TREATMENT STRATEGY AND OUTCOMES FOR MEDIAN VENTRAL HERNIA IN OUR DEPARTMENT

Abstract

Abstract Aim Retro-rectus mesh repair (e-/MILOS) based surgery is performed for ventral hernias in our department. The treatment strategy and results are reported. Material and Methods From April 2020 to October 2023, 104 surgeries were performed on median ventral hernias. Based on the current situation in Japan where BOTOX is not approved for the abdominal wall, we applied prehabilitations (physical therapy and nutritional guidance) before surgery (61 cases). In addition, because of experience of SSI and cancer dissemination in surgery after mesh repair, reconstruction without a mesh (non-mesh e-/MILOS) with retro rectus component separation and reinforcement of Linea alba around the orifice was performed for the younger (under 60 years) and in cases after malignant tumor surgery who don’t refuse in the informed consent (73 cases). Results In the cases with prehabilitations, TAR was performed in 2 cases (3.2%), analgesics was prescribed at 2 weeks after surgery in 4 (6.6%), and recurrence occurred in 2 cases (1.6%) what was significantly lower than those without (13.1%, 14.0% and 7.9%, 3–44 months) (p <0.01). In the non-mesh group, analgesics were prescribed at 2 weeks after surgery in 4 cases (5.4%) and recurrence occurred in 1 (1.3%), significantly lower than the mesh group (12.9%, 9.7%, 3–44 months) (p <0.01). Conclusions Prehabilitations may help reduce postoperative pain and prevent recurrence. Non-mesh not only prevents complications associated with mesh but may be non-inferior in therapeutic effect compared to using mesh. Prospective trials should be planned.