Dataset Information

Dynamic Responsive Inguinal Scaffold Activates Myogenic Growth Factors Finalizing the Regeneration of the Herniated Groin.

ABSTRACT:

Background

Postoperative chronic pain caused by fixation and/or fibrotic incorporation of hernia meshes are the main concerns in inguinal herniorrhaphy. As inguinal hernia is a degenerative disease, logically the treatment should aim at stopping degeneration and activating regeneration. Unfortunately, in conventional prosthetic herniorrhaphy no relationship exists between pathogenesis and treatment. To overcome these incongruences, a 3D dynamic responsive multilamellar scaffold has been developed for fixation-free inguinal hernia repair. Made of polypropylene like conventional flat meshes, the dynamic behavior of the scaffold allows for the regeneration of all typical inguinal components: connective tissue, vessels, nerves, and myocytes. This investigation aims to demonstrate that, moving in tune with the groin, the 3D scaffold attracts myogenic growth factors activating the development of mature myocytes and, thus, re-establishing the herniated inguinal barrier.

Methods

Biopsy samples excised from the 3D scaffold at different postoperative stages were stained with H&E and Azan-Mallory; immunohistochemistry for NGF and NGFR p75 was performed to verify the degree of involvement of muscular growth factors in the neomyogenesis.

Results

Histological evidence of progressive muscle development and immunohistochemical proof of NFG and NFGRp75 contribution in neomyogenesis within the 3D scaffold was documented and statistically validated.

Conclusion

The investigation appears to confirm that a 3D polypropylene scaffold designed to confer dynamic responsivity, unlike the fibrotic scar plate of static meshes, attracts myogenic growth factors turning the biological response into tissue regeneration. Newly developed muscles allow the scaffold to restore the integrity of the inguinal barrier.

SUBMITTER: Amato G

PROVIDER: S-EPMC9680268 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Publications

Dynamic Responsive Inguinal Scaffold Activates Myogenic Growth Factors Finalizing the Regeneration of the Herniated Groin.

Amato Giuseppe G Romano Giorgio G Rodolico Vito V Puleio Roberto R Calò Pietro Giorgio PG Di Buono Giuseppe G Cicero Luca L Romano Giorgio G Goetze Thorsten Oliver TO Agrusa Antonino A

Journal of functional biomaterials 20221118 4

<h4>Background</h4>Postoperative chronic pain caused by fixation and/or fibrotic incorporation of hernia meshes are the main concerns in inguinal herniorrhaphy. As inguinal hernia is a degenerative disease, logically the treatment should aim at stopping degeneration and activating regeneration. Unfortunately, in conventional prosthetic herniorrhaphy no relationship exists between pathogenesis and treatment. To overcome these incongruences, a 3D dynamic responsive multilamellar scaffold has been ...[more]

PMID: 36412894

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Project description:Laparoscopic TAPP/TEP approaches are well-established options for the cure of inguinal hernias. As in the open approach, mesh fixation and poor-quality biologic response represent controversial questions and are a source of concerns. Furthermore, hernia defect patency represents another problem which seems not well acknowledged among surgeons. These problems are considered the cause of frequent intra and postoperative complications. To overcome these concerns, recently a different concept of cure has emerged. Based on a newly developed dynamic responsive 3D scaffold named ProFlor, a permanent hernia defect obliteration has been finalized. Following its inherent centrifugal expansion due to its dynamic responsivity, this hernia device is positioned fixation free within the defect and induces a probiotic biological response allowing for the re-establishment of the degenerated inguinal barrier. A laparoscopic approach with the 3D scaffold has been tested on 71 patients to demonstrate its effectiveness in reducing intra and postoperative complications. The operated patients presented with bilateral and/or recurrent inguinal hernia. Overall, 122 hernia defects were obliterated with 119 dynamic responsive scaffolds. The procedures were carried out from January 2018 to January 2022 with a defined protocol and detailed procedural steps. The laparoscopic technique with the 3D hernia scaffold allowed for fixation free placement, permanent defect obliteration and dynamically induced regenerative effects. The technique proved effective in reducing intra and postoperative complications. In particular, early postoperative pain and discomfort significantly decreased. No chronic pain and no recurrences were reported during follow up. The results achieved with the described laparoscopic technique seem to embody an innovative concept for inguinal hernia repair. Fixation free, dynamic responsive, permanent defect obliteration, histologically proven regenerative effects are the distinctive features of this 3D scaffold. It seems to embody a more physiological and pathogenetically coherent concept of cure, thus improving treatment results of this widespread disease.

Project description:ObjectivesTo evaluate the interexaminer reliability of abdominal palpation and resistance tests in athletes with longstanding groin pain, and to identify the prevalence of positive clinical tests in athletes classified with inguinal-related groin pain.MethodsMale athletes (18-40 years) with longstanding groin pain were prospectively recruited between March 2019 and October 2020 at a sports medicine hospital. Two examiners performed history taking and standardised clinical examination (including abdominal palpation, scrotal invagination and abdominal resistance tests) blinded to each other's findings. Interexaminer reliability was calculated using Cohen's Kappa statistic (κ). Examiners classified groin pain using the Doha agreement meeting terminology. A differentiation was made between 'defined inguinal-related groin pain' (according to recommended definition criteria) and 'likely inguinal-related groin pain' (expert-based application of the Doha agreement classification when not all recommended criteria were present).ResultsOverall, 44 athletes were included (61 symptomatic sides). Interexaminer reliability of inguinal palpation pain provocation tests varied from fair to moderate (κ=0.35-0.49). Reliability of posterior wall structure palpation (firm/soft) was slight (κ=0.01), and posterior wall bulging (yes/no) fair (κ=0.29). Reliability for abdominal resistance tests varied from fair to substantial (κ=0.35-0.72). In athletes classified with defined inguinal-related groin pain, recognisable injury pain on palpation during scrotal invagination when athletes performed a Valsalva manoeuvre was the most prevalent positive palpation test (79%). Abdominal resistance tests were positive in 21%-49% of these cases.ConclusionThe interexaminer reliability for clinical examination tests used to classify inguinal-related groin pain in athletes varies from slight to substantial. There is no single perfect clinical examination test.Trial registration numberNCT03842826.

Project description:BackgroundInguinal hernia is a commonly encountered cause of pain in athletes. Because of the anatomic complexity, lack of standard imaging, and the dynamic condition, there is no unified opinion explaining its underlying pathology.HypothesisAthletes with persistent groin pain would have a high prevalence of inguinal hernia with dynamic ultrasound, and herniorrhaphy would successfully return athletes to activity.Study designCase-control study.Level of evidenceLevel 3.MethodsForty-seven amateur and professional athletes with sports-related groin pain who underwent ultrasound were selected based on history and examination. Patients with prior groin surgery or hip pathology were excluded. Clinical and surgical documentation were correlated with imaging. The study group was compared with 41 age-matched asymptomatic athletes.ResultsUltrasound was positive for hernia with movement of bowel, bladder, or omental tissue anterior to the inferior epigastric vessels during Valsalva maneuver. The 47-patient symptomatic study group included 41 patients with direct inguinal hernias, 1 with indirect inguinal hernia, and 5 with negative ultrasound. Of 42 patients with hernia, 39 significantly improved with herniorrhaphy, 2 failed to improve after surgery and were diagnosed with adductor longus tears, and 1 improved with physical therapy. Five patients with negative ultrasound underwent magnetic resonance imaging and were diagnosed with hip labral tear or osteitis pubis. The 41-patient asymptomatic control group included 3 patients with direct inguinal hernias, 2 with indirect inguinal hernias, and 3 with femoral hernias.ConclusionInguinal hernias are a major component of groin pain in athletes. Prevalence of direct inguinal hernia in symptomatic athletes was greater than that for controls ( P < 0.001). Surgery was successful in returning these athletes to sport: 39 of 42 (93%) athletes with groin pain and inguinal hernia became asymptomatic.Clinical relevancePersistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity.

Dataset Information

Dynamic Responsive Inguinal Scaffold Activates Myogenic Growth Factors Finalizing the Regeneration of the Herniated Groin.

Background

Methods

Results

Conclusion

Publications

Dynamic Responsive Inguinal Scaffold Activates Myogenic Growth Factors Finalizing the Regeneration of the Herniated Groin.

Similar Datasets

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