OC-119 Specialization is essential: our results in 139 incisional hernia repairs with a high percentage of moderate-to-high complex cases.

Abstract

Abstract Aims Presenting 139 repairs by 4 specialised surgeons, mostly of moderate/high complexity. Material & Methods Prospective study (EVEREG registry). Results 65 men. 65.49 (35–93) year-old. Middle BMI 30.31 kg/m2 (52%≥30). 96.4% ASA II/III. Hernias: 113 midline, 15 lateral, 11 combined. Mean defects 86.25cm2 (2–480). 29 W3, 92 W2, 4 paraostomal, 34 recurrent. 9 received botulinum toxin. Surgeries: 132 elective. 89.9% open. 30 components separations (21.6%, 23 TAR). 23 (16.5%) received two meshes. Principal mesh position: 55.4% retromuscular, 34.5% preperitoneal, 6.5% intraperitoneal, 3.6% others. Defect closure: 87.1%. Mean overlap 8.3cm (1–23). 61 associated procedures highligthing 18 dermolipectomies, 10 colorectal surgeries, 8 diffuse adhesiolysis, 8 mesh explants (2 infected). Intraoperative complications: 9 patients (6.5%). 8 bowel injuries (5 serosal tears), 1 muscular bleeding, 1 bladder injury. Postoperative complications: 22.3% patients. 21 grade I, 6 II, 3 III, one IV. Highlighting: ileum (9), hematoma/anemia (9), general (6), seroma (4), 4 surgical site infections (SSI, 1 deep, 2 organ/space, 1 superficial), 1 bowel perforation. 4 reinterventions (2.9%), 2 due to visceral complications. No exitus. Mean stay: 4.46 days. 1 month: 36 patients complicated (25.9%); highlighting 21 seromas (76% types 0-I), 6 superficial SSIs and 3 bowel obstructions (1 required surgery). 6, 12, 24 months: complications stabilized at 8–10%. 4 bulging, 2 late seromas, 1 temporal SSI (1 year), 1 chronic SSI, 6 chronic pains (4 at 24 months), 8 recurrences (5.75%, 7 in mesh border, 1 complete; 6 in highly-complex). Conclusions Specialised surgeons obtained comparable to accreditation standards outcomes even the high complexity.