Inflammatory markers following laparoscopic and open hernia repair Tension-free hernia repair is associated with an increase in inflammatory response markers against the mesh. Systemic inflammatory response after endoscopic (TEP) vs Shouldice groin hernia repair Impact of Heavy Polypropylene Mesh and Composite Light Polypropylene and Polyglactin 910 on the Inflammatory Response Impact of Different Texture of Polypropylene Mesh on the Inflammatory Response Coagulation, inflammatory, and stress responses in a randomized comparison of open and laparoscopic repair of recurrent inguinal hernia Systemic inflammatory response after Kugel versus laparoscopic groin hernia repair: a prospective randomized trial Cytokine modifications after tension-free hernioplasty or open conventional inguinal hernia repair. Tackers versus glue mesh fixation: an objective assessment of postoperative acute and chronic pain using inflammatory markers Improving operative performance using a laparoscopic hernia simulator. Systemic stress responses after laparoscopic or open hernia repair. A randomized, double-blind, placebo-controlled trial to determine effectiveness of antibiotic prophylaxis for tension-free mesh herniorrhaphy. The use of small intestine submucosa in the repair of paraesophageal hernias: initial observations of a new technique. Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study. Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study. Reduced acute phase response after laparoscopic total extraperitoneal bilateral hernia repair compared to open repair with the Stoppa procedure A 5-Year Clinical Experience With Single-Staged Repairs of Infected and Contaminated Abdominal Wall Defects Utilizing Biologic Mesh
Laparoscopic surgery may reduce the inflammatory response to surgery by the avoidance of a skin incision which is frequently the site of maximum tissue trauma . We hypothesized that the inflammatory response is less with minimally invasive procedures . The aim of this study was to evaluate the response of inflammatory mediators following laparoscopic and open hernia repair . Thirty-four patients undergoing unilateral primary inguinal hernia repair were prospect ively assigned to either laparoscopic mesh hernia repair ( n=14 ) , open mesh hernia repair ( n=11 ) , or a Bassini repair ( n=9 ) . Serum sample s withdrawn prior to surgery , 6 h after surgery , and then again at 24 h after surgery were assayed for interleukin-6 and C-reactive protein content . Interleukin-6 levels at 24 h in the laparoscopic ( 13.1±3.1 pg/ml ) , open mesh ( 15.5±2.5 pg/ml ) , or Bassini group ( 15.4±2.0 pg/ml ) did not differ significantly . Neither did C-reactive protein levels at 24 h in the laparoscopic ( 12.4±2.7 pg/ml ) , open mesh ( 23.0±7.8 pg/ml ) , or Bassini group ( 18.6±6.6 pg/ml ) differ significantly . The response of inflammatory mediators to hernia repair is not modified by undertaking the procedure laparoscopically BACKGROUND The purpose of this study was to evaluate the involvement of inflammatory mediators in patients undergoing Lichtenstein tension-free hernioplasty ( LH ) using polypropylene prosthetic material s or conventional Bassini hernia repair ( BH ) .  METHODS Thirty patients male with unilateral inguinal hernia without complications or recurrence were included in this study . R and omly , patients underwent LH or BH .  Peripheral venous bloods sample s were collected 24 hours prior to surgery and then 6 , 24 , 48 and 168 hours postoperatively . RESULTS We present evidence s that LH patients showed a higher increased serum level of fibrinogen , C-reactive protein , alpha-1-antitrypsin , and interleukin-6 than BH patients . Postoperative visual analogue scales for pain were reduced on mobilization for patients undergoing LH compared with BH . Neutrophils were significantly increased only in LH compared with baseline . Ceruloplasmin , transferrin , and albumin levels were unmodified after BH or LH . CONCLUSIONS In conclusion our data show that although LH induces less pain and more rapid postoperative recovery , it is associated with an higher inflammatory response compared with BH , likely due to polypropylene mesh Endoscopic techniques are commonly used for many different types of surgery . It is cl aim ed that videoendoscopic procedures have the advantage of being less traumatic and of offering higher postoperative patient comfort than conventional open techniques . The extent of tissue trauma can be evaluated on the basis of the inflammatory response observed in the wake of surgery . Available studies that have compared endoscopic and conventional techniques suggest that endoscopic cholecystectomy , laparoscopic colorectal resection , and thoracoscopic pulmonary resection have immunologic advantages over conventional approaches . The objective of this prospect i ve study was to determine whether endoscopic hernia repair techniques are also preferable to conventional procedures and to what extent the anesthetic technique ( local or general anesthesia ) influences the postoperative inflammatory response . For this purpose , biochemical monitoring of cytokine activity [ C-reactive protein ( CRP ) , prostagl and in F1α ( PGF1α ) , neopterin , interleukin-6 ( IL-6 ) ] was done prospect ively in 101 patients [ totally extraperitoneal approach ( TEP ) n=32 , unilateral n=12 , bilateral n=20 ; Shouldice n=69 , local anesthesia ( LA ) n=23 , general anesthesia ( GA ) n=46 ] before and until 3 days after surgery . The parameters IL-6 and PGF1α suggested that the immune trauma immediately after surgery was significantly higher in the group of patients with endoscopic hernia repair than in the group of patients who received a Shouldice repair . No significant differences were observed after the first postoperative day . A comparison between the TEP group and the patients who received conventional surgery under local anesthesia showed that the TEP approach was also associated with a higher postoperative neopterin level . Within the first 3 days after surgical intervention , bilateral endoscopic hernia repair induced no significantly higher inflammatory response than the surgical treatment of unilateral conditions . The anesthetic procedure that was used in the Shouldice operation had no significant effect on inflammatory response . Unlike other types of endoscopic surgery , the repair of groin hernias using an endoscopic technique can not be regarded as a minimally invasive procedure that is less traumatic than conventional approaches . Instead , the conventional Shouldice procedure appears to cause the lowest inflammatory response and to be the least traumatic approach to hernia repair , especially when it is performed under local anesthesia The aim of the study was to analyze the acute inflammatory response after implantation of a heavyweight mesh of polypropylene ( PP ) compared with a composite mesh of light PP and polyglactin 910 ( PG ) in patients undergoing inguinal hernioplasty . A total of 30 male patients with inguinal hernia were included in the study and divided into 2 groups ( PP and PP-PG ) according to the mesh used . Changes of leukocytes , cytokines , growth factors , and acute phase proteins were evaluated in the sera . Leukocytes and acute phase proteins were significantly increased postoperatively in both groups , and the values were slightly higher in the PP group . Cytokine levels were significantly increased postoperatively in both groups ; a slight increase was observed in the PP-PG group , especially for the proinflammatory cytokine . Growth factors decreased significantly in both groups immediately after surgery . The authors found that the use of the mesh is a stimulator of inflammatory response , and the 2 types of mesh induce a similar inflammatory response Over the past decade , hernia surgery has undergone a considerable transformation with the use of prosthetic material s. The most used polypropylene meshes induce a rapid acute inflammatory response followed by chronic foreign body reaction . Many factors influence this response such as density , size , physical characteristics , different texture and porosity of each bio material . The aim of this study is to assess whether the implant of monofilament or multifilament meshes , in the inguinal hernioplasty , determine a different inflammatory response .  Thirty-two male patients were included in the study and were r and omly divided into two groups . In the first group ( MO ) inguinal hernioplasty was performed using monofilament polypropylene mesh , while in the second one ( MU ) multifilament prosthesis was used . Peripheral venous blood sample s were collected 24 hours before surgery and then 6,24,48 and 168 hours posto-peratively . Modifications in leukocyte count , C-reactive protein ( CRP ) , alpha-1 antitrypsin ( α1-AT ) , interleukin (IL)-1 , IL-6 , IL-1 ra and IL-10 serum levels were recorded at all sampling times . We present evidence that serum levels of CRP , ( α1-AT ) , leukocytes and cytokines were significantly increased post-operatively in both groups , returning to basal values 168 hours afterwards . In particular , the production of all pro-inflammatory mediators was higher in the MU group , whereas the anti-inflammatory cytokine ( IL-10 , IL-1ra ) production was higher in MO patients . Our results indicate that polypropylene multifilament mesh allows a higher intense acute inflammatory response as compared to monofilament mesh implantation Background In previous comparisons of inflammatory and stress responses to open ( OR ) and laparoscopic ( LR ) hernia repair , all operations were performed under general anesthesia . Since local anesthesia is widely used for OR , a comparison of this approach with LR seemed relevant . Methods Patients with recurrent inguinal hernia were r and omized to OR under local anesthesia ( n = 30 ) or LR under general anesthesia ( n = 31 ) . The magnitude of the surgical trauma was assessed by measuring markers of coagulation ( prothrombin fragment 1 + 2 ) , endothelial activation ( von Willebr and factor ) , inflammation [ leukocytes , interleukin-6 , -8 and -10 , granulocyte macrophage colony-stimulating factor , and C-reactive protein ( CRP ) ] , and endocrine stress ( cortisol ) in blood collected before operation , 4 h postincision , and on postoperative day 2 . Results Leukocyte counts and interleukin-6 and CRP levels increased in both groups , with the CRP increase being significantly greater in the OR group . The other markers did not increase significantly . Conclusion The acute phase response was more pronounced after OR , even when this was done under local anesthesia . Both techniques seemed rather atraumatic Background Kugel repair , a minimally invasive technique , has become an alternative to laparoscopic groin hernia repair , but the technique has not been adequately evaluated by assessment of objective parameters . A prospect i ve r and omized clinical study was carried out to compare the systemic inflammatory response to surgical trauma and clinical outcomes in patients who underwent groin hernia repair by the Kugel and totally extraperitoneal ( TEP ) laparoscopic methods . Methods Forty consecutive patients admitted for unilateral groin hernia were r and omized to Kugel ( n = 20 ) or TEP ( n = 20 ) repair under general anesthesia .  Operation time , length of hospital stay , pain severity , time to return to normal activities , cost , and systemic inflammatory and hormone responses to surgical trauma were compared . Results There were no significant between-group differences in duration of operation , length of hospital stay , time to return to normal activities , or mean visual analogue scale ( VAS ) score ( p > 0.05 for each ) . Serum cortisol , high-sensitivity C-reactive protein ( hsCRP ) , and interleukin (IL)-6 concentrations before surgery , and 1 and 24 h after surgery , did not differ significantly in the two groups ( p > 0.05 ) . There were no recurrences or complications during follow-up . Cost per patient was US $ 546 lower in the Kugel group . Conclusion Kugel herniorrhaphy is a minimally invasive technique that offers all the advantages of TEP and is more cost-effective BACKGROUND The purpose of this study was to evaluate the involvement of proinflammatory cytokines ( interferon-gamma [ INF-gamma ] , interleukin [IL]-6 ) and anti-inflammatory cytokines ( IL-4 , IL-l0 , IL-13 ) in patients undergoing Lichtenstein tension-free hernioplasty ( LH ) using polypropylene prosthetic material s  or conventional Bassini hernia ( BH ) repair . METHODS Thirty-five male patients ( age range 25 to 60 years ) with unilateral inguinal hernia without complications or recurrence were included in this study . R and omly , patients underwent conventional operation and had their inguinal hernia repair performed with polypropylene mesh . Peripheral venous blood sample s were collected 24 hours prior to surgery and then 6 , 24 , 48 , and 168 hours postoperatively . Fifteen healthy controls were included . RESULTS We present evidence that LH patients showed both an increased serum level of Thelper 1 (Th1)-like cytokines ( IFN-gamma ) and an increase in Thelper 2 (Th2)-like cytokines ( IL-6 and IL-l0 ) , associated with a slight reduction of peripheral blood mononuclear cells ( P BMC ) producing IL-6 and a normal level of P BMC producing IFN-gamma , IL-l0 , IL-13 , and IL-4 . Whereas BH patients showed in part an amplification of Th2-like cells , characterized by the sustained serum production of IL-6 and IL-l0 , associated with an increase in IL-l0 secreted by in vitro stimulated PMBC . CONCLUSIONS Our data show that LH is associated with a higher production of inflammatory cytokines ( IFN-gamma and IL-6 ) compared with BH , likely induced by the presence of the polypropylene prostheses Purpose Laparoscopic hernioplasty has become a popular choice for inguinal hernia repair since its advent in 1990s . Postoperative pain is an undesirable clinical outcome impairing daily activity of 22.5 % of patients . The aim of this study is to evaluate postoperative acute and chronic pain via inflammatory markers as an objective assessment following tacks or glue mesh fixation in TEP repair . Methods Sixty-six ( 66 ) patients with unilateral uncomplicated inguinal hernia were r and omized into 34 patients in the tacker and 32 patients in cyanoacrylate glue mesh fixation in TEP repair . The extent of surgical trauma was evaluated by measuring inflammatory markers of C-reactive protein , white blood cell count at 48 h , and ESR at 3 months postoperatively . Postoperative acute and chronic pain was assessed by recording the visual analogue scale scores and surgical complications were recorded over 3 months of the study period . Results The median CRP and WBC levels at postoperative 48 h in both groups raised significantly from the baseline values ( p < 0.05 ) , however , did not differ significantly between the two study groups at 48 h ( p > 0.05 ) . The median ESR level increased significantly at 3 months postoperatively from baseline in the glue mesh fixation group only ( p < 0.05 ) , however , did not differ significantly between the two study groups ( p > 0.05 ) . There was no significant difference for VAS scores at all timelines between the tacker and glue mesh fixation group ( p > 0.05 ) . Conclusion Cyanoacrylate glue mesh fixation technique as an alternative method to mechanical fixation in TEP repair is comparable to tacker and can be considered to be safe and feasible BACKGROUND Traditionally , the acquisition of surgical skill has occurred entirely in the operating room . To meet the exp and ing challenges of cost containment and patient safety , novel methods of surgical training utilizing ex-vivo workstations are being developed . The purpose of our study was to evaluate the impact of a laparoscopic training curriculum on surgical residents ' operative performance . METHODS Twenty-one surgery residents completed baseline laparoscopic total extraperitoneal ( TEP ) hernia repairs .  Operative performance was evaluated using a vali date d global assessment tool . Each resident was then r and omized to a control group or a trained group . A CD ROM , video , and simulator were used for training . At the end of the study , each resident 's operative performance was again evaluated . RESULTS Improvement was significantly greater in the trained group in five of the eight individual global assessment areas as well as the composite score ( P < 0.05 ) . Question naire data suggested that training result ed in improved underst and ing of the TEP hernia repair ( P = 0.01 ) and an increased willingness to offer the operation to patients with nonrecurrent unilateral hernias ( P = 0.02 ) . CONCLUSIONS A multimodality laparoscopic TEP hernia curriculum improves residents ' knowledge of the TEP hernia repair and comfort in performing the procedure , and may also improve actual operative performance OBJECTIVE To compare systemic stress responses after  laparoscopic  and  open hernia repair  to find out if the laparoscopic approach caused less stress than an open operation . DESIGN Prospect i ve r and omised trial . SETTING Teaching hospital , Sanliurfa , Turkey . SUBJECTS 50 patients who required preperitoneal hernia repair were r and omised to be treated by either the open or laparoscopic approach ( n = 25 in each ) . INTERVENTIONS Sample s of venous blood were taken before operation and at 2 , 24 , and 48 hours afterwards for measurement of the concentrations of : glucose , cortisol , malonyldialdehyde ( MDA ) , C-reactive protein ( CRP ) , creatine phosphokinase ( CPK ) , caeruloplasmin , transferrin , fibrinogen , and albumin , and counts of leucocytes , neutrophils , and lymphocytes . MAIN OUTCOME MEASURES Changes in these indicators of a stress response . RESULTS Concentrations of glucose , cortisol , CRP , MDA , and CPK , and counts of leucocytes and neutrophils increased significantly , and the concentration of albumin decreased significantly , in both groups postoperatively . Lymphocyte counts were lower postoperatively but not significantly so . Concentrations of CRP , MDA , and CPK , and leucocyte counts were significantly lower in the laparoscopic group . CONCLUSION These findings suggest that there is less systemic stress response after laparoscopic than after open hernia repair BACKGROUND In recent years , use of prosthetic material for inguinal hernia repair has increased dramatically . Tension-free repairs have gained popularity not only for recurrent or complicated hernias , but for primary hernia repairs as well . Although routine use of prophylactic antibiotics is not recommended in the Philippines for open nonimplant herniorrhaphy , there is little direct clinical evidence on which to base recommendations when implantable mesh is used . STUDY DESIGN We conducted a prospect i ve , r and omized , double-blind , placebo-controlled trial comparing  wound infection rates in 360 patients ( 180 received prophylactic antibiotics , 180 received a placebo ) undergoing primary inguinal hernia repair electively using polypropylene mesh .  Age , gender , American Society of Anesthesiologists class , type of hernia , type of anesthesia , and duration of operation were recorded . Infections were evaluated 1 week , 2 weeks , and 1 month after operation by an independent surgeon . All complications were recorded . Results were assessed using chi-square , Fisher 's exact test , and Student 's t-tests as appropriate . RESULTS Groups were well matched for all preoperative variables studied , including comorbid conditions . Six patients from the antibiotic group and four from the placebo group failed to followup after the second week . Superficial surgical site infection developed in 3 patients ( 1.7 % ) from the antibiotic group and 6 ( 3.3 % ) from the placebo group ( p = 0.50 ) . One from each group developed deep surgical site infection . Both patients were readmitted and underwent repeated debridement , which eventually result ed in graft loss . CONCLUSIONS Preoperative administration of single-dose antibiotic for tension-free inguinal mesh herniorrhaphy did not markedly decrease risk of wound infection in this patient population . Our results do not support use of antibiotic prophylaxis for tension-free mesh herniorrhaphy BACKGROUND Recent reports suggest that when laparoscopy is used to repair paraesophageal hernias recurrence rates reach 20 % to 40 % . Tension-free hernia closure with synthetic mesh reduces recurrence but occasionally results in esophageal injury . We hypothesized that reinforcement of the hiatal closure with small intestine submucosa ( SIS ) mesh , in some unusually large hernias , might reduce recurrence rates without causing injury to the esophagus . METHODS From January 2001 to March 2002 we treated 18 large paraesophageal hernias via a laparoscopic approach .  In 9 of the largest hernias ( one type II and 8 type III , of which 1 was recurrent ) the repair was reinforced with SIS mesh ( Surgisis , Cook Surgical ) and represent the subjects of this study .  Nissen fundoplication with gastropexy was performed in all patients . Clinical follow-up ranged from 3 to 16 months ( median 8) . Every patient was evaluated with barium esophagram or endoscopy or both 1 to 8 months ( median 2 ) postoperatively . RESULTS The presenting symptoms were postpr and ial pain/fullness ( 9 of 9 ) , heartburn ( 4 of 9 ) , anemia ( 4 of 9 ) , dysphagia ( 3 of 9 ) , regurgitation ( 3 of 9 ) , and chest pain ( 3 of 9 ) . One patient died of a hemorrhagic stroke within 30 days of the operation . Postoperatively , presenting symptoms resolved ( 83 % ) or improved ( 17 % ) in each of the remaining 8 patients . One patient required endoscopic dilation for mild dysphagia .  Seven of 8 patients had a normal barium esophagram without evidence of hernia . One morbidly obese ( body mass index = 47 ) patient had a small ( 2 cm ) sliding hiatal hernia postoperatively . There were no other complications , and specifically no perforations or mesh erosions . CONCLUSIONS These observations suggest that the use of SIS in the repair of paraesophageal hernias is safe and may reduce recurrence . Longer follow-up and a r and omized study are needed to vali date these results UNLABELLED By Evidence Based Medicine ( EBM ) principles , several meta-analyses concluded that use of mesh is superior to the non-mesh operations in inguinal hernia surgery . Wound infection is a potential complication of all hernia repairs and deep-seated infection involving an inserted mesh may result in chronic groin sepsis . In the event of incarcerated or strangulated hernias , however ; placement of prosthetic material is presumed to increase that risk of infection . AIM Aim of the study is to compare the outcome of tension-free mesh repair to Bassini technique used to treat strangulated inguinal hernia . PATIENTS AND METHODS In the period from May 2004 to December 2006 , 54 patients were su bmi tted to emergency operation because of strangulated inguinal hernia . The patients were r and omized into two groups ( 27 patients in each group ) . Group A patients underwent open tension-free anterior repair utilizing a monofilament polypropylene mesh according to Lichtenstein " tension-free " technique , whereas group B patients underwent Bassini technique . Mesh hernioplasty was not attempted in patients with preoperative peritonitis , inflammatory hernia and for those in whom bowel resection was perfumed for ischemic necrosis caused by strangulated inguinal hernia and they were excluded from the study . Assessment of the primary outcome included surgical complications and hospital stay and secondary outcome was the recurrence of hernia . RESULTS Postoperative complication rate did not differ significantly between the two groups . Postoperative hospital stay was also significantly longer in group B compared to group A ( 5+/-3.4 days versus 3+/-2.1 days , p<0.01 ) . During the follow-up , ( mean 22+/-6months ) , three patients had recurrence after Bassini operation ( group B ) , but there was no recurrent hernia after mesh herniorrhaphy ( group A ) ( 0/27=0 % versus 3/27=7 , 11.1 % , p<0.001 ) . CONCLUSION The use of Lichtenstein " tension-free " technique in emergency treatment of strangulated inguinal hernia is safe , effective with an acceptably low rate of postoperative complications and without recurrence OBJECTIVE To see if the inflammatory responses during and after laparoscopic and open inguinal hernia repairs differed . DESIGN R and omised prospect i ve study . SETTING County hospital , Denmark . PATIENTS 18 men aged 25 - 77 years with unilateral inguinal hernias . INTERVENTIONS Ten patients had a laparoscopic repair and 8 an open tension-free repair .  MAIN OUTCOME MEASURES Serum concentrations of interleukin (IL)-2 receptors ( R ) of the alpha group ( IL-2Ralpha ) , IL-6 , anti-IL-6 , IL-10 , tumour necrosis factor (TNF)-alpha , sTNF-RI and sTNF-RII before and 2 , 6 , 12 , and 24 hours after the repairs . Duration of operation and time for return to normal activities or work were also recorded . RESULTS Serum IL-6 concentrations increased significantly after operation in both groups ( p < 0.0001 ) , but the increase was significantly higher after open than after laparoscopic surgery at all sampling times ( p = 0.00 ) at 6 hours postoperatively ) . Anti-IL-6 and IL-10 remained undetectable at all time points . There were no significant differences or increases in the concentrations of TNF-alpha or sTNF-RII . However , sTNF-RI concentrations increased significantly in both groups ( p < 0.001 ) though there was no difference in between the two groups . IL-2Ralpha decreased significantly in both groups ( p < 0.01 ) with no differences between the groups . The median operation time was 85 min ( range 55 - 100 min ) in the laparoscopic group and 52 min ( range 45 - 79 min ) in the " open " group ( p < 0.01 ) . Median time to return to normal activities/work were 2 and 13 days after laparoscopic and open operations , respectively ( p < 0.01 ) . CONCLUSION The surgical trauma of laparoscopic inguinal hernia repair is less than that of open tension-free hernia operations as assessed by circulating mediators of the postoperative inflammatory response . The clinical relevance of this finding must be evaluated in larger r and omised studies Background : Although  laparoscopic hernia repair  has been shown to be associated with less postoperative pain and an earlier recovery , there is still controversy about its role in hernia surgery . In general , laparoscopy produces less trauma to tissues than open surgery . This has been reflected by the reduced acute phase inflammatory response observed after laparoscopic surgery compared to open surgery in various setting s , such as cholecystectomy or hysterectomy . The aim of this study was to evaluate the acute phase response after bilateral hernia repair by comparing the open Stoppa procedure with the laparoscopic totally extraperitoneal prosthetic repair ( TEPP ) . Methods : Patients were r and omly allocated to either technique after written informed consent was obtained . Measurements were made of complete blood count , erythrocyte sedimentation rate ( ESR ) , C-reactive protein ( CRP ) , interleukin-1b ( IL-1b ) , IL-6 , and tumor necrosis factor-a ( TNF-a ) preoperatively and 4 , 24 , and 48 h postoperatively . VAS pain scores , consumption of analgesics , and delay before resumption of normal activities were also recorded . All the procedures were performed under general anesthesia by or in the presence of the same surgeon . Results : Thirty-nine patients were included : 19 underwent the Stoppa procedure and 20 had a laparoscopic repair .  The two groups were well matched for age , sex , ASA score , and preoperative values . The operation took longer ( p < 0.001 ) in the group undergoing TEPP . Patients resumed their normal activities earlier ( p < 0.05 ) after laparoscopy . In the open group , there was a larger decrease of the lymphocyte count after 4 ( p < 0.01 ) and 24 h ( p = 0.04 ) ; an increased elevation of ESR after 48 h ( p = 0.02 ) ; a larger increase of IL-6 after 4 ( p = 0.05 ) , 24 ( p = 0.003 ) , and 48 h ( p < 0.001 ) ; and a larger increase in CRP after 24 ( p = 0.05 ) and 48 h ( p = 0.01 ) . There was no morbidity . There was no difference in postoperative IL-1b , TNF-a , total white blood cell count , polymorphonuclear count , VAS for pain , or need for analgesics between the two groups , except on the operative day . Conclusions : The acute phase inflammatory response in clearly more active after the open Stoppa procedure than after TEPP , indicating that the former is associated with increased tissue trauma . This may play a role in the earlier recovery seen after the TEPP procedure Objective : Our objective was to evaluate the safety and durability of biologic mesh for single-staged reconstruction of contaminated fields . Introduction : The presence of contamination during  ventral hernia repair ( VHR ) poses a significant challenge . Some advocate for a multistaged reconstructive approach with delayed definitive repair , whereas others perform definitive repair at the initial operation . Methods : Patients undergoing single-staged VHR in a contaminated field with biologic mesh over a 5-year period were retrospectively review ed from a prospect ively maintained data base . Outcome measures included wound complication and hernia recurrence . Results : A total of 128 patients ( 76 F , 52 M ) were identified , with a mean age of 58.2 years , mean American Society of Anesthesiologist ( ASA ) score 3.1 , and mean body mass index ( BMI ) 34.1 ± 9.7 kg/m2 . Comorbidities included COPD ( n = 29 ) , diabetes ( n = 65 ) , smoking ( n = 29 ) , and immunosuppression ( n = 8)  . Mean hernia defect size was 431 cm2 ( range 40–2450 cm2 ) . Reasons for contamination included the presence of infected mesh ( n = 45 ) , stoma ( n = 24 ) , concomitant gastrointestinal ( GI ) surgery ( n = 17 ) , enterocutaneous fistula ( n = 25 ) , open nonhealing wound(s ) ( n = 6 ) , enterotomy/colotomy ( n = 5 ) , and chronic draining sinus ( n = 6 ) . Postoperative wound complications were identified in 61 ( 47.7 % ) patients . Predictors of wound complications included ASA score , diabetes , smoking , number of previous abdominal surgeries or hernia repairs , hernia defect size , and operative time . With a mean follow-up time of 21.7 months , hernia recurrence was identified in 40 ( 31.3 % ) patients . The majority of recurrent hernias were asymptomatic and 7 patients underwent repair . Conclusions : Despite the high rate of wound morbidity associated with single-staged reconstruction of contaminated fields , it can safely be performed with biologic mesh reinforcement . Although biologic mesh in these situations is safe , the long-term durability seems to be less favorable
The systemic inflammatory response was normalized before or on the seventh postoperative day .
Conclusions Hernia repair elicits a systemic inflammatory response characterized by an increase in CRP , IL-6 , leukocytes , neutrophils , IL-1 , IL-10 , fibrinogen , and α1-antitrypsin and a decrease in lymphocytes and albumin .
A higher inflammatory response was found after mesh repair compared with non-mesh repair and after open mesh repair compared with laparoscopic mesh repair
Purpose All surgical procedures elicit a complex systemic inflammatory response effectuated and modulated by cytokines .
The purpose of this systematic review was to present an overview of the inflammatory response and the serum markers associated with hernia repair and to compare the response between patients treated with and without mesh .