Intraperitoneal Mesh Research Articles

P-104 A STEP-UP APPROACH FROM IPOM + IN MINIMALLY INVASIVE ABDOMINAL WALL SURGERY

Abstract Aim To compare the early outcomes of two different techniques for ventral hernia repair in our abdominal wall surgery unit. Materials and Methods A prospective non-randomized review was perfomed including patients who underwent laparoscopic hernia repair from January 2018 to April 2022. All patients were followed-up for 1 month and the hernia orifice was closed in all cases. Patients and hernias characteristics, operative data and early complications were reviewed. Postoperative pain was defined as ≥4 value in Visual Analogue Scale. We compared 2 laparoscopic techniques: intraperitoneal mesh fixed with a double crown of resorbable tackers (IPOM+) and self gripping sublay positioned mesh (preperitoneal –PREP- or retromuscular –RIVES- position). Outcomes During the study period, 44 patients were assigned into 2 groups: 31 (70%) in IPOM+ group and 13 (30%) in Rives/Preperitoneal group. No differences were found in risk factors, population and hernia data between both groups. 6 patients (19%) from IPOM+ group presented postoperative pain and only 1 patient (7,7%) in Rives/Prep group (p: 0,30). There was no differences in other complications, length of stay or operative time. Conlusion Early outcomes of sublay techniques (Rives or preperitoneal) do not report more complications during perioperative time, but they could help reducing immediately postoperatorive pain.

OC-078 LAP-T LAPAROSCOPIC GAS-LESS TECHNIQUE FOR THE REPAIR OF RECTUS MUSCLES DIASTASIS AND HERNIA IN ATHLETES

Abstract Background/Aim Diastasis of Rectus Abdominis Muscles (DRAM) in athletes is typically associated with muscle and fascial tearing and fracture and umbilical/epigastric hernias. Parietal damage is generally located on midline, subjected to continuous efforts and overload. Contrarily to repair of DRAM consequent to pregnancy or obesity, in athletes, the trigger of injury will persist after repair. LAP-T Technique aims at Mini-Invasive restoration of anatomy and physiologic functionality through laparoscopic tailored suture&mesh repair, allowing return to full sport activity. Methods 96 cases from January 2010 to May 2021, minimum follow-up of 12 months. Elected patients: athletes, under 60 years old, BMI < 30, ASA1 – ASA2, with maximum IRD 10cm and associated AWR. Rectus muscles are re-approximated from xiphoid to pubis with tailored sutures, and hernia defect repaired, using laparoscopic running self-locking barbed sutures. Entire procedure is performed in gas-less laparoscopy (3mmHg). Considering persistence of triggering cause after repair in athletes, the repair is consolidated placing an intra-peritoneal mesh. 10–15 days from surgery, patients start following a tailored rehabilitation program up to full resumption of sport activity. Results In all patients, AW anatomy and physiological functionality were successfully restored, any hernia repaired, with the restitution ad integrum of the AW; no higher pain related to the continuous suturing has been reported compared to bridge IPOM laparoscopic repair, while allowing for physiologic outcome and stronger repair. No intra operative bleeding, no seroma formation, chronic pain, nor mesh infection. All athletes retrieved full sport activity at pre-hernia and DRAM level. 98% follow up at 12 months, 91% at 24, with no recurrences observed. Conclusions LAP-T technique proved to be feasible technique for Athletes, allowing for sound and anatomic reconstruction of DRAM, associated hernias, and musculo-fascial tearing, with reduced trauma, fast recovery and full resumption of sport activity.

V-020 LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY: FIRST EXPERIENCE AT HOSPITAL UNIVERSITARIO DE CANARIAS

Abstract We present the case of a 46-year-old-male patient, personal history: Chronic smoking; no previous abdominal surgeries. Height: 1,88 m. Weight: 100 Kg. BMI: 28. Clinical and ultrasound diagnosis of a painful and reducible ventral hernia M3 W1 (EHS Classification) associated with supraumbilical rectal diastasis (RD) of 4 cm transverse diameter T2 D2 H1 (EHS Classification). It is programmed for hernia and RD correction using de Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) technique. Access is laparoscopic at the left anterior axillary line level. Reduced umbilical hernia is identified and sickle cell ligament dissection is performed to identify and treat RD. The size of the umbilical defect and that of the supraumbilical RD are measured and, by means of a mathematical formula, the posterior aponeurosis of both rectal muscle is opened longitudinally parallel to both margins of the defect and the diastasis in order to suture the two flaps in the midline, allowing a tensión-free closure and also avoinding seroma formation and post-op bulging effect. We ended the procedure by placing an intraperitoneal mesh that we fixed covering the defect generated in the posterior aponeurosis. The LIRA technique could be considered an alternative to conventional defect closure (CD) or endoscopic component separation for midline defects smaller than 10 cm in transverse diameter. This is the first case of LIRA published in our latitude. It is a safe, effective and reproducible technique.

P-086 MINIMALLY INVASIVE TREATMENT OF PARASTOMAL HERNIA: FROM THE LAPAROSCOPIC SANDWICH TECHNIQUE TO THE ROBOTIC RETROMUSCULAR TECHNIQUE

Abstract Aim Parastomal hernias are frequent and highly recurrent. The sandwich technique (ST) (Berger et al. [2007]) uses a double intraperitoneal mesh, whereas the retromuscular technique (RMT) (Pauli et al. [2016]) dissects the retromuscular space, releases the transversus muscle, and lateralizes the stoma to place a retromuscular mesh. The aim was to evaluate the results of these interventions. Matherial & Methods Observational retrospective study of patients with parastomal hernia intervened by our Abdominal Wall Unit in a tertiary referral centre. The intervention performed was the ST from February 2016 to September 2020, and the RMT from September 2020 to March 2022. Results A total of 12 patients were intervened with the ST, eight laparoscopically and four robotically, and 7 patients were intervened with the RMT, all robotically. There were no statistically significant differences in basal characteristics between groups. According to the European Hernia Society classification, the parastomal hernias intervened in the ST were 16.7% type I, 33.3% type II, 16.7% type III, 33.3% type IV, while in the RMT most were type II (85.7%). The surgical time was more prolonged in the RMT. There were no statistically significant differences in early complications. Long term follow-up was longer in the ST (median: 24 months vs. 1.6 months), and the recurrences observed were 25% (3/12) for ST and 14.3% (1/7) for RMT (p:1.000). Conclusions RMT is a challenging procedure with similar rate of early complications and promising relapse results despite a shorter follow-up. It is currently our procedure of choice for parastomal hernia.

Evaluation of Treatment Differences Between Men and Women Undergoing Ventral Hernia Repair: An Analysis of the Abdominal Core Health Quality Collaborative.

Sex is emerging as an important clinical variable associated with surgical outcomes and decision making. However, its relevance in regard to baseline and treatment differences in primary and incisional ventral hernia repair remains unclear. This is a retrospective cohort study using the Abdominal Core Health Quality Collaborative database to identify elective umbilical, epigastric, or incisional hernia repairs. Propensity matching was performed to investigate confounder-adjusted treatment differences between men and women. Treatments of interest included surgical approach (minimally invasive or open), mesh use, mesh type, mesh position, anesthesia type, myofascial release, fascial closure, and fixation use. A total of 8,489 umbilical, 1,801 epigastric, and 16,626 incisional hernia repairs were identified. Women undergoing primary ventral hernia repair were younger (umbilical 46.4 vs 54 years, epigastric 48.7 vs 52.7 years), with lower BMI (umbilical 30.4 vs 31.5, epigastric 29.2 vs 31.1), and less likely diabetic (umbilical 9.9% vs 11.4%, epigastric 6.8% vs 8.8%). Women undergoing incisional hernia repair were also younger (mean 57.5 vs 59.1 years), but with higher BMI (33.1 vs 31.5), and more likely diabetic (21.4% vs 19.1%). Propensity-matched analysis included 3,644 umbilical, 1,232 epigastric, and 12,480 incisional hernias. Women with incisional hernia were less likely to undergo an open repair (60.2% vs 63.4%, p < 0.001) and have mesh used (93.8% vs 94.8%, p = 0.02). In umbilical and incisional hernia repairs, women had higher rates of intraperitoneal mesh placement and men had higher rates of preperitoneal and retro-muscular mesh placement. Small but statistically significant treatment differences in operative approach, mesh use, and mesh position exist between men and women undergoing ventral hernia repair. It remains unknown whether these treatment differences result in differing clinical outcomes.

Spontaneous Migration of Intraperitoneal Mesh into Rectum following Ventral Hernia Repair

AbstractWe present a rare case of spontaneous migration of mesh into the anal canal 6 years after laparoscopic intraperitoneal mesh placement for ventral hernia. Mesh migration is an uncommon phenomenon with an unclear etiology and is probably attributed to prolonged subclinical infection or foreign body reaction. This is probably the first case in literature to our knowledge, where composite mesh was migrated into the anal canal after a laparoscopic intraperitoneal mesh placement and was retrieved in a natural way without surgical intervention.

Primary closure of the midline abdominal wall defect during laparoscopic ventral hernia repair: analysis of risk factors for failure and outcomes at 5 years follow-up.

The primary aim of this prospective study is to report bulging and recurrence rates and to analyze the risk factors responsible for failure, after laparoscopic ventral hernia repair (LVHR) with primary closure of defect (PCD) using a running suture and intraperitoneal mesh placement, at 5-year follow-up. The secondary endpoint is to evaluate 30-day postoperative complications, seroma, and pain. PCD failure was defined as the presence of postoperative bulging and/or recurrence. Pain was evaluated using a visual analogue scale (VAS). After surgery, fifty-eight patients underwent clinical examination and computed tomography scan to diagnose bulging, recurrence, and seroma (classified according to the Morales-Conde classification). At 60months follow-up, recurrence was observed in five patients (8.6%), while bulging, not needing a surgical treatment, occurred in fifteen patients (25.9%). Chronic obstructive pulmonary disease (COPD) is the only risk factor responsible for both outcomes together, bulging and recurrences (p = 0.029), while other considered risk factors as gender, age, body mass index, diabetes, smoke habits, primary or incisional hernia and the ratio defect width/transverse abdominal axis did not achieve the statistically significance. Clinical seroma was diagnosed at one month in eight patients (13.8%). Seromas were observed at one year of follow-up. During the follow-up, pain reduction occurred. LVHR has evolved toward more anatomical concepts, with the current trend being the abdominal wall anatomical reconstruction to improve its functionality, reducing seroma rates. Based on results obtained, PCD is a reliable technique with excellent recurrence rate at 5years follow-up, even when the defect closure may generate tension at the midline. On the other hand, this tension could be related with high bulging rate at long-term, particular in case of patients with COPD.

Anatomical Repair Versus Intra Peritoneal Mesh Repair of Umbilical and Paraumbilical Hernia in Ascitic Patients: Randomized Controlled Study

Anatomical Repair Versus Intra Peritoneal Mesh Repair of Umbilical and Paraumbilical Hernia in Ascitic Patients: Randomized Controlled Study

Diaphragmatic Hernia in Pregnancy – a Case Report

Background: Maternal diaphragmatic hernias (DH) identified during pregnancy are rare and pose significant management challenges with respect to the timing of delivery, mode of delivery, and hernia repair. Case presentation: We describe a case of traumatic maternal DH, diagnosed at 31 weeks of gestation presenting with multiple episodes of vomiting. Owing to no evidence of visceral compromise and a stable maternal and fetal condition, the patient was conservatively managed allowing further fetal maturation and was delivered by cesarean section at 34 weeks. This was followed by laparoscopic intraperitoneal mesh hernial repair at 6 weeks postpartum. The patient had an uncomplicated recovery. Conclusion: Maternal DH in pregnancy require multidisciplinary care and individualized management for the optimal outcome for mother and fetus.

Comparative Effectiveness Analysis of Resorbable Synthetic Onlay and Biologic Intraperitoneal Mesh for Abdominal Wall Reconstruction: A 2-Year Match-Paired Analysis.

Abdominal wall reconstruction persists as a challenging surgical issue with a multitude of management strategies available. The aim of this study was to examine the efficacy of resorbable synthetic mesh onlay plane against biologic mesh in the intraperitoneal plane. A single-center, two-surgeon, 5-year retrospective review (2014 to 2019) was performed examining subjects who underwent abdominal wall reconstruction in the onlay plane with resorbable synthetic mesh or in the intraperitoneal plane with biologic mesh. A matched paired analysis was conducted. Data examining demographic characteristics, intraoperative variables, postoperative outcomes, and costs were analyzed. Eighty-eight subjects (44 per group) were identified (median follow-up, 24.5 months). The mean age was 57.7 years, with a mean body mass index of 30.4 kg/m2. The average defect size was 292 ± 237 cm2, with most wounds being clean-contaminated (48.9 percent) and 55 percent having failed prior repair. Resorbable synthetic mesh onlay subjects were significantly less likely (4.5 percent) to experience recurrence compared to biologic intraperitoneal mesh subjects (22.7 percent; p < 0.026). In addition, mesh onlay suffered fewer postoperative surgical-site occurrences (18.2 percent versus 40.9 percent; p < 0.019) and required fewer procedural interventions (11.4 percent versus 36.4 percent; p < 0.011), and was also associated with significantly lower total costs ($16,658 ± $14,930) compared to biologic intraperitoneal mesh ($27,645 ± $16,864; p < 0.001). Abdominal wall reconstruction remains an evolving field, with various techniques available for treatment. When faced with hernia repair, resorbable synthetic mesh in the onlay plane may be preferable to biologic mesh placed in the intraperitoneal plane because of lower long-term recurrence rates, surgical-site complications, and costs. Therapeutic, III.

Robotic vs Laparoscopic Ventral Hernia Repair with Intraperitoneal Mesh: 1-Year Exploratory Outcomes of the PROVE-IT Randomized Clinical Trial.

Laparoscopic and robotic ventral hernia repair with intraperitoneal mesh have been demonstrated previously to have comparable 30-day outcomes in the PROVE-IT randomized clinical trial. Here we report our 1-year follow-up of enrolled patients to examine exploratory outcomes. All patients enrolled in a previously published, registry-based, randomized trial investigating laparoscopic vs robotic ventral hernia repair with intraperitoneal mesh were reviewed. Several exploratory secondary outcomes were assessed: pain intensity (Patient-Reported Outcomes Measurement Information System [PROMIS 3a]), hernia-specific quality of life (Hernia-Specific Quality of Life Survey [HerQLes]), composite hernia recurrence, and reoperations. A total of 95% (71 of 75) follow-up was achieved: 33 laparoscopic repairs and 38 robotic repairs. Median follow-up time was 12 months [interquartile range 10 to 12 months]. Following regression analysis adjusting for baseline scores, there was no difference in postoperative pain intensity at 1 year (p = 0.94). However, HerQLes scores increased by 12.0 more points following robotic repairs compared to laparoscopic counterparts (95% CI 1.3 to 22.7, p = 0.03). Composite hernia recurrence was 6% (2 of 33) for the laparoscopic cohort and 24% (9 of 38) for the robotic group (p = 0.04). There was no difference in rates of reoperation (p = 0.61). Our exploratory analyses have identified potential differences in quality of life and recurrence, favoring the robotic and laparoscopic approaches, respectively. These findings warrant further study with larger patient cohorts to verify their potential significance.

Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study

Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly debated. Purpose of this study was to evaluate predictive factors of recurrence following LVHR with intraperitoneal onlay mesh with a single type of mesh for both PH and IH. A retrospective, multicentre study of data collected from patients who underwent LVHR for PH and IH with an intraperitoneal monofilament polypropylene mesh from January 2014 to December 2018 at 8 referral centers was conducted, and statistical analysis for risk factors of recurrence and post-operative outcomes was performed. A total of 1018 patients were collected, with 665 cases of IH (65.3%) and 353 of PH (34.7%). IH patients were older (p < 0.001), less frequently obese (p = 0.031), at higher ASA class (p < 0.001) and presented more frequently with large, swiss cheese type and border site defects (p < 0.001), compared to PH patients. Operative time and hospital stay were longer for IH (p < 0.001), but intraoperative and early post-operative complications and reinterventions were comparable. IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p < 0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.18–7.31). LVHR with a light-weight polypropylene mesh has low intra- and post-operative complications and is appropriate for both IH and PH. Non absorbable tacks and mixed fixation system seem to be preferable to absorbable tacks alone.

Non-absorbable Barbed Sutures for Primary Fascial Closure in Laparoscopic Ventral Hernia Repair.

PurposeThe aim of this study is to describe the safety and effectiveness of laparoscopic ventral hernia repair with intraperitoneal fascial closure using a barbed suture prior to mesh placement.Materials and methodsPatients who underwent laparoscopic ventral hernia repair were included in this retrospective review. Patients were divided into two groups. In the first group, primary fascial closure was performed with a 2-polypropylene non-absorbable unidirectional barbed suture followed by fixation of the intraperitoneal mesh. In the second group, the mesh was fixed intraperitoneally using tacks without closing the fascial defect.ResultsA total of 148 patients who underwent laparoscopic primary ventral hernia repair were included. A total of 72 (48.6%) patients were included in the barbed suture with mesh group and 76 (51.4%) patients in the mesh-only group. The mean fascial defect size was 25 cm2 in the first group and 64 cm2 in the second group. The median suturing time for fascial closure was 15 minutes. The average surgery time was 98 minutes in the first group and 96 minutes in the second group. The mean follow-up period was 80 days for Group 1 and 135 days for Group 2. No hernia recurrence or mortality occurred in this study.ConclusionThe barbed suture closure technique is a fast, safe, and effective technique for fascial closure during laparoscopic ventral hernia repair in combination with mesh placement. Further evidence to support these findings and longer follow-up periods are warranted to evaluate long-term outcomes.

How-I-do-it: minimally invasive repair of ileal conduit parastomal hernias.

Parastomal hernia after radical cystectomy and ileal conduit urinary diversion is an underestimated and undertreated condition with significant impact on quality of life. However, its surgical treatment is challenging and prone to complications and the optimal surgical treatment of this condition remains to be determined. In this article, we describe our surgical techniques in the minimally invasive treatment of ileal conduit parastomal hernia and present our preliminary results. In a retrospective single-center design, a prospectively maintained database was screened. Data from all patients undergoing surgical treatment for a parastomal hernia after cystectomy and ileal conduit urinary diversion in our center were collected. Between May 2016 and June 2020, 15 patients underwent minimally invasive repair of a parastomal hernia of an ileal conduit. Details on the surgical approach are provided, along with a flow chart to standardize the choice of surgical technique, depending on the presence of a concomitant midline incisional hernia and perioperative findings. The majority of patients were treated with robotic-assisted laparoscopic surgery (10/15; 66.7%). Median postoperative hospital stay was 5days. One-third of patients developed a postoperative urinary infection. Median follow-up was 366days. One patient developed a local recurrence of her parastomal hernia on day 66 postoperatively, treated with intraperitoneal mesh. The minimally invasive surgical treatment of a parastomal hernia after ileal conduit urinary diversion poses specific perioperative challenges that require a broad surgical armamentarium and a tailored approach. Preliminary results confirm a significant morbidity after this type of surgery.

Complications of Intraperitoneal Mesh Techniques for Incisional Hernia - A Systematic Review.

Incisional hernia is considered to be one of the most frequent complication of abdominal surgery, with an incidence up to 20% or 35-50%. Given the latest focus on laparoscopic approach of any surgical pathology, there is a tendency in managing the incisional hernias in this particular manner, which impose intraperitoneal onlay mesh placement (IPOM). The aim of this review is to gather more information regarding the possible complications that can be associated with this technique. The study was conducted based on a bibliographic research using the databases: PubMed, Scopus and Web of Science. The work was reported in line with PRISMA guidelines. The study conducted shows that the short-term risks of intraperitoneal mesh placement for incisional hernia repair are not life-threatening and are comparable to other prosthetic surgical techniques. The most frequent complications can be devided in minor: seroma, hematoma and recurrent pain, and major: enterocutaneous fistula, mesh infection and Adhesions-Bowel obstruction. The high rate of unavailability for follow-up, especially regarding major complications that usually occur after a significant period of time, limits the results of the studies documented and they lack the quality-of-life assessment.

P135 ESTABLISHMENT OF MINIMALLY INVASIVE VENTRAL HERNIA REPAIR WITH EXTRAPERITONEAL MESH PLACEMENT AS A STANDARD APPROACH OF VENTRAL HERNIA REPAIR USING THE ROBOTIC PLATFORM

Abstract Aim Several meta-analyses indicated, that extraperitoneal mesh placement in the retromuscular or preperitoneal space shows advantages over intraperitoneal mesh placement. Previous surgical interventions which included extraperitoneal mesh placement were usually performed using open surgery. For several years now, our hospital has pursued to treat ventral hernias using a minimally invasive approach with extraperitoneal mesh placement. A Da Vinci X system has been available since the beginning of 2019. The aim of this analysis is to show the process of changing the operative procedure in ventral hernia repair over the period from 2016 to 2020. Material and Methods All hernia operations from 2016-2020 were evaluated using our hospitals information system. Every surgical intervention which included ventral hernia repair with the indication for mesh implantation was taken into the analysis. Results In 2016, the proportion of minimally invasive procedures was 36.67%. In all of these cases an intraperitoneal mesh was implanted in the abdominal cavity (laparoscopic IPOM operation). Open surgery was performed in 63.33%, out of which we implanted an intraperitoneal mesh in 23.68%, a retromuscular mesh in 73.68% and an onlay mesh in 2.63% of the cases. In 2020, the proportion of minimally invasive operations was already 87.5%, of which 83.33% were performed robotically assisted and 16.67% laparoscopically. In 94.29% of the minimally invasive operated patients an extraperitoneal mesh implantation was carried out, among which 75.76% were placed in the retromuscular and 24.24% in the preperitoneal position. Conclusions The majority of elective operations on ventral hernias can be performed in a minimally invasive technique with retromuscular mesh placement, using the robot.

P153 CHALLENGES IN MINIMALLY INVASIVE REPAIR OF ILEAL CONDUIT PARASTOMAL HERNIAS

Abstract Aim Parastomal hernia after radical cystectomy and ileal conduit urinary diversion is an underestimated and probably undertreated condition with significant impact on quality of life. However, its surgical treatment is challenging and prone to recurrence and complications. Literature on the subject is scarce and of poor quality, and the optimal surgical treatment of this condition remains to be determined. Material and Methods In this retrospective patient series, a prospectively maintained database was screened. Data from all patients undergoing surgical treatment for a parastomal hernia after cystectomy and ileal conduit urinary diversion in our center were collected. The incidence of local recurrence was defined as primary endpoint. The rate of in-hospital complications was defined as secondary endpoint. Results Between May 2016 and June 2020, 15 patients underwent minimally invasive repair of a parastomal hernia of an ileal conduit at our center. Almost half of the patients had a concomitant midline incisional hernia (7/15; 46,7%). The majority of patients were treated with robotic-assisted laparoscopic surgery (10/15; 66,7%). Median follow-up was 366 days. One patient developed a local recurrence of her parastomal hernia on day 66 postoperatively, this recurrence was treated with intraperitoneal mesh. Conclusions The minimally invasive surgical treatment of a parastomal hernia after ileal conduit urinary diversion poses specific perioperative challenges that require a broad surgical armamentarium and a tailored approach. This paper confirms the significant morbidity after this type of surgery and proposes a flow chart to standardize the choice of surgical technique, depending on the presence of a concomitant midline incisional hernia and perioperative findings.

P049 SAFETY AND EFFICACY OF ABSORBABLE AND NON-ABSORBABLE FIXATION SYSTEMS FOR INTRAPERITONEAL MESH FIXATION: AN EXPERIMENTAL STUDY IN SWINE

Abstract Aim Choice of the best fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of this study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation. Material and Methods Fourteen Landrace swine were utilized and the experiment included two stages. Initially, four pieces of polypropylene mesh with hydrogel barrier coating1 were fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. Each mesh was anchored with a different tack device between titanium2, steel3 or absorbable (4,5) fasteners. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy. The primary endpoint was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks. Results Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Steel tacks had higher peel strength when compared to titanium and absorbable fasteners. No significant differences were noted regarding the secondary endpoints. Conclusions Steel fasteners provided higher peel strength that the other devices in this swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.

P031 OPEN VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: A NATIONWIDE DATABASE STUDY

Abstract Aim Although laparoscopic repair of incisional hernias decreases the incidence of wound complications as compared with open repair, there has been a rising concern related to intraperitoneal mesh placement. The aim of this study was to examine outcomes after open or laparoscopic elective incisional hernia mesh repair on a nationwide basis. Material and Methods A merge of data between the Danish Hernia Database and the National Patient Registry provided data on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence from 2007-2018. Results A total of 3,090 (57.5%) and 2,288 (42.5%) patients were operated by laparoscopic and open approach, respectively. The defect was closed in 27.9% (865/3,090) of the laparoscopic cases. The median follow-up time was 4.0 (1.8-6.8) years. Rates of readmission (16.2%, 502/3,090) and re-operation for complication (7.0%, 216/3,090) were significantly lower for laparoscopic compared to open repairs (19.3%, 442/2,288, P = 0.003 and 12.5%, 288/2,288, P &amp;lt; 0.001). Re-operation for bowel obstruction or bowel resection was twice as high after laparoscopic repair (0.6%, 20/3,090) compared with open repair (0.3%, 6/2,288, P = 0.044). Patients were significantly less prone to undergo repair of recurrence following laparoscopic compared with open repair of defect widths 2-6 cm (P = 0.002). Conclusions Laparoscopic intraperitoneal mesh repair for incisional hernia should still be considered for fascial defects between 2 and 6 cm, because of decreased incidences of early complications and repair of hernia recurrence compared with open repair.

VP028 TAPP REPAIR FOR INCISIONAL LUMBAR HERNIA

Abstract Aim “Incisional hernias are very common and can present even after minimally invasive surgery for other pathologies. Laparoscopic ventral hernia repair first described by LeBlanc in 1992, gained great popularity, because of its known advantages over the open techniques. In the last decade because of increasing concerns about the future risks of using an intra-peritoneal mesh, several minimally invasive techniques using a mesh outside abdominal cavity have been described. We report the use of a TAPP technique.” Material and Methods “48 yo female patient, that underwent a laparoscopic right adrenalectomy, for myelolipoma, in 2015, with subsequent incisional lumbar hernia (L4W1) in the extraction incision.” Results “The patient was submitted to a laparoscopic TAPP repair in ambulatory surgery with extended recovery. The hernia defect was closed with a barbed suture and it was used a 15x15cm medium weight polypropylene mesh without traumatic fixation. For pain control it was done a TAP block guided by laparoscopy. The duration of surgery was 90 minutes. The patient had no complications. No recurrence on follow-up (4 months).” Conclusions “New minimally invasive procedures for the repair of incisional hernias avoid the intraperitoneal mesh position and maintain all the advantages of the minimally invasive approach. Some of these techniques may be complex and have a long learning curve. TAPP seems reproducible and a good option if a good extra-peritoneal dissection is possible. Larger series are needed, to accurately compare these new techniques with IPOM, open sublay and to select the best technique for each patient.”