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	Certificates Approvals Services for expatriates Online appointments HOME \| AESTHETIC SURGERY \| INDUSTRIAL MEDICINE \| PHYSICIANS \| DOCTOR'S ADVICE \| MEDICAL TRANSPORT \| INTERNAL PARTNERS \| EQUIPMENTS \| PHOTO GALLERY \| CONTACT AGENDA Home Medical Services Subscriptions News Aesthetic Surgery Industrial Medicine Physicians Doctor's Advice Medical Transport Internal Partners Equipments Services for expatriates Online Appointments Photo Gallery Contact DOCTOR'S ADVICE Hernia Hernia represents a spontaneous, temporary and permanent, externalization of an abdominal viscus under the skin, in an area of anatomical weakness, following a congenital or acquired predisposition, removing all anatomical elements of the abdominal or pelvic wall. To each of these points of anatomical weakness corresponds a topographic variety of hernia, but regardless of the particulars conferred by topography or by their visceral content, all hernias show common general characteristics, whose knowledge is indispensable. If in 2003 in the U.S., the annual cost of operations for primary parietal defects was of 2.5 to 3 billion dollars, the sums spent for relapses were over 300 million dollars. No country can any longer afford to ignore or treat lightly the issue of parietal defects pathology, if not with impressive costs or major flaws in the health system. That's why, in this domain, there appeared an overspecialization under the form of dedicated clinics, study groups, general surgeons with an additional concern for parietal defects. The introduction of bio-prosthetics in the surgical treatment of abdominal parietal defects has lead to a great progress in recent years; most statistics show that the relapse rate dropped to almost 1-2% in specialized clinics around the world (Shouldice Clinic in Toronto, Canada, Lichtenstein Clinic in Los Angeles-USA, Trabucco Clinic - Italy). While some people (Simons- the central figure of Dutch science of hernia, Parviz Amid- the manager of Lichtenstein Hernia Institute in Los Angeles) believes that we only need a simple technique not only 10 kinds, others, more pragmatic, say we have to know some correct surgeries and to adapt the procedure to the patient's characteristics (one-two performing tissue procedures, one or two prosthetic procedures and optionally, one laparoscopic procedure). After 1990, the concept of "no tension" (tension-free) appeared, and also the prosthesis procedure widely appeared, with a dramatic decrease of the recurrence rates (1-2%). Nowadays, open and laparoscopic surgeries are practically used. The predictions of laparoscopy partisans ("Velvet surgery") who hoped in 1992 for a monopoly, did not come true. The extrapolation with laparoscopic cholecystectomy was hazardous. Open surgeries still dominate the hernial primary therapeutic (being simple, efficient, easy reproducible, inexpensive, of a low scale, with rare complications). The laparoscopic "Tsunami" of biliary surgery has not disorientated the hernial open surgery. The tension in the suture line has been widely recognized as an essential aetiologic element in the hernial recurrence. Although Usher introduced the polypropylene mesh in 1959, allowing the "no tension" hernioplasty, the merit to popularize the concept of "tension-free", he used in all patients with inguinal hernia a polypropylene mesh large enough to cover the even the exceed the margins of the posterior wall of the inguinal canal and created a new internal hole so that the spermatic cord to pass through the prosthesis. Historically, the hernia cure was done by a tissue suture procedure which created a tissue tension and was associated with a relatively high rate of recurrence. However, the technical improvements and development of a variety of new prosthetic materials to reinforce the raffia have revolutionized and improved the patients outcomes. The recent advances on the technique and devices to repair the injuries of the abdominal wall are more numerous than most doctors realize. In about 60% of the alloplastic belts of inguinal hernia there are used certain types of flat mesh, and for the remaining 40% there are used stopper-type devices or mesh-stopper combined systems. In addition, 90% of the eventration belts incorporate the use of a prosthetic material. The inguinal hernia cure by tissue processes is yet still used in about 10% -15% of cases. However, most hernia belts used this day involve the use of a synthetic prosthetic biomaterial of mesh-type, stopper or newer versions of these devices. Some of these procedures, about 15% are laparoscopic, although the relative merits of the open techniques versus laparoscopy remain the centre of the clinical and economic debates. Currently, general surgery has access to a wider and more sophisticated range of synthetic biomaterials to be used in the hernial cure than at any other time. The advantages and disadvantages of each of these devices must be understood before choosing any of the implants. The polypropylene mono-filament meshes are preferred for the hernia procedures. - The poli-filament meshes may anchor bacteria among their many fibers, where the leukocytes (white cells) can not penetrate. This can cause infections and as a result it may be necessary to replace the mesh. - Gor-Tex has too small pores, of about 10 m. The bacteria have less than 10 m in size and can pass through pores. On the other hand, leukocytes are larger than 10 m and are unable to penetrate, this can also lead to infections and mesh replacement. - All above materials are inert in the human body, are not reabsorbable, quickly become attached and incorporated into the host tissue and are resistant to infections. So, polypropylene mono-filament meshes are the most resistant to infections. Complications caused by the materials used in hernia surgery - The contact with the intestines and other abdominal viscera must be avoided when using polypropylene meshes of any kind. When placed in contact with the intestine, the mesh can join. This can lead to intestinal obstruction, migration (erosion) of the mesh in the intestinal lumen and intestinal fistula formation. - Gor-Tex and the composed meshes are the only materials that can be placed in contact with the intestines or viscera. However, Gor-Tex has potential for the complications described above, and the efficiency of the compound meshes has not been substantiated by clinical studies. Once the absorbent layer has disappeared, the risk of complications is the same with the other meshes. - The less rigid meshes may tend to fold when implanted in the human body. This folding can cause complications such as hematomas, infections and even recurring. - In the medical literature it was documented by Dr. Amid of Lichtenstein Hernia that the polypropylene meshes, after a while in the human body, will shrink at a rate of 20%. This can lead to serious problems. - Many other complications may occur due to surgical technique and / or surgeon's skill. Herniamesh Products All Herniamesh products are CE certified and approved by the FDA. They are suitable for surgery procedures in abdominal wall hernias and thorax injuries. It was said in the medical literature by Dr. Amid of Lichtestein Hernia Institute that surgical polypropylene meshes, after the implantation in the human body, will shrink at a rate of 20%. - This documentation does not include Herniamesh products - A recent study conducted in Italy by Dr. Petruzzelli, shows that Herniamesh meshes do not shrink in the human body. The patients that were applied steel clamps on the mesh underwent radiographies, made at different times. Even at four months after the surgery there has not been recorded any contraction of the meshes. - This is a significant finding, because if a mesh contracts, it has an increased risk for recurrence. Herniamesh products have a dimensional stability of the superior surface (see the references to "controlled memory" in medical literature). - When Herniamesh mesh is rolled or folded (which is made in laparoscopic surgery), once it is released, it will return to its original shape. - The dimensional stability is created to facilitate the placement in the human body. It can also reduce the risk of an inappropriate distribution of the mesh tensions due to the sutures. This is determined by its tendency to be stretched. - If a mesh is not stretched in the human body, it can cause complications such as infections and hematomas. - Fewer complications result in a reduced discomfort for patients, shorter periods of hospitalization and fewer days of absence from work. - Herniamesh mesh is always packed in a flat shape, for easier handling. All Herniamesh products have been designed by a surgeon* just to ensure their physical and structural ideal features, such as the ideal design for the preformed models. - Herniamesh models are based on important structural features, porosity, resistance to stretching and suture retention. - All Herniamesh meshes perfectly fit in the ideal scope of porosity (200 -50 µm). This allows a complete fibroblastic infiltration, essential for a complete cure. - All Herniamesh meshes have a good suture retention and resistance to stretching, which are necessary for a guaranteed strengthening of the injury. - The preformed models save surgeon's time and reduce the risk of a possible contamination. When a mesh is cut into the OR, the risk of contamination increases, which results in a post-surgical infections. Also, some meshes tend to "run" (apart) if they are cut with the scissors. - All preformed Herniamesh meshes are protected by patents. Other companies may have similar models, but which do not have the rigidity of Herniamesh models. This rigidity is required for the hernioplasty of Trabucco-type. - No other company can not legally sell pads similar to Herniamesh pads. They are protected by patents. - It was written in the medical literature that "free floating pads" are associated with complications such as migration and blood vessel compression. - Herniamesh pads are not free to float, they have edges. This helps to strengthen the area around the injury. Of the information available, it was not reported any complication associated with using Herniamesh pads. All the Specialties HELIOS MEDICAL CENTRE Internal Medicine Gastroenterology Family Medicine Industrial Medicine Allergology Pulmonology Cardiology Interventional Cardiology BP Monitoring, ECG, Holter Endocrinology Dermatology Orthopaedics Obstetrics-Gynaecology Doppler Sonography Ophthalmology E.N.T. 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