Common Hernia Research Articles

Subcutaneous Onlay Laparoscopic Approach for small ventral hernias associated with divarication of rectus abdominis muscle

BackgroundVentral hernias when associated with divarication of rectus abdominis if repaired without concomitant repair of the divarication is plagued by higher rates of recurrences. Out of the many options available for the repair, Subcutaneous Onlay Laparoscopic Approach (SCOLA) with concurrent plication of the divarication is gaining popularity. MethodsAll patients with a ventral hernia associated with divarication of recti were included in this prospective study. The calculated sample size was 34 with a confidence level of 95% and a margin of error of 5%. The patient demographics, operative time, intraoperative and postoperative complications, need for post-operative blood transfusion, and the recurrence were recorded. Categorical data were compared using Student's t-test, whereas chi-square test was used to compare the nominal variables between the two groups. A P-value of <0.05 was considered to be statistically significant. ResultsThirty-six patients were analysed for the study with a mean age of 43.40 years. A total of 55.55% patients were female. Twelve patients had co-morbidities. Umbilical hernia was the most common hernia. The mean size of the hernial defect was 3.67 cm, and the mean operative time was 156.66 min (±31.02 min). The first 15 cases took longer time for the surgery (mean operative time 183.53 min [±19.73 min]). No intraoperative complications were recorded, except for one patient in whom we encountered an excessive bleeding but was tackled with harmonic scalpel. Eight patients (22.2%) had complications with Seroma formation being the commonest. ConclusionSCOLA is feasible and advantageous because of faster recovery and minimal complication and recurrence rates.

Clinical study of mesh repair in ventral hernia with comorbidities (diabetes mellitus and/or obesity and/or hypothyroidism) in a tertiary care hospital

Background: Ventral hernias comprise the second-most common hernia presentation, or 21–35% of all hernia types in the surgical world. Ventral hernias include incisional, umbilical, epigastric, and spigelian hernias, among others. This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications. Aims and Objectives: This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications. Materials and Methods: Forty-five cases of ventral hernias treated were studied prospectively from January 2021 to June 2022, in which each patient was evaluated thoroughly and surgery was planned to obtain a satisfactory outcome. The distribution of ventral hernias with respect to age, sex, comorbidities, and risk was recorded. Common presenting symptoms of ventral hernias, diagnosis, and complications were studied. The data collected was entered in a proforma, tabulated, and statistically analyzed. Results: Females were affected much more than males. Out of the three types of hernia that were studied, umbilical hernia showed more incidence (n=23/51%), followed by incisional hernia (n=15/33%), and epigastric hernia (n=7/16%). The most common age presentation was in the fourth and fifth decades. The most common type of mesh repair was pre-peritoneal repair in 28 (62%). The pain was relatively more common post-surgery complications, as noted in 11 (24%). In 100% of the cases, swelling was the complaint, followed by pain (18.8%). Obesity was the most common etiological factor in the development of ventral hernias (60%), followed by diabetes (35%). Conclusion: The most common ventral hernia was an umbilical hernia. Ventral hernias are more common in females. Obesity and diabetes are observed to be the major predisposing risk factors. Good pre-operative evaluation and preparation, sound anatomical knowledge, and meticulous attention to surgical detail are the most important factors for the prevention of postoperative complications. In view of the limited period of follow-up, we were not in a position to comment on recurrence rates, but when proper surgical procedures are adopted along with pre-operative correction of comorbid factors, results will always be excellent.

The pros and cons of suturing the ventral hernia defect using the intraperitoneal onlay mesh technique

Background/Aim. Laparoscopic ventral hernia surgery, including intraperitoneal onlay mesh (IPOM), is as effective and safe as open surgery, with a lower recurrence rate. Some surgeons advocate laparoscopic primary fascial closure (PFC) with intraperitoneal mesh placement to reduce recurrence rates. The aim of this study was to compare the treatment outcome between two laparoscopic techniques: the PFC technique and mesh placement without suture closure (IPOM technique) for defects under 4 cm in patients with ventral hernias. Methods. The study sample was comprised of 50 patients who underwent laparoscopic ventral hernia surgery from January 1, 2018, until December 31, 2020. Half of the patients underwent only the IPOM technique (group of patients without the suture), while in others, this was preceded by the closure of the hernial ring (group of patients with the suture). All hernias were midline and all defects were under 4 cm. The studied groups were homogeneous according to gender and age. Comorbidities, complications, and postoperative comfort were monitored. Results. The most common (76%) hernias were primary, and the most common comorbidity was arterial hypertension (28%). One (2%) patient had intraoperative bleeding, and the most common postoperative complication was pain in 7 (14%) patients. After a threeyear follow-up, there were 10 (20%) patients with complications - one hernia recurred, while 9 (18%) patients died. There was no difference in the types of occurrence of hernias, comorbidities, and intraoperative complications. The distribution of postoperative complications differed significantly (p = 0.007) between the groups. Pain was statistically significantly more prevalent in patients with sutures. During the first three months postoperatively, significantly more patients with sutures had chronic pain (?2 = 8.140; p = 0.004). Conclusion. We recommend the application of the PFC technique in selected ventral hernia repair cases, although it can lead to more frequent postoperative pain (which, fortunately, is easily treated).

Tracheostomy in infants: Indications and outcomes

Background/Aim. Laparoscopic ventral hernia surgery, including intraperitoneal onlay mesh (IPOM), is as effective and safe as open surgery, with a lower recurrence rate. Some surgeons advocate laparoscopic primary fascial closure (PFC) with intraperitoneal mesh placement to reduce recurrence rates. The aim of this study was to compare the treatment outcome between two laparoscopic techniques: the PFC technique and mesh placement without suture closure (IPOM technique) for defects under 4 cm in patients with ventral hernias. Methods. The study sample was comprised of 50 patients who underwent laparoscopic ventral hernia surgery from January 1, 2018, until December 31, 2020. Half of the patients underwent only the IPOM technique (group of patients without the suture), while in others, this was preceded by the closure of the hernial ring (group of patients with the suture). All hernias were midline and all defects were under 4 cm. The studied groups were homogeneous according to gender and age. Comorbidities, complications, and postoperative comfort were monitored. Results. The most common (76%) hernias were primary, and the most common comorbidity was arterial hypertension (28%). One (2%) patient had intraoperative bleeding, and the most common postoperative complication was pain in 7 (14%) patients. After a three-year follow-up, there were 10 (20%) patients with com-plications ? one hernia recurred, while 9 (18%) patients died. There was no difference in the types of occurrence of hernias, comorbidities, and intraoperative complications. The distribution of postoperative complications differed significantly (p = 0.007) between the groups. Pain was statistically significantly more prevalent in patients with sutures. During the first three months post-operatively, significantly more patients with sutures had chronic pain (?2 = 8.140; p = 0.004). Conclusion. We recommend the application of the PFC technique in selected ventral hernia repair cases, although it can lead to more frequent postoperative pain (which, fortunately, is easily treated).

Outcomes after ventral hernia repair using the extended totally extraperitoneal approach: Initial experience from the Philippines.

Newer extraperitoneal techniques of laparoscopic ventral/incisional hernia repair (LVIHR) have been continually introduced since the popularity of the laparoscopic intraperitoneal onlay mesh technique began in 1993. One of which is the extended totally extraperitoneal (eTEP) approach allowing wide mesh augmentation, concurrent repair of diastasis recti, and performance of transversus abdominis release (TAR) for large/complex hernias. However, minimally invasive/laparoendoscopic ventral hernia repair is not yet widely adopted in the Philippines. We aim to share our preliminary experience with LVIHR using the eTEP approach. This was a retrospective review of all consecutive eTEP repairs for ventral hernia between January 2019 and September 2023. The clinical profiles of all patients were gathered. Hernia characteristics, operative profile, and postoperative outcomes were reported. Thirty-five patients were included in the study with a mean age of 54.7; 60% were incisional hernias, and the most common hernia location was the umbilical area. A defect size between 4 and 10 cm was reported in 54.3%. eTEP-TAR was necessary in 12 patients. At a median follow-up of 16 months, two patients developed seroma, one hematoma, and two surgical site infections. All were successfully managed conservatively. Only one patient developed recurrence. eTEP approach is safe and feasible for repairing ventral hernias. Our preliminary experience showed acceptable outcomes similar to the published literature. Surgeons interested in this technique should be familiar with the abdominal wall anatomy, carefully select patients during preoperative planning, and undergo mentorship with hernia surgeons experienced with the technique to shorten the learning curve.

An Unusual Case of a Strangulated Right Inguinal Hernia Containing the Caecum Managed with Desarda’s Repair

Groin hernias are most common hernias in abdominal wall hernias (75%). 95% of groin hernias, are from inguinal canal and remaining area femoral hernias. Two-thirds of the inguinal hernias are indirect and remaining are direct inguinal hernia. An indirect inguinal hernia is the most common, regardless of gender and in men, indirect hernias predominate over direct hernias at a ratio of 2:1. Direct hernias are uncommon. Strangulated external hernia is a relatively common serious surgical emergency. In these approximately 50% of cases involves small bowel obstruction and accounts for most of the deaths from this condition. Presenting a case of 64-year gentleman diagnosed with strangulated right inguinal hernia, managed with urgent surgery and underwent right hemicolectomy with Desarda’s repair in view of gangrenous caecum. This case report underscores the clinical presentation and prompt surgical management of an unusual case of a strangulated right inguinal hernia containing the cecum, entailing both hernia repair and right hemicolectomy. The Desarda’s technique was chosen as the hernia repair method which focuses on autologous tissue repair. Keywords: Strangulated hernia, Desarda’s repair, right hemicolectomy, ileo-transverse anastomosis, small bowel obstruction.

Gender, racial, and socioeconomic disparity of preoperative optimization goals in ventral hernia repair.

Preoperative optimization cut-offs are frequently utilized to determine eligibility for elective ventral hernia repair. Our objective was to assess the relationship between gender, race, and socioeconomic status and preoperative optimization goals. We queried our institutional database for adults with ventral hernia diagnoses between 2016 and 2021. Demographics, comorbidities, laboratory, and operative data were collected and analyzed. The following cut-offs were used to determine eligibility for elective repair: body mass index (BMI) < 40kg/m2, no active smoking, and glycated hemoglobin (HbA1c) < 8%. Socioeconomic status was assessed using the Distressed Communities Index. A total of 5638 patients were included [Whites = 4321 (77%), Blacks = 794 (14%), Hispanics = 318 (6%), and other/unknown 205 (4%)]. Median age was 61years and 50% were male. Most common hernia types were umbilical (36%) and incisional (20%). 10% had BMI > 40kg/m2, 9% were active smokers and 4% had HbA1c > 8%. 21% of all patients did not meet the preoperative optimization cut-offs at time of diagnosis and those were less likely to undergo hernia repair during the study timeframe compared to those who did (OR 0.50; 95% CI [0.42-0.60]). There was a higher proportion of females (21%) and Blacks (22%) with BMI > 40kg/m2 compared to males (11%) and other races (11-15%), p = 0.002. As the level of socioeconomic distress increased, there was a corresponding increase in the proportion of patients who did not meet preoperative optimization cut-offs from 16% in prosperous communities to 25% in distressed communities (p < 0.0001). Nearly 1 of 5 patients with ventral hernias is affected by commonly used arbitrary preoperative optimization cut-offs. These cut-offs disproportionately impact females, Black patients and those with higher socioeconomic distress. These disparities need to be considered when planning preoperative optimization protocols and resource allocation to ensure equitable access to elective ventral hernia repair.

İnkarsere Karın Ön Duvarı Fıtıklarında Üçüncü Basamak Hastane Deneyimi

Background: This study aims to evaluate the results of incarcerated anterior abdominal wall hernia cases in which we performed emergency surgery in light of the literature. Materials and Methods: The records of 124 patients who underwent emergency surgery for incarcera-ted anterior abdominal wall hernia between January 2016 and December 2019 were retrospectively reviewed. The patients' files, computer records, epicrisis reports, surgery reports, and outpatient clinic records were evaluated. Patients; Age, gender, hernia type, location, time of admission, previous hernia surgery history, affected organs, type of anesthesia applied, surgical techniques, resection status, length of hospital stay, morbidity, and mortality rates were recorded. Results: The mean age of 124 patients was 59.47 ± 17.75 (17-94) years. Of the patients, 64 (51.6%) were female, and 60 (48.4%) were male. The mean hospital stay was 4.12±3.52 (1-19) days. Thirteen (10.5%) patients had additional disease. General anesthesia was applied to 100 (80.6%) patients, and regional anesthesia was applied to 24 (19.4%) patients. 25 patients were operated on with the diagnosis of recur-rence and 99 with the diagnosis of a primary hernia. The most frequently compressed organs in the hernia sac were the omentum (64.5%) and small intestine (32.2%). Bowel resection was performed in 16 of the patients. Mesh was applied to 90 patients during the operation. The most common hernia types were inguinal, umbilical, and incisional. 31 (13.7%) complications developed in 17 patients. Sepsis, wound infection, ileus, atelectasis, and respiratory failure were the most common. Mortality was developed in 6 (4.8%) of the patients. Conclusions: This study showed that additional disease increases morbidity in hernia cases, and intestinal resection due to strangulation increases morbidity and mortality. Therefore, patients presenting with an incarcerated hernia should be operated on as soon as possible before strangulation develops.

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)

A Comparative Study on Pre- and Post-operative Quality of life of Hernia patients

Hernia repair is one of the common surgical procedures performed all over the world. Sociodemographic factors as well as lifestyle do have a greater weight on the development of hernia. Open and laparoscopic techniques are available for hernia repair, although most of the patients prefer laparoscopic techniques to open surgical procedure due to its minimum invasive capacity, reduced wound infection, shorter hospital stays etc. While considering the risk involved with surgery, evaluating the patient’s quality of life both before and after surgery is critical. This study was conducted among 104 eligible hernia patients and their data were collected by interviewing them. The pre- operative quality of life eligible candidates is compared to post-operative quality of life using a scale called European Registry for Abdominal Wall Hernias Quality of life (QOL) assessment scale (EuraHS) consist of 9 questions, for an interval of 6 months for each patient. The most common hernia type, risk factors, causes and post-operative complications were also noted. It was found out that there was a significant hike in QOL of hernia patients after surgery. This study shows the effectiveness of EuraHS-QOL Score in QOL Assessment of hernia patients. This scale has an excellent reliability and applicability in both ventral and groin hernias.

Incidentally found Bilaterally Occult Femoral Hernia during Transabdominal Preperitoneal Inguinal Hernia Repair: A Case Report

Hernia is defined as an area of anatomical weakness or an abnormal protrusion of a viscous or a part of a viscous through an opening, covering it. Inguinal hernia is the most common hernia because of the presence of natural weakness like the deep ring and cord structures. The minimally invasive procedures for inguinal hernia repair include Intraperitoneal Onlay Mesh (IPOM) repair, Transabdominal Preperitoneal Repair (TAPP), and Total Extraperitoneal (TEP) repair. Laparoscopic inguinal hernia repair has the advantage of inspecting the entire myopectineal orifice, as it allows for the identification of bilateral or recurrent hernias. The principle behind laparoscopic repair includes strengthening of myopectineal orifice in all the above approaches. TAPP repair is mainly indicated for large indirect hernias or irreducible hernia. TEP repair is technically challenging to perform and has the advantage of avoiding interbowel adhesions as the peritoneum is not opened. IPOM repair is not routinely performed but has advantages in cases where there is an increased risk of spermatic cord injury seen in patients with a history of lower abdominal irradiation or a history of multiple recurrent hernia surgery. Occult contralateral inguinal hernia and the occult femoral hernia can be easily diagnosed and repaired with no extra incisions while performing TAPP repair. These hernias, if left untreated may present as recurrent hernias or as non resolution of symptoms posthernia surgery. A rare case of bilateral occult femoral hernia found during laparoscopic TAPP repair of an inguinal hernia was reported. The entire myopectineal orifice was repaired using the same mesh with no extra risk or cost.

SJLA_2024_A19: Outcomes of Slow Absorbable Biosynthetic Mesh (Phasix™) in Ventral Hernia Repair in National Guard Health Affairs

Introduction: Mesh has become the preferred method due to its ability to integrate with the host’s tissue, reducing recurrence rates compared to primary suture repairs. While synthetic mesh reduces recurrence rates, it may lead to inflammation and infection. To evaluate its performance, this study aims to assess the short-term outcome following ventral hernia repair with biosynthetic mesh. Background: In Ventral Hernia Working Group Grade 3 hernias, which are often contaminated due to factors like prior wound infections, the presence of a stoma, or gastrointestinal tract violations, the heightened risk of infection poses significant challenges. In such cases, the success of mesh repair is jeopardized by potential contamination, complicating the surgical process; prompting consideration of resorbable or biological meshes despite higher costs. A recent advancement is biosynthetic mesh, notably poly-4-hydroxybutyrate, which offers strength comparable to polypropylene mesh and undergoes resorption. However, it retains only 70% strength after 12 weeks, potentially contributing to recurrence. Its efficacy in contaminated sites requires further exploration. Methods: We conducted a retrospective cohort study to thoroughly assess the potential complications following ventral hernia repair. This study will include all patients whose ages are &gt;16 and underwent either open or laparoscopic ventral hernia repair with a biosynthetic mesh at King Abdulaziz Medical City, Saudi Arabia, Riyadh National Guard Health Affairs. The study period extends from January 2020 to December 2023. The study data were extracted from patients’ medical records through the BestCare system. Results: The mean age of our cohort was 58.65 with body mass index 39.6 when looking at comorbidities diabetes mellitus and HTN were the most common comorbidities with 32% affected with diabetes, and 39% affected with hypertension. The most common hernia type observed in our study was incision hernia accounting for 36% of all hernia types followed by inguinal hernia 24.6%. Complications were assessed at 4 time intervals of 1, 3, and 6 months and 1 year. The majority of the patients with complications presented at the 1st month with seroma accounting for 2.2% followed by surgical site infection (SSI) 1.8% and only three patients had 1-year postoperative recurrence. Discussion: The long-term effects of using a permanent synthetic mesh have not been fully understood. However, examining the outcomes associated with absorbable mesh can provide a useful framework for discussing potential risks with patients. Reported outcomes include rates of hernia recurrence and various surgical site occurrences requiring intervention, such as SSI, seroma, wound dehiscence, skin necrosis, hematoma, and fistula. It is important to note that this study is a retrospective cohort study with long-term follow-up, rather than a randomized controlled trial. In addition, other peer-reviewed studies have assessed alternative resorbable synthetic or biologic hernia repair materials, including TIGR® Matrix, Gore® Bio-A®, and Strattice™. Conclusion: In short, our results are comparable to the published reports. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report the lasting presence of mesh sensation. Results of the biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations.

Shared genetic architecture of hernias: A genome-wide association study with multivariable meta-analysis of multiple hernia phenotypes.

Abdominal hernias are common and characterised by the abnormal protrusion of a viscus through the wall of the abdominal cavity. The global incidence is 18.5 million annually and there are limited non-surgical treatments. To improve understanding of common hernia aetiopathology, we performed a six-stage genome-wide association study (GWAS) of 62,637 UK Biobank participants with either single or multiple hernia phenotypes including inguinal, femoral, umbilical and hiatus hernia. Additionally, we performed multivariable meta-analysis with metaUSAT, to allow integration of summary data across traits to generate combined effect estimates. On individual hernia analysis, we identified 3404 variants across 38 genome-wide significant (p < 5×10-8) loci of which 11 are previously unreported. Robust evidence for five shared susceptibility loci was discovered: ZC3H11B, EFEMP1, MHC region, WT1 and CALD1. Combined hernia phenotype analyses with additional multivariable meta-analysis of summary statistics in metaUSAT revealed 28 independent (seven previously unreported) shared susceptibility loci. These clustered in functional categories related to connective tissue and elastic fibre homeostasis. Weighted genetic risk scores also correlated with disease severity suggesting a phenotypic-genotypic severity correlation, an important finding to inform future personalised therapeutic approaches to hernia.

A clinical study on groin hernias presenting as acute emergencies in a tertiary care hospital

Background: Inguinal hernias are the most common hernias encountered in the surgical practice. A small section of cases present to the emergency with certain complications at time of presentation. Complications like irreducibility, obstruction and strangulation occur which require immediate management. Aim of this study is to study groin hernias presenting as emergencies and their surgical management. Materials and Methods: This study was a prospective observational study, conducted in the Department of General Surgery, Rangaraya Medical College and Hospital, during May 2021 to May 2022(1 Years). The study population is 50 patients.Results: The incidence of hernia is more common in the age group consisting 60-70 years (34%). The incidence at the age group 51-60 years is 22%.The frequency of hernia in males is greater than females. Incidence in males is 98% and 2% in females. The duration of hernia before the acute episode is more common in the first year. Complications were more common on the right side than the left side. The common site of constriction is at the internal ring. The duration of hernia before the acute episode is more common in the first year. Complications were more common on the right side than the left side. The common site of constriction is at the internal ring. Pain is universal in all patients. Pain and irreducibility were present in the frequency of 50 patients. Constipation was found in 36 patients and fever was present in 16 cases respectively. Complications like obstruction which were present in 64% of cases. Pain and irreducibility were present in 22% of cases. Strangulation was seen in 14% of the cases. Optimum procedure done was herniorrhaphy in 84% of cases. Resection and anastomosis was done in 6% of the cases. Omentectomy was done in 3% of the cases.Conclusion: The most common age group of presentation is 51 to 60 years. It is more common in male sex group. Pain and irreducibility were universal. The incidence of complications were common in the first year of presentation. The most common site of constriction is the deep ring followed by superficial and femoral canal. Pain and irreducibility were universal. Herniorrhaphy was done universally for all cases with resection and anastomosis of gangrenous bowel and omentectomy as adjunctive procedures.

Strangulated Umbilical Hernia: A Case Report

Background: The abdominal wall hernia repair was one of the most frequently performed operations by general surgeons worldwide. The second most common hernia operation is repairs of umbilical hernia. It is estimated that 5% of individuals will develop an abdominal wall hernia over their lifetime. This study aimed to present a case of strangulated umbilical hernia.&#x0D; Case presentation: 51 years old male patient presented with sharp, non-radiating pain in the left abdominal region, obstipation, and noted bulge at his umbilicus about one year ago that did not shrink when he was lying down two days ago, the diameter about 7 cm. A plain Abdominal X-ray showed partial small bowel obstruction. The patient was taken to the operation theatre for laparotomy resection and reanastomose ileum and repair hernia defect with mesh. Prior to surgery, the patient received antibiotic therapy with Cefazolin 2gr intravenous, and the nasogastric decompression tube (NGT) was installed. On exploration, it was found necrotic ileum along 15 cm and performed resection, followed by end-to-end anastomosis. After the surgical procedure, the patient's hemodynamics was stable.&#x0D; Conclusion: Overall mortality and prognosis of hernia are influenced by whether the surgery was emergent or elective. Mortality is increased to up to 3% with emergency surgery for strangulated bowel, notably when bowel resection is performed.

Are Surgeons of the Abdominal Core Health Quality Collaborative Following Guidelines in Umbilical and Epigastric Hernia Repair?

Umbilical and epigastric hernias are among the top three most common hernia surgeries performed in the USA with varied techniques. The European and Americas Hernia Societies (EAHS) recently published guidelines for repair of umbilical and epigastric hernias. We evaluated how closely the general surgeons of the Abdominal Core Health Quality Collaborative (ACHQC) follow these guidelines and to identify areas for possible improvement. Data from patients undergoing elective and emergent umbilical or epigastric hernia repair from 2013 to 2021 were extracted from the ACHQC database. The procedures performed on eligible subjects were compared to those proposed by the EAHS guidelines. Data was reported as a percentage and a cutoff of 70% was selected to determine compliance. Based on these criteria, 11,088 patients were included and most of the recommendations, including appropriate preoperative antibiotic dosing (96.1% umbilical; 97.2% epigastric), permanent mesh selection (umbilical 97.8%; 96.1 epigastric), mesh fixation with suture (83.6% umbilical; 75.5% epigastric), use of mesh for open repair of hernias greater than 1cm (83.6 umbilical; 85.7 epigastric), and primary defect closure during open (98.6% umbilical; 97.5% epigastric) and laparoscopic (99.6% umbilical; 100% epigastric) repair, were met. Surgeons of the ACHQC adhere to most of the published guidelines on umbilical and epigastric hernia repair. Further research is needed to reinforce or modify the existing recommendations. Standardization of surgical approach will facilitate additional research needed to improve procedural efficiency, while reducing negative outcomes and cost.

Sublay mesh versus Onlay mesh: a randomized comparative study

Introduction. Ventral hernias are the second most common hernia; Onlay and Sublay operating techniques are procedures commonly performed in such cases. There is no consensus on the superiority of these procedures. The aim of this study was to compare the results of both procedures in order to identify the recommended technique between the two options. Materials and Methods. A total of 106 patients with epigastric, umbilical, paraumbilical, incisional hernias were studied. These patients were grouped into group A (onlay) and Group B (sublay). The outcomes of the two techniques were compared with respect to operative time, pain, hospital stay, seroma, infection, recurrence and patient satisfaction. Results. The mean operative time was 81.30 minutes in group A, and 85.85minutes in group B. Twenty-two (42.5%) patients in group A and seven (12.96%) patients in group B developed seroma. Nine (17.3%) patients in group A, 3 (5.55%) patients in group B developed post-operative infection. 30 (57.69%) patients in group A and 47(87.3%) patients in group B reported moderate pain, whereas three (5.76 %) and seven (12.96%) patients in group A and group B were reported severe pain in immediate post-operative period. At 48 hours, 20 (38.46%) and 24 (44.44%) of patients in group A and B were reported moderate pain, whereas 32 (61.53%) and 30 (55.55%) patients in group A and B reported mild pain. The mean hospital stay was 10.11 days in group A and 6.22 in group B. Three (5.76 %) patients of group A has recurrence, none of the patients in sublay group has developed recurrence. Thirty-nine (72.22%) patients of sublay group expressed their satisfaction but only 20(38.46%) patients in onlay group expressed their satisfaction. Conclusion. With reference to all the study parameters except one, the sub lay technique of mesh placement appears to be better. The exception is pain in the immediate postoperative period.

A novel method for evaluating the tensile behavior isotropy of surgical meshes based on the analysis of the polar graph of tensile properties using image processing method

The most common hernia treatment method is using a surgical mesh. The functional properties of surgical meshes, including structural and mechanical properties affect mesh performance. Anisotropy of the tensile behavior of the surgical mesh influences the hernia treatment process. In this research, a novel index named ‘isotropy index’ is introduced based on the analysis of the polar graph of the tensile properties of surgical meshes. The isotropy index, which is expressed in percent, was defined as the ratio of the polar diagram area of the tensile elastic modulus to the area of the circle surrounding the polar graph and calculated using the meshes' tensile elastic modulus in five directions(0°(course), 30°, 45°, 60°, and 90°(wale)) using the image processing method. For this purpose, common net warp-knitted fabrics in surgical mesh production were produced with five various knit patterns(quasi-Sandfly, Tricot, Pin-hole-net, Sandfly, and quasi-Marqussite) using polypropylene monofilament yarns, and their tensile properties were analyzed in various directions(0°(course), 30°, 45°, 60°, and 90°(wale)). Results revealed that the quasi-Sandfly mesh is the most isotropic(57.74%), and the quasi-Marqussite mesh is the most anisotropic(17.12%) among evaluated surgical meshes. Tricot mesh(54.98%), Sandfly mesh(49.17%), and Pin-hole-net mesh(46.41%) in terms of the tensile behavior isotropy are between quasi-Sandfly mesh and quasi-Marqussite mesh. The Sandfly mesh has the closest isotropy index to the abdominal wall tissue. Considering the importance of the lightness, adequate porosity, larger pore size, and closeness of the mesh’ isotropy index to abdominal wall tissue for enhancing mesh functional properties, the Sandfly mesh was selected as the best-knit pattern for surgical mesh.

MO674: Risk Factors for Abdominal Wall Hernias in Peritoneal Dialysis Patients

Abstract BACKGROUND AND AIMS Abdominal hernias are relatively common non-infectious complications in peritoneal dialysis (PD) patients with reported prevalence rates ranging from 7% to 27.5%. This complication can be troublesome and is sometimes associated with PD suspension and transition to hemodialysis, that can be transiently or definitively. Several risk factors for hernia formation have been proposed and included male gender, advanced age, autosomal dominant polycystic kidney disease (ADPK) and previous hernia repair. A larger dialysate diffusion volume is associated with increased intra-abdominal pressure and has been reported to increase the risk of hernia. However, studies are in conflict regarding risk factors for hernia formation. The aim of this study was to establish the incidence and the risk factors for hernia formation in patients receiving PD at our center. METHOD We developed a single-center, retrospective, observational study. Incident PD patients from January 2010 until October 2020 were screened for inclusion. Multiple logistic regression based on variables with P-value &amp;lt;0.05 in univariate comparative test and Cox regression were applied to estimate the predictors for hernia formation. A value of P &amp;lt; 0.05 was considered statistically significant. RESULTS A total of 163 PD patients were enrolled since and followed until December 2020, with 53 hernia events and 32 hernioplasties being registered in 28 patients (52.8%). The incidence rate was 0.09 hernias/patient/year. Table 1 summarizes the general characteristics of the patient with and without hernias. The umbilical hernias were the most common hernia type encountered (64.2%), followed by inguinal and incisional hernias. Median duration on PD therapy was 24.0 months (range: 18.5–35 months) and the median time from the start of PD to the development of hernia was 12.8 months (range: 6.1–18.9 months). The majority of patients who developed hernia were on continuous ambulatory PD (CAPD) (79.2%; n = 42). In the univariate comparative test (Table 1), previous abdominal surgery (49.1% versus 11.8%, P &amp;lt; 0.001) and past history of hernia (34% versus 5.5%, P &amp;lt; 0.001) were identified as risk factors. We also observed significant differences between groups in relation to total dialysate fill-volume (P = 0.001) and PD modality (P = 0.026). There was no statistically significant difference in demographic characteristics and comorbidities. Multivariate analysis showed ADPK as the only independent risk factor for development of hernia (OR 0.2, 95% CI [0.04–1.07]). In Cox regression analysis, male gender, history of nephrectomy or other abdominal surgery, CAPD and largest total dialysate fill-volume were associated with an earlier development of hernias (P &amp;lt; 0.05), but no association was found with these variables in the adjusted models for the Cox regression analyses. Overall, 32 hernias (60.4%) were surgically repaired, nearly all were handled electively (29 of 32, 90.6%); the remaining 3 hernias required emergency surgery. Six hernias (18.8%) recurred, with a median time to recurrence of 13.1 months (range: 3.7–29.6 months). Longer PD vintage was the only factor associated with the recurrence of hernia (P = 0.005). CONCLUSION In our study, abdominal hernias are very frequent in the PD population. ADPK was an independent risk factor for their development. We found that longer PD vintage is an important factor for recurrence of hernia after surgical repair.

Association of pediatric inguinal hernia contents with patient age and sex

Although pediatric inguinal hernia (IH) is a very common disease, systematic reviews of herniated organs are scarce. The current study aims to clarify the contents of pediatric IH using preoperative ultrasonography (US) in association with patient age, sex, and risk for developing irreducible/strangulated hernia. The medical records of pediatric IH patients who underwent inguinal US examination prior to surgery between 2014 and 2019 were reviewed. Hernia contents were categorized into four groups based on US findings: bowel, omentum, ovary with or without fallopian tube, and ascites. A total of 524 IH lesions found in 220 men and 304 women were analyzed. The most common hernia content in patients under 12 months of age was the bowel (91.0%) in males and ovaries (89.5%) in females. The omentum became the most common herniated organ in both men (78.6%) and women (88.0%) aged 2 years and older. Emergency operations were performed in 3 patients (0.57%) due to irreducible IH, where 2 patients with irreducible ovaries, 5 and 7 months old, developed ovarian torsion and needed to undergo emergent salpingo-oophorectomy. The contents of pediatric IH depended on patient age and sex. Herniated ovaries in infants can twist in the hernia sac and become strangulated. It is important for clinicians to expect the herniated organ and take appropriate measures in the pediatric primary care setting.