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Why can’t excised sac material be used as reinforcement?
Reading here and elsewhere about the proliferation of biologic mesh made me wonder: Why can doctors not use the excised sac as a biologic “mesh” derived from the patient’s own body? Is it the wrong type of tissue, or is its size/integrity too variable?
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5 Replies
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Thanks for the clarification. My gut (no pun intended) feeling when I read these cases is that if it were truly revolutionary I’d be seeing more than one report of it.
To a layman, it sounded like an autologous prosthesis. Would that be possible if the sac had a layer of stretched fascia?
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Thanks for your insightful question.
The hernia sac has has no structural integrity to it. It stretches, hence the increase in hernia size with time. It is anti-adhesive in its property. So it doesn’t immediately attach itself to anything. Because it’s not inflammatory or adhesive, it can cause fluid collections. The paper reports fluid seeping out of wounds in 5%, so perhaps that is why.
We prefer not to cut out the hernia sac as part of the hernia repair. First, it’s unnecessary most of the time. There is some thought that cutting the peritoneum (Hernia sac) can contribute to the acute hernia pain.
Just to clarify, the cited paper shows a typical tissue repair with onlay of peritoneum. It is not using the peritoneum as any support or patch.
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Guess someone has tried this after all. Any other studies out there about its efficacy? Note: I’m almost certain the “20%” recurrence cited in the abstract is a typo; other parts of the article refer to “2%”
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Interesting, didn’t realize that technique actually removed muscle from elsewhere for repair (vs sewing together previously unconnected tissue).
One clarification: by “sac material” I meant the excised peritoneum creating the sac, not its actual contents. Based on what Dr. Kang has said about this material thickening over time, it sounds like this is what millions of years of. Human evolution came up with prior to modern surgery…
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Based on the videos of surgeries I’ve seen, a lot of the times the “sac material” is basically fat, or intestine that has to be pushed back into the abdomen, so I don’t think it’s considered viable as a reinforcement in either case.
But what you propose as ‘mesh derived from the patients own body’ is basically the gist of the Desarda repair, which uses a piece of muscle from the abdomen, it is relatively new repair and not widely accepted yet though, perhaps more studies are being done.
Overall I strongly agree with your sentiment, surely the holy grail of hernia repair is easily repairing a hernia with a patients own tissue, maybe grown in a lab from stem cells or as a graft or whatever else, that will remodel and grow with the patient perfectly, without any risk of rejection, nerve entrapment, etc. Maybe one day…
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