Hernia Patients Research Articles

Does the use of bioabsorbable mesh for hiatal hernia repair at the time of bariatric surgery reduce recurrence rates? A meta-analysis.

Anywhere from 16% to 37% of patients undergoing bariatric and metabolic surgery are estimated to have a hiatal hernia. To address the lack of long-term data showing the efficacy of bioabsorbable mesh in reducing the recurrence of hiatal hernia in patients who undergo bariatric surgery, we evaluated the world literature and performed a meta-analysis. To evaluate hiatal hernia recurrence rates after placement of bioabsorbable mesh in bariatric patients. Meta-analysis of world literature. We performed a literature search using PubMed and MEDLINE with search terms including "hiatal hernia recurrence," "bariatric surgery," "bioabsorbable mesh," "Gore BIO-A," and "trimethylene carbonate." Analysis was conducted to compare surgical time, length of stay, recurrence rate, hernia size, and changes in body mass index before and after surgery between mesh-group (MG) and nonmesh (NM) patients. The meta-analysis was described using standardized mean difference, weighted mean difference, effect size, and 95% confidence interval (CI). An I2 statistic was computed to assess heterogeneity. Twelve studies with 1351 patients were included in our meta-analysis. Four studies had both an MG and an NM group. There were 668 patients in the MG and 683 patients in the NM group. Hernia size noted in the NM group (7 cm2) was compared with that in the MG (6.5 cm2) (95% CI: 3.89-9.14; P = .86). The MG had fewer recurrences than the NM group (effect size, 2% versus 14%; 95% CI: -.26 to -.02; P = .027). The average follow-up was 28.8 months for the MG and 32.8 months for the NM group. Repair with bioabsorbable mesh at the time of the index bariatric surgery is more effective at reducing the recurrence rate of hiatal hernia than suture cruroplasty. Further studies investigating the long-term outcomes of bioabsorbable mesh placed at the time of bariatric surgery are needed.

The inheritance of groin hernias: an updated systematic review with meta-analyses.

The aim of this systematic review was to assess the inheritance of groin hernias. The primary outcome was to assess the inheritance based on the family history of groin hernias. We included studies that reported family history in patients with groin hernias, assessed the development of groin hernias in patients with a positive family history, or assessed the development of groin hernias in twins. Searches were conducted in PubMed, EMBASE, and Cochrane CENTRAL in November 2021. Results were synthesized narratively and with meta-analyses. Twenty-two studies with unique participants were included. While two twin studies did not show convincing results of a genetic origin in children, database studies with low risk of bias showed that a positive history in parents or siblings increased the risk of inguinal hernia in children, and the risk was highest between mothers and daughters and between sisters. In adults, patients with inguinal hernia had higher odds of having a positive family history compared with patients without groin hernia (odds ratio 5.3, 95% confidence interval 3.3-8.7), and a nationwide study found the highest risk of inguinal hernia repair when a sister had been repaired compared with a brother. This study also found that having a sibling repaired for a groin hernia increased the risk of femoral hernia repair. Despite studies being heterogeneous, there is overwhelming evidence that a positive family history is a risk factor for developing inguinal hernia in both children and adults, seemingly with a pronounced female-female inheritance pattern.

Identification of Sliding Hiatus Hernia by High-Resolution Manometry and Upper Gastrointestinal Endoscopy in Patients with Gastro-Oesophageal Reflux Disease

The aim of this study was to compare high-resolution manometry (HRM) and upper gastrointestinal (GI) endoscopy as diagnostic utilities in detecting a sliding hiatus hernia in patients with gastro-oesophageal reflux disease (GORD) symptoms. For both diagnostic modalities, the data obtained from 31 patients (20 females; mean age 48.2) who qualified for Nissen fundoplication were analysed using oesophageal pressure topography in line with the Chicago Classification. Confirmation of hiatus hernia during the surgery was considered the gold standard. HRM protocol involved 10 consecutive boluses of 10 mL of water. Sliding hiatus hernia was confirmed intraoperatively in 29 out of 31 patients. In 14 patients, hiatus hernia was detected in HRM, while 19 patients were found to have hiatus hernia by upper GI endoscopy before surgery. No false positive results were obtained in HRM, while 15 false negative results were shown. In upper GI endoscopy, false positive data were observed in 1 patient, while false negative results were found in 10 patients. Thus, the sensitivity of HRM in detecting hiatus hernia was 48% (95%CIs: 29-67%), and sensitivity of upper GI endoscopy was 66% (95%CIs: 46-82%). It was not possible to assess the specificity of HRM or upper GI endoscopy because only 2 of 31 patients had no hiatus hernia during fundoplication (gold standard). False negative results (sensitivity) were not significantly different between compared diagnostic modalities HRM and upper GI endoscopy (52% vs. 34%, respectively, p = 0.29). Due to poor sensitivity, both modalities, i.e., HRM and upper GI endoscopy, are not reliable tools to diagnose sliding hiatus hernia in patients with GORD symptoms.

A study on clinical profile and risk factors in incisional hernia patients

Incisional hernias of the abdominal wall are a frequently encountered complication in cases of open abdominal surgeries like midline laparotomies, caesarian sections etc. Wound infections, obesity, poor healing due to malnutrition etc., were thought to be the important causative factors in the development of incisional hernia.To study the clinical profile of incisional hernia patients with respect to various etiological factors, distribution of cases in relation to age and sex, details of previous surgical procedures undergone.52 patients admitted in Department of General Surgery were included in the study. Study was conducted during the period from August 2018 to August 2020 including all patient with incisional hernia. Pediatric cases were excluded from the study. Data of all the patients were collected from the hospital records and were compiled in a predesignated proforma which included patient details, clinical examination, investigations, and previous surgical history. Informed consent was obtained from each patient. Retrospective observational study. There were 32 females (61.54%) and 20 males (38.46%) with female to male ratio was found to be 1.6:1. Majority of the patients presented with abdominal swelling (n=30, 58%) followed by both abdominal swelling and pain (n=20, 38%). Among the females now presented with incisional hernias the mean parity was 2.69. Majority of the cases developed hernias within 1 year (n=29, 55.77%) and about 26.93% of the patients developed hernia in 1 to 3 years. Most of cases of incisional hernia in our study occurred over midline (n=22, 42.3%) at the site of incisions made for midline laparotomy (n=20.38.5%) Risk factors favouring incisional hernia formation were post-operative wound infection (n=45, 84.9%) and obesity (n=21, 40.38%). Incisional hernia is more common in females who undergo emergency midline laparotomy and emergency caesarean section. Majority of the cases presented within 1 year of surgery. Post-operative wound infection, obesity and anemia were the crucial factors for the development of incisional hernias.

RF03 | PMON300 Sex Hormones, Sex Hormone Binding Globulin, and Gonadotropins in Men with Inguinal Hernias

Abstract Background More than 1 in 4 men will undergo inguinal hernia repair during their lifetime. Age is a significant risk factor for inguinal hernias in men with increased incidence in older age. Sex steroid hormone changes are observed with a higher ratio of serum estradiol (E2) to testosterone (T) as men age. We previously demonstrated that a shift from androgen to estrogen action caused inguinal hernia formation in a transgenic male mouse model with increased estrogen action in lower abdominal muscle tissues. However, age-related changes in serum E2 levels in men are conflicting, as some studies have reported increases but others have noted unchanged or even decreased E2 levels with advancing age. Method: This study was performed on 212 men with inguinal hernias, aged 20 to 90 years, stratified at 10-year intervals of age (20-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90 years). We assessed total T (TT), total E2 (TE2), dehydroepiandrosterone (DHEA), sex hormone-binding globulin (SHBG), and gonadotropins (FSH and LH). Body mass index (BMI) was calculated using height and weight. Results The BMI distribution was balanced for men with inguinal hernias among all age groups. TE2 was low in 23.7%, normal in 65.8%, and high in 10.5% of men 50 years or younger. In contrast, the percentage of patients with high TE2 was increased 2.6-fold in men over the age of 50 (20.1% in low, 52.3% in normal, and 27.6% in high). TT was normal in all men 50 years and younger but was low in 3.5% and normal in 96.5% of men over the age of 50. We found that serum TE2 levels and the ratio of TE2/TT positively correlated with age (p=0.001). In addition, serum TE2 levels were significantly higher in the advanced age groups (71-80 and 81-90 years) than in the young age group (20-40 years). Serum TT levels decreased but did not reach significance in the advanced age groups compared to the young age group. Remarkably the ratio of E2/T was higher in the advanced age groups than in the young age group (20-30 years). Serum DHEA levels in men over the age of 50 were significantly higher than in men 50 years or younger. SHBG levels were higher in men over 70 years than men 50 years or younger (p< 0.01). Serum levels of FSH and LH in men over 60 years were 3-fold greater than in men 50 or younger (p<0.01). Conclusions Our findings suggest a correlation of increased estrogen action in the formation of inguinal hernias at an advanced age. This points to a potential utilization of inhibitors of estrogen synthetase or estrogen antagonists in a subset of elderly inguinal hernia patients with increased circulating estrogen as a non-surgical intervention. Presentation: Saturday, June 11, 2022 1:42 p.m. - 1:47 p.m., Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Comparative study between sublay (retrorectus) and onlay mesh placement in ventral hernia repair at a teaching hospital

Background: Anterior abdominal wall defects give rise to ventral hernias. Treatment modalities vary from surgical options such as open procedure, laparoscopic method to further advanced robotic surgeries. The present study aimed to find the comparison between the postoperative and short term outcomes of onlay and retrorectus (sublay) mesh placements as ventral hernia repair methods. Materials and Methods: Our enrolled ventral hernia patients were divided into two groups of 20 each. Group A underwent traditional open onlay mesh repair and group B had open sublay/retrorectus mesh hernia repair. Age, gender, body mass index, comorbidities, and past surgical history, among both groups, were comparable. Results: The duration of surgery was significantly shorter in onlay group. The sublay group was related to fewer postsurgical complications and shorter duration of drain insertion. The duration of hospital stay had no statistical significance. Conclusion: Both techniques have their pros and cons and further research is required to determine a superlative.

Patient-reported outcomes in 645 patients after laparoscopic fundoplication up to 10 years

BackgroundLaparoscopic fundoplication is the gold-standard surgical management for gastroesophageal reflux disease. Optimal patient outcomes include resolution of symptoms with minimal postoperative side effects of dysphagia or gas-bloat. This study aims to review outcomes at a single institution up to 10 years after surgery. MethodsThis is a retrospective review of a prospectively maintained quality database. Patients who underwent laparoscopic fundoplication from 2009 to 2021 were included. Transition in surgical practice mid-2017 with incorporation of fundoplication algorithm and impedance planimetry. Patient-reported outcome scores include Reflux Symptom Index, gastroesophageal reflux disease–health-related quality of life, and dysphagia score. Comparisons were made using two-tailed Wilcoxon rank sum tests. ResultsSix hundred forty-five patients underwent laparoscopic fundoplication (2009–July 2017 n = 355, July 2017–November 2021 n = 290) from January 2009 to November 2021. Patients had an improvement in patient-reported outcomes and did not worsen from 2 to 10 years after surgery. Comparison of each time period showed that the second time period had fewer gas-bloat symptoms at 2 years (P = .04). Paraesophageal hernia was present in 66% of patients. Preoperative patient-reported outcomes in non-paraesophageal hernia include worse Reflux Symptoms Index (P < .01) and gastroesophageal reflux disease–health-related quality of life (P < .01) than the paraesophageal hernia group. Patient-reported outcomes were similar between the 2 except for worse gas-bloat in non-paraesophageal hernia patients at 2 years (P = .02). Endoscopy was performed in 10.9% (n = 58) of the study population at a median of 16 months, with 1.5% of patients (n = 8) from the entire cohort with abnormal DeMeester Scores. Median (interquartile range) preoperative DeMeester Score of 31 (17–51) decreased to 5 (2–14) at postoperative evaluation. ConclusionThis single-institution study reports excellent long-term patient-reported outcomes after laparoscopic fundoplication that persist up to 10 years.

A retrospective review of a large series of groin hernia patients operated with robotically assisted laparoscopic technique (R-TAPP)

We have reviewed the patient outcome and the feasibility of robotically assisted inguinal hernia repair (R-TAPP) from the first 4-years period after its introduction in our department in a Scandinavian Public Health hospital. A total of 226 hernia repairs were performed in 195 patients (31 bilateral hernias). 160 patients had primary hernias, whereas 35 had recurrent hernias. Of the recurrent hernias, three had recurred twice. The majority of the hernias were in the right groin (53.3%) and the lateral location was the most common (65.0%). The hernia was scrotal in 29 cases. The mean operation time was significantly reduced throughout the observation period for our cohort, i.e. from 81 to 57 min (p < 0.001). The operation time was 27 min faster (mean value) in unilateral vs bilateral hernias and 19 min faster (mean value) in primary vs residual hernias. There were no statistically significant differences in operation time between lateral and medial hernias, and no differences in operation time between the obese and normal-weight cases. We experienced four severe per-operative complications (4/226; 1.8%): two cases of abdominal wall bleeding subsequently undergoing intravascular coiling, one perforation of the urinary bladder and one perforation of small bowel that were both closed by direct suture intraoperatively. There were no conversions to laparoscopy or open procedure. One hernia recurred during the observation period. Our findings suggest that the R-TAPP procedure in a Scandinavian Public Health hospital’s surgical department is both safe and feasible.

Complex Abdominal Wall Reconstruction with Biologic Mesh for Ventral/Umbilical Hernias in Patients with Cirrhosis

Introduction: Patients with cirrhosis undergoing non-liver transplant surgery have a higher risk of adverse events than those without cirrhosis. Methods: This study had retrospective and prospective components, including all cirrhotic patients at our center with complex abdominal wall reconstruction (CAWR) for ventral/umbilical hernia repair with biologic mesh between December 2016 and November 2021. Results: We studied 37 patients with cirrhosis. Their mean age was 57.2 years. 64.9% were male. The median BMI was 28.1 kg/m2. Ascites was present in 83.3% of patients. The other most common comorbidities were alcohol abuse (67.6%), hypertension (37.8%), and diabetes (24.3%). All complications in aggregate occurred in 11 patients (29.7%). Six patients (16.2%) underwent reoperation. Surgical site infection (SSI) occurred in 5 patients (13.5%). Four deaths occurred within 90 days (11.2% cumulative mortality). By 120 days, there were 5 deaths (14.2% mortality, but none due to the operation). Three predictors (mesh size ≥200 sq cm, lysis of adhesions, and VHWG grade ≥3) achieved an area under the receiver operating characteristic curve (AUROC) for SSI of 0.938 and two predictors (BMI ≥35 kg/m2 and preoperative aspirin) yielded an AUROC of 0.825 for 120-day mortality. Conclusion: Our results suggest that CAWR for ventral/umbilical hernias among cirrhotic patients is feasible given a dedicated CAWR team in collaboration with transplant surgeons and a transplant hepatologist. The rates of adverse outcomes were low or at the midpoint of the range of the study-specific estimates.

Botulinum Toxin Use for Abdominal Wall Reconstruction

INTRODUCTION: Preoperative botulinum toxin (BTX) injection may assist in fascial closure of large incisional hernia repair. We examine outcomes of incisional hernia patients who receive BTX injections before abdominal wall reconstruction (AWR). METHODS: A retrospective cohort study of patients from 2019–2021 who underwent BTX abdominal wall injections and interval AWR was conducted. A matched cohort who underwent IH repair without BTX treatment was selected for comparable defect size and BMI. Clinical and demographic data were extracted from charts. RESULTS: Twenty patients received BTX injections, and 30 comparable patients did not. There was no difference in average age (58.6 and 61.4 years, p = 0.514), BMI (32.9kg/m2 and 32.4kg/m2, p = 0.813), or defect size (663.9 cm2 and 608.43 cm2, p = 0.513). Primary outcome of fascial closure was achieved in every patient in the BTX group (20 of 20) vs 86.7% (26 of 30) in the non-BTX group (p = 0.089). The BTX group had a lower rate of component separation (65.0% of the BTX group vs 93.3%, p = 0.01). The BTX group had higher rates of seroma (p = 0.03) and longer surgery time, 4:07 vs 3:58 (p < 0.01). The postoperative period had one dehiscence (non BTX group). There was no difference in incidence of surgical site infection, abscess, delayed healing, respiratory failure, pulmonary embolism, acute kidney injury, or length of stay. CONCLUSION: Patients receiving botulinum toxin injections into their abdominal wall musculature achieved greater rates of closure with good outcomes. We conclude that botulinum toxin injection for large incisional hernias is an effective method for relaxation of abdominal wall muscle and closure of large abdominal wall.

Tolerability of Incisional Hernia Repair Under Local Anesthesia. A Comparative Study

Introduction: Surgery under local anesthesia, a gold standard for many abdominal wall hernia, was already used for incisional hernia surgery. There are no available studies about the tolerability of this method so far. Aim of this work is to check perioperative tolerability of incisional hernia repair under local anesthesia, comparing it with local anesthesia for inguinal hernioplasty. Methods: Between 2008 and 2018 we compared tolerability of local anesthesia in 100 patients undergoing incisional hernia repair (Group A) and 100 randomized patients receiving groin hernioplasty (Group B). Selection criteria for incisional hernia patients were size of hernia defects (<10 cm), absence of obstructive symptoms, hernia reducibility. We registered referred intraoperative pain (using Visual Analogue (VAS) score: range 0-10), local anesthesia needed in ml (m.v.) for 3 solutions (A, B, C), use of intraoperative sedation, intraoperative cardiovascular alterations, early ambulation, and discharge time. Statistical comparison was made with Mann-Whitney test. Results: In Gr.A 82 patients reported no pain, 17 reported mild pain and 1 reported moderate pain vs Gr.B respectively: 51, 41 and 8. For local anesthesia solutions volume(A,B,C): in Gr.A (19.96, 44.18, 5.54 ml) vs Gr.B (19.43, 53.47, 5.72) (p>0.01, p < 0.001, p>0.5). No differences in intraoperative sedation needs or cardiovascular alterations. Conversion necessity to general anesthesia was Gr.A 2/100 vs Gr.B 0/100 (p>0.05). Postoperative early ambulation and discharge in day surgery Gr.A vs Gr.B (98/98 vs 100/100, p>0.05). Conclusion: No differences in perioperative tolerability were found between Groups. Less pain was referred in Gr.A. Local anesthesia could be proposed routinely for incisional hernia repair.

V-044 ABDOMINAL WALL RECONSTRUCTION OF A POST-HEMIPELVECTOMY INCISIONAL HERNIA: AT THE LIMITS OF WHAT IS POSSIBLE

Abstract Incisional hernias in patients with bone defects are a real challenge. There is very little evidence of how to repairing them. Clinical Case 56-year-old patient. He underwent a left external hemipelvectomy for osteosarcoma of the iliac bone in 2012 and a left nephrectomy in 2013. The patient presents an inguinal and right thigh root bulge of progressive growth with severe pain and limited mobility. In the past month, he was unable to walk. Physical examination: inguinal defect, defect in the right thigh root and a large lateral bulge. Preoperative CT scan: atrophy of the left abdominal musculature, absence of the left hemipelvis, left hip prosthesis with a pseudocapsule, a large lumbar defect, and a large defect in the inguinal area. Surgery Dissection of hernia sacs and retroperitoneal/preperitoneal dissection was performed, cranially to the retrodiaphragmatic area, medially to the linea alba, posteriorly to the spine and caudally to the pelvis. The abdominal wall is reconstructed with a polyglycolic acid and trimethylene carbonate mesh to reinforce the abdominal wall and a large polypropylene mesh that envelops the visceral sac and is fixed to the right pubis and the pseudocapsule of the hip prosthesis. In the postoperative period, the patient presented pulmonary thromboembolism and surgical wound infection. He was discharged on the 17th postoperative day. One year after surgery, the patient is asymptomatic, and has a continent wall with discrete lateral bulging. Preperitoneal dissection makes it possible to solve very complex wall defects, even with very large bone defects.

P-106 CAN POOR ORAL HYGIENE BE RESPONSIBLE FOR MESH INFECTION FOLLOWING HERNIA REPAIR? A SYSTEMATIC REVIEW AND SUGGESTION FOR NEW PRACTICE

Abstract Background There is a reasonable evidence around oral/dental health and implant infection in orthopaedic and cardiovascular surgery. Mesh hernia repair is another area of surgical practice associated with a permanent implant. The aim of this SR was to review the evidence around oral/dental health and mesh infection. Mehods The study was registered at Prospero. A systematic review of the literature was undertaken according to the PRISMA2020 statement. The initial search identified 520 publications. After a review by title and abstract, 40 papers were read in full text. A further 4 papers were identified from references and searching.15 publications were included in the final review. Results There is no published evidence investigating the state of oral hygiene/health and the risk of mesh infection. Improvement in oral hygiene/health can reduce surgical site infection and implant infection in colorectal, gastric, liver, orthopaedic and cardiovascular surgery. Poor oral hygiene/health is associated with a large increase in oral bacteria and bacteraemia on everyday activities such as when chewing or brushing teeth. Antibiotic prophylaxis does not appear to be necessary before invasive dental care in patients with an implant. Conclusion Good oral hygiene and oral health is a strong public health message. The effect of poor oral hygiene on mesh infection and other complications of mesh hernia repair is unknown. While research is clearly needed in this area, extrapolating from evidence in other areas of surgery where implants are used, good oral hygiene/health should be encouraged amongst hernia patients both prior and after their surgery.

P-090 EMERGENCY INTRAPERITONEAL ONLAY MESH REPAIR OF INCARCERATED VENTRAL E INCISIONAL HERNIA

Abstract Aim Abdominal wall hernia surgery is the frequent surgical operation. Incarceration and strangulation are the complications for patients going to emergency surgery clinics.Laparoscopic approach in emergency is controversial. IPOM treatment permits safe hernia reduction, accurate abdominal exploration,diagnosis and treatment of unknown hernia. Material and Methods in one year,we operated 12 urgent ventral hernia patients with IPOM technique. All patientsshowed hemodynamic stability. We evaluated safety of hernia reduction, conversion rate,operative time,hospital stay, and prosthesis infection. Results Nine patients underwent surgery for incarcerated incisional hernia, 3 patients for primary incarcerated ventral hernia. We used a laparoscopic approach. In 10 cases,we placed an intraperitoneal mesh. In two cases, we converted to open surgery, because of small bowel injury. It was never necessary to perform Intestinal resection for strangulated hernia.Contents of hernia sacs were omentum (7 patients), large bowel (1 patients), 4 omentum and small bowel (4 patients). Patients presented signs of small bowel obstruction. Average size of the defect was 6cm.Average operative time was 91 min, the mean post-operative hospital stay was 3.5 days. Post-operative complications weren't recorded. There wasn't mortality. During the follow-up none patients had mesh infection or hernia recurrence. Conclusion In emergency the Intraperitoneal Onlay Mesh Repair of Incarcerated Ventral and Incisional Hernia allowed safe adesiolysis, bowel reduction. Laparoscopic approach was associated to low post-operative complications even in emergency setting.

P-092 LAPAROSCOPIC TRANS-PERITONEAL HERNIOPLASTY (TAPP) IN EMERGENCY

Abstract The aim efficacy and technical feasibility of TAPP operation by analyzing patients operated on incarcerated inguino-crural hernia in emergency setting. Materials and methods In 1 year, we enrolled 8 urgent incarcerated hernia patients operated using laparoscopic trans-peritoneal approach (TAPP) operated on acutely for inguino-crural incarcerated hernia associated with suspected visceral ischemic damage. Results We repaired 6 inguinal incarcerated hernia and 2 cases of crural hernia. Among 6 inguinal hernia, only one was recurrent. In one case the laparoscopic approach permitted to exclude an obstructed Spigelian hernia diagnosed through tomography. In another case, TAPP allowed to diagnose omental incarcerated Spigelian hernia. In 3 cases this approach permitted to diagnose concomitant unknown wall defects. All cases presented signs of small bowel obstruction. The content of the sac in three cases was small bowel, in other three cases it was omentum, and in other two cases it contained lipoma. None of the cases were converted to open technique. The operative average time was 95 min; the average hospital stay was 1.5 days. No chronic pain or recurrences were observed after a mean follow up time of 8 months. Conclusions The repair of complicated inguino-crural with TAPP in emergency is not a standard treatment. In our experience the laparoscopic approach allowed a safe reduction of hernia, the observation of the feature of hernia content, the diagnosis and repair of unknown wall defect, and a crural defects and contralateral inguinal hernia.

P-121 RETROSPECTIVE REVIEW OF PRACTICE AND OUTCOMES USING A SINGLE BRAND BIOLOGIC MESH AT A DISTRICT GENERAL HOSPITAL

Abstract Aim A retrospective review of all operated hernia patients in which a single brand of Biologic mesh was used, since it's first introduction in our Trust and to date, has been conducted. During last almost 5 years, twelve patients were identified and included. All patients operated with any other type of Biologic mesh and all patients operated with synthetic meshes were excluded, as the aim of the study was to look at the efficiency of a particular product, which was the cheapest biologic mesh at the time of contract with our Hospital. Material and Methods Retrospective review of patient's notes and outcomes, including post-op follow-up and long-term follow-up. The study looked at the following criteria: indication of use as per VHWG (ventral hernia working group) classification of the patients, LOS (length of stay) compared with patients operated with synthetic mesh, any post-op complications including SSO/SSI (surgical site occurrence and/or infection) and outcome at follow-up to date, including recurrence, chronic pain or mesh infection. Results The biologic mesh studied proved itself as a reliable product and provided a durable repair in the cases where it was used. It was noticed that majority of the cases were emergency presentations for complicated ventral or inguinal hernias, the complexity of the cases compared with elective cases being higher (higher ASA grade patients, non-optimised etc). Conclusions The outcome of the study recommends to continue utilising this product, as efficient and financially competitive.

P-094 LAPAROSCOPIC VS OPEN VENTRAL HERNIA REPAIR: AN OBSERVATIONAL SINGLE CENTRE STUDY

Abstract Background Various surgical techniques are practised to provide best possible outcome for ventral hernia patients. This study was conducted to understand the patient's perspective regarding the choice and outcome of treatment. Aim To determine the level of satisfaction 1 month after ventral hernia repair. To analysed various factors which affects the patient's decision regarding the choice of surgery. To compare post operative outcomes between laparoscopic and open ventral hernia repair. Material &amp; Methods An observational study was conducted between January 2020 and December 2021. Total 70 patients with ventral hernia were included. Relevant data was collected and analysed using SPSS version 28. Results 39 patients underwent open repair and 31 patients underwent laparoscopic repair. 40% patients thought that their choice is better than the other option. 18.5% patients who preferred laparoscopic surgery were scared of big incision and 5% patients opted for open surgery because of unaffordability of mesh. 11.4% patient's decision was affected by the advice from other doctors whom they may have consulted before, 2.8% patients took advise from friends and family. Almost 20% patients left the decision on the treating team. The incidence of complications was significantly less in laparoscopic repair. However, there was no significant difference in the postoperative pain, duration of hospital stay, return to activity and satisfaction at discharge. level of satisfaction at 1 month was significantly higher in the laparoscopic group compared to open group. Conclusion laparoscopic ventral hernia repairs should be preferred in view of fewer complications and higher satisfaction.

Logistic regression analysis of risk factors for intra-abdominal hypertension after giant ventral hernia repair: a retrospective cohort study.

Intra-abdominal hypertension (IAH) is a classical complication after giant ventral hernia surgery and may lead to abdominal compartment syndrome (ACS). Assessment of risk factors and prevention of IAH/ACS are essential for hernia surgeons. We performed a retrospective study including 58 giant ventral hernia patients in our center between Jan 1, 2017, and Mar 1, 2022, we recorded age, gender, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), hypertension, type 2 diabetes mellitus (T2DM), hypoproteinemia, body mass index (BMI), the ratio of hernia sac volume to abdominal cavity volume (HSV/ACV), defect width, tension reduction procedure (TRP), positive fluid balance (PFB) and IAH of these patients and analyzed the data using univariate and multivariate logistic regression to screen the risk factors for IAH after surgery. The multivariate analysis showed that HSV/ACV ≥ 25%, hypoproteinemia, and PFB were independent risk factors for the occurrence of IAH after giant ventral hernia repair (P = 0.025, 0.016, 0.017, respectively). We did not find any correlation between postoperative IAH and the patient's age, gender, COPD, CHD, hypertension, T2DM, BMI, defect width, TRP, and PFB. Identifying risk factors is of great significance for the early identification and prevention of IAH/ACS. We found that HSV/ACV ≥ 25%, hypoproteinemia, and PFB were independent risk factors for IAH after giant ventral hernia repair.

Robotic versus laparoscopic transabdominal preperitoneal (TAPP) approaches to bilateral hernia repair: a multicenter retrospective study using propensity score matching analysis

BackgroundSince the introduction of minimally invasive surgery, new techniques like transabdominal preperitoneal (TAPP) repair have progressively gained acceptance for the treatment of groin hernia. Laparoscopic TAPP (LTAPP) is recommended for bilateral repairs. Likewise, the introduction of robotic platforms has promised additional surgical benefits for robotic TAPP (RTAPP), which are yet to be confirmed. This study compared multicenter data obtained from patients undergoing bilateral inguinal hernia repair with RTAPP, performed during the preliminary learning curve period, versus conventional LTAPP.Materials and methodsAll consecutive bilateral inguinal hernia patients from four Italian centers between June 2015 and July 2020 were selected. A propensity score model was used to compare patients treated with LTAPP versus RTAPP, considering sex, age, body mass index, current smoking status, overall comorbidity, hernia classification (primary or recurrent), and associated procedures as covariates. After matching, intraoperative details and postoperative outcomes were evaluated.ResultsIn total, 275 LTAPP and 40 RTAPP were performed. After matching, 80 and 40 patients were allocated to the LTAPP and RTAPP cohorts, respectively. No intraoperative complications or conversion to open surgery occurred. However, a longer operative time was recorded in the RTAPP group (79 ± 21 versus 98 ± 29 min; p < 0.001). Postoperative visual analog scale (VAS) pain scores (p = 0.13) did not differ and complication rates were similar. There were no clinical recurrences in either group, with mean follow-up periods of 52 ± 14 (LTAPP) and 35 ± 8 (RTAPP) months. A statistical difference in length of hospital stay was found between the groups (1.05 ± 0.22 vs 1.50 ± 0.74 days; p < 0.001).ConclusionIn this patient population, outcomes for bilateral inguinal hernia repair appear comparable for RTAPP and LTAPP, except for a shorter recovery after laparoscopic surgery. A longer operative time for robotic surgery could be attributable to the learning curve period of each center.

Emergency repair and smoking predict recurrence in a large cohort of ventral hernia patients.

Ventral hernias are frequent and hernia repair is regularly performed by general surgeons. Emergency repair is less frequent and can be challenging. Long-term data comparing outcomes of emergency- vs. elective ventral hernia repair are scarce. Consecutive patients undergoing emergency and elective ventral hernia repair at our institution were prospectively entered in our HerniaMed database between August 2013 and February 2020. Patients were contacted after 1 and 5 years to assess long-term complications. Risk factors for emergency repair and hernia recurrence were assessed by univariate and multivariate analysis. We included 1307 patients. Emergency and elective hernia repair were performed in 11% and 89% of patients with 1-year follow-up rates of 94% and 92%. Female gender, BMI > 40kg/m2, ASA class 3 and 4, large size umbilical herniation (> 4cm) and epigastric herniation were more frequent in emergency hernia repair. Binary logistic regression analysis identified emergency repair and smoking as predictors of recurrence (Odds ratio: 4.04 and 95% confidence interval: 1.67-14.21, p = 0.004; Odds ratio: 2.94 and 95% confidence interval: 1.33-9.15, p = 0.011). Furthermore, female gender and significant comorbidity (ASA class 3 and 4) were risk factors for emergency repair (Odds ratio: 1.98 and 95% confidence interval: 01.05-3.74, p = 0.034; Odds ratio: 3.54 and 95% confidence interval: 1.79-6.98, p < 0.001). Emergency repair and smoking predicted hernia recurrence. Females and highly comorbid patients are at increased risk for emergency repair and should be prioritized for early elective hernia repair.