Hernia Defect Size Research Articles

Intraperitoneal Onlay Mesh Repair (IPOM) versus Intraperitoneal Onlay Mesh Repair with Closure of Fascia Defect (IPOM Plus) for Ventral Hernias: Retrospective Analysis of Postoperative Outcomes

Background: Intra-peritoneal onlay mesh (IPOM) repair, a type of Laparoscopic Ventral Hernia Repair (LVHR), comprises bridging the defect from the peritoneal side with a composite mesh. Recently, IPOMPlus has become the recommended type of LVHR in which the defect in the fascia is sutured before placing the mesh. Materials and Methods: This study is a retrospective cohort study conducted at Dharan Hospital, Salem. Patients who had undergone IPOM-Plus or IPOM during January 2020 to June 2021 were selected. Data regarding demographics, intra-operative and post-operative outcomes were collected from medical record section. Patients were followed up for 6 months. Data analysis was performed using SPSS version 26.0 taking a p-value of <0.05 as statistically significant. Results: A total of 74 patients were included in this study, out of which 34 patients had undergone IPOM (Group A) and 40 patients underwent IPOM-Plus (Group B). In both the groups, there was no statistical difference in demographic variables except more number of umbilical hernia in both the groups compared to epigastric and paraumbilical hernia. Hernia defect size and mean operative time were varied significantly (p-value < 0.05) in both groups. More number of seroma formation (p=0.021), pseudosac at first OPD visit (p=0.020) and pseudosac at 6 months (p=0.027) in Group A compared to Group B. Conclusions: IPOM plus repair is safe with possible advantages over a standard IPOM repair in patients with ventral hernia in term of postoperative outcomes. Keywords: Ventral hernia, IPOM, IPOM Plus, Laparoscopy

Open suture repair versus PermacolTM mesh repair of small ventral hernias in patients with end-stage kidney disease.

Ventral hernia is a common surgical problem among patients with end-stage kidney disease (ESKD), while the optimal repair technique for small ventral hernias is controversial. This study aimed to compare the outcomes of open suture repair versus biological mesh repair of small ventral hernias with defect size ≤2 cm in ESKD patients. Data from consecutive ESKD patients who underwent elective ventral hernia repair with defect size ≤2 cm at a single institution from January 2012 to January 2022 were retrospectively reviewed. Outcomes of open suture repair were compared to PermacolTM mesh repair. The primary outcome was recurrence rate. Secondary outcomes included post-operative complications, peri-operative and post-operative dialysis regimen. Forty-seven ventral hernia repairs were included, with 20 being suture repairs and 27 being PermacolTM mesh repairs. Median age at hernia repair was 60 (range 32-81) years old. Pre-operatively, 42 patients (89.4%) were on peritoneal dialysis (PD). Paraumbilical hernia (59.6%) was most common. Median hernia defect size was 15 mm (range 2-20 mm). Upon median follow-up of 56 (range 9-119) months, more patients in the suture repair group developed recurrence (30% vs. 0%, p = 0.004). Median time to recurrence was 10 (range 5-16) months. There was no wound or mesh infection. The majority of patients underwent intermittent PD peri-operatively and were able to resume on PD in the long run. Ventral hernia repair is indicated in ESKD patients even for small defects; repair with PermacolTM mesh was associated with a lower recurrence rate when compared to suture repair and post-operative morbidity was low.

Mesh versus suture for elective primary umbilical hernia open repair: a systematic review and meta-analysis.

Recent guidelines indicate the use of mesh in UHR for defects > 1cm, as it reduces recurrence, with 10% recurrence rate compared to up to 54.5% with primary closure. However, Nguyen et al. shows that primary closure is still widely performed in UHR, especially for small defects (1-2cm), for which there is no published data to determine the optimal approach. In addition, previous meta-analysis by Madsen et al. comparing mesh repair with primary closure in UHR didn't exclude emergency conditions and recurrent hernias; also, didn't report subgroup analysis on hernia defect size. Thus, we aimed to perform a systematic review and meta-analysis comparing the mesh repairs vs. primary closure of the defect in an open elective primary UHR. We searched for studies comparing mesh with suture in open UHR in PubMed, Scopus, Cochrane, Scielo, and Lilacs from inception until October 2023. Studies with patients ≤ 18 years old, with recurrent or emergency conditions were excluded. Outcomes were recurrence, seroma, hematoma, wound infection, and hospital length of stay. Subgroup analysis was performed for: (1) RCTs only, and (2) hernia defects smaller than 2cm. We used RevMan 5.4. for statistical analysis. Heterogeneity was assessed with I² statistics, and random effect was used if I² > 25%. 2895 studies were screened and 56 were reviewed. 12 studies, including 4 RCTs, 1 prospective cohort, and 7 retrospective cohorts were included, comprising 2926 patients in total (47.6% in mesh group and 52.4% in the suture group). Mesh repair showed lower rates of recurrence in the overall analysis (RR 0.50; 95% CI 0.31 to 0.79; P = 0.003; I2 = 24%) and for hernia defects smaller than 2cm (RR 0.56; 95% CI 0.34 to 0.93; P = 0.03; I2 = 0%). Suture repair showed lower rates of seroma (RR 1.88; 95% CI 1.07 to 3.32; P = 0.03; I2 = 0%) and wound infection (RR 1.65; 95%CI 1.12 to 2.43; P = 0.01; I2 = 15%) in the overall analysis, with no differences after performing subgroup analysis of RCTs. No differences were seen regarding hematoma and hospital length of stay. The use of mesh during UHR is associated with significantly lower incidence of recurrence in a long-term follow-up compared to the suture repair, reinforcing the previous indications of the guidelines. Additionally, despite the overall analysis showing higher risk of seroma and wound infection for the mesh repair, no differences were seen after subgroup analysis of RCTs. A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024476854).

A retrospective study of 3D laparoscopy and 2D laparoscopy in transabdominal preperitoneal (TAPP) for unilateral inguinal hernia in elderly patients.

This study aims to explore the safety and efficacy of 3D laparoscopy in elderly patients undergoing transabdominal preperitoneal (TAPP) surgery for inguinal hernia. Patients were divided into two groups based on the laparoscopic equipment used during surgery. Clinical data preoperatively, intraoperatively, and postoperatively were collected and subjected to statistical analysis. From January 2020 to August 2023, a total of 127 patients with primary unilateral inguinal hernia were evaluated in this study, 61 in the 3D TAPP group and 66 in the 2D TAPP group. There were no statistically significant differences in baseline data, including average age, gender distribution, BMI index, hernia type, hernia defect size and location, comorbidities, and usage of anticoagulant drugs between the two groups (P > 0.05). In terms of operative indicators, the 3D group showed shorter mean operation time (51.61 ± 7.16min vs. 78.59 ± 13.51min, P < 0.001), mean mesh placement time (6.07 ± 1.40min vs. 9.77 ± 1.21min, P < 0.001), and mean peritoneal suture time (7.34 ± 1.85min vs. 9.73 ± 1.32min, P < 0.001) compared to the 2D group. However, there were no statistically significant differences in mean blood loss, postoperative pain scores, postoperative hospital stay, and total hospital costs between the two groups (P > 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P > 0.05). No adverse reactions such as dizziness or nausea were reported by surgeons during the procedures in either group. Three-dimensional laparoscopy in TAPP surgery provides high-definition, three-dimensional surgical images, reducing the difficulty of operations and effectively shortening the operation time.

LUMBAR INCISIONAL HERNIA REPAIR-PREPERITONEAL PLACING OF MESH-THE IMPORTANCE OF CT EVALUATION

Abstract Background Lumbar hernias can be congenital (primary) or aquired (postoperative and posttraumatic). The margins are well-known: the iliac crest, 12th rib, the erector spinae and the external oblique muscle. The most number of lumbar incisional hernias occur after nephrectomy. Objective To show the results in treatment of lumbar incisional hernias in district General hospital and to review the importance of CT evaluation before and after treatment of lumbar incisional hernias (specially for W3 = the width of hernia defect ≥ 10 cm ≈ large hernias). Methods This is retrospective case-study analysis from June 2005 till November 2021.The mean follow-up for all patients was 36 months. Results From 15 June 2005. to 15 November 2021 we operated 18 patients with diagnosis: Lumbar incisional hernia. 16 patients were operated due to principles of sublay-preperitoneal placing of MESH (all by the same surgeon). In our evaluation we divided the patients in 3 groups according to the width (size) of hernia defect – W1, W2 and W3. For the patients with “large hernias” (W3) – 5 patients, we perform CT of abdomen 3 times (before operation, a few months after operation and 2 or 3 years after operation). All other patients have CT of abdomen before operation-only certain proof for diagnosis. We do not have recurrences and none of our patients need analgetics more than two weeks after surgery. Laparoscopic incisional hernia surgery is not performed routine in our hospital yet. Conclusion Lumbar incisional hernias should be treated with sublay (preperitoneal placing of MESH) whenever is possible. CT evaluation before and after surgery is always usefull for large hernias, with big level of recommendence.

A comparison of robotic enhanced-view totally extraperitoneal approach versus trans-abdominal retro-muscular approach for midline ventral hernias.

The evolution of midline ventral hernia repair has progressed from the open Rives-Stoppa technique to minimally invasive robotic approaches, notably the trans-abdominal retromuscular (TARM) and enhanced-view Totally Extraperitoneal (eTEP) methods. This study compares these two robotic techniques in repairing medium-sized midline ventral hernias. A retrospective comparative study of electronic medical records from 2015 to 2021 was conducted on patients undergoing robotic TARM or eTEP at NYU Langone Hospital-Long Island. Data on demographics, comorbid conditions, surgical history, intraoperative details, hernia characteristics, and postoperative outcomes were analyzed. Both eTEP and TARM groups exhibited comparable outcomes regarding operative duration, hernia defect size, and overall complications. However, notable differences were observed in patients' BMI, implanted mesh area, mesh composition, and fixation techniques across the groups. The TARM group required a longer hospital stay (median: 1day) in contrast to the eTEP group (median: 0days). Additionally, eTEP patients indicated reduced postoperative pain scores (median: 2) compared to TARM (median: 3), with both differences being statistically significant (p < 0.001). The robotic eTEP approach is associated with lower post-operative pain scores, decreased hospital length of stay, and larger areas of mesh implantation as compared to the TARM approach. Other variables are largely comparable between the two techniques. Level III.

Descriptive Analysis of Outcomes After Onlay Ventral Hernia Repair in Obese Patients.

To determine outcomes after on lay large ventral hernia repair in obese patients. Large ventral hernia repairs (VHR) in obese patients remain a challenge. Obesity is a risk factor for intraoperative difficulties and postoperative complications. Recurrence rates after VHR in obese patients range between 12-50% versus 10% in nonobese patients. While results of laparoscopic techniques in VHR compare favorably to open, outcomes in correlation with obesity, technique, and defect size are less understood. A single surgeon's experience of 329 consecutive VHR between 2013-2022 was retrospectively reviewed. Inclusion criteria were obesity (BMI >30) and large hernia defects (>5cm). A modified onlay technique was used which included component release and a lightweight monofilament polypropylene mesh. Primary outcome measures were hernia recurrence and wound complications. A total of 56 patients met inclusion criteria. Patients were majority male (n=30, 54%), with a median age of 58.5years (inter quartile range (IQR) 33-83), and median BMI of 36kg/m2 (IQR: 30-72). Median hernia defect size was 8cm (IQR: 5-15). Twenty patients had undergone prior mesh repairs. Median follow-up was 52 months (IQR: 6months-9years). Two patients experienced recurrence (3.6%) and four experienced wound complications (four seromas, one panniculitis, 8.9%). No patients suffered flap ischemia or necrosis. Obesity is a risk factor for poor outcomes after VHR. We developed a protocol for obese patients with large defects involving a modified onlay technique which demonstrates comparable results to other VHR techniques in obese patients.

Achieving fascial closure with preoperative botulinum toxin injections in abdominal wall reconstruction: outcomes from a high-volume center.

Preoperative injection of Botulinum Toxin A (Botox) has been described as an adjunctive therapy to facilitate fascial closure of large hernia defects in abdominal wall reconstruction (AWR). The purpose of this study was to evaluate the impact of Botox injections on fascial closure and overall outcomes to further validate its role in AWR. A prospectively maintained database was retrospectively reviewed to identify all patients undergoing AWR at our institution between January 2014 and March 2022. Patients who did and did not receive preoperative Botox injections were analyzed and compared. A total of 426 patients were included (Botox 76, NBotox 350). The Botox group had significantly larger hernia defects (90 cm2 vs 9 cm2, p < 0.01) and a higher rate of component separations performed(60.5% vs 14.4%, p < 0.01). Despite this large difference in hernia defect size, primary fascial closure rates were similar between the groups (p = 0.49). Notably, the Botox group had higher rates of surgical-site infections (SSIs)/surgical-site occurrences (SSOs) (p < 0.01). Following propensity score matching to control for multiple patient factors including age, sex, diabetes, chronic obstructive pulmonary disease (COPD), and hernia size, the Botox group still had a higher rate of component separations (50% vs 26.3%, p = 0.03) and higher incidence of SSIs/SSOs (39.5% vs 13.5%, p = 0.01). Multimodal therapy with Botox injections and component separations can help achieve fascial closure of large defects during AWR. However, adding these combined therapies may increase the occurrence of postoperative SSIs/SSOs.

Maximizing mesh mileage: evaluating the long-term performance of a novel hybrid mesh for ventral hernia repair.

The objective of this study is to evaluate the safety and long-term outcomes of GORE Synecor™ in ventral hernia repair (VHR). This retrospective, single-center case review analyzed outcomes in patients who underwent VHR with Synecor from May 2016 to December 2022. Primary outcomes were hernia recurrence and mesh infection rates. Secondary outcomes were 30-day morbidity, 30-day mortality, 30-day readmission, re-operation, surgical-site infection (SSI) and occurrence (SSO) rates, and occurrences requiring intervention (SSOI). 278 patients were identified. Mean follow-up was 24.1 (0.2-87.1) months. Mean hernia defect size was 63.4 (± 77.2) cm2. Overall hernia recurrence and mesh infection rates were 5.0% and 1.4% respectively. No mesh infections required full explantation. We report the following overall rates: 13.3% 30-day morbidity, 4.7% 30-day readmission, 2.9% re-operation, 7.2% SSI, 6.1% SSO, and 2.9% SSOI. 30-day morbidity was significantly higher in non-clean (42.1% vs 11.2%, p < 0.01), onlay (OL) mesh (37.0% vs preperitoneal (PP) 16.4%, p = 0.05 vs retrorectus (RR) 15.0%, p < 0.05 vs intraperitoneal (IP) 5.2%, p < 0.001), and open cases (23.5% vs 3.1% laparoscopic vs 4.4% robotic, p < 0.01). SSI rates were significantly higher in non-clean (31.6% vs 5.4%, p < 0.001), OL mesh (29.6% vs RR 11.3%, p < 0.05 vs PP 5.5%, p < 0.01 vs IP 0.0%, p < 0.001), and open cases (15.2% vs 0% laparoscopic vs 0% robotic, p < 0.05). Long-term performance of a novel hybrid mesh in VHR demonstrates a low recurrence rate and favorable safety profile in various defect sizes and mesh placement locations.

ROLE OF WOUND DRAINS VS ABDOMINAL BINDER AND PERCUTANEOUS ASPIRATION AFTER OPEN REPAIR OF VENTRAL HERNIA USING POLYPROLENE MESH

Background: Abdominal wall hernias are among the most common of all surgical problems. Ventral hernia repair (VHR) is a commonly performed operation so hernia defect size affects operative time and surgical technique for repair of a ventral hernia. Incisional hernia is the most frequent postoperative complication following general surgery. Complications of ventral hernia repair include seroma, hematoma, wound infection, bowel injury, bowel obstruction, recurrence whether earlyorlate,the mostcommoncomplicationisseroma formation.New advances in the management of ventral hernias including different methodsofrepaireitheropenor laparoscopic and differentmesh types: non-absorbable partially absorbable and absorbable. Objectives: This study was done to review and assess thedifference between insertion of wound drain and the use of abdominal binder and percutaneousaspirationafteropenrepairofventralherniasanditseffect on postoperative outcome. Patients and Methods: A total of 100 patients with non-complicated abdominal wall (ventral) hernia were enrolled to review andassess the difference between insertion of wound drain and the use of abdominal binder and percutaneous aspiration after open repair of ventral hernias and its effect on postoperative outcome. Patients were divided into two groups: Group (A) includes 50 patients with insertion of wound drain. Group (B) includes 50 patients with application of abdominal binder immediately postoperatively for 2 weeks. Results: This study showed distribution of patients according to age, ranging from 27 years to 70 years with mean age of 49.2 years (±11.6 years).25% of patients below 39, 50 % of patients below 50 and 75% ofpatientsbelow59.75.Inourstudy,60%ofoperationswerecarriedout under spinal anesthesia and 40% of operations were carried out under general anesthesia. Out of 100 patients of our study, in 28 % of cases, the hernial content was intestine and in 72 of cases the hernial content wasomentum.Outof100patientsofourstudy,therewasdevelopingof significant seroma in (30%) of patients as follow: (17%) at group A (with drain)&amp; (13%) at group B (without drain). Significant seroma was not seen in (70%) of patients. Wound infection was developed in (18%)ofpatientsasfollow(12%)forgroupA(withdrain)and(6%)for groupB(withoutdrain).Woundinfectionnotseenin(82%)ofpatients. Out of 100 patients of our study, (2%)oftotalcountonlyshowing earlyrecurrencethatpresentat group B. (9%) of total count only complained of persistent postoperativepainasfollows, 6 cases fromgroup (A) and 3 casesfrom group (B). Mean hospital stay was 1.46 days for group (A) and 1.26 daysforgroup(B).Meanperiodbeforereturningto normalactivitywas 3.7weeksforgroup(A)and2.9weeksforgroup(B). Conclusion: Combined abdominal binder and percutaneous aspiration for selected caseswere superior to insertionof wound drains asregards seroma formation, wound infection and postoperativereturn to normal activity with no significant difference as regards hematoma, postoperative pain, hospital stay andpatientsatisfaction.

Use of statewide financial incentives to improve documentation of hernia and mesh characteristics in ventral hernia repair.

Documentation of intraoperative details is critical for understanding and advancing hernia care, but is inconsistent in practice. Therefore, to improve data capture on a statewide level, we implemented a financial incentive targeting documentation of hernia defect size and mesh use. The Abdominal Hernia Care Pathway (AHCP), a voluntary pay for performance (P4P) initiative, was introduced in 2021 within the statewide Michigan Surgical Quality Collaborative (MSQC). This consisted of an organizational-level financial incentive for achieving 80% performance on eight specific process measures for ventral hernia surgery, including complete documentation of hernia defect size and location, as well as mesh characteristics and fixation technique. Comparisons were made between AHCP and non-AHCP sites in 2021. Of 69 eligible sites, 47 participated in the AHCP in 2021. There were N = 5362 operations (4169 at AHCP sites; 1193 at non-AHCP sites). At AHCP sites, 69.8% of operations had complete hernia documentation, compared to 50.5% at non-AHCP sites (p < 0.0001). At AHCP sites, 91.4% of operations had complete mesh documentation, compared to 86.5% at non-AHCP sites (p < 0.0001). The site-level hernia documentation goal of 80% was reached by 14 of 47 sites (range 14-100%). The mesh documentation goal was reached by 41 of 47 sites (range 4-100%). Addition of an organizational-level financial incentive produced marked gains in documentation of intra-operative details across a statewide surgical collaborative. The relatively large effect size-19.3% for hernia-is remarkable among P4P initiatives. This result may have been facilitated by surgeons' direct role in documenting hernia size and mesh use. These improvements in data capture will foster understanding of current hernia practices on a large scale and may serve as a model for improvement in collaboratives nationally.

Preoperative Botulinum Toxin Injection for Complex Abdominal Wall Hernia Repair

Introduction: Due to their higher rates of morbidity and recurrence, complex abdominal wall hernias provide a difficult clinical dilemma. Botulinum toxin injection has been suggested as a feasible treatment option to ease patients' tense muscles and promote primary fascial closure. This study focus on how well preoperative botulinum toxin injections worked for patients with complicated abdominal wall hernias. Methodology: The patients in this retrospective study had complex abdominal wall hernias. Between January 2021 and December 2022, they had received preoperative botulinum toxin injections for those hernias. Age, gender, the extent of the transverse hernia defects both before and after the procedure, loss of domain, and muscle length, all were the study's variables. The data were analyzed using comparative analysis and paired t-tests. Results: The study involved 8 patients in all, with an average age of 53.38 ± 12.56 years. The mean fascial defect size before injection was 13.14 ± 4.58 cm, while the mean fascial defect size after injection was 11.84 ± 4.07 cm. Following the Botox injection, there was a statistically significant decrease in the size of the transverse hernia defect (p 0.001). The mean loss of domain before the surgery was 18.46 ± 11.96%, while the mean loss of domain after the 7.21%. Following the Botox injection, there was a statistically significant decrease in loss of domain (p 0.05). In 7 individuals, primary fascial closure was accomplished (87.5%). Both surgical and chemical components had no significant side effects. Conclusion: In individuals with complicated abdominal wall hernias, preoperative botulinum toxin injection is an efficient and secure method for lowering muscle tension and attaining primary fascial closure. it is challenging to make firm judgments on the effectiveness of preoperative Botox injection for complex abdominal wall hernia repair in the absence of a control group. The results of the current study need to be confirmed by larger studies with longer follow-up times and a control group.

Preservation of deep epigastric perforators during anterior component separation technique (ACST) results in equivalent wound complications compared to transversus abdominis release (TAR).

The use of component separation results in myofascial release and increased rates of fascial closure in abdominal wall reconstruction(AWR). These complex dissections have been associated with increased rates of wound complications with anterior component separation having the greatest wound morbidity. The aim of this paper was to compare the wound complication rate between perforator sparing anterior component separation(PS-ACST) and transversus abdominus release(TAR). Patients were identified from a prospective, single institution hernia center database who underwent PS-ACST and TAR from 2015 to 2021. The primary outcome was wound complication rate. Standard statistical methods were used, univariate analysis and multivariable logistic regression were performed. A total of 172 patients met criteria, 39 had PS-ACST and 133 had TAR performed. The PS-ACST and TAR groups were similar in terms of diabetes (15.4% vs 28.6%, p = 0.097), but the PS-ACST group had a greater percentage of smokers (46.2% vs 14.3%, p < 0.001). The PS-ACST group had a larger hernia defect size (375.2 ± 156.7 vs 234.4 ± 126.9cm2, p < 0.001) and more patients who underwent preoperative Botulinum toxin A (BTA) injections (43.6% vs 6.0%, p < 0.001). The overall wound complication rate was not significantly different (23.1% vs 36.1%, p = 0.129) nor was the mesh infection rate (0% vs 1.6%, p = 0.438). Using logistic regression, none of the factors that were significantly different in the univariate analysis were associated with wound complication rate (all p > 0.05). PS-ACST and TAR are comparable in terms of wound complication rates. PS-ACST can be used for large hernia defects and promote fascial closure with low overall wound morbidity and perioperative complications.

OC-024 THE IMPACT OF THE INTRODUCTION OF ROBOT-ASSISTED SURGERY ON A DEDICATED VENTRAL HERNIA PROGRAM

Abstract Aim The role of a robot-assisted approach in hernia surgery remains controversial due to the high costs associated with robotic surgery and the proposed equal outcomes compared to open surgery. In the current study, we report the 30-day results of the introduction of robot-assisted approach in a dedicated regional ventral hernia repair center. Material &amp; Methods This was a retrospective single-center cohort study, including consecutive patients undergoing ventral hernia repair from 2017 to 2022. To reduce the risk of bias, patients undergoing robotic and open repair were matched by propensity scores in a 1:2 ratio on the variables age, type of hernia (primary/ventral) and horizontal fascial defect size. Multivariable logistic regression was performed. Results A total of 109 patients undergoing robotic repair were compared to 231 undergoing open repair, of which 61.2% were incisional and 38.8% primary hernias. Mean hernia defect size was 4.9×6.5 cm (horizontal x vertical). The mean length of stay was lower after robotic repair (0.1 vs. 1.9 days, P &amp;lt; 0.001) as was the incidence of readmission (3.7% vs. 15.2%, P &amp;lt; 0.001). The incidence of reoperation was insignificantly lower after robotic repair (0.9% vs. 4.8%, P = 0.139), however after adjusting for confounders there was a significantly reduced risk of reoperation after robotic compared to open repair (OR 0.08, CI 0.01–0.92, P = 0.043). Conclusions The introduction of a robotic approach was associated with significantly improved postoperative outcomes.

P-063 Comparison of isokinetic dynamometer and strain gauge as measurement methods of abdominal wall strength in patients with abdominal hernia

Abstract Aim The goal was to analyse trunk flexion strength in patients undergoing incisional hernia surgery, obtaining the data using both isokinetic dynamometer (gold standard for the measurement of the abdominal wall strenght) and strain gauge. Methods Observational cohort study, including patients with incisional hernia (July-December 2022). Collected data were demographic characteristics, clinical characteristics related with the hernia, and measures of the abdominal wall strength using an isokinetic dynamometer and a strain gauge. Comparative analysis was performed using Pearson correlation test adjusted for body composition parameters. Results 53 patients were enrolled (56,6% female) with a mean age of 57,42 age (SD 10,49). Mean BMI was 30,42 (SD 5,15), and mean maximum diameter of hernia defect was 6,75cm (SD 2,16). Bending force moment measurement was 80,23 N/m (SD 38,17). Results obtained with the strain gauge were: force peak with hip and knee flexion at 90° 171,1 N (SD 52,98), rate of force development (RFD) 523,29 N/s (SD 410,04). Adding 45° trunk rotation, peak force was 158,4 N (SD 42,76) and RFD 376,72 N/s (SD 288,74). Significant Pearson correlation indexes were found exceeding r= 0,641 for peak force and r= 0,305 for RFD (both at 90°), and r= 0,6 for peak force and r= 0,315 for RFD (both at 45°) when compared to isokinetic moment values. Conclusions In our group of study, we found a correlation between data obtained using isokinetic dynamometer and strain gauge. Further studies should analyze these associations controlling for other variables such as gender, age or hernia defect size.

OC-028 USING THE VACUUM ASSISTED “FRENCH FRY” TECHNIQUE (FFT) FOR WOUND CLOSURE IN CONTAMINATED OPEN ABDOMINAL WALL RECONSTRUCTION (AWR)

Abstract Introduction In some settings, it is not appropriate to close wounds primarily, such as when patients are felt to be at high risk for wound infection. FFT is a useful method of wound closure in these patients following open AWR. Methods A consecutive series of patients were closed with FFT following AWR from 2019–2022. The FFT includes cutting a vacuum-assisted closure (VAC) sponge into 1×1×8cm segments that are partially placed through an otherwise closed wound. A skin VAC is placed over the wound and external portion of the FFs. Patient characteristics, operative details, and postoperative outcomes were collected. Standard descriptive statistics were reported. Results Wound closure was performed with FFT in 15 patients. Patients were 63.8±13.1 years old, mean BMI was 31.1±6.5 kg/m2, and there was history of tobacco use in 40.0% of patients, diabetes in 46.7%, and prior failed hernia repair in 11(73.3%). Almost all had CDC wound class of 3 or 4(13, 86.7%) wounds, and hernia defect size was 144[8, 310]cm2. Biologic mesh was placed in 9(60.0%), and no mesh was used in 6(40.0%). Wound complication risk based on the CeDAR risk score was 59.5±15.1%. There were 2(13.3%) 30-day readmissions, including 1(6.7%) for a wound infection that was reopened at the bedside. There were no other wound complications. Conclusions FFT is an alternative method of wound closure for significantly at-risk wounds in patients undergoing AWR. The present study describes FFT use in high-risk, complex patients with only 1 of 15 patients having a postoperative wound complication.

OC-116 IMPACT ANALYSIS OF DIASTASIS RECTI ASSOCIATION IN PRIMARY VENTRAL HERNIA REPAIR. OUR EXPERIENCE

Abstract Aim The aim of the study is to analyze concomitant diastasis recti impact in ventral hernia repair in our experience. Material and methods An observational single-center retrospective analysis was performed. We analyzed primary ventral hernia preperitoneal repairs in our Hospital from 2019 to 2021. Two groups were compared according to the presence of concomitant diastasis recti or not. We performed a descriptive analysis; comparative univariate analysis for complication and recurrence and risk factors analysis. Results From 312 ventral hernia repairs a total of 279 (89%) preperitoneal open hernia repairs were performed. 18 (6.5%) patients had diastasis recti. 236 (84.6%%) were day case surgery. 7 (13.4%) patients had surgical complications. There were no reoperations, 4 readmissions (1.4%%), and 1 death (0.3%) Diastasis recti group had no statistically significative difference with the control group except that more frequently were repaired by an abdominal wall surgeon specialist 1.2 vs 5.9%; p= 0.009) In complications risk factors univariate analysis higher size of mesh and hernia defect and lower mesh/defect ratio were associated with more complications. Recurrence was significatively lower in patients with chronic renal failure. No risk factors for recurrence were found. Conclusions In our ventral hernia repair serie small or medium size diastasis recti associated to ventral hernia repair seem not to impact in hernia repair outcomes. Diastasis repair should carefully take it into account when repairing an associated ventral hernia repair in order to not increase surgery complications. And mesh/hernia defect size ratio is related to complications.

OC-126 PRESERVATION OF DEEP EPIGASTRIC PERFORATORS DURING ANTERIOR COMPONENT SEPARATION TECHNIQUE (ACST) RESULTS IN EQUIVALENT WOUND COMPLICATIONS COMPARED TO TRANSVERSUS ABDOMINIS RELEASE (TAR)

Abstract Aim The use of component separation results in myofascial release and increased rates of fascial closure in abdominal wall reconstruction (AWR). These complex dissections have been associated with increased rates of wound complications with anterior component separation having the greatest wound morbidity. The aim of this paper was to compare the wound complication rate between PS-ACST and TAR. Material &amp; Methods Patients were identified from a prospective, single institution hernia center database who underwent PS-ACST and TAR from 2015–2021. The primary outcome was wound complication rate. Standard statistical methods were used, univariate analysis and multivariable logistic regression were performed. Results A total of 172 patients met criteria, 39 had PS-ACST and 133 had TAR performed. The PS-ACST and TAR groups were similar in terms of diabetes (15.4% vs 28.6%, p=0.097), but the PS-ACST group had a greater percentage of smokers (46.2% vs 14.3%, p&amp;lt;0.001). The PS-ACST group had a larger hernia defect size (375.2±156.7 vs 234.4±126.9cm2, p&amp;lt;0.001) and more patients who underwent preoperative Botulinum toxin A (BTA) injections (43.6% vs 6.0%, p&amp;lt;0.001). The overall wound complication rate was not significantly different (23.1% vs 36.1%, p=0.129) nor was the mesh infection rate (0% vs 1.6%, p=0.438). Using logistic regression, none of the factors that were significantly different in the univariate analysis were associated with wound complication rate (all p&amp;gt;0.05). Conclusion PS-ACST and TAR are comparable in terms of wound complication rates. PS-ACST can be used for large hernia defects and promote fascial closure with low overall wound morbidity and perioperative complications.

Biomechanical stability of hernia-damaged abdominal walls

Hernia occurs when the peritoneum and/or internal organs penetrate through a defect in the abdominal wall. Implanting mesh fabrics is a common way to reinforce the repair of hernia-damaged tissues, despite the risks of infection and failure associated with them. However, there is neither consensus on the optimum mesh placement within the abdominal muscles complex nor on the minimum size of hernia defect that requires surgical correction. Here we show that the optimum position of the mesh depends on the hernia location; placing the mesh on the transversus abdominis muscles reduces the equivalent stresses in the damaged zone and represents the optimum reinforcement solution for incisional hernia. However, retrorectus reinforcement of the linea alba is more effective than preperitoneal, anterectus, and onlay implantations in the case of paraumbilical hernia. Using the principles of fracture mechanics, we found that the critical size of a hernia damage zone becomes severe at 4.1 cm in the rectus abdominis and at larger sizes (5.2–8.2 cm) in other anterior abdominal muscles. Furthermore, we found that the hernia defect size must reach 7.8 mm in the rectus abdominis before it influences the failure stress. In other anterior abdominal muscles, hernia starts to influence the failure stress at sizes ranging from 1.5 to 3.4 mm. Our results provide objective criteria to decide when a hernia damage zone becomes severe and requires repair. They demonstrate where mesh should be implanted for a mechanically stable reinforcement, depending on the type of hernia. We anticipate our contribution to be a starting point for sophisticated models of damage and fracture biomechanics. For example, the apparent fracture toughness is an important physical property that should be determined for patients living with different obesity levels. Furthermore, relevant mechanical properties of abdominal muscles at various ages and health conditions would be significant to generate patient specific results.

CT-measured hernia parameters can predict component separation: a cross-sectional study from China.

Currently, there are no reliable preoperative methods for predicting component separation (CS) during incisional hernia repair. By quantitatively measuring preoperative computed tomography (CT) imaging, we aimed to assess the value of hernia defect size, abdominal wall muscle quality, and hernia volume in predicting CS. The data of 102 patients who underwent open Rives-Stoppa retro-muscular mesh repair for midline incisional hernia between January 2019 and March 2022 were retrospectively analyzed. The patients were divided into two groups: ''CS group'' patients who required CS to attempt fascial closure, and ''non-CS'' group patients who required only Rives-Stoppa retro-muscular release to achieve fascial closure. Hernia defect width, hernia defect angle, rectus width, abdominal wall muscle area and CT attenuation, hernia volume (HV), and abdominal cavity volume (ACV) were measured on CT images. The rectus width to defect width ratio (RDR), HV/ACV, and HV/peritoneal volume (PV; i.e., HV + ACV) were calculated. Differences between the indices of the two groups were compared. Logistic regression models were applied to analyze the relationships between the above CT parameters and CS. Receiver operator characteristic (ROC) curves were generated to evaluate the potential utility of CT parameters in predicting CS. Of the102 patients, 69 were in the non-CS group and 33 were in the CS group. Compared with the non-CS group, hernia defect width (P < 0.001), hernia defect angle (P < 0.001), and hernia volume (P < 0.001) were larger in the CS group, while RDR (P < 0.001) was smaller. The abdominal wall muscle area in the CS group was slightly greater than that in the non-CS group (P = 0.046), and there was no significant difference in the CT attenuation of the abdominal wall muscle between the two groups (P = 0.089). Multivariate logistic regression identified hernia defect width (OR 1.815, 95% CI 1.428-2.308, P < 0.001), RDR (OR 0.018, 95% CI 0.003-0.106, P < 0.001), hernia defect angle (OR 1.077, 95% CI 1.042-1.114, P < 0.001), hernia volume (OR 1.002, 95% CI 1.001-1.003, P < 0.001), and CT attenuation of abdominal wall muscle (OR 0.962, 95% CI 0.927-0.998, P = 0.037) as independent predictors of CS. Hernia defect width was the best predictor for CS, with a cut-off point of 9.2cm and an area under the curve (AUC) of 0.890. The AUCs of RDR, hernia defect angle, hernia volume, and abdominal wall muscle CT attenuation were 0.843, 0.812, 0.747, and 0.572, respectively. Quantitative CT measurements are of great value for preoperative prediction of CS. Hernia defect size, hernia volume, and the CT attenuation of abdominal wall muscle are all preoperative predictive indicators of CS.