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Allograft AlloDerm(®) tissue for laparoscopic transabdominal preperitoneal groin hernia repair: A case report.

Amirlak B, Gerdes J, Puri V, Fitzgibbons RJ - Int J Surg Case Rep (2014)

Bottom Line: AlloDerm(®) Regenerative Tissue Matrix (LifeCell Corporation, Branchburg, NJ) is derived from human cadaver skin and may be associated with fewer visceral adhesions and more durability in infected fields than synthetic mesh.Previous pelvic radiation and multiple previous groin repairs can render the peritoneum friable, resulting in obstacles to successful closure.AlloDerm is a reasonable choice for groin hernia repairs when such factors are present.

View Article: PubMed Central - PubMed

Affiliation: University of Texas Southwestern Medical Center, Department of Plastic and Reconstructive Surgery, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States. Electronic address: bardiaamirlak@gmail.com.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photograph showing identification of an incidental femoral hernia upon laparoscopic examination of the left myopectineal orifice. Femoral defect (FD) is shown on the left side. The round ligament (RL), iliac vessels (IV), Cooper's ligament (CL), iliopubic tract (IT), and epigastric vessels (EV) are shown.
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fig0015: Intraoperative photograph showing identification of an incidental femoral hernia upon laparoscopic examination of the left myopectineal orifice. Femoral defect (FD) is shown on the left side. The round ligament (RL), iliac vessels (IV), Cooper's ligament (CL), iliopubic tract (IT), and epigastric vessels (EV) are shown.

Mentions: An 80-year-old white female presented with an umbilical hernia (2 cm, reducible mass) and a recurrent symptomatic right inguinal hernia (3 cm, painful, reducible mass). Significant past history included a right inguinal hernia repair over 30 years ago, thought to be a tissue repair. She suffered a recurrence in 1995, which was repaired with mesh, and another recurrence 2 years later, which became incarcerated and was also repaired using mesh. All were open conventional repairs. She had undergone radiation therapy to the pelvic region in 1989 for vulvar cancer and had a history of rheumatoid arthritis under treatment with steroids. With this history of multiple open repairs on the right inguinal hernia, the decision was made to repair the hernia laparoscopically. During the operation, a moderate amount of bowel adhesions in the pelvis were encountered. Given the history of radiation, adhesions were taken down very carefully, and the site of hernia recurrence was identified. The peritoneum was very thin and friable on the right and was easily fragmented during the dissection (Fig. 1). In addition, there was milky fluid which looked suspicious for an infection. Although the intraoperative gram stains were negative, we were concerned about possible occult infection of the previous material that was still in place. For these collective reasons, we decided to use a biologic tissue matrix instead of synthetic polypropylene or dual-sided polypropylene/polytetrafluoroethylene (PTFE) mesh. Because the gram stain was negative, we elected to continue with the repair. Two small pieces of AlloDerm were prepared and sutured together with running polydioxanone sutures, creating an 8 cm × 8 cm piece. The matrix was then tacked to the abdominal wall in several places superiorly and slightly laterally (using caution to stay medial to the nerves), and Cooper's ligament inferior-medially with 1-cm overlap inferiorly to completely cover the myopectineal orifice (Fig. 2). Laparoscopic examination of the left myopectineal orifice identified an incidental femoral hernia (Fig. 3). We decided to use a 10 cm × 4 cm piece of AlloDerm for the repair of the left side with final coverage with peritoneum (Fig. 4). The patient's immediate postoperative recovery was unremarkable. The floor of the inguinal regions on subsequent follow-up examinations was felt to be strong. However, the patient developed a femoral hernia on the right side after 3 months. This was a small, asymptomatic reducible hernia that was repaired under local anesthesia with a large Bard PerFix® plug (Davol Inc., Warwick, RI, USA). There have been no further complications in 2 years of follow-up since the last repair in this patient.


Allograft AlloDerm(®) tissue for laparoscopic transabdominal preperitoneal groin hernia repair: A case report.

Amirlak B, Gerdes J, Puri V, Fitzgibbons RJ - Int J Surg Case Rep (2014)

Intraoperative photograph showing identification of an incidental femoral hernia upon laparoscopic examination of the left myopectineal orifice. Femoral defect (FD) is shown on the left side. The round ligament (RL), iliac vessels (IV), Cooper's ligament (CL), iliopubic tract (IT), and epigastric vessels (EV) are shown.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4066573&req=5

fig0015: Intraoperative photograph showing identification of an incidental femoral hernia upon laparoscopic examination of the left myopectineal orifice. Femoral defect (FD) is shown on the left side. The round ligament (RL), iliac vessels (IV), Cooper's ligament (CL), iliopubic tract (IT), and epigastric vessels (EV) are shown.
Mentions: An 80-year-old white female presented with an umbilical hernia (2 cm, reducible mass) and a recurrent symptomatic right inguinal hernia (3 cm, painful, reducible mass). Significant past history included a right inguinal hernia repair over 30 years ago, thought to be a tissue repair. She suffered a recurrence in 1995, which was repaired with mesh, and another recurrence 2 years later, which became incarcerated and was also repaired using mesh. All were open conventional repairs. She had undergone radiation therapy to the pelvic region in 1989 for vulvar cancer and had a history of rheumatoid arthritis under treatment with steroids. With this history of multiple open repairs on the right inguinal hernia, the decision was made to repair the hernia laparoscopically. During the operation, a moderate amount of bowel adhesions in the pelvis were encountered. Given the history of radiation, adhesions were taken down very carefully, and the site of hernia recurrence was identified. The peritoneum was very thin and friable on the right and was easily fragmented during the dissection (Fig. 1). In addition, there was milky fluid which looked suspicious for an infection. Although the intraoperative gram stains were negative, we were concerned about possible occult infection of the previous material that was still in place. For these collective reasons, we decided to use a biologic tissue matrix instead of synthetic polypropylene or dual-sided polypropylene/polytetrafluoroethylene (PTFE) mesh. Because the gram stain was negative, we elected to continue with the repair. Two small pieces of AlloDerm were prepared and sutured together with running polydioxanone sutures, creating an 8 cm × 8 cm piece. The matrix was then tacked to the abdominal wall in several places superiorly and slightly laterally (using caution to stay medial to the nerves), and Cooper's ligament inferior-medially with 1-cm overlap inferiorly to completely cover the myopectineal orifice (Fig. 2). Laparoscopic examination of the left myopectineal orifice identified an incidental femoral hernia (Fig. 3). We decided to use a 10 cm × 4 cm piece of AlloDerm for the repair of the left side with final coverage with peritoneum (Fig. 4). The patient's immediate postoperative recovery was unremarkable. The floor of the inguinal regions on subsequent follow-up examinations was felt to be strong. However, the patient developed a femoral hernia on the right side after 3 months. This was a small, asymptomatic reducible hernia that was repaired under local anesthesia with a large Bard PerFix® plug (Davol Inc., Warwick, RI, USA). There have been no further complications in 2 years of follow-up since the last repair in this patient.

Bottom Line: AlloDerm(®) Regenerative Tissue Matrix (LifeCell Corporation, Branchburg, NJ) is derived from human cadaver skin and may be associated with fewer visceral adhesions and more durability in infected fields than synthetic mesh.Previous pelvic radiation and multiple previous groin repairs can render the peritoneum friable, resulting in obstacles to successful closure.AlloDerm is a reasonable choice for groin hernia repairs when such factors are present.

View Article: PubMed Central - PubMed

Affiliation: University of Texas Southwestern Medical Center, Department of Plastic and Reconstructive Surgery, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States. Electronic address: bardiaamirlak@gmail.com.

No MeSH data available.


Related in: MedlinePlus