper hepatic artery. The gastroduodenal artery then sends two branches to the first part of the duodenum – the supraduodenal artery and the posteriorly running superior pancreaticoduodenal branch – aka as the retroduodenal artery of Edwards)

Peritumoral Injection in Sentinel Lymph Node Breast Biopsy

Injection of isosulphan blue dye and technetium in the area around the tumor as has been classically described in sentinel lymph node biopsy has limitations in patients with upper outer quadrant breast lesions.
Continue reading "August 6, 2007"

Lymphatic Drainage Patterns of the Breast

When considering the chance of a false negative sentinel lymph node biopsy, it is important to understand the lymphatic drainage patterns of the breast.

Continue reading "August 5, 2007"

Patients suffering cervical spinal cord injuries often can not evaculate their bowels normally. To prevent obstipation and the possible autonomic
Continue reading "The 3-2-1 Bowel Regimen for Spinal Cord Patients"

CA 19-9

Cancer antigen (CA) 19-9 is a tumor marker first described in 1979. An elevated serum level is most closely associated with adenocarcinoma of pancreatic exocrine ducts, which comprise about 95% of all pancreatic cancers.

Although the sensitivity and specificity of an elevated CA 19-9 is 90% and 98% respectively, it can not be used as a screening test for pancreatic cancer as it can be elevated in other gastrointestinal cancers, cirrhosis, and in benign conditions that cause obstructive jaundice.

CA 19-9 is not elevated in pancreatic cancer in patients that have the Lewis antigen blood type. The gene for Lewis antigen causes a deficiency in fucosyltransferase that is required for production of CA 19-9. These patients will have a normal CA 19-9 even in the setting of a large and advanced tumor.


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