Open Hernia Repair Research Articles

Efficacy and safety of 5% lidocaine patches for postoperative pain management in patients undergoing unilateral inguinal hernia repair: study protocol for a prospective, double-blind, randomized, controlled clinical trial

BackgroundAcute postoperative pain is a common complication of inguinal hernia repair. Pain management using local application of anesthetic agents over the skin surrounding the surgical incision may reduce the requirement for other pain medications. Targeted topical analgesics such as 5% lidocaine patches have been known to improve acute and chronic pain. However, the clinical effect of lidocaine patches on postoperative pain after inguinal hernia repair has not been studied, especially in patients undergoing surgery at day surgery units.Methods/designThis is a single-center, prospective, double-blind, randomized, controlled clinical trial. Participants with unilateral inguinal hernia will be randomized to the lidocaine patch group or the placebo patch group. Based on the randomized allocation sequence, either lidocaine patches or placebo patches will be attached near each participant’s surgical wound after open hernia repair under general anesthesia. Participants will be asked to follow up at our outpatient clinic on the first postoperative day and at 1 week after surgery. The primary outcome is pain intensity, which will be measured using the visual analog scale (VAS) at the time of discharge from the day surgery unit. The secondary outcomes are VAS score at 24 h and 1 week after surgery. We will collect and analyze the participants’ clinical data (amount of intraoperative opioid use, time to recovery, and pain intensity at 30 min after surgery) and demographic characteristics (age, sex, body weight, and height).DiscussionThis trial may not only provide evidence on the efficacy of a 5% lidocaine patch for acute postoperative pain management after unilateral inguinal hernia repair, but also demonstrate the efficacy and safety of the patch for post-discharge pain management.Trial registrationClinicalTrials.gov NCT04754451. Registered on February 10, 2021.

Laparoscopic versus open groin hernia repair in older adults: a systematic review and meta-analysis.

Groin hernia repair is a common surgical procedure and includes both open and laparoscopic techniques. Studies comparing outcomes of laparoscopic versus open groin hernia repair specifically in the geriatric population are lacking. This study compares the outcomes of laparoscopic versus open groin hernia repair techniques in older adults. A literature search was conducted in each of the five selected databases up till June 2021: PubMed (MEDLINE), EMBASE, CINAHL, Cochrane and PsychInfo (OVID). Outcomes measured included but were not limited to total length of hospital stay, mean total operative time, intraoperative complications, post-operative complications such as wound infection, seroma formation, chronic pain, mesh infection and recurrence of inguinal hernia. A total of five articles were included in the final analysis. The length of postoperative hospitalization stay was shorter in patients who underwent laparoscopic hernia repair (95% CI: -1.50 to -0.72; P < 0.01, I2 = 79%). The laparoscopic repair group had a significantly smaller number of patients who sustained postoperative wound infections (95% CI: 0.02 to 0.47; P=0.003, I2 = 0%), and lower incidence of chronic pain (95% CI: 0.14 to 0.37, P < 0.01, I2 = 46%). Analysis of the remaining outcomes did not reveal any statistically significant differences between open and laparoscopic hernia repair. The results of this analysis showed a shorter length of stay, lower wound infection rates and lower chronic pain with laparoscopic groin hernia repair as compared to open repair in older adults. Future prospective studies examining the impact of age on the relationship between surgical approach (open versus laparoscopic) and surgical outcomes are needed.

The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it

PurposeTo describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospitalMethodsWe describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR.ResultsWe performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009).ConclusionA structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.

Cost-effectiveness analysis of mesh fixation techniques for laparoscopic and open inguinal hernia surgeries

PurposeThis study reports economic evaluation of mesh fixation in open and laparoscopic hernia repair from a prospective real-world cohort study, using cost-effectiveness analysis (CEA) and cost-utility analysis (CUA).MethodsA prospective real-world cohort study was conducted in two university-based hospitals in Thailand from November 2018 to 2019. Patient data on hernia features, operative approaches, clinical outcomes, associated cost data, and quality of life were collected. Models were used to determine each group’s treatment effect, potential outcome means, and average treatment effects. An incremental cost-effectiveness ratio was used to evaluate the incremental risk of hernia recurrences.ResultsThe 261 patients in this study were divided into six groups: laparoscopic with tack (LT, n = 47), glue (LG, n = 26), and self-gripping mesh (LSG, n = 30), and open with suture (OS, n = 117), glue (OG, n = 18), and self-gripping mesh (OSG, n = 23). Hernia recurrence was most common in LSG. The mean utility score was highest in OG and OSG (both 0.99). Treatment costs were generally higher for laparoscopic than open procedures. The cost-effectiveness plane for utility and hernia recurrence identified LSG as least cost effective. Cost-effectiveness acceptability curves identified OG as having the highest probability of being cost effective at willingness to pay levels between $0 and $3,300, followed by OSG.ConclusionGiven the similarity of hernia recurrence among all major procedures, the cost of surgery may impact the decision. According to our findings, open hernia repair with adhesive or self-gripping mesh appears most cost-effective.

Operative time tracking for umbilical hernia patients.

Army medical treatment facilities (MTFs) use a surgery scheduling system that reviews historical OR times to dictate expected procedural time when posting new cases. At a single military institution there was a noted inflation to umbilical hernia repair (UHR) times that was leading to issues with under-utilized operating rooms. This is a retrospective review determining what variables correlate with longer UHR operative time. Umbilical, ventral, epigastric, and incisional hernia repairs (both open and laparoscopic) were pulled from the local OR scheduling system at Dwight D. Eisenhower Army Medical Centerfrom January 2013 to June 2018. A total of 442 patients were included in the study with a mean age of 45.74years and 54.98% male. Patient ASA level (p 0.045), primary vs. mesh repair (p < 0.001), number of hernias repaired (p 0.05), hernia size (p < 0.001), and absence of student nurse anesthetist (SRNA) (p 0.05) all correlated with longer UHR OR times. For the aggregated open hernia repair data, almost all independent variables of interest were statistically significant including age, PGY level, history of DM, case acuity, presence of SRNA, patient ASA level, patient's BMI, hernia defect size, number of hernias, history of prior repair, and history prior abdominal surgery. Multivariate regression analysis was done on the open hernia repair variables with only age and size of hernia being significant. This data were used to create a new case request option (open UHR without mesh and open UHR with mesh) to more effectively utilize available OR time.

A case of bilateral inguinal hernia associated with Marfan syndrome

Marfan syndrome, a connective tissue disease, is associated with a high incidence and recurrence rate of inguinal hernia. We herein report a three-year-old boy with bilateral inguinal hernia associated with Marfan syndrome. While preoperative contrast-enhanced computed tomography (CT) revealed a left indirect inguinal hernia and a right direct inguinal hernia, laparoscopy showed bilateral patent processus vaginalis (PPV) and vulnerability of the abdominal wall at the bilateral medial inguinal fossae. In addition to laparoscopic percutaneous extraperitoneal closure (LPEC), open iliopubic tract repair was also performed. To our knowledge, this is the first report of a therapeutic strategy for pediatric inguinal hernia with Marfan syndrome. • Children with Marfan syndrome may develop direct inguinal hernias. • Computed tomography while awake in the prone position led to the diagnosis. • Combined laparoscopic and open hernia repair were useful.

Comment on "Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials".

Comment on "Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials".

Impact of malnutrition on outcomes following groin hernia repair: Insights from the ACS NSQIP

BackgroundThe present study examined the association of nutrition status, as defined by preoperative serum albumin, with postoperative outcomes and resource use after groin hernia repair. MethodsThe 2006 to 2019 American College of Surgeons National Surgical Quality Improvement Program database was queried for adults (≥18 years) undergoing open or laparoscopic repair of inguinal or femoral hernia. Patients were stratified based on the following preoperative serum albumin levels: <2.5 g/dL (severe hypoalbuminemia), 2.5 to <3.0 (moderate hypoalbuminemia), 3.0 to <3.5 (mild), and ≥3.5 (normal albumin). Multivariable regression models were developed to assess the association of hypoalbuminemia with outcomes of interest, including 30-day mortality, postoperative complications, length of stay, and 30-day readmission. ResultsOf the 261,052 patients meeting inclusion criteria, 0.3% had severe, 1.1% had moderate, and 7.4% had mild hypoalbuminemia, with 91.2% classified as normal albumin. After risk adjustment, mortality risk was greater for severe (5.8%, 95% confidence interval: 4.1–7.6), moderate (4.4%, 95% confidence interval: 3.4–5.3), and mild hypoalbuminemia (1.5%, 95% confidence interval: 1.2-1.8) relative to normal albumin (0.3%, 95% confidence interval: 0.2–0.3). Decreasing serum albumin levels were associated with a stepwise increase in risk of complications, length of stay, and 30-day readmission. ConclusionDecreased preoperative serum albumin is associated with increased mortality and morbidity after open and laparoscopic groin hernia repair. Serum albumin remains a relevant predictor of postsurgical outcomes and can thus be used in shared decision-making and optimization of malnourished patients in need of groin hernia repair.

Comparison of the Analgesic Effect of Subcutaneous Bupivacaine Infiltration and Intravenous Diclofenac vs. Intravenous Diclofenac Monotherapy After Inguinal Hernioplasty: A Retrospective Study.

BackgroundPostoperative pain is a significant problem encountered by patients after a surgical intervention, and there is a crucial need for effective postoperative pain control. The studies have shown that multimodal analgesia and wound infiltration are effective ways to reduce this pain and have a substantial role in the reduction of postoperative medications requirement. This study aimed to evaluate the effect of subcutaneous infiltration of bupivacaine hydrochloride and intravenous (IV) diclofenac as postoperative pain relief in adults undergoing inguinal hernia repair.MethodsA single-center retrospective study included 104 patients aged 18-65 undergoing unilateral inguinal herniorrhaphy at the selected hospital. The patients were in two groups of 52 each. Group A received a 75 mg dose of IV diclofenac plus a subcutaneous injection of 10 mL of bupivacaine hydrochloride (HCl) 0.5% while Group B only received the IV diclofenac without the bupivacaine injection. The postoperative pain was assessed at one, two, three, six, and 12 hrs after the operation using the visual analog scale (VAS), which exhibited a range of pain from zero (no pain) to 10 (extreme pain).ResultsOf a total of 104 patients, 92% of patients were male. The patients' mean age was 36 ± 11 years, and the mean body mass index (BMI) was 22 ±3 kg/m2. American Society of Anesthesiologists physical class I was similar in both groups (90.4% versus 84.6%). Patients in Group A had significantly lower VAS pain scores at one, two, three, six, and 12 hrs after the operation and a longer emergence time than Group B (all p-values were < 0.001). Subcutaneous bupivacaine infiltration and IV diclofenac were also found to be an effective analgesic technique in open hernia repair with mesh (p-value < 0.001 for all).ConclusionSubcutaneous injection of bupivacaine combined with IV diclofenac provides superior analgesia to monotherapy intravenous diclofenac after inguinal hernia repair.

Short-term complications after minimally invasive retromuscular ventral hernia repair: no need for preoperative weight loss or smoking cessation?

Obesity and smoking areassociated with postoperative wound complications following open hernia repair. However, with the advancements in minimally invasive surgical techniques, we hypothesized that obese and/or smoking patients undergoing minimally invasive repairs were not subjected to an increased risk of postoperative surgical complications. As opposed to nonobese and/or nonsmoking patients. This was a retrospective cohort study including patients undergoing minimally invasive retromuscular repair at a single university hospital. Patients were divided into two groups according to exposure; obese vs. nonobese and smoking vs. nonsmoking. One month postoperatively, all patients underwent clinical follow-up. The main outcome was surgical site occurrence (SSO). A total of 94 patients were included, undergoing both laparoscopic (n = 32) and robotic (n = 62) retromuscular repair. Of these, 7.7% of the obese patients had SSO when compared with 19.1% of the nonobese patients. A total of 17.2% of the nonsmokers had SSO compared with 13.3% of the active smokers. Of the nonsmokers, 12.5% developed seroma and 6.2% hematoma postoperatively, the corresponding numbers were 13.3% and 0% among the active smokers. After multivariable analysis, there was no significant risk factors for developing postoperative SSO. There was no association between obesity or smoking and surgical complication in patients undergoing minimally invasive retromuscular repair. If the results of the current study are confirmed, patients who are unable to obtain weight loss or smoking cessation may be offered minimally invasive retromuscular ventral hernia repair without inducing an increased risk of short-term complications.

655 Is It Time to Change Practice in Patients with Unilateral Inguinal Hernia – a Comparative Study of Laparoscopic vs Open Hernia Repair in LMIC Country

Abstract Aim Our aim was to assess if a return to regular activity is improved in patients undergoing one-sided inguinal hernia repair. This is critical in LMIC countries where finances are constrained, and the cost of laparoscopic repair is significantly higher than the open technique. Method The study was conducted at Aga Khan University Hospital, Pakistan. Patients between ages 16 to 65 planned for unilateral inguinal hernia repair were selected using non-probability consecutive sampling. Patients were selected from 1st May 2016 till 30th April 2017 and were divided into two groups. Group A included patients having laparoscopic TAP repair while Group B consisted of Liechtenstein hernia repair. All patients were followed at 1 week for resumption of regular activities, at 1 and 3 years for recurrence, the study was concluded on 30th April 2020. Results A total of 60 patients were enrolled in this study. Group A and B each had included 30 patients. The mean duration of return to work in group A was 5.33 ± 4.46 days and for group B it was 6.83 ± 4.58 days. There was 1 recurrence seen at 3 years in Group A. Conclusions Hernia recurrence is not different from the technique of repair at 1-year follow-up. Laparoscopic repair although is associated with little early return to work when compared with open technique but this difference was not statistically significant in our study. The decision of the type of repair should be balanced between surgeon expertise and patient's wishes.

602 Using Plastic Surgery Techniques in Abdominal Wall Surgery

Abstract Complex Abdominal Wall Hernias (CAWH) present a huge challenge to surgeons and patients often requiring Abdominal Wall Reconstruction (AWR). AWR aims to restore abdominal wall anatomy, improve function, and reduce the risk of future herniation. Plastic surgery techniques can be used including primary closure, skin grafts, flaps, tissue expansion and small bite, small stitch technique. Below are two cases where some of these techniques were utilised. Case 1 LC is a 65 y/o female with CAWH. Her gastric band became infected requiring a laparotomy for perforation of gastroesophageal junction. She subsequently had primary open repair of abdominal hernia using Permacol. It became infected requiring 5 debridements and application of a VAC device. Her hernia was a Ventral Hernia Working Group (VHWG) grade 3 at 10cm×16cm. Her CAWH was repaired using a Rives-Stoppa technique and a Surgimend mesh. The epigastric component of her wound was closed using a superiorly based local rhomboid flap and a Prevena VAC dressing. Case 2 KH is a 37 y/o female with a para-ileal conduit skin granuloma that was painful and refractory to other treatments such as silver nitrate and steroid topical treatments. She had excision of the area of granulation and her wound was closed using a local advancement flap taking account of previous scars raised and a prevena VAC dressing. Discussion CAWH requiring AWR is a complex operation benefiting from plastic surgical specialists. Plastic surgical techniques can help with closure of the abdominal wall and reduce complication rates including wound infections and incisional hernia.

1061 Is There Potential for Prevention of Emergency Open Hernia Repairs?

Abstract Aim Emergency hernia repairs are associated with increased post-operative complications. We aim to compare symptoms and healthcare contacts prior to surgery in patients undergoing emergency hernia repair to those who underwent elective hernia repair. Method Retrospective study of all patients with acutely strangulated/obstructed hernias between October 2019 and October 2021. Emergency repairs were compared with cohort of elective repairs carried out over the same study period. Results 41 patients required emergency open hernia repairs. The median age was 79(range 44–91) years. 25 were inguinal hernias, 7 para-umbilical, 4 incisional, and 4 femoral. 14/41(35.4%) patients had healthcare consultation for hernia prior to acute presentation. Of these, 11(27.1%) were already awaiting elective surgery. 25/41(60.4%) patients were asymptomatic prior to acute presentation. 28/48(68.7%) patients were not aware of hernia diagnosis prior to emergency surgery. There was significantly higher presence of hernia symptoms, healthcare contact, and awareness of diagnosis, in the elective patients compared to the emergency group (P&amp;lt;0.05). There was significantly higher rate of in-patient stay and need for small bowel resection in emergency patients (P&amp;lt;0.001). We found significantly higher rates of wound infection, haematoma/seroma, and urinary retention in emergency repair patients compared to the elective group (P&amp;lt;0.01). Conclusion Early diagnosis and hernia repair is required to prevent need for emergency surgery and reduce risks of post-operative complications. Improved patient education regarding early presentation would allow earlier detection and intervention. Lack of symptoms prior to incarceration, however, would hinder early presentation, and therefore potential for emergency surgery prevention remains limited.

953 Amyand's Hernia: The Fortuitous Intraoperative Diagnosis – a Case Report

Abstract Introduction Amyand's hernia is a very rare form of inguinal hernia, in which the vermiform appendix is in the inguinal canal/hernia sac. Its incidence is less than 1% of groin hernias and is complicated by appendicitis in about 0.1% of cases. It is commoner in males, on the right side and has a bimodal age distribution – neonates and the elderly. We present the case of an elderly gentleman with amyand's hernia diagnosed intraoperatively. Case Presentation A 78-year-old male with a background of systemic hypertension presented to the clinic with an 18-month history of painless right groin swelling. Physical examination revealed a full, non-tender abdomen. He had a 4cm soft, reducible right groin swelling, with visible and palpable cough impulse. A diagnosis of right inguinal hernia was made. Baseline blood workup and ECG were unremarkable. He was listed for a day case open hernia repair. Intra-operatively, the right indirect hernia sac contained a grossly uninflamed appendix lying freely within it. Figure 1. Appendicectomy was performed and a tension-free repair was done. The post-operative period was uneventful. Histology of the excised appendix revealed reactive lymphoid hyperplasia and submucosal fibrosis. Conclusion As only about 1 in 60 cases of Amyand's hernia are diagnosed pre-operatively, usually as an incidental finding on imaging; the overwhelming majority are intra-operative findings. Although rare, the vermiform appendix remains a possible content of the inguinal hernia sac, and it is important to be aware of likely complications and options of repair.

A Comparison of outcome between Transabdominal Preperitoneal (TAPP) and Lichtenstein operation for primary inguinal hernia repair – An institutional study

Introduction: Inguinal hernia repairs are one of the most common operations in general surgery. Apart from the classical open repairs, minimally invasive approaches are increasingly preferred to manage groin hernia repair. However, the optimal surgical approach still remains controversial.&#x0D; Methods: This is a prospective observational study done in Shree Birendra Hospital, a 750- bedded tertiary care military hospital located in Kathmandu from July 2021 to December 2021. A total of 120 patients operated for inguinal hernia by either open Lichtenstein repair or Transabdominal Preperitoneal (TAPP) in the department of surgery were included in this study.&#x0D; Results: The mean age of patients between open Lichtenstein repair and TAPP was 59.3 (22-79) and 63.4 (27-70) years respectively. The majority of patients were male among both the groups constituting of more than 95%. The mean intraoperative duration among the two groups was 44.12±7.23 minutes and 77.43±8.77minutes, respectively (p=0.021). The mean postoperative pain was less in TAPP procedure compared to open procedure (p=0.037). The mean duration of the postoperative hospital stay was 2± 1.12 and 1±0.79 respectively. At the three-month evaluation, there were four cases of recurrence of which one of them underwent open procedure while three underwent TAPP procedure.&#x0D; Conclusion: Both the open Lichtenstein repair and the TAPP procedures are safe and effective in the repair of primary inguinal hernia. In a view of postoperative pain, seroma formation and length of hospital stay TAPP procedure has been found superior to open procedure in our study.

Observational study of comparison between laparoscopic retro-rectal vs open pre-peritoneal Ventral hernia repair

Background: Hernias are one of the most common anatomical derangements in men and women and have left an indelible mark throughout most of recorded history. For hundreds of years various surgical and non-surgical treatments were offered to patients suffering from chronic pain, obstruction and strangulation related to their hernias. Materials &amp; Methods: The study was undertaken in tertiary health centre in prospective manner from July 2017 to July 2019 on Laparoscopic retro-rectal versus Open pre-peritoneal ventral hernia repair. Results: In present study, mean age of patients in Laparoscopy group was 45.26 years &amp; in Open group was 48.92 years. 25 patients were males and 15 patients were females in the study. 10 patients were of Umbilical hernia, 3 patients were of Paraumbilical hernia and 2 patients were of Epigastric hernia in Laparoscopy group. While for Open group there were 14, 7 &amp; 4 patients respectively. Swelling in abdomen which disappears on lying down was the main complaint of patients, followed by pain in abdomen. Average BMI of patients in Laparoscopy group was 25 Kg/m2 while in Open group it was 25.33 Kg/m2.

Comparing functional outcomes in minimally invasive versus open inguinal hernia repair using the army physical fitness test.

The advantages of minimally invasive inguinal hernia repair (MIHR) over open hernia repair (OHR) continue to be debated. We compared MIHR to OHR by utilizing the Army Physical Fitness Test (APFT) as an outcome measure. The APFT is a three-component test scored on a normalized 300 point scale taken semiannually by active-duty military. We identified 1119 patients who met inclusion criteria: 588 in the OHR group and 531 in the MIHR group. Changes in APFT scores, time on post-operative duty restrictions (military profile), and time interval to first post-operative APFT were compared using regression analysis. Postoperatively, no APFT score change difference was observed between the OHR or MIHR groups (-7.3 ± 30 versus -5.5 ± 27.7, p = 0.2989). Service members undergoing OHR and MIHR underwent their first post-operative APFT at equal mean timeframes (6.6 ± 5months versus 6.7 ± 5.1, p = 0.74). No difference was observed for time in months spent on an official temporary duty restriction (military profile) for either OHR or MIHR (0.16 ± 0.16 versus 0.15 ± 0.17, p = 0.311). On adjusted regression analysis, higher pre-operative APFT scores and BMI ≥ 30 were independently associated with reduction in post-operative APFT scores. Higher-baseline APFT scores were independently associated with less time on a post-operative profile, whereas higher BMI (≥ 30) and lower rank were independently associated with longer post-operative profile duration. Higher-baseline APFT scores and lower rank were independently associated with shorter time intervals to the first post-operative APFT. Overall, no differences in post-operative APFT scores, military profile time, or time to first post-operative APFT were observed between minimally invasive or open hernioplasty in this military population.

EP-503 An Audit of Day case surgery for Inguinal Hernia Repair

Abstract Aims To compare the trust-wide performance with the standard by the British Association of Day Surgery in the management of inguinal hernias. Methods Electronic data of patients who underwent Inguinal Hernia Repairs in the trust from September 2019 to December 2019 was analyzed. Results A total of 122 male and 11 female patients had hernias repaired in this time period.18 were emergency while the rest of the cases were elective. The ages ranged from 19–91 with a mean age of 62. Of the 115 electives, 60% were performed as day-case. The mean length of stay was 1.7days (R 0–12).34 out of 46 (74%) patients who stayed inpatient were actually booked as day-case. 73% had no documented reason for their admission.4 patients were admitted for medical reasons 2 for post-operative surgical complications. Of patients pre-booked as inpatients,10 were quoted to have serious medical issues while 5 had no clear reason. The vast majority had open repairs while 26% of the 115 patients had laparoscopic repairs. Conclusion Our Performance was noted to be 30% lower than the BADS standard. There is a need of: Development of inpatient surgery booking criteria and adherence. Discussion with anesthetic colleagues to assist drive towards day-case surgery. Clear documentation in the clinical letters to explain the reason for inpatient management and booking. Perioperative notes need improvement.

TH1.11 Outcomes of Sublay Mesh repair in Ventral Abdominal hernia; retrospective study

Abstract Introduction Ventral hernia repair is one of the challenging surgical operations over time. It is suggested that sublay mesh repair has the lowest recurrence and surgical site infection in open anterior abdominal hernia repair. This study aimed to analyse the pros and cons of sublay mesh in ventral hernia repair to evaluate the significance of this technique as a treatment modality. Hospital stay, acute postoperative complications, and the recurrence rate were the main areas of investigation. Methods A retrospective study on 79 Patients with ventral hernias were operated on (electively) with sublay mesh repair over 3 years. Fit patients with first-time ventral hernias (primary and incisional) were included. Recurrent hernia, associated decompensated cardiopulmonary disorders, and bleeding disorders were excluded. The project Performa includes; patient's demographics, operative details, length of stay, postoperative complications, and follow-up, up to 12 months. Results All patients underwent open mesh repair using the sublay technique. Ventral hernia was five times more common in females than males. Mean age of presentation was at 44.8 years old. Mean operating time was 67 minutes and a 1-day hospital stay. Para-umbilical and incisional hernias represented the majority of cases. Component separation approach was added in three cases (3.7%). Simultaneous cholecystectomy was performed in 2 cases (2.5%). Only 6 cases (6.3%) developed wound-related complications, while 2 cases (2.5%) had a recurrence. Conclusion Sublay mesh repair is favourable for ventral abdominal hernia reconstruction. It is associated with a smooth and short hospital stay and the least incidence of complications and recurrence.

WE3.11 Inguinal hernia repair operation; review of the consent and the supported decision-making in the out-patient department

Abstract Introduction In 2015, the ruling of the UK Supreme Court in Scotland in the case of Montgomery v Lanarkshire fundamentally changed the practice of consent. According to the Judges, doctors are no longer the sole arbiter of determining what risks are material to their patients. In this study, the RCS CONSENT: SUPPORTED DECISION-MAKING guide was used to evaluate our practice in regards to consent taking for inguinal hernia repair. Methods OPD letters to GPs were reviewed between 01/01/2019 to 30/12/2019. For risks with its percentages, alternative management exploration with the patient and whether information leaflets supplied to the patients. Results There were 63 patients. 19/63 letters had different options of treatment documented. 37/63 letters showed risks and complications documented and only 4/63 letters had percentages of the risks written. 25/63 patients signed consents in OPD. 0/63 letters indicated a signed consent copy was given to patients. Only 10 patients had been given an information leaflet. Conclusion Overall quality of letters was: 36/63 were poor, 21/63 were average and 5/63 were good. Therefore, to improve our practice leaflets shall be made easily accessible in all clinics. A prompt notification, if consent has been signed when booking a patient. workshops with feedback for middle grades.