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 Cytokine modifications after tension-free hernioplasty or open conventional inguinal hernia repair. Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study Impact of Different Texture of Polypropylene Mesh on the Inflammatory Response Tackers versus glue mesh fixation: an objective assessment of postoperative acute and chronic pain using inflammatory markers Impact of Heavy Polypropylene Mesh and Composite Light Polypropylene and Polyglactin 910 on the Inflammatory Response Systemic inflammatory response after Kugel versus laparoscopic groin hernia repair: a prospective randomized trial A randomized prospective trial comparing clinical outcomes 3 years after surgery by Marcy repair and Prolene Hernia System® repair for adult indirect inguinal hernia Use of Fibrin Sealant for Prosthetic Mesh Fixation in Laparoscopic Extraperitoneal Inguinal Hernia Repair Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up Insulin attenuates the systemic inflammatory response in endotoxemic rats. Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study. Coagulation, inflammatory, and stress responses in a randomized comparison of open and laparoscopic repair of recurrent inguinal hernia Effects of simvastatin on systemic inflammatory responses after cardiopulmonary bypass. Systemic and Peritoneal Inflammatory Response After Laparoscopic or Conventional Colon Resection in Cancer Patients One-year supplementation with a grape extract containing resveratrol modulates inflammatory-related microRNAs and cytokines expression in peripheral blood mononuclear cells of type 2 diabetes and hypertensive patients with coronary artery disease. Parastomal hernias -- clinical study of therapeutic strategies. Melanocortin receptor expression is associated with reduced CRP in response to resistance training. Decreased Levels of Plasma Vitamin C and Increased Concentrations of Inflammatory and Oxidative Stress Markers After Stroke α-Defensin Expression of Inflammatory Response in Open and Laparoscopic Colectomy for Colorectal Cancer Prospective double-blind randomized controlled study comparing heavy- and lightweight polypropylene mesh in totally extraperitoneal repair of inguinal hernia: early results
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 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 Background Parastomal hernias can be prevented or repaired using synthetic mesh ; however , reported complications include infection , fibrosis and potential bowel erosion . The study aim was to assess the safety , feasibility and potential efficacy of using a prophylactic collagen implant . Methods Twenty patients undergoing defunctioning stomas were r and omised to a conventional procedure or reinforcement with the implant . Follow-up included regular symptom question naires , clinical examination , stoma site ultrasound , and serum inflammatory markers . Results Ten patients ( four males ; mean BMI 26.3 ) had a conventional stoma , and ten ( three males ; mean BMI 26.3 ) received the implant . At a median of 6.5 months follow-up , a parastomal hernia was clinical ly evident in three of ten patients without the implant , and in none of ten patients with the implant . There were no clinical complications , ultrasound evidence of chronic seromas or serological evidence of a systemic inflammatory response . Conclusions Xenogeneic collagen has been demonstrated to aid soft tissue reinforcement . In this study , in contrast to published data relating to the use of conventional synthetic mesh , there were no complications related to infection or the implant ’s proximity to the bowel . This trial demonstrates that the implant is safe , feasible to use and has the potential to prevent parastomal herniation 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 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 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 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 Purpose The use of mesh in the surgical repair of adult indirect inguinal hernias is widely recommended in Western countries , but no r and omized controlled trials have so far been reported in Japan . The purpose of the present r and omized prospect i ve trial was to compare a mesh method with non-mesh method for surgical repair of primary adult indirect inguinal hernias in which the diameter of the internal inguinal ring was up to 3.0 cm ( I-1 or I-2 of Japanese Hernia Society Classification ) . Methods Patients with a primary unilateral inguinal hernia and I-1 or I-2 surgical findings were r and omized to undergo either Marcy repair or Prolene Hernia System ® repair . Primary endpoints were recurrence , infection , and pain , with follow-up continued for 3 years postoperatively . Results Ninety-one of 479 patients with an inguinal hernia during the study period did not meet the exclusion criteria , and 46 were allocated to Marcy repair and 45 were allocated to Prolene Hernia System ® repair .  No recurrence was observed in either group , and no significant differences were identified between the groups in any of the primary endpoints . Conclusion This r and omized prospect i ve trial of I-1 and I-2 inguinal hernias suggests that Marcy repair is not inferior to PHS repair . A large-scale r and omized controlled trial appears warranted to confirm whether to use mesh for Japanese adult I-1 and I-2 hernias Objective To evaluate the efficacy of mesh fixation with fibrin sealant ( FS ) in laparoscopic preperitoneal inguinal hernia repair and to compare it with stapled fixation . Summary Background Data Laparoscopic hernia repair involves the fixation of the prosthetic mesh in the preperitoneal space with staples to avoid displacement leading to recurrence . The use of staples is associated with a small but significant number of complications , mainly nerve injury and hematomas .  FS ( Tisseel ) is a biodegradable adhesive obtained by a combination of human-derived fibrinogen and thrombin , duplicating the last step of the coagulation cascade . It can be used as an alternative method of fixation . Methods A prosthetic mesh was placed laparoscopically into the preperitoneal space in both groins in 25 female pigs and fixed with either FS or staples or left without fixation . The method of fixation was chosen by r and omization . The pigs were killed after 12 days to assess early graft incorporation . The following outcome measures were evaluated : macroscopic findings , including graft alignment and motion , tensile strength between the grafts and surrounding tissues , and histologic findings ( fibrous reaction and inflammatory response ) . Results The procedures were completed laparoscopically in 49 sites . Eighteen grafts were fixed with FS and 16 with staples ; 15 were not fixed . There was no significant difference in graft motion between the FS and stapled groups , but the nonfixed mesh had significantly more graft motion than in either of the fixed groups . There was no significant difference in median tensile strength between the FS and stapled groups . The tensile strength in the nonfixed group was significantly lower than the other two groups . FS triggered a significantly stronger fibrous reaction and inflammatory response than in the stapled and control groups . No infection related to method of fixation was observed in any group . Conclusion An adequate mesh fixation in the extraperitoneal inguinal area can be accomplished using FS . This method is mechanically equivalent to the fixation achieved by staples and superior to nonfixed grafts . Biologic soft fixation with FS will prevent early graft migration and will avoid the complications associated with staple use Laparoscopy enables hernial orifices to be observed and tension-free mesh repair to be carried out effectively . In the first r and omised controlled trial on hernia repair , which compared laparoscopic transabdominal pre-peritoneal ( TAPP ) mesh with open darn repairs , laparoscopic repair was less painful and enabled patients to return to work and normal activity more quickly.1 Since then , several r and omised controlled studies and systematic review s have largely confirmed these results . 2 3 More recently in the United Kingdom , the National Institute for Clinical Excellence review ed the available early results and published its guidance on the use of laparoscopic surgery for inguinal hernias.4 We present results of a r and omised controlled trial of  inguinal hernia repair with over five years ' follow up , comparing laparoscopic TAPP mesh repair with Lichtenstein open mesh repair . The main long term objective of this study was to compare the complication rates of these procedures . We conducted the trial Insulin decreases the mortality and prevents the incidence of infection and sepsis in critically ill patients . The molecular and cellular mechanisms by which insulin improves survival have not been defined . The purpose of the present study was to determine the effect of insulin on the inflammatory reaction during endotoxemia . Endotoxemic rats were r and omly divided into two groups to receive either saline or insulin . The effects of insulin on hepatic signal transcription factor mRNA expression , proinflammatory and antiinflammatory cytokine mRNA and protein concentration were determined . Insulin administration did not change glucose or electrolyte levels , but significantly decreased proinflammatory signal transcription factors [ CCAAT/enhancer-binding protein-beta , signal transducer and activator of transcription-3 and -5 , RANTES ( regulated on activation , normal T cell expressed and secreted ) ] and cytokine expression in the liver and serum levels of IL-1beta , IL-6 , macrophage inflammatory factor , and TNFalpha .  Insulin administration further decreased high mobility group 1 protein in the serum compared with controls . In addition , insulin increased antiinflammatory cytokine expression in the liver ; serum levels of IL-2 , IL-4 , and IL-10 ; and hepatic suppressor of cytokine signaling-3 mRNA expression .  Insulin modulates the inflammatory response by decreasing the proinflammatory and increasing the antiinflammatory cascade . Because glucose and electrolyte levels did not differ between insulin-treated patients and controls , we hypothesize that the effects are direct antiinflammatory mechanisms of insulin , rather than indirect , through modulation of glucose or electrolyte metabolism 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 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 AIM Cardiopulmonary bypass is associated with a complex systemic inflammatory response and the extent of their increase has been correlated with the development of postoperative complications . Recent studies suggest that treatment with statins is associated with a significant and marked decrease in inflammation-associated variables such as cytokines . Therefore , we investigated the effects of preoperative simvastatin treatment on systemic inflammatory response and perioperative morbidity after cardiopulmonary bypass . METHODS A prospect i ve , r and omized study , was design ed . Forty-four subjects undergoing elective coronary artery bypass grafting who fulfilled the inclusion criteria were r and omized to treatment with  simvastatin ( 20 mg/day , group A , N. 22 ) or control ( group B , N. 22 ) before surgery . Plasma levels of interleukins ( IL-6 , IL-8 , TNF-alpha ) , and systemic inflammatory response score ( SIRS ) were measured during the surgical intervention and over the following 48 postoperative hours . Cytokine levels were measured by enzyme-linked assays from plasma sample s obtained at specific time points pre- and post-operation . RESULTS In both groups the serum levels of the proinflammatory cytokines ( IL-6 , IL-8 , TNF-alpha ) , and leukocytes , and the SIRS score increased significantly over the baseline , though no significant differences were observed between the two groups . The preoperative and postoperative course did not differ between both groups . CONCLUSIONS In patients undergoing coronary artery bypass grafting with cardiopulmonary bypass , the administration of simvastatin doses not produce any changes in the inflammatory response as measured by the levels of IL-6 , IL-8 , TNF-alpha and SIRS score , nor does it reduce the complications after cardiac surgery Abstract PURPOSE : This study was design ed to evaluate differences in both the peritoneal and systemic immune response after laparoscopic and conventional surgical approaches . METHODS : Patients with a primary carcinoma were prospect ively r and omized to curative laparoscopic ( n = 12 ) or conventional ( n = 14 ) colon resection . The proinflammatory cytokines interleukin-6 , interleukin-8 , and tumor necrosis factor-alpha were measured in the peritoneal drain fluid and in the serum . C-reactive protein and leukocyte counts and the differences in leukocyte sub population s and expression of human leukocyte antigen-DR on monocytes were measured perioperatively . RESULTS : Significantly higher levels of proinflammatory cytokine were found in the peritoneal drain fluid than in the circulation after both procedures . Serum interleukin-6 and interleukin-8 levels were significantly lower 2 hours after laparoscopic surgery than with the conventional procedure . Postoperative cellular immune counts and human leukocyte antigen-DR expression normalized earlier after the laparoscopic approach . CONCLUSIONS : The systemic proinflammatory concentrations after both surgical approaches represent only a small fragment of what is generated in the peritoneal drain fluid . Even if the immediate levels of proinflammatory cytokines in the serum are significantly lower in the laparoscopic group , the same cytokines locally produced showed no differences , which suggests that the two intra-abdominal approaches are equally traumatic . No differences in cellular response were observed between the groups Numerous studies have shown that resveratrol ( RES ) exerts anti-inflammatory effects but human trials evidencing these effects in vivo are limited . Furthermore , the molecular mechanisms triggered in humans following the oral intake of RES are not yet understood . Therefore , the purpose of this study was to investigate the molecular changes in peripheral blood mononuclear cells ( P BMC s ) associated to the one-year daily intake of a RES enriched ( 8 mg ) grape extract ( GE-RES ) in hypertensive male patients with type 2 diabetes mellitus ( T2DM ) . We used microarrays and RT-PCR to analyze expression changes in genes and microRNAs ( miRs ) involved in the inflammatory response modulated by the consumption of GE-RES in comparison to a placebo and GE lacking RES . We also examined the changes in several serobiochemical variables , inflammatory and fibrinolytic markers . Our results showed that supplementation with GE or GE-RES did not affect body weight , blood pressure , glucose , HbA1c or lipids , beyond the values regulated by gold st and ard medication in these patients . We did not find either any significant change on serum inflammatory markers except for a significant reduction of ALP and IL-6 levels . The expression of the pro-inflammatory cytokines CCL3 , IL-1β and TNF-α was significantly reduced and that of the transcriptional repressor LRRFIP-1 increased in P BMC s from patients taking the GE-RES extract . Also , a group of miRs involved in the regulation of the inflammatory response : miR-21 , miR-181b , miR-663 , miR-30c2 , miR-155 and miR-34a were found to be highly correlated and altered in the group consuming the GE-RES for 12 months . Our results provide preliminary evidence that long-term supplementation with a grape extract containing RES downregulates the expression of key pro-inflammatory cytokines with the involvement of inflammation-related miRs in circulating immune cells of T2DM hypertensive medicated patients and support a beneficial immunomodulatory effect in these patients UNLABELLED Parastomal hernias are parietal defects adjacent to the stomasite , after ileostomy and colostomy . Their incidence is variable and they are generally underestimated . METHODS Between 2001 and 2010 at the First Surgical Clinic Iasi , we treated 861 incisional hernias , of which there were 31 parastomal hernias in 26 patients ( 3 % ) , 5 of which were recurrent parastomal hernias . Parastomal hernias have been explored clinical ly , through imaging and intraoperatively . Because our experience and literature review have demonstrated that a mesh repair is a safe procedure in the treatment of parastomal hernia , in 2010 we initiated a prospect i ve r and omized trial on the use of prophylactic polypropylene mesh at the time of stoma formation to reduce the risk of parastomal hernia . We enrolled in the study 20 patients with mesh implanted at the primary operation and 22 patients without mesh . The inclusion criteria were : patients with low rectal cancer , stage II-III , irradiated , obese , with a history of hernias , patients who do physical work . RESULTS Most parastomal hernias were asymptomatic ; only six cases with parastomal hernias required emergency surgical treatment . We performed local tissue repair in 16 cases ( 4 cases with recurrent parastomal hernia , stoma relocation in one case ) , sublay mesh repair in 15 cases ( one case with recurrent parastomal hernia ; stoma relocation in 5 cases ) . Postoperative morbidity registered included 4 wound infections ( one case after mesh repair which required surgical reintervention ) and stoma necrosis in one case with strangulation parastomal hernia with severe postoperative evolution and death . After local tissue repair recurrences were seen in 6 cases , after mesh repair we registered recurrence only in one case and no relapse after the relocation of the stoma . The patients with prophylactic mesh at the time of stoma formation to reduce the risk of parastomal hernia were followed for a median of 20 months(range 12 to 28 months ) by clinical examination and ultrasound exam every 3 months . We registered 6 recurrences(27,2 % ) , all in the no mesh cohort . We have not seen any morbidity in patients from the mesh group . CONCLUSIONS Parastomal hernia is a relatively rare disease compared to the number of incisional hernias . With increasing life expectancy st and s we noted increased incidence of parastomal hernia as well . Prophylactic use of mesh during the primary operation is a safe procedure and reduces the risk of parastomal hernia The existing paradigm of exercise-induced decreases in chronic inflammation focuses on the expression of inflammatory receptors on systemic monocytes in response to exercise training , with the role of anti-inflammatory receptors largely ignored . Our recent preliminary studies indicate that the anti-inflammatory melanocortin receptors ( MCRs ) may play a role in modulating exercise-induced decreases in chronic inflammation . Here , we present a study design ed to determine the effect of intense , resistance exercise training on systemic monocyte MCR expression . Because low- grade chronic inflammation is associated with elevated cardiometabolic risk in healthy population s and exercise decreases chronic inflammation , we investigated the associations between systemic monocyte cell surface expression of MCRs and inflammatory markers as a possible mechanism for the beneficial anti-inflammatory effects of resistance training . To this end , the present study includes 40 adults ( aged 19 - 27 yr ) and implements a 12-wk periodized , intensive resistance training intervention . Melanocortin 1 and 3 receptor expression on systemic monocytes and inflammatory markers , including C-reactive protein ( CRP ) , interleukin (IL)-6 , IL-1β , and IL-10 , were measured before and after the intervention . Resistance training significantly altered MCR systemic monocyte cell surface expression , had no chronic effects on IL-6 , IL-1β , or IL-10 expression , but significantly decreased CRP levels from a moderate to a low cardiovascular disease risk category . More specifically , decreased melanocortin 3 receptor expression significantly correlated with decreased CRP , independent of changes in adiposity . These data suggest that the observed responses in MCR expression and decreases in cardiovascular disease risk in response to resistance training represent an important anti-inflammatory mechanism in regulating exercise-induced decreases in chronic inflammation that occur independent of chronic changes in systemic cytokines Background and Purpose — Inflammatory response is a critical component of the complex pathophysiological response to stroke .  Vitamin C has been shown to have important roles in cell performance and vascular function . In this study , we compared the  nutritional status and levels of inflammatory markers between stroke cases and controls and assessed which antioxidant was associated with levels of inflammatory markers and oxidative stress among cases and controls . Methods — We evaluated the  nutritional status  and measured plasma levels of vitamins C and E , uric acid  , serum levels of C-reactive protein ( CRP ) , the cytokines tumor necrosis factor-&agr ; and interleukin-1&bgr ; , intercellular adhesion molecule-1 ( ICAM-1 ) and chemokine monocyte chemoattractant protein-1 ( MCP-1 ) , prostagl and ins PGE2 and PGI2 , and 8-isoprostanes ( 8-epi PGF2&agr ; ) for 15 patients with ischemic stroke within 2 to 5 days after stroke onset and for 24 control subjects . Results — Stroke patients had significantly lower plasma levels of vitamin C  than did controls . Among stroke patients , CRP was significantly elevated , as were the ICAM-1 , MCP-1 , and 8-epi PGF2&agr ; , but the prostagl and ins PGE2 and PGI2 were significantly reduced . Interestingly ,  vitamin C concentration was significantly inversely correlated with the levels of CRP and 8-epi PGF2&agr ; among stroke patients , and 8-epi PGF2&agr ; was significantly associated with the levels of CRP . Uric acid was also elevated among stroke patients . Conclusions — Lower vitamin C concentration , higher serum levels of inflammatory ( CRP , ICAM-1 , MCP-1 ) and oxidative stress ( 8-epi PGF2&agr ; ) markers , and lower PGI2 and PGE2 concentrations among stroke patients indicate the presence of an inflammatory response associated with stroke Background Surgical procedures are related to the activation of the inflammatory reaction . This is called surgical stress . It is believed that diminished surgical trauma reduces surgical stress . The laparoscopic approach reduces trauma , but the systemic immune responses are still invariably activated . Cytokines and C-reactive protein ( CRP ) are the main markers in the study of inflammatory or stress response . α-Defensins play an important role in host defense , acting early in phagocytosis . α-Defensins , as early markers — earlier than cytokines — of the inflammatory response , have been used , together with high-sensitivity CRP ( hs-CRP ) and interleukin-6 ( IL-6 ) , to determine the inflammatory response in laparoscopic and open colectomy for cancer . Material s and methods A total of 40 patients with colorectal cancer were r and omized to two groups : group A ( n = 20 ) , open colectomy ; group B ( n = 20 ) , laparoscopic colectomy .  One hour preoperatively an epidural catheter was placed in all patients and rupivacaine was administered perioperatively and again 48 h postoperatively . Blood sample s were taken for calculating α-defensins , IL-6 , and hs-CRP levels preoperatively , 5 min after division of the colon ( group A ) , or 5 min after deflation of pneumoperitoneum ( group B ) , 6 h and 24 h postoperatively . Results The mean operative time was 115 min for group A and 142 min for group B ( p < 0.05 ) . The mean blood loss was 240 ml and 105 ml , respectively ( p < 0.001 ) . The mean hospital stay was 8 days and 5 days , respectively ( p < 0.05 ) . α-Defensin levels were statistically significantly lower in group B than in group A , 5 min and 24 h postoperatively ( p < 0.002 and p < 0.007 , respectively ) . The IL-6 levels were statistically significantly lower in group B than in group A , 6 h and 24 h postoperatively ( p < 0.0001 at both time intervals ) , whereas the levels of hs-CRP were significantly lower in group B than in group A 24 h postoperatively ( p < 0.001 ) . Conclusions The present study confirms the results of previous studies , that the inflammatory immune response and surgical stress are significantly less after laparoscopic colectomy versus open colectomy for colorectal cancer . More investigation is needed to study if surgical stress has any influence on survival of these patients Background Success of totally extraperitoneal ( TEP ) inguinal herniorrhaphy  depends upon strengthening of the weakened native tissue by inflammation result ing in mesh – aponeurosis scar tissue ( MAST ) complex formation . The inflammatory response attributable to polypropylene ( PP ) content of the mesh is linked to weight of PP and pore size of the mesh . Continuation of the inflammatory process beyond MAST complex formation can entrap contiguous structures , leading to adverse outcome such as groin pain . Reduction of PP content has been shown to be beneficial in animal studies . Paucity of r and omized controlled trials ( RCTs ) on human beings has left choice of mesh to surgeon preference or cost . We carried out a double-blind RCT comparing heavy- and lightweight PP-based meshes in TEP . Patients and methods Consecutive , married , sexually active male c and i date s for bilateral TEP herniorrhaphy were enrolled without any exclusion , with ethical and informed consent protocol . St and ard TEP technique was followed for day-care surgery . Heavy- and lightweight meshes were implanted in each patient , one in either groin after r and omization . Surgeon and patient were blinded to side of groin and type of mesh . An independent doctor ( AID ) evaluated the patients for groin pain , discomfort , sexual dysfunction , and clinical recurrence . A nonmedical secretary/AID transferred prospect i ve data for both sides of groin collected by AID to Microsoft Excel . Results Twenty-five bilateral TEPs implanting 25 heavy- and 25 lightweight PP meshes , one of each type in each patient , were performed from December 2005 to July 2007 without difficulty or complication . Lightweight PP mesh was associated with significantly better pain scores , patient comfort , and sexual function . There was no infection or recurrence with either type of mesh . Conclusion Lightweight PP mesh is associated with significantly better outcomes in TEP inguinal herniorrhaphy as compared with heavyweight PP mesh
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 .