Absorbable Mesh Research Articles

BN SO28 - Dual Mesh Technique in Revisional Complex Laparoscopic Repair of Recurrent Paraesophageal Hernia (PEH)

Abstract Background Mesh Augmentation in laparoscopic repair of complex PEH has been an ongoing debate with regards to its risk profile and success rate in reducing hernia recurrence.1 There have been concerns regarding the deployment of non-absorbable mesh around the hiatus resulting in erosion and stricture, which may lead to oesophagectomy or gastrectomy.2 Absorbable mesh has been introduced with appealing advantages of lower mesh-related morbidities, however its high cost and unclear long-term durability remains questionable for its role as an ideal mesh.2 Method This is the case of a 65-year-old patient with chronic reflux symptoms undergoing revisional complex laparoscopic repair of recurrent type 4 PEH. The focus of this video is using a dual mesh technique involving fixation of a non-absorbable synthetic mesh at least 15mm from the oesophageal wall, reinforced with placement of an absorbable biosynthetic mesh which is in contact with the hiatus boundary. Results With regards to position of the permanent synthetic mesh, direct contact with the oesophagogastric wall should be avoided due to complications secondary to erosions and strictures. The deployment of a second mesh of absorbable material is preferred in this patient for hiatal reinforcement to reduce risk of recurrence due to friability of adjacent tissues. Conclusion The dual mesh technique aims to overcome the limitations of both types of mesh materials while preserving their individual benefits, expectantly reducing recurrence.

Immediate Breast Reconstruction After Nipple-Sparing Mastectomy with Prepectoral Implant Placement Supported by a Partial Coverage Technique Employing Late Absorbable Synthetic Mesh

Immediate Breast Reconstruction After Nipple-Sparing Mastectomy with Prepectoral Implant Placement Supported by a Partial Coverage Technique Employing Late Absorbable Synthetic Mesh

Ventral Hernia Repair With a Hybrid Absorbable-permanent Preperitoneal Mesh.

To analyze device safety and clinical outcomes of ventral hernia repair with the GORE SYNECOR Preperitoneal Biomaterial (PRE device), a permanent high-strength mesh with bioabsorbable web scaffold technology. This multicenter retrospective review analyzed device/procedure endpoints and patient-reported outcomes in patients treated for hernia repair ≥1 year from study enrollment. Included in this analysis were 148 patients with a mean age of 56 years; 66.2% met the Ventral Hernia Working Group grade 2 classification. Median hernia size was 30.0cm 2 and 58.8% of patients had an incisional hernia. Repairs were primarily a robotic (53.4%) or open approach (41.9%). All meshes were placed extraperitoneal. Procedure-related adverse events within 30 days occurred in 13 (8.8%) patients and included 7 (4.8%) patients with surgical site infection, 2 (1.4%) with surgical site occurrence (SSO), 4 (2.7%) requiring readmission, and 3 (2.0%) who had reoperation. The rate of SSO events requiring procedural intervention was 2.7% (4 patients) through 30 days and 3.4% (5 patients) at 12 months. The rate of procedure-related surgical site infection remained at 4.8% through 12 months (no further reports after 30d) and 3.4% for SSO (2 reports after 30d). There were no site-reported clinically diagnosed hernia recurrences throughout the study. Median patient follow-up including in-person visit, physical examination, reported adverse event, explant, death, and questionnaire response was 28 months (n = 148). Median patient follow-up with patient questionnaire was 36 months (n = 88). Use of the PRE device, which incorporates the proven advantages of both an absorbable synthetic mesh and the long-term durability of a permanent macroporous mesh, is safe and effective in complex ventral hernia repairs. When used in the retromuscular space, the combination of these 2 materials had lower wound complications and recurrence rates than either type of material alone.

A systematic review and meta-analysis of randomized controlled trials for the management of ventral hernia: biologic versus synthetic mesh.

An abdominal wall hernia near the location of a prior surgical incision is referred to as an incisional hernia. A midline incisional hernia is the most prevalent form. The management of incisional hernia includes many options, from conservative to surgical. The surgeon might consider using a synthetic or biological mesh when discussing surgical options with patients. Our aim through this study is to comprehensively compare synthetic and biological mesh in terms of complication and infection rates for managing elective incisional hernia. This systematic review was designed and conducted using PRISMA guidelines. The literature was systematically searched in January 2023 using the following databases: MEDLINE, Cochrane, and EMBASE. Among the terms used to aid the search were the following: incisional hernia, ventral hernia, ventral herniorrhaphy, biologic mesh, polypropylene mesh, absorbable mesh, permanent mesh, biomaterial mesh, biological mesh, and synthetic mesh. The review of the literature resulted in a total of 3115 publications. By applying our criteria, six articles were included in this study, with 949 participants. Our meta-analysis showed the overall complication incidence displaying a significant difference favouring the synthetic mesh group (IV = 1.25, 95% CI 1.11-1.42, P = 0.0002). The operation failure rate, defined as hernia recurrence, also significantly favoured synthetic mesh (IV = 2.42, 95% CI 1.66-3.52, P < 0.00001). In conclusion, the present study found that the synthetic mesh proved superior in overall complication rate and operation failure compared to biologic mesh. However, it had no significant differences in other complications.

Impact of pre-existing mesh at the hiatus at revisional hiatal hernia surgery.

Recurrence after laparoscopic hiatus hernia repair (LHR) is high, with few symptomatic patients undergoing redo LHR. Morbidity is higher in redo surgery compared with the primary operation. Tens of studies have explored the safety of redoing LHR. However, the impact of existing mesh on operative risk is rarely examined. We aim to assess the impact of mesh at the hiatus on the safety of redo LHR. This was a cohort study examining redo LHR patients from a prospectively maintained database from January 2002 to December 2023. The primary outcome was intra-/postoperative complications. Follow-up was extracted from clinical records. Predictors of complications were assessed using univariable and multivariable logistic regression analyses. Redo LHR was performed in 100 patients; 22 had previous mesh. One encountered mortality with 23 complications. Five patients had absorbable mesh, with the remainder nonabsorbable. Overall complications were significantly higher with mesh at nine (40.9%) compared to no mesh redo at 14 (17.9%), P = 0.023. There was no difference in rates of visceral injury with mesh at four (18.2%) and no mesh at six (7.7%), P = 0.22. The median follow-up was 7months; there was no difference in reflux rates (P = 0.70) but higher rates of dysphagia (P = 0.010). Higher overall complications were noted in patients with previous hiatal mesh repair at the time of LHR. However, major visceral complications were similar regardless of mesh use. Mesh at the hiatus should not be a deterrent for reoperative hiatus surgery.

Robotic Pauli repair of parastomal hernia.

Robotic retro-muscular mesh repair of parastomal hernia (PH) is possible with transversus abdominis release. The aim of this study is to report mid-term results with this method. Patients who underwent surgery for PH were enrolled in a prospective study. Patients with concomitant midline hernia also underwent Rives repair. Polypropylene meshes with an absorbable buffer mesh were used in the retro-muscular pocket-except PTFE was chosen for inflammatory bowel disease patients. Follow-up was by telephone and physical examination and CT if suspicion of complication. Of the 56 included ostomy patients, 44 had colostomies, 10 had ileostomies, and two had urostomies. Thirty-nine percent had a concomitant hernia, and 25% had recurrent PH. The mean operating time without accessory repair was 156min (SD 37), and with accessory repairs 220min (SD 62). One bowel lesion and one vascular injury to the stoma occurred, prompting intraoperative stoma revision without postoperative morbidity. Postoperative complications ensued in 12 patients (23%). One patient had stoma necrosis after 3weeks and the stoma was relocated. One patient had a mesh infection, 3 patients temporary ileus, one patient hypovolemic renal failure, and two patients experienced a flare-up of their Crohn's Disease. One parastomal abscess was drained percutaneously. The median postoperative stay was 3days (1-21; mean 3.7days), and the readmission rate was 8.9%. The recurrence rate at mean and median 24months follow-up is 5.4%, two in ileostomy patients and one colostomy patient with unaltered bulging where CT shows a relatively large prolapse and recorded as a failure. Robotic Pauli repair has shown promising results. However, repair fails of PH at small bowel ostomies with short mesentery. ePauli/TAR is now the preliminary choice for eligible patients at our site. Comparative studies with the intraperitoneal mesh standard are needed.

420. MESH REINFORCEMENT IN HIATAL HERNIA REPAIR: CLINICAL RESULTS OF OUR EARLY EXPERIENCE

Abstract Background Approximately one-third of the population develops diaphragmatic hernias among which only 10% are symptomatic. Restoration of the normal anatomy, hiatus closure and fundoplication are effective methods in the surgical treatment of diaphragmatic hernia repair. Placement of absorbable meshes to cover the hiatal closure emerges as a new, albeit controversial in the literature, technique for reinforcement. This study aims to assess the quality of life of patients diagnosed with hiatal hernia who underwent Nissen or Toupet fundoplication with absorbable biosynthetic mesh placement covering the suturing of the hiatus as an additional step during the laparoscopic or robotic hiatal hernia repair. Methods Data of all patients who underwent Nissen or Toupet fundoplication with absorbable mesh reinforcement at the hiatus between 2020-2023 at our specialised unit was collected and analysed. Thirteen patients who had completed their 6-month and 1-year postoperative follow-up, were interviewed. GERD score, PPI use and postoperative endoscopy were evaluated. Results Occasional use of PPI was reported by one patient, whereas those who had already undergone endoscopy of the upper gastrointestinal tract presented no signs of esophagitis, recurrence of hernia or Barrett esophagus. One patient reported symptom improvement after the operation with a GERD score of 13, while the rest of the patients had a GERD score of 0 (12/13). Conclusion The treatment of diaphragmatic hernias with Nissen or Toupet fundoplication using absorbable mesh reinforcement of the hiatus after closure with sutures seems to be an effective therapeutic method with a success rate over 90% in our case series provided that the rest of the surgical steps are identical between the cases through a well-established technique by our surgical team. However, further studies with larger number of patients and longer follow-up are mandatory aiming to further investigate the potential benefits when mesh reinforcement is applied.

Long-term results with biosynthetic absorbable P4HB mesh in ventral abdominal wall repair: a multicentre analysis.

The aim of this multicentre study was to analyse the outcomes of biosynthetic absorbable poly-4-hydroxybutyrate (P4HB) prosthesis implantation in patients undergoing ventral hernia repair (VHR) in the context of different degrees of contamination. From May 2016 to December 2021, a multicentre retrospective analysis of patients who underwent elective or urgent hernia repair with P4HB prosthesis was performed in seven hospitals in Spain and Portugal. Patients with a postoperative follow-up of less than 20months and those within the theoretical period of prosthesis resorption were excluded from the study. Regarding the degree of contamination, patients were assessed according to the modified Ventral Hernia Working Group (VHWG) classification. Epidemiological data, hernia characteristics, surgical and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. Risk factors related to long-term recurrence were studied by a multivariate analysis. In 236 cases of P4HB prosthesis implantation, repair in cases of Grade 3 was the most frequent (49.1%), followed by Grade 2 in 42.3% of cases and Grade 1 in 8.4%. The most frequent complications were Grade 1, with the majority occurring during the first year. The overall rate of surgical site occurrences (SSO) was 30%. The hernia recurrence rate was 14.4% (n = 34), with a mean postoperative follow-up time of 41months (22-61). The multivariate analysis showed that the onlay location of the mesh (OR 1.07; CI 1.42-2.70, p = 0.004) was a significant independent risk factor for recurrence. The use of a P4HB bioresorbable mesh for the VHR with different degrees of contamination leads to favourable results overall, with an acceptable rate of hernia recurrence. The onlay location of the P4HB prosthesis is the main factor in recurrence in both elective and emergency settings.

"The GalaFLEX 'Empanada' for Direct to Implant Prepectoral Breast Reconstruction".

Therapeutic, IV.

Quality of life following repair of large hiatal hernia is not influenced by the use of mesh-Longer-term follow-up from a randomized trial.

The use of prosthetic mesh in laparoscopic repair of large hiatus hernias remains controversial. Clinical and quality of life outcomes from a randomized controlled trial of mesh versus suture repair previously showed few differences at early follow-up. This study evaluated longer-term quality of life outcomes from that trial. A prospective, multicentre, double blind randomized controlled trial assessed three methods of repair for large hiatus hernias: sutures-only versus absorbable mesh versus non-absorbable mesh. Quality of life was assessed using the Short-Form 36 (SF-36) questionnaire which was completed preoperatively and then at 3, 6, 12months following surgery and annually thereafter. SF-36 outcomes were compared across the three repair techniques at longer-term follow-up (3-6years), and to earlier baseline and 12-month outcomes. 126 patients were randomized; 43-suture-only, 41-absorbable mesh and 42-non-absorbable mesh. Questionnaires were completed by 118 patients preoperatively, 115 at 12months and 98 at longer-term follow-up (median 5years). There were no significant differences between the repair techniques for the subscale and composite scores at longer-term follow-up. The mental component score improved significantly after surgery and was sustained across follow-up for all techniques. The physical component score also improved significantly but was lower at longer-term follow-up compared to the 12-month follow up in both mesh groups. Surgical repair of large hiatus hernias provides sustained long-term improvement in quality of life. The addition of mesh does not improve quality of life. This trial is registered with the Australia and New Zealand Clinical Trials Registry ACTRN12605000725662.

COMPARATIVE ANALYSIS OF ANATOMICAL SHAPED AND STANDARD FLAT MESH IN TRANSABDOMINAL PREPERITONEAL (TAPP) INGUINAL HERNIA REPAIR: EARLY OUTCOMES

Abstract Background Mechanical fixation in transabdominal preperitoneal inguinal hernia mesh repair (TAPP) is associated with pain syndrome and mesh migration may occur without flat protheses fixation. An anatomical shaped mesh (4DTM Cousin Biotech) using no fixation would improve the pain syndrome. Method A retrospective case study, that included 100 patients and 200 TAPP performed from 2019 to 2023. This study was conducted to compare laparoscopic inguinal hernia repair with (group A) or without mesh fixation (group B) regarding outcomes using two different mesh technologies: well-established flat macroporous partially absorbable mesh and the anatomical shaped partially absorbable lightweight mesh (4DTM Cousin Biotech). Results Recurrence rates, postoperative outcomes, and complication rate and type were analyzed to provide insights into the performance of each mesh in TAPP. There was statistically significant difference in postoperative early pain, assessed via VAS score, 3 days after surgery (group A versus group B; 3,4 ± 1.46 vs. 4 ± 1.6, P &amp;lt;0.001) and a week after surgery (group A versus group B; 1.5 ± 0.9 vs. 2.5 ± 0.6, P &amp;lt;0.001). Operative time, on average, was longer in group B (92 ± 12. vs. 79 ± 20 min, P &amp;lt;0.001). Conclusion The study results revealed that laparoscopic TAPP inguinal hernia repair with anatomical shaped mesh without fixation is safe and feasible with no increase in recurrence rate. In addition, it offers an improvement of operation time than TAPP mesh fixation. However, further study with a longer follow-up will be needed to confirm the results.

Surgical and Patient-Reported Outcomes After Mastectomy and Implant-Based Prepectoral Reconstruction Using TIGR® Synthetic Mesh.

Background Single-stage direct-to-implant (DTI) breast reconstruction after mastectomy has gained popularity over the last decade, thanks to the wide use of biological matrices and synthetic meshes. Despite their high cost, there is no evidence of superior outcome from the biological matrices compared to the synthetic meshes. In this study, we aimed to evaluate our experience with TIGR, a synthetic, long-term absorbable mesh, in mastectomy and immediate breast reconstruction (MIBR) with a focus on patient-reported outcomes (PROMs). Methods This was a single-trust prospective quality improvement study conducted between 2017 and 2019. The main objectives were complication rates including infection, implant loss, and other surgical complications in patients undergoing TIGR mesh-assisted MIBR in the prepectoral plane for either cancer or risk reduction. PROMs were measured using the validated European Organisation for Research and Treatment of Cancer (EORTC) breast questionnaire module. Clinical evaluations were conducted at one week, three weeks, and 12 months postoperatively. All patients provided written consent, and the audit was registered with the Quality Improvement Department of the organization. Results One hundred and twelve meshes were used in 93 patients with a mean age of 49 (24-75) years and a body mass index (BMI) of 23.4 (19.1-29.6). During the follow-up period, complications occurred in 26 patients (28%), including infection in four (4.3%), complete skin flap necrosis in one (1%), partial flap necrosis in three (3.2%), and implant loss in four (4.3%) patients. PROM data from 41 individuals indicated a moderate overall quality of life (82.7%), with high functional domain scores with relatively lower emotional functioning scores. Symptom domains generally scored poorly except for body image and sexual functioning. Conclusion Mastectomy and immediate prepectoral breast reconstruction using TIGR mesh is safe with low major complication rates. It is associated with high functional and quality of life scores but low scores in symptom domains which could be multifactorial. However, limitations due to study type and follow-up duration suggest caution in generalizing findings.

Remodeling and Regenerative Properties of Fully Absorbable Meshes for Abdominal Wall Defect Repair: A Systematic Review and Meta-Analysis of Animal Studies.

Fully absorbable meshes can repair abdominal wall defects and effectively reduce the incidence of complications, but different types of fully absorbable meshes have different remodeling and regeneration effects. In order to investigate and compare the effects of different fully absorbable meshes on remodeling and regeneration in animals and reduce the biological risk of clinical translation, SYRCLE was adopted to evaluate the methodological quality of the included studies, and GRADE and ConQual were used to evaluate the quality of evidence. According to the inclusion and exclusion criteria, a total of 22 studies related to fully absorbable meshes were included in this systematic review. These results showed that fiber-based synthetic materials and fiber-based natural materials exhibited better restorative and regenerative effects indicated by infiltration and neovascularization, when compared with a porcine acellular dermal matrix. In addition, the human acellular dermal matrix was found to have a similar regenerative effect on the host extracellular matrix and scaffold degradation compared to the porcine acellular dermal matrix, porcine intestinal submucosa, and fiber-based natural materials, but it offered higher tensile strength than the other three. The quality of the evidence in this field was found to be poor. The reasons for downgrading were analyzed, and recommendations for future research included more rigor in study design, more transparency in result reporting, more standardization of animal models and follow-up time for better evaluation of the remodeling and regenerative performance of abdominal wall hernia repair meshes, and less biological risk in clinical translation.

Use of polyglactin mesh coated with platelet-rich plasma for diaphragmatic defect healing in rabbits. Protocol for a Randomised Controlled Trial

Absorbable, biosynthetic scaffolds are a promising option for repair of diaphragmatic defects, since they are associated with less mesh-related complications than non-absorbable synthetic meshes. Coating of absorbable synthetic meshes with anti-inflammatory and healing agents, such as platelet-rich plasma (PRP), is a widely studied technique for improving mesh-tissue integration and reducing recurrence rate. The aim of this study is to investigate the synergic effect of a PRP-coated synthetic absorbable polyglactin mesh 2cmx2cm in healing of a diaphragmatic defect in an experimental rabbit model. Animals will be equally randomised in the PGM-PRP group (absorbable polyglactin mesh enriched with PRP) or the PGM group (use of absorbable polyglactin mesh only). Rabbits will undergo laparotomy under general anaesthesia and resection of a portion of the diaphragmatic central tendon 1cmx1cm. Samples will be euthanised on the 91th postoperative day and samples of 3cmx3cm will be harvested. The mesh-tissue integration will be assessed based on macroscopic, microscopic, immunohistochemical and morphometric parameters. The study is indesign stage and results are expected to be available by the end of the following year. High-quality evidence is expected regarding the synergic effect of PRP and synthetic absorbable polyglactin meshes in diaphragm repair.

Does crural repair with biosynthetic mesh improve outcomes of revisional surgery for recurrent hiatal hernia?

BackgroundLaparoscopic revisional surgery for recurrent hiatal hernia (HH) is technically demanding. Re-recurrences are common and esophageal hiatus mesh reinforcement might improve durability of the repair, thus minimizing the risk of re-herniation.PurposeAssess safety and effectiveness of simple suture repair (no mesh group) vs. crural augmentation with a biosynthetic absorbable mesh (mesh group) in patients with recurrent HH.MethodsObservational retrospective study from September 2012 to December 2022. Only patients undergoing redo surgery for previous failures of hiatal hernia repair were enrolled. Surgical failure was defined as symptomatic recurrent HH with > 2 cm of gastric tissue above the diaphragmatic impression at upper gastrointestinal endoscopy and/or swallow study. Gastro-Esophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) and Short Form-36 (SF-36) questionnaires were used to assess and preoperative and postoperative symptoms and quality of life.ResultsOne hundred four patients were included. Overall, 60 patients (57.7%) underwent mesh-reinforced cruroplasty, whereas 44 (42.3%) underwent simple suture cruroplasty. Mesh and no mesh groups had similar baseline demographics, symptoms, prevalence of esophagitis and Barrett’s esophagus, and HH size. A composite crural repair was most commonly performed in the mesh group (38.3% vs. 20.5%; p = 0.07). In addition to cruroplasty, most patients (91%) underwent a Toupet fundoplication. The 90-day postoperative complication rate was 8.6%, and there was no mortality. Recurrent HH was diagnosed in 21 patients (20.2%) with a clinical trend toward reduced incidence in the mesh group (16.7% vs. 25%; p = 0.06). Compared to baseline, there was a statistically significant improvement of median GERD-HRQL score (p < 0.01) and all SF-36 items (p < 0.01).ConclusionsLaparoscopic revisional surgery for recurrent HH is safe and effective. Selective use of biosynthetic mesh may protect from early recurrence and has the potential to reduce re-herniation in the long-term.

Open transversus abdominis release in incisional hernia repair: technical limits and solutions.

Incisional hernias with a defect width of more than10cm are considered complex. The European Hernia Society guidelines recommend that such hernias should only be repaired by surgeons with experience of component separation. The standard component separation technique now is posterior component separation with transversus abdominis release (PCSTAR). Questions are raised about the limits of this technique. A literature search of publications on PCSTAR was performed for any references to the limits of this technique in open incisional hernia repair. We found 26 publications relevant to answer this research questions. The standard PCSTAR can generally be used for a defect width of up to 15-17cm. For defects greater than 17cm problems must be expected with procedural tasks involving closure of the posterior layer and anterior fascia. No data are available in the literature on the bridging rate for the posterior layer. However, our own experiences show that gaps (holes) occur in the very thin peritoneum/fascia transversalis during dissection and these must be carefully closed. Furthermore, bridging with an absorbable synthetic mesh is needed not so rarely. Closure of the anterior fascia is successful in 81.0-97.2% of cases. In addition to a further mesh for anterior fascial closure, the hernia sac bound with multiple, accordion-like stitches can also be used. For a defect width greater than 17cm, the limits of PCSTAR become increasingly evident and can be overcome through special technical solutions for closure of the posterior layer and the anterior fascia.

How to Reduce Inferomedial Orbital Wall Fracture Using a Navigation System: Tips and Pearls.

The orbit is a confined space with a defined bony structure. Bony protrusion into the ethmoid or maxillary sinuses by the blowout fracture can displace orbital tissues, including rectus muscles and adjacent fascial septae. Especially, reconstructing the orbit's floor and medial wall can be challenging when the inferomedial strut or posterior bony ledge is affected, leading to a loss of critical anatomic landmarks and support. Correctly positioning an implant in the precise anatomic location can be challenging. Recent updates to the navigation system have addressed this issue. Despite its early application, using a navigation system in these orbital fractures advances plastic surgeons in a way that has more confidence and accuracy in surgical planning. The video demonstrates how these 2 can be combined in an operating room. Intraoperatively, the authors check the superior, anterior, and posterior ends of the medial wall fracture and the posterior end of the floor fracture. A single orbital implant was trimmed and reshaped to match defect measurements. The implant placement was meticulously executed to repair the fracture while ensuring the inferior oblique muscle was not injured. After confirming the correct placement of the implant, it was secured to the inferior orbital rim using a single screw. Depending on the medial orbital wall fracture depth or degree of soft tissue herniation, the authors used an artificial dermal matrix or trimmed absorbable mesh plate to cover the uppermost part of the medial wall fracture to prevent postoperative enophthalmos. Finally, a forced duction test was performed. Our study shows that navigation-assisted inferomedial orbital wall reconstruction using materials readily available in the market is safe and effective.

Partially absorbable composite mesh versus non-absorbable polypropylene mesh in laparoscopic repair of inguinal hernia in a tertiary care center

Background: The choice of mesh is far more important than the technique used as a determinant of patient outcome. Randomized studies have compared polypropylene and modified composite mesh (polypropylene and polyglactin) and found decreased foreign body reactions and post-operative complications and improved long-term quality of life with the use of composite mesh. However, a limited number of studies have been done comparing the early outcomes such as inguinodynia, the presence of a seroma or hematoma, foreign body sensation, testicular problems, and the return to normal work activities. Aims and Objectives: The primary objective was to assess and compare the early outcome of non-absorbable polypropylene mesh vs. partially absorbable composite mesh in laparoscopic inguinal hernia repair. The secondary objective was to compare the complications associated with both types of mesh hernioplasty. Materials and Methods: A total of 50 cases of elective reducible indirect inguinal hernia patients admitted to the Department of Surgery, VIMSAR, Burla, were included in our study. The total group was split into Group A and Group B of 25 cases each. All patients underwent laparoscopic inguinal hernia repair transabdominal prepeitoneal. The partially absorbable composite lightweight meshes are used in Group A, and the non-absorbable polypropylene meshes are used in Group B. After surgery, comparison between the two groups was made on the basis of parameters such as age distribution, inguinodynia, analgesia, foreign body sensation, presence of a lump (hematoma or seroma), return to work activities, and recurrence. Results: The mean age of patients is 50.24 ± 12.994 years. The majority of the patients were in the age group of 51–60 years. Initially, there was no significant difference in transient neuralgia between the two groups, but after 6 weeks, Group A had significantly less pain. Foreign body sensation is significantly more in Group B, but later, this was not significant. Conclusion: Based on the results of this study, composite mesh may be recommended for use in laparoscopic inguinal hernia repair owing to the less pain, less foreign body sensation, and earlier return to work.

Postoperative Outcomes and Recurrence Rate in Laparoscopic Tep Inguinal Hernia Repairs Using Partially Absorbable Meshes: A Retrospective Single-Surgeon Study Over a 5-Year Period.

This study aimed to evaluate the postoperative outcomes and recurrence rate in laparoscopic inguinal hernia repairs performed over a 5-year period with totally extraperitoneal (TEP) technique and use of partially absorbable meshes. A total of 100 patients (mean (SD, min-max) age: 51.0 (14.6, 16-83) years, 91.0% were males) who underwent 150 laparoscopic TEP inguinal hernia repairs (bilateral in 50 patients) with use of the partially absorbable mesh were retrospectively reviewed. Data on patient demographics, hernia characteristics (side, subtype), date of operation, operating time, early and late postoperative complications as well as the recurrence rate were recorded over a 5-year period. The inguinal hernia was bilateral in 50 (50.0%) patients and indirect hernia was noted in 53 (53.0%) patients, while lipoma was evident in 17 (17.0%) cases. Median operating time was 45.0 min (range, 23.0 to 140.0 min). Overall, seroma occurred in 6 (6.0%) patients and was treated conservatively, while none of patients developed preperitoneal hematoma, infection or persistent chronic inguinal pain. Recurrence rate was 0.67% (1/150 operations) within a median 30.0 months (range, 2 to 60 months) of postoperative follow-up. Bilateral hernia was associated with significantly longer operating time compared to left or right unilateral hernia (median (min-max) 50.0 (34.0-140.0) vs. 40.0 (23-80) and 40.0 (25.0-130.0) min, p<0.01 and p<0.001, respectively). Operating time was positively correlated both with patient age (r=0.240, p=0.017) and BMI (r=0.205, p=0.044). In conclusion, our findings indicate that laparoscopic TEP inguinal hernia repair with use of the partially absorbable meshes enables a favorable postoperative outcome with minimal early and late postoperative complications and 0.67% recurrence rate over a 5-year period.

Laparoscopic modified mesh rectopexy: medium-term results of a novel approach for external rectal prolapse.

Rectal prolapse is a common and significantly debilitating condition. Surgical correction is usually required. The two most common abdominal approaches are ventral mesh rectopexy and posterior suture rectopexy. Both may be complicated, respectively, by either mesh-related complications or significant postoperative constipation. We report the outcome of a novel rectopexy operation which combines aspects of both the aforementioned approaches, for the treatment of external rectal prolapse (ERP). The technique involves laparoscopic partial posterior-lateral rectal mobilization of the rectum with posterior suture fixation to the sacral promontory and placement of an absorbable mesh in the rectovaginal space. Data were collected on postoperative complications, prolapse recurrence, mesh-related complications and the assessment of quality of life. Eighty patients underwent a modified mesh rectopexy for ERP. Seventy-seven were women. The median age was 67.5 years. Almost a third had undergone a previous rectal prolapse repair. Recurrences were seen in 11 (13.8%). No mesh-related complications were seen. Eleven patients reported postoperative constipation. The laparoscopic modified mesh rectopexy may be a safe and effective operation for the treatment of ERP.