Abdominal Wall Hernia Research Articles

Role of Collagen in the Etiology of Inguinal Hernia Patients: A Case-Control Study.

Introduction Technical faults are no longer accepted as the sole reason for recurrence following inguinal hernia (InH) repairs. Medical literature has been studied to find any contributing factors and collagen has emerged as a promising marker. Owing to their long half-lives, it has been found to best reflect the process of scarring, which is central to ensuring the formation of a proper fibrous tissue that incorporates the mesh with the abdominal wall. Methods Sixty participants were divided into two groups. The case group were patients diagnosed with InH and the control group had patients undergoing abdominal surgeries for indications other than abdominal wall hernias. A 0.5x0.5cm specimen of skin and transversalis fascia were biopsied and subsequently stained to determine the amount of collagen I and III. Results Collagen I, collagen III and the ratio of collagen I to III was measured. Collagen I was normal in the skin of both groups but decreased in transversalis fascia of cases. Collagen III was found to be normal in transversalis fascia of both cases and controls, but increased in the skin of cases. Ratio of collagen I to III was decreased in both skin and transversalis fascia of cases. Statistical analysis was carried out using an unpaired t-test, non-parametric Mann-Whitney test, ANOVA and chi-square test. Conclusions Our study has reported that in patients with inguinal hernia, collagen III or immature collagen is increased in skin and collagen I or mature collagen is decreased in the transversalis fascia. The ratio of collagen I/III is decreased in both skin and transversalis fascia.

Day Surgery for Spigelian Hernia Repair Under Local Anesthesia: A “Real Minimally Invasive” Surgical Approach

Spigelian hernia (SH) represents less than 1% of all hernias and about 0,1% of abdominal wall hernias. Although it is a very rare hernia, it has a considerably high risk of strangulation. The aim of this work is to propose the open approach based on local anesthesia on a Day Surgery regimen as a safe treatment for Spigelian Hernia surgery. We report a series of 17 clinical cases (9 men and 8 women, between 40 and 80 years old) who underwent SH open repair on a Day Surgery basis between 2004 and 2021 in our University Hospital. In our single-center case series, no early postoperative complications occurred, except for a bulky seroma of about 800 cc. No prosthesis or surgical wound infections occurred and no recurrences were observed in the early postoperative period. Looking at our experience and the literature, Spigelian hernia repair under local anesthesia on a Day Surgery regimen, using a pre-peritoneal polypropylene mesh, could be proposed as a safe and “real minimally invasive” approach in elective settings.

Abdominal wall hernia repair: from prosthetic meshes to smart materials.

Hernia reconstruction is one of the most frequently practiced surgical procedures worldwide. Plastic surgery plays a pivotal role in reestablishing desired abdominal wall structure and function without the drawbacks traditionally associated with general surgery as excessive tension, postoperative pain, poor repair outcomes, and frequent recurrence. Surgical meshes have been the preferential choice for abdominal wall hernia repair to achieve the physical integrity and equivalent components of musculofascial layers. Despite the relevant progress in recent years, there are still unsolved challenges in surgical mesh design and complication settlement. This review provides a systemic summary of the hernia surgical mesh development deeply related to abdominal wall hernia pathology and classification. Commercial meshes, the first-generation prosthetic materials, and the most commonly used repair materials in the clinic are described in detail, addressing constrain side effects and rational strategies to establish characteristics of ideal hernia repair meshes. The engineered prosthetics are defined as a transit to the biomimetic smart hernia repair scaffolds with specific advantages and disadvantages, including hydrogel scaffolds, electrospinning membranes, and three-dimensional patches. Lastly, this review critically outlines the future research direction for successful hernia repair solutions by combing state-of-the-art techniques and materials.

Results of surgical treatment of patients of fertile age planning pregnancy with hernias of the anterior abdominal wall

BACKGROUND: Currently, there is no consensus and approved tactics for choosing the method of hernioplasty in the surgical treatment of patients of fertile age planning pregnancy with hernias of the anterior abdominal wall. The study is devoted to the comparative analysis of surgical treatment of these patients.
 AIM: To determine the algorithm of surgical treatment of hernias of the anterior abdominal wall in the patients of fertile age planning pregnancy.
 MATERIALS AND METHODS: The analysis of the treatment results of fertile age patients with hernias of the anterior abdominal wall in the period from 2010 to 2019 has been carried out. The inclusion criteria were as follows: patients of fertile age who underwent surgical treatment of hernias of the anterior abdominal wall, who did not have a relapse before pregnancy. Thus, 252 patients have been included in the study.
 RESULTS: The surgical tactics and optimal timing of the operation in patients of fertile age with hernias of the anterior abdominal wall have been determined.
 CONCLUSIONS: When planning surgical treatment of hernias of the anterior abdominal wall in patients of fertile age, it is necessary to clarify information about pregnancy planning. The most favorable period for planning pregnancy and childbirth is 3 years or more after hernioplasty. When planning a pregnancy in the next 12 years after surgical treatment of a ventral hernia, it is necessary to give preference to hernioplasty with local tissues, which has fewer complications in the long-term postoperative period as well as fewer relapses after childbirth compared with open prosthetic surgery. When planning a pregnancy 3 or more years after surgical treatment, preference should be given to prosthetic hernioplasty. When analyzing the results of treatment of the patients of fertile age with inguinal and femoral hernias, planning pregnancy, clinical experience has shown that there are no contraindications to performing laparoscopic transabdominal preperitoneal prosthetic hernioplasty.

Umbilical hernioplasty under transverse abdominis plane and rectus block: a case report

Umbilical hernia is a common diagnosis in surgery. Approximately, 10% of all abdominal wall hernias are defined as umbilical hernia. The European hernia society defines a primary umbilical hernia as a ventral hernia present at birth or developed spontaneously without trauma to the abdominal wall as the cause of the hernia and with its center at the umbilicus. Rectus sheath block has been traditionally used to provide analgesia for anterior abdominal wall surgeries, as it spares the visceral pain component. It’s been used efficiently for intraoperative, post-operative analgesia, providing stable hemodynamic. The emergence of ultrasound has potentially increased the rate of success, while avoiding complications like bleeding, peritoneal puncture, visceral injury. Rectus sheath block is emerging as a valuable regional. Anesthesia technique. It can be used as an adjuvant or alternative to central neuraxial block and general anesthesia for surgeries of anterior abdominal wall, pediatric umbilical hernia, incisional hernia, laparoscopic surgeries and abdominal gynecological procedures and for analgesia. This is a case report of 47-year-old male with multiple comorbidities posted for umbilical hernia repair performed under combined rectus sheath and tap block.

Ventral Hernias in Kalyana Karnataka Teaching Hospital: A Prospective Study.

A ventral hernia is a protrusion of the abdominal viscus through the anterior abdominal wall occurring at any site other than the inguinal and femoral areas and is a common problem encountered by surgeons.
 Aims & Objective: Due to the lack of prospective cohorts to determine the natural history of untreated ventral hernias, most surgeons recommend that these hernias be repaired as soon as they are discovered. The purpose of this study was to determine the proportion of ventral hernias occurring in both sexes, various age groups, various risk factors, and complications, as well as their clinical presentations and treatment.
 Material and Methods: During the period August 2020 to August 2021 (12 months), a prospective study was conducted at our tertiary care hospital. The study included 50 cases of anterior abdominal hernias excluding groin hernias and posterior abdominal wall hernias. A detailed history and a thorough clinical examination were used to collect data. In the proforma, data was entered, tabulated, and analyzed using statistical software (SPSS 2015).
 Results: Ventral hernias accounted for 5% of surgical admissions. Among the ventral hernias, para umbilical hernias were the most prevalent (48%). An infra umbilical midline herniation accounted for 36% of cases, followed by an umbilical region herniation in 18% of cases. Constipation and obesity were found to be the major risk factors. Most defects are small (>2cm). 48% of inlay mesh repairs were made.
 Conclusion: 50 cases of ventral hernias were studied in the present study, which was conducted in our tertiary care hospital. Five percent of all admissions to the surgical ward were due to ventral hernias. The females to males ratio was 1:17, and the mean age was 41. The mean total duration for surgery in sublay group was 75.4±9.23 minutes compared to 63.7±10.58 minutes in onlay group, which was statistically significant (p<0.05).

A Comparative Study on Outcomes and Quality of Life Changes Following Ventral Transabdominal Preperitoneal (Ventral-TAPP) and Laparoscopic Intraperitoneal Onlay Mesh (IPOM)-Plus Repair for Ventral Hernia.

Background Ventral transabdominal preperitoneal (ventral-TAPP) repair and intraperitoneal onlay mesh (IPOM) plus repair are two options among the available techniques of laparoscopic ventral hernia repair (LVHR). We conducted a comparative study to evaluate the clinical and quality of life (QoL)-related outcomes between ventral-TAPP and IPOM-plus repair. It was hypothesized that both procedures offered similar outcomes and QoL. Materials and methods The study included 32 consecutive patients undergoing LVHR, divided equally between ventral-TAPP and IPOM-plus groups. In the ventral-TAPP procedure, a peritoneal flap was created around the defect, followed by defect approximation and polypropylene mesh placement in the pre-peritoneal pocket. For the IPOM-plus procedure, the defect was closed and a composite (dual-side) mesh was placed around the defect. The minimum overlap beyond the original defect margin in both groups was 5 cm. Data regarding pre-operative parameters and postoperative outcomes, including pain and QoL at one week, one month, and three months, were recorded. A p-value of less than or equal to 0.05 was considered to be statistically significant. Results While the mean duration of surgery was longer, the cost of treatment was lower in group 1 (ventral-TAPP) with a p-value of <0.05 for both parameters. The length of hospital stay was significantly shorter in group 1 (ventral-TAPP), while the return to normal activity was similar in both groups. The visual analog scale (VAS) score for overall pain perception and the European registry for abdominal wall hernias (EuraHS; hernia-related QoL) score for 'Pain at Site' and 'Restriction of Activity' domains were significantly higher in group 2 (IPOM-plus) at one week. Conclusion Although the ventral-TAPP procedure requires more time and expertise to perform, the EuraHS QoL assessment at one week was better in group 1 (ventral-TAPP). Ventral-TAPP group scored better in terms of length of hospital stay and cost-effectiveness as well.

Efficacy of extended view totally extra peritoneal approach versus laparoscopic intraperitoneal on lay mesh plus for abdominal wall hernias: a single center preliminary retrospective study

BackgroundLaparoscopic minimally invasive surgery has become the primary treatment for ventral hernias. The laparoscopic intraperitoneal on lay mesh (IPOM) plus approach for abdominal wall hernias is the most used procedure, while extended view totally extraperitoneal (e‑TEP) repair is a newer option. This study aimed to compare the effectiveness and complications of the 2 procedures for abdominal wall hernias repair.MethodsThis was a retrospective and comparative single-center study done at The Second Clinical Medical College, Jinan University Hospital (Shenzhen People’s Hospital), Shenzhen, China. The study included patients with a 2 to 6 cm abdominal wall defect who underwent hernia repair from January 2022 to December 2022. Patients’ baseline characteristics, hernia features, operative time, blood loss, postoperative pain level, and total hospitalization expenses were extracted from the medical records and compared between patients who underwent the IPOM plus and e-TEP repair.ResultsA total of 53 patients were included: 22 in the e-TEP group and 31 in IPOM plus group. Patient demographic characteristics were similar between the 2 groups. The operation time of the e-TEP groups was significantly longer than the IPOM plus (98.5 ± 10.7 min vs. 65.9 ± 7.3 min, P < 0.01). Postoperative pain levels (VAS; visual analog scale) (4.2 ± 0.9 vs. 6.7 ± 0.9, P < 0.01), analgesic requirements (Tramadol) (25.0 ± 37.0 mg vs. 72.6 ± 40.5 mg, P < 0.01), length of hospital stay (1.2 ± 0.5days vs. 2.2 ± 0.6days, P < 0.01), and total hospitalization expenses (19695.9 ± 1221.7CNY vs. 35286.2 ± 1196.6CNY, P < 0.01) were significantly lower in the e-TEP group. The mean intraoperative blood loss was similar between the 2 groups. No postoperative complications were observed in either group.ConclusionThe e-TEP approach for abdominal wall hernias appears to be better than IPOM plus with respect to postoperative pain levels(VAS: 4.2 ± 0.9 vs. 6.7 ± 0.9, P < 0.01), analgesic requirements(25.0 ± 37.0 mg vs. 72.6 ± 40.5 mg, P < 0.01), length of hospital stay(1.2 ± 0.5days vs. 2.2 ± 0.6days, P < 0.01), and hospitalization costs (19695.9 ± 1221.7CNY vs. 35286.2 ± 1196.6CNY, P < 0.01).

Assessing operative competence in core surgical training: A reliability analysis

BackgroundThis study quantifies the number of observations required to reliably assess the operative competence of Core Surgical Trainees (CSTs) in Ireland, using the Supervised Structured Assessment of Operative Performance (SSAOP) tool. MethodsSSAOPs (April 2016–February 2021) were analysed across a mix of undifferentiated procedures, as well as for three commonly performed general surgery procedures in CST: appendicectomy, abdominal wall hernia repair, and skin/subcutaneous lesion excision. Generalizability and Decision studies determined the number of observations required to achieve dependability indices ≥0.8, appropriate for use in high-stakes assessment. ResultsA total of 2,294 SSAOPs were analysed. Four assessors, each observing 10 cases, can generate scores sufficiently reliable for use in high-stakes assessments. Focusing on a selection of core procedures yields more favourable reliability indices. ConclusionTrainers should conduct repeated assessments across a smaller number of procedures to improve reliability. Programs should increase the assessor mix to yield sufficient dependability indices for high-stakes assessment.

Abdominal Wall Hernias in Patients with Hiatal Hernias: Predictors of Association in a Large Cohort of Patients

Introduction: Hiatal hernia and abdominal wall hernia (AWH) have a common theme of pathogenesis and etiology. This suggests a potential relationship between these 2 types of hernia. However, no large studies have examined such an association. We designed the current study to characterize this association and identify factors associated with this coexistence. Methods: A database of patients seen at a large multi-center health network serving 3 states in the mid-Atlantic region of the United States was queried for patients with a documented diagnosis of hiatal hernia (HH) or paraesophageal hernia (PEH). This population was then divided into groups based on whether or not they had a history of another type of AWH (ventral, inguinal/ femoral, umbilical, or incisional hernia). Demographic and clinical data were compared between groups using univariate, followed by multivariable logistic analysis. Results: The final study population consisted of 28 114 patients (66.5% female) with HH/PEH. The prevalence of AWH in this population was 8.2% (n = 2299). Of these 69.1% had only one AWH with the remaining 30.9% having two or more hernias. Multivariable analysis showed male patients with HH/PEH were more likely to have AWH (OR: 1.97; 95% CI: 1.810-2.162, P &lt;0 .0001). The odds of AWH were higher in patients aged 50 to 80 years old compared to younger patients (OR: 1.527; 95% CI: 1.348-1.730, P &lt;0 .0001). Patients with any comorbidity were also more likely to develop AWH (OR: 1.764; 95% CI: 1.566-1.986, P &lt; 0.0001), with obstructive sleep apnea (OSA) being the comorbidity with the highest risk (OR: 1.295; 95% CI: 1.161-1.444, P &lt;0 .0001), followed by obesity (OR: 1.267; 95% CI: 1.156-1.388, P &lt;0 .0001). Conclusion: The prevalence of an AWH in patients with a HH/PEH was 8.2%. Although HH/PEH are more prevalent in females, males with HH/PEH are at higher risk for AWH. Obesity, OSA, tobacco use, hypertension, diabetes, and hypothyroidism are independent risk factors for presence of an AWH in patients with HH/PEH.

Preoperative Abdominal Muscle Elongation Facilitated Laparoscopic Intraperitoneal Onlay Mesh Repair of Complex Ventral Hernia.

Background: Complex ventral hernia remains a challenging situation for any surgeon. In this study, our aim was to analyze the effect of laparoscopic intraperitoneal onlay mesh (IPOM) repair in the treatment of complex abdominal wall hernia, with the assistance of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA). Methods: In this retrospective study, we included 13 patients with complex ventral hernia between May 2021 and December 2022. All patients undergoing PPP and BTA protocol before hernia repair. The length of abdominal wall muscles and abdominal circumference were measured from CT scan. All hernias were repaired with laparoscopic or laparoscopic-assisted IPOM. Results: Thirteen patients received PPP and BTA injections. PPP and BTA administration time was over 8.8 ± 2.5 days. Before and after PPP and BTA, imaging showed that the length of lateral muscle on each side increased from 14.3 to 17.4 cm (P < .05). The abdominal circumference increased from 81.8 to 87.9 cm (P < .05). Complete fascial closure was obtained in 13 patients (100%), and no patient experienced postoperative abdominal hypertension and ventilatory support. No patient suffered from recurrent hernia to date. Conclusions: Preoperative PPP combined with BTA injection plays a role similar to component separation technique, avoids the abdominal hypertension after laparoscopic IPOM repair of complex ventral hernia.

Comparison of Sublay and Onlay Mesh Repair in Terms of Post-Operative Complications

Objective: To compare Sublay and Onlay mesh repair in terms of post-operative complications among patients undergoing hernioplasty.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Surgical Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2020 to Jun 2021.&#x0D; Methodology: This study was conducted on 300 patients who underwent hernioplasty for anterior abdominal wall hernias at our hospital. They were randomly divided into two groups before the surgery. Group-A received only mesh repair, while Group-B received subway repair. They were followed up for two weeks for any post-operative complications. Post-operative pain, seroma formation, hematoma formation and the presence of surgical site infection were compared in both groups.&#x0D; Results: Out of 300 patients included in the final analysis, 189(63%) were male, and 111(37%) were female. About 163(54.4%) underwent subway repair, while 137(45.6%) underwent only repair. The commonest complication observed in patients was post-operative pain 68(22.7%), followed by surgical site infection 36(12%). Statistical analysis revealed that seroma formation, post-operative pain and surgical site infection were significantly observed more in patients undergoing only mesh repair than subway repair (p-value&lt;0.05).&#x0D; Conclusion: Post-surgical complications were commonly observed in patients within two weeks of surgery. In addition, patients undergoing Onlay mesh repair were more prone to have seroma formation, post-operative pain and surgical site infection than those undergoing Sublay repair.

An Observational Comparative Study of the Impact of Accidental Pneumoperitoneum in Understanding the Learning Curve for Totally Extraperitoneal and Extended Totally Extraperitoneal Inguinal Hernia Repair.

Abdominal wall hernia repair is among the fundamental procedures in general surgical practice. Subsequent to the advent of minimally invasive repair, there have been efforts to find the most reliable technique, with easily reproducible results that can be practiced by surgeons worldwide. From an analytical point of view, this study aimed to highlight the advantages and disadvantages of two techniques. A total of 60 participants were divided into two groups of 30 patients: the totally extraperitoneal (TEP) and the extended TEP (eTEP) hernia repair groups. Covariates and outcomes were analyzed using the chi-square and Mann-Whitney U tests. The study was carried out at a tertiary postgraduate teaching hospital in the western zone of Maharashtra, Pune, India, by a single surgeon. The operative procedures were as per standard surgical practice for both groups.The study was conducted to understand types of difficulties observed in the early implantation stages and the learning curve of these procedures. Ten percent of the procedures in the TEP group and 6.7% of procedures in the eTEP group required Veress needle use to manage accidental pneumoperitoneum (P=0.64). The mean operative time in the eTEP group was significantly shorter than that of the TEP group (P=0.031). Compared with the TEP approach, eTEP repair is associated with shorter operative times, owing to a shorter learning curve, a wider-angle view, a wider range of motion for instrument manipulation, and an ergonomically superior operative experience.

Management and outcomes of obturator hernias: a systematic review and meta-analysis.

Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair. PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups. Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient's clinical status, comorbidities, and degree of intraoperative contamination.

BASING THE SELECTION CRITERIA FOR HERNIOALLOPLASTY IN POSTOPERATIVE VENTRAL HERNIAS

According to the World Health Organization, hernia of the anterior abdominal wall is one of the most common surgical diseases, it is observed among 3-7% of the population, and the disease is observed mainly among the population of working age. ( ) More than 5% of all laparotomies are complicated by the formation of postoperative ventral hernias. , in addition, their frequency depends on the nature and urgency of the surgical intervention( ). About 10% of all surgical interventions are the operative approach to eliminate ventral hernias (VH). Existing traditional hernioplasty methods are not always effective in treatment. In this case, the recurrence varies from 4.3% to 46%, with wide and large defects, the frequency can be repeated up to 60%. In this regard, at present, various variants of allogenioplasty are the preferred method of surgical treatment, which allowed to significantly improve long-term results. However, ongoing research in this direction, on the basis of existing diseases in patients, the selection of the optimal method as a result of the comparative approach of the operative method, the size and location of hernias, and other factors, indicate the unsatisfactory results of the treatment of such patients and indicate the relevance and social importance of this problem.

A Study on Incidence of Inguinal Hernia in Relation to BMI

Background: Inguinal Hernias (IH) are the most common hernia of abdominal wall. These hernias affect both males and females. There are many factors that are linked with the increased risk of developing these hernias. Obesity is believed to be one of them. However, with current epidemiological advances, increased body mass index (BMI) has proven to have fewer incidences of inguinal hernias. Objective: The aim of this study is to determine the relationship of inguinal hernia both unilateral and bilateral with body mass index (BMI) Study Design: This is a cross-sectional study. Methodology: This study was conducted in the department of General Surgery Unit 2 of Dow University Hospital, Karachi, Pakistan. A total of 60 patients were included in this study using non probability convenient sampling which was conducted from January of 2022 till December of 2022. Results: A total of 60 patients who were clinically diagnosed with inguinal hernia were enrolled in our study. Their mean age was 39.25 ± 14.18 years, mean height was 170.55 ± 5.51 cm and mean weight was 67.28 ± 8.64 kg. Their average BMI was 23.10 ± 2.55 kg/m2. 56 (93.3%) of the participants were males and 4 (6.7%) were females. Only 1 (1.7%) patient with inguinal hernia was underweight, 48 (80%) patients were normal weighted, 10 (16.7%) patients were overweight and 1 (1.7%) patient was obese. Conclusion: According to the research that we conducted, most patients who underwent surgical hernia repair of either right, left or bilateral sides had normal BMI. Keywords: Inguinal Hernia, Body Mass Index (BMI)

Falciform ligament herniation treated with combined trans-peritoneal laparoscopic dissection and abdominal wall repair by hand-interrupted suture: A case series report and review of literature

Falciform ligament hernia is a very rare internal hernia and is difficult to diagnose before surgery. Most reported cases are incisional hernias secondary to prior abdominal surgery. We report three cases of primary falciform ligament herniation into the epigastric region that was repaired by the intra-peritoneal laparoscopic approach combined with an extra-abdominal small skin incision. All laparoscopic procedures were performed without conversion to laparotomy, and all specimens were histopathologically diagnosed as lipomas. Three patients successfully recovered and were discharged on surgical days 2, 2, and 5, respectively. There were no complicationor recurrence during the 12-month follow-up. This technique is safe and feasible for repairing midline abdominal wall herniation. If the hernia orifice is less than 2cm in diameter, the abdominal wall defect may be improved by this procedure using Safil 1.0 or Vicryl 1.0 suture without mesh.

When it seemed impossible: Irreparable abdominal wall hernia and placement of a peritoneal dialysis catheter.

When it seemed impossible: Irreparable abdominal wall hernia and placement of a peritoneal dialysis catheter.

V-051 SCOLA TECHNIQUE WITH PERIUMBILICAL MINI-INCISION FOR UMBILICAL HERNIA WITH BIG DIASTASIS RECTI: A CASE REPORT

Abstract Background Diastasis of the rectus abdominis muscles (DRAM) is frequent and may be associated with abdominal wall hernias. In 2017 subcutaneous onlay laparoscopic approach (SCOLA) was described which combines diastasis recti plication and abdominal wall hernia repair without requiring a great incisions nor skin resections. Objective To show a video of a SCOLA technique with open periumbilical dissection through 2.5 cm periumbilical mini-incision. The aim is to reduce operative time and to improve the quality of life with good aesthetic results by a minimal invasive procedure. Method We report a case of a 39 years old woman with 3 previous caesarian deliveries, diagnosed with umbilical hernia and diastasis recti with a 95mm internal gap. The patient was scheduled electively for a SCOLA technique. Results Surgery was performed with no intraoperative complications. Persistent hematic output through drains was seen first 24h postoperatively which required blood transfusion for anemization, but no need for reoperation, correct hemoglobin controls afterward. Small hematoma detected in 1st month control, with correct resolution on 4th month control. No recurrence of umbilical hernia nor diastasis recti observed during this short follow-up. Conclusion SCOLA technique has been proven to be a reproductive and secure technique for those patients with DRAM associated with abdominal wall hernia that do not require nor need skin resection or great incisions. The aim of the periumbilical dissection through mini-incision is to decrease surgical time. One must consider the risk of bleeding or seroma associated with the extensive dissection in cases with great diastasis gap.

P-037 Zinc oxide/collagen (ZnOC) biocomposites for the development of novel meshes

Abstract When we talk about abdominal wall hernias, we are talking about a complex surgical approach. In recent years there is a special interest in the use and development of meshes with antimicrobial properties. Doctors are making efforts to continue progress in this area. We propose the development of meshes covered with Zinc Oxide in a collagen matrix. They have biomedical applications and antimicrobial properties. The objectives of the study are to highlight the major contributions that Zinc Oxide in collagen matrices could make, in the development of new antimicrobial properties. The research will test both the synthesis method of Zinc Oxide in collagen matrix, as well as its ability to inhibit the bacterial activity of different species of bacteria. We demonstrate the significant contributions that could be made by using composites based on Zinc Oxide in collagen matrices for the development of new biocompatible medical devices with antimicrobial properties. This will lead to important advances in the development of new networks based on Zinc Oxide in collagen matrix (ZnOC). Physicochemical characterization of ZnOC composites was performed, using appropriate techniques such as X-ray diffraction (XRD), scanning electron microscopy (SEM and EDS) and transmission electron microscopy (TEM), infrared spectroscopy (FTIR). The antimicrobial properties of ZnOC biocomposites was investigated using clinical and reference microorganisms belonging to Gram positive, Gram negative and fungal families.