Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia.
Department of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia.
Hernia. 2020 Feb;24(1):197-204. doi: 10.1007/s10029-019-02063-y. Epub 2019 Oct 31.
The purpose of this paper is to communicate two new concepts with the potential to cause major morbidity in hernia repair, effective porosity and biofilm. These 2 concepts are interrelated and have the potential to result in mesh-related complications. Effective porosity is a term well described in the textile industry. It is best defined as the changes to pore morphology after implantation of mesh in situ. It is heavily dependent on mesh construct and repair technique and has the potential to impact hernia repair by reducing mesh tissue integration and promoting fibrosis. Bacterial biofilm is a well-described condition affecting prosthesis in breast and join replacement surgery with catastrophic consequences. There is a paucity of information on bacterial biofilm in mesh hernia repair. We speculate that bacterial biofilm has the potential to reduce the effective porosity of mesh, resulting in non-suppurative mesh-related complications as well as the potential for late suppurative infections. We describe the aetiology, pathogenesis, diagnosis, treatment and preventative measures to address bacterial biofilm in mesh hernia surgery. Hernia surgeons should be familiar with these two new concepts which have the potential to cause major morbidity in hernia repair and know how to address them.
Ovid Medline and PubMed were searched for communications on "effective porosity" and "bacterial biofilm".
There is a paucity of information in the literature of these conditions and their impact on outcomes following mesh hernia repair.
We discuss the two concepts of effective porosity and biofilm and propose potential measures to reduce mesh-related complications. This includes choosing mesh with superior mesh construct and technical nuances in implanting mesh to improve effective porosity. Furthermore, measures to reduce bacterial biofilm and its consequences are suggested.
本文旨在介绍两个可能导致疝修补术重大并发症的新概念，即有效孔隙率和生物膜。这两个概念相互关联，有可能导致与网片相关的并发症。有效孔隙率是纺织工业中一个术语，它被很好地描述。最好的定义是网片原位植入后孔径形态的变化。它严重依赖于网片的结构和修复技术，有可能通过减少网片与组织的整合和促进纤维化来影响疝修补术。细菌生物膜是一种在乳房和关节置换手术中影响假体的已有描述的病症，其后果是灾难性的。在网片疝修补术中，有关细菌生物膜的信息很少。我们推测细菌生物膜有可能降低网片的有效孔隙率，导致非化脓性与网片相关的并发症，以及化脓性感染的潜在风险。我们描述了细菌生物膜在网片疝手术中的病因、发病机制、诊断、治疗和预防措施。疝外科医生应该熟悉这两个可能导致疝修补术重大并发症的新概念，并知道如何处理这些问题。
在 Ovid Medline 和 PubMed 上搜索关于“有效孔隙率”和“细菌生物膜”的文献。
文献中这些情况及其对网片疝修补术后结果的影响的信息很少。
我们讨论了有效孔隙率和生物膜这两个概念，并提出了减少网片相关并发症的潜在措施。这包括选择具有优越网片结构的网片和在植入网片时采用技术细节来提高有效孔隙率。此外，还提出了减少细菌生物膜及其后果的措施。
