Complex Incisional Hernias Research Articles

Role of sarcopenia in complex abdominal wall surgery: does it increase postoperative complications and mortality?

Sarcopenia is defined as the loss of skeletal muscle mass and is associated with an increased risk or morbidity and mortality in complex surgical patient populations. Its role in complex abdominal wall surgery (AWS) is yet to be determined. The aim of this study is to establish if sarcopenia has an impact on postoperative complications, mortality and hernia recurrence. Retrospective study of patients undergoing elective surgery for complex incisional hernias > 10cm (W3 of European Hernia Society classification) between 2014-2023. Sarcopenia was stablished as the skeletal muscle index (SMI), measured at L3 transversal section of a preoperative CT-scan. Previously defined literature-based SMI cutoff values were used: men ≤ 52.4cm2/m2, women ≤ 38.5cm2/m2. 135 patients undergoing complex AWS were included. Of them, 38 were sarcopenic (28.1%). The median follow-up time was 13months (IQR 12-25). In total, 11 patients died (8.1%). We found that sarcopenia was associated with a higher risk of mortality [HR 7.494 (95% CI 1.985-28.289); p 0.003]. There were no statistically significant differences in postoperative complications or hernia recurrence between both groups. Although sarcopenia does not seem to have an influence on hernia recurrence or the development of postoperative complications, whether local or systemic, in our study sarcopenia is associated with a higher risk of mortality after complex abdominal wall surgery. Nonetheless, with the results obtained in our study, we think that prehabilitation programs before complex AWS is advisable.

EP281 - Outcomes of the Abdominal Wall Reconstruction in a District General Hospital

Abstract Background The aim of this study was to explore the outcomes of abdominal wall reconstruction surgery by assessing postoperative complications and recurrence. Methods This is a retrospective case series. All patients who underwent abdominal wall reconstruction between 2018 and 2023 were included and followed up for complications and recurrence till January 2024. Patient demographics, operative parameters and postoperative complications were extracted in an Excel sheet, and data analysis was performed with SPSS 27 software. Results Forty-two patients were included in this study with a median age of 61.5 (34-83) and 1.2: 1 female: male gender distribution. Moreover, 41% of the included patients had a BMI > 35, and 47.6% were smokers. The type of hernia was incisional in 50% and recurrent hernia in 31%, and the defect size was > 10 centimetres in 48% of the included cohort. The type of operation was as follows: Rives-Stoppa (50%), TAR (24%), and combined procedure (26%). additionally, only 18% had their operation laparoscopically, and the position of mesh was retro-rectus in 88% of the cases. Post-operative complications were SSI (11.9%), seroma (28.6%), haematoma (7.1%), re-operation (9.5%), entero-cutaneous fistula (2.4%), and Hernia recurrence (4.7%) at a median follow-up of 42.5 months. Length of hospital stay was < 5 days in 48% of patients. Conclusion The Component separation technique is an excellent approach to repairing complex incisional hernia with excellent results (<5% recurrence rate). Abdominal reconstruction is feasible in district general hospital settings.

Comprehensive retrospective analysis of the European hernia Society quality of life in patients undergoing abdominal wall reconstruction

IntroductionThis study aimed to analyze the European Hernia Society Quality of Life (EHS-QoL) in abdominal wall reconstruction by comparing preoperative scores with those at 1 and 2 postoperative years. MethodsData from 105 patients with complex incisional hernias were collected preoperatively and at 1 and 2 years postoperatively. Statistical analyses included three ART ANOVA models to compare scores among the three time points and within each time point's items. ResultsThe EHS score significantly decreased from preoperative (Mdn ​= ​57) to 1 year (Mdn ​= ​10.5) and 2 years postoperative (Mdn ​= ​8). The most significant changes occurred between preoperative and 1-year measurements, particularly in pain levels during activities and limitations in heavy labor and activities outside the home. ConclusionPatients' quality of life notably improved at 1 year post-surgery, with some reaching near-maximum levels, and this improvement was generally sustained or increased at 2 years post-surgery.

PATIENT CASE STUDY: REBUILDING A PATIENT’S LIFE NOT JUST THEIR ABDOMINAL WALL – EXPERIENCE FROM A TERTIARY HERNIA CENTRE ON THE IMPACT OF ABDOMINAL WALL RECONSTRUCTION ON QUALITY OF LIFE

Abstract Introduction Abdominal wall reconstruction is a transformative intervention, significantly improving the quality of life for individuals with complex defects. This paper focuses on sharing a patient's experience post-surgery. Case Presentation The patient presented with a complex incisional hernia following a laparotomy, Hartmann’s procedure and splenectomy for perforated diverticular disease. Their CT scan showed a 16.5 × 17.5 cm defect, with a separate component involving their colostomy and lateral displacement of their muscle complexes. The hernia significantly impacted the patient's quality of life, manifesting as daily moderate pain that hindered routine activities. They required daily dressings and antibiotics due to skin changes over the hernia. Furthermore, dissatisfaction with the cosmetic appearance of the hernia contributed to the overall burden on the patient. Management and Outcomes The patient underwent pre-operative botulinum toxin injections six weeks prior to their abdominal wall reconstruction. They received 200 units divided equally between internal and external obliques. During their surgery they required a left sided transversus abdominus release and an >5cm mesh overlap was achieved in all directions. A post-operative CT scan conducted ten days after the surgery revealed no complications. The patient's recovery progressed well, leading to their discharge 12 days post-surgery. Discussion The patient was reviewed nine months post-surgery. Expressing high satisfaction with the surgical outcome, they conveyed a profound positive impact on their quality of life. The patient's newfound confidence in the improved cosmesis of their hernia was evident. Overall, the surgery proved transformative, liberating the patient from the burdens of frequent medical appointments and instilling a renewed sense of self-assurance.

Three-year follow-up of the grip concept: an open, prospective, observational registry study on biomechanically calculated abdominal wall repair for complex incisional hernias

PurposeWe studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial.MethodsFrom July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva’s maneuver.ResultsLarger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years.ConclusionsBiomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.

Open intraperitoneal onlay mesh repair with anterior component separation as a bail-out procedure in the management of complex hernias.

Surgical repair of complex abdominal wall hernias remains technically demanding and is widely recognized as a risk factor for unfavorable outcomes with high recurrence and morbidity rates. The objective is to assess short- and long-term complications after open intraperitoneal onlay mesh (IPOM) repair combined with bilateral anterior component separation (ACS) for large and difficult incisional hernias, alongside evaluating hernia recurrence rates. This retrospective analysis utilized data sourced from Hospital electronic health records and a prospective database at an academic tertiary referral center. Data collection was carried out from patients operated between January 2006 and December 2017. Eligible patients had complex incisional hernias measuring at least 10cm in their transverse diameter and had an open IPOM repair with bilateral ACS. In our study group of 45 patients, the 30-day surgical site occurrence (SSO) rate was high (37.8%), primarily consisting of superficial postoperative complications as seroma (17.8%) and wound dehiscence (6.7%). Among six patients (13.3%), wound complications escalated to chronic infected mesh-related problems, leading to complete mesh removal in four cases (8.9%) and partial mesh removal in two cases (4.4%). Regarding long-term complications, five patients (11.1%) developed enterocutaneous fistula. The recurrence rate was modest [5 out of 41 (12.2%)] over a median follow-up period of 99 months. Despite a high SSO rate, application of the open IPOM technique with ACS could serve as a valuable rescue option for managing large and complex hernias, with acceptable hernia recurrence rates at long-term follow-up.

The Benefit of Open Rives-Stoppa Procedure in Complex Incisional Hernia.

Introduction: Ventral hernia is one of the most common general surgical pathologies. An incisional hernia will develop in 10–15% of patients with an abdominal incision, and the risk increases to up to 23% in those who develop surgical site infections.
 Ventral hernia repairs are mostly elective (90%) procedures, but the repair methods are highly variable.
 Popularized in Europe by Rives and Stoppa, the retromuscular technique has proven to be very effective, with a 94.2% probability of having the lowest odds for recurrence and a 77.3% probability of having the lowest odds for SSI.
 The study aimed to evaluate our experience at a secondary care center performing Rives-Stoppa repair for abdominal ventral and incisional hernias.
 Materials and Methods: Between April 2019 and August 2021, 46 patients in the practice at a secondary regional hospital, Teni Konomi, Korce, Albania, underwent a Rives-Stoppa incisional hernia repair.
 Results: There were 14 (31%) males and 32(69%) females (age range 31-75).
 Most incisional hernias were midline xiphoid-pubic incision and supraumbilical, with several subcostals (2 right and 1 left) hernias.At the time of repair, most incisional hernias were symptomatic and evident on physical exam. In four cases, the hernia sac was incarcerated at the presentation time.
 Conclusion: The Rives-Stoppa technique has excellent long-term results and low morbidity in patients with large primary or recurrent incisional hernias. It is the gold standard for most surgeons.
 Keywords: Incisional Hernia, mesh, polypropylene, abdominal wall surgery, rectus muscle

Comparison of open anterior component and open transversus abdominus release in repair of large subcostal hernias.

Large subcostal incisional hernias are considered as complex defects, and a few different approaches have been described for repair. The purpose of this comparative cross-sectional study is to evaluate the outcomes of patients with large subcostal incisional hernias treated with either the open anterior components separation technique (ACS) or with the open transversus abdominis release technique (TAR). From the database of patients with large complex incisional hernias who underwent abdominal wall reconstruction with open techniques between April 2007 and October 2022 at our institution, on May 25th, 2023 we identified those whose hernias were located in the subcostal areas and who underwent reconstruction with a components separation technique and mesh. Perioperative variables and outcomes were compared between the patients with large subcostal hernias who underwent abdominal wall reconstruction with either the ACS or the TAR techniques. Thirty-one patients with large subcostal hernias were included in the study. ACS and intra-abdominal mesh was used in 11 patients; TAR and retro-muscular mesh was performed in 20 patients. More postoperative local abdominal wall complications were seen in patients who had ACS as opposed to TAR (55% vs 15%, p = 0.02). Hernia recurrence was more common in patients who had ACS as opposed to TAR (55% vs 5%, p = 0.008). More post-operative complications and recurrences were seen in patients who had ACS as opposed to TAR.

Early outcomes of open anterior versus posterior components separation with transversus abdominis release for large median incisional hernias: a retrospective stepwise analysis.

Complex incisional hernia is still a debatable topic, with increasing incidence and an increased local and systemic postoperative morbidity and mortality. The size of the defect is a risk factor for both difficult closure and 30-day readmission due to complications. The main option for closure such defect is a mesh augmented component separation technique. The goal was to evaluate 30-day wound events and general complications including 90days mortality. We present a retrospective study that includes patients from two different university hospitals who underwent open incisional hernia repair with anterior component or posterior component separation between January 2015 and December 2021. Only non-contaminated adult patients (over 18years old) with postoperative primary or recurrent median abdominal wall defects larger than 6cm and with complete fascial closure were included. Demographics (age, gender, Body Mass Index-BMI, American Society of Anesthesiologists Classification-ASA score), recurrence rank, and co-morbidities), operative details, patient outcomes complications were collected. A native abdomen/pelvis computerized tomography (CT) scan was performed preoperatively in all patients and the anatomy of the defect and volumetry (abdominal cavity volume, incisional hernia volume and peritoneal volume) were evaluated. One of the component separation technique was performed according to Carbonell's equation. Two hundred and two patients (101 from each group) were included. The patients with posterior component separation were more comorbid and with larger defects. The procedure was longer with 80min but overall length of hospital stay shorter (p < 0.001) for posterior component separation. Seroma, hematoma and skin necrosis were equally distributed for both group of patients and there was no direct relation to surgery (OR 0.887, 95% CI 0.370-2.125, p = 0.788; OR 1.50, 95% CI 0.677-3.33, p = 0.318 and OR 0.386, 95% CI 0.117-1.276, p = 0.119). Surgical Site Infection rate was increased for anterior component separation (p =0.004). Complex incisional hernia repair is a challenge given by a large amount of wound complications. Choosing between anterior and posterior component separation is still a source of significant debate. We were not able to depict significant different rates of complications between the procedures and we couldn't find any specific factor related to complications.

Comparative effectiveness of hybrid and laparoscopic techniques for repairing complex incisional ventral hernias: a systematic review and meta-analysis

BackgroundThe recently developed Hybrid Hernia Repair technique (HHR), an adaptation of the laparoscopic method, has been proposed as a potential alternative for the treatment of complex Incisional Ventral Hernias (IVH). While single-arm studies have reported promising outcomes, a comprehensive meta-analysis affirming these benefits is lacking. This meta-analysis aims to compare the clinical outcomes of HHR and Laparoscopic Hernia Repair (LHR) in the management of IVH.MethodsAn exhaustive search of the literature was conducted, targeting publications in both English and Chinese that compare HHR and LHR up to March 31, 2023. The primary outcomes examined were operation time, blood loss, and intestinal injury. Secondary outcomes included rates of seroma, wound infection, post-operative acute/chronic pain, recurrence, and mesh bulging. The RevMan 5.0 software facilitated the statistical meta-analysis.ResultsThe final analysis incorporated data from 14 studies, encompassing a total of 1158 patients, with 555 undergoing HHR and 603 treated with LHR. Follow-up data, ranging from 12 to 88 months, were available in 12 out of the 14 identified studies. The HHR method was associated with a significantly lower risk of seroma (OR = 0.29, P = 0.0004), but a higher risk of wound infection (OR = 2.10, P = 0.04). No significant differences were observed between the two techniques regarding operation time, blood loss, intestinal injury, intestinal obstruction, post-operative pain, mesh bulging, and recurrence.ConclusionsThe HHR technique did not demonstrate a clear advantage over LHR in reducing surgical complications, apart from a lower incidence of postoperative seroma. Surgeons with substantial expertise may choose to avoid incidental conversion or intentional hybrid procedures. Further research is needed to clarify the optimal surgical approach for IVH.

Open IPOMs for medium/large incisional ventral hernia repairs in the French Hernia Registry: factors associated with their use and mesh-related outcomes.

The use of open intra-peritoneal onlay mesh repairs (O-IPOMs) for treating medium/large incisional ventral hernias has come into question due to the development of minimally invasive and sublay procedures. This study aimed to identify factors that are associated with the use of O-IPOMs in France. We analysed prospectively collected data from the French Hernia Registry on incisional ventral hernia repairs (IVHR) for hernias ≥ 4cm in width. We obtained data for 2261 IVHR (from 11/09/2011 to 30/03/2020): 733 O-IPOMs and 1,528 other techniques. We found that the O-IPOMs were performed on patients with more patient-related risk factors compared with the other techniques. Specifically, there was a higher proportion of patients with ASA III/IV (40.47% vs. 28.02%; p < 0.00001) and at least one patient-related risk factor (66.17% vs. 58.51%; p = 0.0005). Of the 733 O-IPOMs, 195 used Ventrio ST™ (VST), the most commonly used mesh for such IPOMs in our database; the other 538 O-IPOMs used other meshes (OM). The VST subgroup had a higher proportion of patients with ASA III/IV (52.58% vs. 36.07%; p < 0.0001) and on anticoagulants (26.04% vs. 18.41%; p = 0.0229) compared with the OM subgroup; they also had a lower recurrence rate after 2years (5.83% vs. 15.41%; p = 0.008). However, large (≥ 10cm) or lateral defects were more common in the OM subgroup, and their mesh/defect area ratio was lower. O-IPOMs were performed on patients with more comorbidities and/or complex incisional hernias compared with other techniques.

P-014 SURGICAL TREATMENT OF COMPLEX INCISIONAL HERNIAS

Abstract Aim to study the early and long-term outcomes of the abdominal wall reconstruction (AWR) of complex incisional hernias. Material &amp; Methods We retrospectively reviewed prospectively collected data from 121 patients with 1 to 7 years of follow-up, who underwent midline AWR between 2015 and 2022. The complexity of hernia was determined according to the criteria of N. J. Slater et all. All patients had a hernia gate width ≥10cm (W3). “Loss of domain”≥20% had 38% of patients, a recurrence after previously performed mesh-reinforced AWR (R1–5) - 36%, purulent fistulas, trophic ulcers and chronic seromas - 9%. Three laparotomies or more in anamnesis had 48.7% patients. Obesity had 74.4%; type II diabetes mellitus - 26.5%; COPD - 15.7%. Mesh-reinforced fascial repairs were used in 73 (60.33%) cases, bridged repairs were used in 48 (39.67%) cases. Results Wound complications in the early postoperative period were observed in 48 (40.5%) patients. Long-term outcomes: recurrence hernia - 7 (5.8%), ligature fistula - 3 (2.5%), chronic wound - 2 (1.6%), pseudocyst - 3 (2.5%), building of the mesh - 7 (5.8%). Mesh-reinforced AWRs with primary fascial coaptation resulted in fewer hernia recurrences (2.7% vs 10.4%) and fewer wound (31.5% vs 52.2%) and overall (5.5% vs 16.6%) complications than bridged repairs. At the same time, bridged repairs resulted in fewer postoperative pain (9.6% versus 4.2%) than mesh-reinforced AWRs. Conclusions Surgical treatment of patients with complex incisional hernias requires the use of combined techniques for AWR using a mesh, which reduces the recurrence to 5.8%.

OC-051 CAN ETEP APPROACH IMPROVE COMPLEX INCISIONAL HERNIA REPAIR OUTCOMES?

Abstract Aim To compare postoperative results of two cohorts of patients with simple and complex incisional hernias, operated using the extended totally extraperitoneal technique (eTEP). Materials and Methods Retrospective comparative multicenter study based on prospective database conducted at the Fundación Jiménez Díaz University Hospital and La Paz Hospital in Madrid, including eTEP repairs performed between March 2019 and January 2023. Patients were classified as complex hernias if they met at least one criterion according to the Slater definition (1). If no criteria were met, it was classified as a simple hernia. Results 159 patients were operated on via eTEP during the study period, and 111 incisional hernias were analyzed according to the EHS classification: 38 complex cases and 73 simple cases. The median defect size was 50mm (40–97) in simple cases and 66mm (24–126) (p&amp;lt;0.01), the median surgical time was 130min (59–360) and 145min (63–240) respectively without significant differences. TAR was required in 26 (35.6%) simple cases versus 23 (60.5%) complex cases (&amp;lt;0.01). One (1.4%) recurrence was observed in simple cases and 2 (5.3%) in complex cases, as well as 7 (9.6%) complications in simple cases and 5 (13.2%) in complex cases, both without statistical significance. The median follow-up was 26 months in simple cases and 11 months in complex cases (p&amp;lt;0.01). Conclusions The application of the eTEP approach in selected complex cases can improve postoperative results close to simple hernias. 1. Slater NJ et al. Criteria for definition of a complex abdominal wall hernia. Hernia 2014, 18:7–17.

P-074 SAILING ROUGH SEAS – MANAGING THE COMPLEX RECURRENT INCISIONAL HERNIA PATIENT WITH ADJUVANT TECHNIQUES – CASE REPORT

Abstract Aim Case report regarding the repair of a complex incisional hernia, with loss of domain (LoD), where adjuvant techniques were used. Materials and methods Data from the patient's electronic chart and literature review. Results A 77-year-old female patient is referred for evaluation. She had a multi-recurrent incisional hernia, symptomatic with pain and recurrent episodes of intestinal occlusion. Clinical and imaging evaluation confirmed a complex incisional hernia with LoD, located in the left iliac and flank regions. Abdominal wall muscle blockade was done with botulinum toxin. A progressive pneumoperitoneum catheter was placed laparoscopically, and 11 liters of air were instilled over 13 days. Imaging showed lengthening of the AW muscles. Posterior component separation and transversus abdominis release was performed on the left side, and a retrorectus dissection the right side. A macroporous polypropylene mesh was attached on the left to the twelfth rib, psoas muscle, transverse process of lumbar vertebrae, iliac crest, Cooper's ligament and pubis, and on the right with transfascial sutures. A seroma developed on the post operative period. No other complications occurred. Discussion If a patient never had an AW reconstruction surgery, with a mesh on the retromuscular plane, this option should be offered, by a specialized hernia surgeon, regardless of the number of recurrences. Progressive pneumoperitoneum has existed for many years, but is seldom used. Likewise, botulinum toxin is emerging as a powerful tool to prepare AW reconstruction, but much is still unknow. Heterogeneity in the data is a hinderance to the wide adoption of these techniques.

OC-011 SARCOPENIA IN COMPLEX ABDOMINAL WALL SURGERY: IMPACT ON THE POSTOPERATIVE COMPLICATIONS

Abstract Aim Sarcopenia is defined as the skeletal muscle mass loss and is considered as a prognostic factor in oncological surgical patients, liver transplant and trauma surgery. It can be reversed with exercise and diet. Nonetheless there is a lack of evidence of its impact on complex abdominal wall surgery. The aim is to evaluate the impact of sarcopenia in postoperative complications after complex incisional hernia repair. Material and Methods Retrospective study of patients undergoing surgery for complex incisional hernias &amp;gt;10cm (W3 of European Hernia Society classification) between 2014–2021. Sarcopenia was stablished as the skeletal muscle index (SMI), measured at L3 transversal section of a preoperative CT-scan. Previously defined literature-based SMI cutoff values were used: men &amp;lt;52,4cm2/m2, women &amp;lt;38,5cm2/m2. Results We included 105 patients, of which 29 (27,6%) were sarcopenic. The mean follow-up was 24,11 (19,28) months. The mean age and body mass index was 65,34 (10,98) and 31,85 (5,55), respectively. Sarcopenia was significantly associated with a higher risk of death [OR 11,21 (IC95% 2,76–45,52); p=0,001]. We observed a difference in need of intensive care unit (ICU) stay [OR 2,24 (IC95% 0,88–5,69); p=0,089] and cardiac complications [OR 2,96 (IC95% 0,79–11,11); p=0,108], not reaching statistical significance. Differences in surgical site occurrence or infection were not observed. After analysing by possible cofounding factors (age, comorbidities, ICU stay), sarcopenia remains associated with a higher risk of death [OR 9,08 (IC95% 2,08–39,59); p=0,003]. Conclusions Given the results of our study sarcopenia might increase the risk of death, independent of age, comorbidities and ICU stay.

OC-060 PREDICTING FACTORS OF RECURRENCE AFTER TRANSVERSUS ABDOMINIS MUSCLE RELEASE (TAR) FOR COMPLEX INCISIONAL HERNIAS. RETROSPECTIVE ANALYZE OF A COHORT

Abstract Background Transversus Abdominis Muscle Release (TAR) is used to provide adequate coverage for large abdominal wall defects and appears to be more advantageous compared to Anterior Component Separation concerning complications and recurrence rates. The aim of this study was to identify the independent predictors associated with hernia recurrence after TAR in the treatment of complex incisional hernias. Methods This is a retrospective observational study of 191 patients who underwent TAR between November 2014 and December 2021. The main inclusion criteria were adults with large complex incisional hernias larger than 10 cm in transverse diameter. The recurrence rate was determined by clinical examination and by abdominal CT scan. Results At a median of 49.6 months (range 36–75 months) of postoperative follow-up, we reported 19 cases of recurrence (9.94%). Recurrences occurred after a mean period of 12.4 months (range 10–49 months). On multivariate analysis, the development of postoperative hematoma (OR 2.9; CI 1.55–4.10, p = 0.001), and needing surgery for the hematoma (OR 2.1; CI 1.21–3.29, p = 0.004), obesity and chronic pulmonary disease (COPD) were predictors of recurrence after TAR. The area under Curve (AUC) was highly specific for all these independent factors (AUC = 0.842). There was no significant difference in recurrence rate among obesity, smoking, urgent repair, type of mesh fixation, operative time, type of prosthesis, or concomitant procedures. Conclusions In our current study, the development of postoperative hematoma and needing surgery for the hematoma, and obesity were associated with an increased risk of hernia recurrence after RSR.

P-039 INITIAL EXPERIENCE IN ROBOTIC APPROACH IN ABDOMINAL WALL SURGERY

Abstract Aim To evaluate the results of our robotic hernia repair case series. Material and Methods Prospective and observational study on hernia repair cases operated with a robotic approach. We have performed a descriptive analysis of demographic and surgical variables and short-term complications. Results From October 2021 to January 2023, 64 robotic interventions, including 39 men (60.1%) and 25 women (39.1%). Mean age is 60,66 years (+/- 11,72). Mean Body Mass Index (BMI) is 30,70kg/m2 (+/- 5.58). Interventions: 3 unilateral inguinal hernia (2 recurrents), 16 bilateral inguinal hernia (9 recurrents), 13 primary ventral hernias, 23 incisional hernia, 8 mixed hernias and 1 parastomal hernias. Conversion rate is 1,6% (one case). Techniques in inguinal hernia: 22 rTAPP (Transabdominal Preperitoneal) (85,91min +/- 31.90). In unilateral hernia the mean of intervention time is 50min +/- 25,98 and in bilateral hernia is 95,31min +/- 28,83. Techniques in abdominal hernia: 2 iPOM+ (Laparoscopic Intraperitoneal Onlay Mesh) (127.50 min +/- 3.54), 1 rTAPP (90min), 1 rRives (260min), 28 TARUP (Robotic Transabdominal Retromuscular Umbilical Prosthetic) (135.50 min +/- 54.02), 2 eTEP (Enhanced-view Total Extraperitoneal) (165 min +/- 49.48), 4 rTAR (Transversus Abdominis Muscle Release) (122.50 min +/- 51.07), 2 rLIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) (147.50 min +/- 74.25) and 1 Pauli (155 min). Complications: 21 SSO (surgical site occurrence) (32,81%), 2 SSI (surgical site infection) (3.1%), 1 recurrence (1.6%). Conclusions Robotic surgery facilitates the approach of complex incisional hernias and the performance or retromuscular techniques. It doesn`t provide clear benefits in inguinal hernia.

OC-121 TRANSVERSUS ABDOMINIS RELEASE (TAR) IN CONTAMINATED FIELDS

Abstract Aim Complex abdominal wall reconstructions in contaminated fields is a controversial topic. Although some prefer a staged approach, others advocate performing a single surgery even associating bowel and colon resections with synthetic mesh reinforcement. We aimed to evaluate and compare results of Transversus Abdominis Release (TAR) in clean and contaminated fields. Material &amp; Methods A consecutive series of patients undergoing TAR for complex incisional hernias between 2014 and 2022 with a minimum of 6-month follow-up was included. The cohort was divided into 2 groups according to the Modified Hernia Grading System of the Ventral Hernia Working Group (VHWG): G1, Grade 1 (low risk) and Grade 2 (comorbid); and G2: Grade 3 (contaminated). Demographics, operative and postoperative variables were analyzed and compared. Results A total of 69 TAR repairs were performed; 54 (78,3%) were included in G1 and 15 (21,7%) in G2. There were no differences in overall morbidity at 30 postoperative days (G1 19% vs G2 27%; p=NS). Surgical Site Infection (SSI) was significantly higher in G2 (G1 11,1% vs G2 46,6%; p=0,01), however Surgical Site Occurrence Requiring Procedural Intervention (SSOPI) was similar in both groups (G1 5,5% vs G2 11,1%; p=NS). No mesh removal was recorded. After 31 ± 10 months follow-up, the recurrence rate was 2.9% (2 patients). Conclusions TAR technique is feasible and safe for the treatment of complex hernias in contaminated fields. Although an increase in SSI rate might be observed, most cases are superficial without the need for invasive procedures.

V-017 LAPAROSCOPIC TRANSVERSUS ABDOMINIS RELEASE (L-TAR) VIA TOTALLY EXTRAPERITONEAL REPAIR (TEP)

Abstract Aim Posterior component separation via transversus abdominis release (TAR) allows the treatment of complex incisional hernias, although it is associated with high morbidity rates. In recent years, the laparoscopic TAR was introduced, showing the benefits of the minimally invasive surgery such as less postoperative pain, less surgical site infection, and a shorter hospital stay. When compared to the transabdominal preperitoneal (TAPP) approach, the Totally Extraperitoneal Repair (TEP) technique avoids entry into the abdominal cavity, making it a suitable strategy for patients with previous abdominal surgeries. Material &amp; Methods We present the case of a 68-year-old male with three previous umbilical repairs, one of them with mesh. He consulted for a recurrent umbilical hernia associated with a large weakness on the abdominal wall in the left flank. He complained that it increased in size and significantly altered his quality of life. Computed tomography scan revealed weakness and atrophy of the abdominal wall muscles in the left anterolateral area, which measured 22×10×15 centimeters. Surgical repair was decided and a TEP-TAR technique with mesh reinforcement was performed to restore the abdominal wall anatomy. Results The patient had an uneventful postoperative course and was discharged 36 hours after surgery. No recurrence was observed at 6 months. Conclusions Complex abdominal wall defects are challenging. The use of minimally invasive advanced techniques is feasible and safe, making it a suitable tool for the management of this type of cases.

P-006 OUR EXPERIENCE WITH TAR FOR COMPLEX INCISIONAL HERNIA REPAIR

Abstract Aim Transverse abdominis muscle release (TAR) enables dissection of the preperitoneal space and the placement of large meshes. We present our experience with TAR in the treatment of complex incisional hernias (IH). Material and Methods Retrospective, descriptive study of patients operated with the TAR technique (October 2019-July 2022). Epidemiological characteristics, comorbidity, prehabilitation, type of IH, bridging, surgical time, hospital stay, morbidity, mortality and recurrence were studied. Results 69 TAR (30 females/39 males); age 64.9 years (24–85), body mass index 31 (19–49), CeDAR 35% (4–92). 66 cases (96%) treated preoperatively with Botulinum Toxin A, 31 (45%), with preoperative progressive pneumoperitoneum and 29 (42%) with both. Classification (EHS): M 52 (46%), L 7 (10%), ML 9 (13%), parastomal 1 (1%), tumour 1 (1%). 36 cases R0 (52%), R1 22 (32%), R2 4 (10%) and R3 6 (9%). Median size 17.8 cm(3–30) x13.7 cm (6–25), area 694.3 cm2. Primary fascial closure was achieved in 26 cases (38%), remaining 43 (62%) with bridging (8.7 cm (2–19)x5 cm (1–16)), postoperative area 125.6 cm2 (82% reduction). Surgical time was 242 minutes (140–450). Hospital stay 9 days (3–45). Wound-related complications 35 (50%): infection 15 (21%), seroma 17 (24%), haematoma 15 (7%), skin necrosis 1 (1%). General complications 7 (10%): 2 urinary tract infection, 1 intestinal perforation, 1 pneumonia, 1 haematoma, 1 haemorrhagic shock, 1 heart failure. Mortality 2 (3%). Recurrences 0 (0%). Conclusions TAR is a very useful and effective technique for resolving complex eventrations. It is not exempt from morbidity, therefore adequate patient selection is recommended.