IPOM Repair Research Articles

LOSS OF DRAINAGE VACUUM AFTER MINIMAL INVASIVE SUBLAY OPERATION – EARLY INDICATOR FOR AN INTERPARIETAL HERNIA WITH SMALL BOWEL OBSTRUCTION – A CASE REPORT

Abstract Background Newer repair techniques for abdominal wall hernias, such as the enchanced-view totally extraperitoneal technique or the mini- or less-open sublay operation are increasingly being used. With these new techniques special complications might occur. Case Report We present an 81-year-old patient with a recurrent ventral incisional hernia after IPOM repair. The preoperative abdominal CT scan showed the hernia defect, measuring 3 × 3 cm. A repair was performed in MILOS technique, the IPOM mesh was removed. The posterior the rectus sheath was closed under slight tension. A Mesh 15 × 15 cm without fixation and a 14 french Redon drainage were inserted. Over the next 4 postoperative days the drainage had a repeatedly loos of vacuum, until the patient developed clinical symptoms of a ileus. A CT scan showed a bowel dysfunction without a clear sign for incarceration. At this point, the suction drainage was without vacuum a total of seven times. A diagnostic laparoscopy was performed and a small bowel loop was found trapped between the implanted mesh and the posterior rectus sheath, as an interparietal retro-rectus hernia (iRRH). The intestinal loop could be removed, no necrosis or ischemia was found. The fascial defect was covered using vicryl mesh patch. Conclusion The role of vacuum drainage remains to be considered. Suction of remaining intraabdominal gas might occur due to fascia dehiscence and CT diagnostics can mislead surgeons decisions. Tension free fascial closure remains of capital importance. Mesh fixation, use of special stitching techniques, transversus-abdominis-release or preoperative application of botulinum toxin should be kept mind.

Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Ventral Hernias: A Systematic Review.

Introduction: Preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTX) have been used together in the preoperative preparation of patients with loss of domain hernias. This study aims to evaluate the efficacy and safety of the combined use of PPP and BTX. Methods: A systematic electronic search was performed according to the PRISMA criteria. A literature search of scientific articles was conducted up to December 2023. Articles were chosen based on the reference to BTX and PPP in loss of domain ventral hernias with a defect width greater than 10cm before surgery. The GRADE methodology and the modified Newcastle-Ottawa scale were used to assess the quality of the studies. Results: The research yielded seven articles, with 217 patients analysed in total. BTX was performed 29.5 ± 1.7 days before surgery and PPP was inflated 14.8 ± 5.8 days before surgery. PPP complications were reported in 25.6% of patients, The average reduction of the volume of hernia (VH)/volume of the abdominal cavity (VAC) ratio was 7.6% (range 0.9%-15%). Only 40 patients (18.4%) required a PCS or TAR to repair the loss of domain hernias. The SSI and SSO rates were 17.5% and 26.2%, respectively. No differences in SSI and SSO rates were found between the different repair techniques. The recurrence rate was 5.9% (13/217). Recurrence was significantly higher in patients who underwent IPOM repair than other techniques (p < 0.001). Conclusion: BTX and PPP may be useful tools for the management of loss of domain hernias presenting lower SSI and SSO. The combination of BTX and PPP reduces the use of more invasive repair techniques.

Laparoscopic IPOMPLUS repair-current outcomes and complications

Purpose: The study aims to assess the current outcomes and complications of laparoscopic ventral hernia repair using intraperitoneal onlay mesh with defect closure (IPOM PLUS) technique by use of dual-sided synthetic mesh. Material and methods: Retrospectively clinical data for 27 patients with umbilical, paraumbilical, incisional, ventral, and primary hernia, operated in the Department of General, Visceral and Emergency Surgery “Pirogov” from 01.06.2022 to 01.06. 2022 was analyzed. The diagnosis was based on history, physical examination(mainly), ultrasound, and CT. Of the hospitalized, women were 16 (59.26%) men 11 (40.74%). Results: Of the selected group, 13 patients had umbilical defects, 3 with an epigastric hernia, 7 with a paraumbilical hernia, and 4 with incisional defects. Adhesiolysis was needed in 18 cases, while others were performed straight with hernia closure. The operating time varied between 49 and 127 minutes (average 57.4 minutes). The hospital stay ranged from 1 day to 4 days (average 1.7 days). We had noticed complications in three of the cases (11.11%). Conclusion: IPOM PLUS repair is safe, practicable, and advantageous over a standard IPOM or open repair as reported in the literature. Accordingly, we prefer this approach with the closure of the fascial defect first while repairing ventral abdominal wall hernias.

Mini- or less-open sublay (E/MILOS) operation vs open sublay and laparoscopic IPOM repair for the treatment of incisional hernias: a registry-based propensity score matched analysis of the 5-year results.

Open sublay and laparoscopic IPOM repair have specific disadvantages and risks. In recent years, this evidence led to a paradigm shift and induced the development of new minimally invasive techniques of sublay mesh repair. Pioneering this trend, we developed the endoscopically assisted mini- or less-open sublay (MILOS) concept. The operation is performed trans-hernially via a small incision with light-holding laparoscopic instruments either under direct, or endoscopic visualization. After dissection of an extra-peritoneal space of at least 8cm, port placement and CO2 insufflation, each MILOS operation can be continued endoscopically (EMILOS repair). All E/MILOS operations were prospectively documented in the Herniamed Registry with 1- and 5-year questionnaire follow-ups. Propensity score matching of incisional hernia operations comparing the results of the E/MILOS operation with the laparoscopic intraperitoneal onlay mesh operation (IPOM) and open sublay repair from all other institutions participating in the Herniamed Registry was performed. The results with perioperative complications and 1-year follow-up have been published previously. This paper reports on the 5-year results. The 5-year follow-up rate was 87.5% (538 of 615 patients with E/MILOS incisional hernia operations). Comparing E/MILOS repair with laparoscopic IPOM and open sublay operation, propensity score matching analysis was possible with 448 and 520 pairs of operations, respectively. Compared with laparoscopic IPOM incisional hernia operation, the E/MILOS repair is associated with significantly fewer general complications (P = 0.004), recurrences (P < 0.001), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.016) and tends to result in fewer postoperative complications (P = 0.052), and less pain at rest (P = 0.053). Matched pair analysis with open sublay repair revealed significantly fewer general complications (P < 0.001), postoperative complications (P < 0.001), recurrences (P = 0.002), less pain at rest (P = 0.004), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.014). A limitation of this analysis is a relative low 5-year follow-up rate for laparoscopic IPOM and open sublay. The E/MILOS technique allows minimally invasive trans-hernial repair of incisional hernias using large standard meshes with low morbidity and good long-term results. The technique combines the advantages of sub-lay repair and a mini- or less-invasive approach. ClinicalTrials.gov Identifier NCT03133000.

Outcomes of recurrent incisional hernia repair by open and laparoscopic approaches: a propensity score-matched comparison.

Recurrent incisional hernias are challenging, and their surgical outcomes have not been well studied. We aimed to analyze the outcomes of recurrent incisional hernia repair in a propensity score-matched cohort study on laparoscopic intra-peritoneal onlay mesh repair (lap. IPOM) versus open sublay repair. All consecutive patients who had undergone open sublay repair and lap. IPOM of recurrent incisional hernia between January 2015 and December 2021 at a tertiary hernia center was identified. One-to-one propensity score matching was used to achieve a balanced exposure groups at baseline. Of 255 patients, 85/95 with open sublay repair were matched to 85/160 with lap. IPOM. Before matching, the open sublay group had significantly larger hernia defects (6.3cm vs. 5.0cm) than the lap. IPOM group. Other major baseline imbalances were also found in body mass index (BMI), obesity and European Hernia Society (EHS) width classification. The pre-match results showed that the lap. IPOM group had significantly shorter operative time (median 75 vs. 95min) and shorter postoperative hospital stay (median 8 vs. 11days) compared with the open sublay group. Wound infection (8.4% vs. 1.9%) and hematoma (5.3% vs. 0.6%) occurred more frequently after open sublay repair. After matching, baseline characteristics were well balanced. The recurrence rate and incidence of complications were comparable between the two groups. However, the post-match analysis still showed that lap. IPOM was associated with decreased length of postoperative stay. The outcomes of recurrent incisional hernia surgery after lap. IPOM and open sublay repair appear similar, except that the former had shorter length of postoperative stay. However, the poor outcomes were more likely associated with the unfavorable risk profiles, such as larger defect size, rather than the procedure technique itself.

A comparative study between laparoscopic trans-abdominal retromuscular repair and intraperitoneal onlay mesh repair techniques in ventral hernia

Background A hernia is a projection of an organ or part of an organ through a defect in the body wall. When compared to open procedures, laparoscopic ventral hernia repair has consistently demonstrated lower overall complication rates, shorter hospital stays, and faster return to work. Aim To compare the efficacy and safety between laparoscopic transabdominal retromuscular mesh (TARM) repair and laparoscopic (IPOM) repair in the treatment of patients with ventral hernia in Zagazig University Hospitals as a single center experience. Patients and methods This study is a prospective randomized clinical trial carried out upon 48 patients who were randomized by closed envelope method into two groups: Group (A): had undergone Laparoscopic TARM repair. Group (B): had undergone Laparoscopic IPOM repair. Results There was statistically significant variation between groups concerning cost which was significantly lower in laparoscopic TARM repair. Group B was lower regard intra operative complication rate but not significantly, but regard postoperative complication Group A significantly associated with Seroma and Group B significantly associated with Bulge. Complicated cases were significantly younger and wider regarding hernia width. Conclusion TARM repair technique was more time consuming but with less cost in comparison to the IPOM technique. TARM has the advantage of defect closure and avoiding mesh contact with abdominal viscera.

V-001 ROBOTIC E-TEP APPROACH FOR RECURRENT INCISIONAL HERNIA AFTER LAPAROSCOPIC IPOM REPAIR: HAZARD OR RIGHT CHOISE?

Abstract The video shows the case of a 40-year-old male patient with a recurrent umbilical hernia after a laparoscopic IPOM repair. The preoperative CT scan with Valsalva shows a M3 defect with a width of 7 cm at the lower border of the intraperitoneal mesh, associated with upper midline diastasis. We decide to address the hernia repair with a robotic e-TEP approach and a lateral docking. Despite a difficult access and dissection of the retromuscular space due to the adhesions beetwen the rectus muscle and the non-absorbable tacks, the procedure was successful and the patient was discharged the day after the surgery. No complications or recurrence were detected at the 6-month follow-up.

OC-086 COMPARISON OF MESH-FIXATION TECHNIQUES IN LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA, RELIATACK™ V PROTACK™ (TACKOMESH) NCT 03434301

Abstract Background A study examining post-op pain, comparing permanent versus absorbable tack fixation devices, Protack™ versus Reliatack™, in IPOM plus repair. Methods TACKoMesh is a single-centre double-blind RCT conducted from 2017–2020 with 1-year follow up. Patients were randomised to either Protack™ (titanium tacks) or Reliatack™ (an articulating-arm with dissolvable tacks). Primary outcome was reported pain on activity at Day30. Secondary outcomes include recurrence and quality of life measures (SF-36 &amp; Carolina Comfort Score). Results 67 patients randomised: 36 with Protack™, 27 with Reliatack™, with 4 conversions. No significant difference in reported pain ‘on activity’ (post-operative Day 1, 6, 30 and 365). There was significantly reduced pain ‘at rest’ on Day1 with Reliatack™ (Protack™ 6 [4 to 9] vs Reliatack™ 4 [3 to 5], p = 0.020) and reduced pain at all other points with Reliatack™. Operation (p = 0.001) &amp; mesh-fixation (p = 0.001) times were longer, with more knots (p = 0.001) &amp; tacks (p = 0.001) used with Reliatack™. Entire cohort hernia recurrence, seroma formation, SSI &amp; Clavien-Dindo Grade III-V complication were 8/63 (12.7%), 33/63 (52.4%), 7/63 (11.1%), and 12/63 (19.1%) respectively. There were no significant differences in these outcomes between the treatment groups. CCS showed improvement from post-op Day30 to 365. SF36 showed a reduction in baseline scores at post-op Day30. Conclusion There is no difference in reported pain ‘on activity’ following elective IPOM plus hernia repair when choosing either Protack™ or Reliatack™. There is a trend towards improved post-op pain ‘at rest’ with Reliatack™.

V-056 LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH GORE SINECOR INTRAPERITONEAL BIOMATERIAL: OUR CENTER EXPERIENCE

Abstract Aim Ventral hernias including incisional ones are very common in our population. Mesh reinforcement options for ventral/incisional hernia repair continue to evolve with advances in polymer science and better understanding of the extracellular matrix. Consensus on the safety and efficacy of these various types of synthetic and biologic mesh has yet to be reached. Intraperitoneal onlay mesh (IPOM) is the laparoscopic technique most frequently used in our center to treat umbilical and abdominal ventral defects sized 3 cm to 8 cm. Our equipe built an expertise with Gore DualMesh prosthesis (2% recurrence ratio in our center); we used the Gore Sinecor Intraperitoneal Biomaterial for the first time here. Methods Symptomatic supraumbilical incisional hernia in a 74 years old man; parietal defect sized 7×8 cm. We performed an Ipom repair procedure using a 20×25 cm Gore Sinecor Intraperitoneal Biomaterial, trimmed to 18×20 cm. Follow-up at one and six months from surgery. Results The patient was discharged the day after surgery. He did not complain severe pain in the first week after surgery and he only use Paracetamolo 1g die as antalgic therapy. After seven days he resumed his daily activities. He did not experience any short-term sieroma nor long-term complication at follow up. Conclusions The Gore Sinecor Intraperitoneal Biomaterial, while maintaining a firm peritoneal adhesivity, has a better handling and feels lighter than the Gore DualMesh we routinely use. The transparency makes it possible to visualize the overlying abdominal wall, allowing a safer tacs positioning.

P-149 FEASIBILITY AND SAFETY OF AMBULATORY ETEP RETRORECTUS RIVES-STOPPA REPAIR FOR VENTRAL HERNIA

Abstract Introduction Endoscopic totally extraperitoneal retromuscular repair (eTEP-RS) was recently introduced as a new technique for ventral hernia repair. It has been reported to have a significant reduction in analgesia need and reduce length of stay compared to laparoscopic intraperitoneal repair. We aim to evaluate the safety and feasibility of ambulatory primary ventral hernia and incisional hernia repair using eTEP technique. Methods Patients planned for ambulatory eTEP ventral hernia repair between October 2020 to April 2022 were retrospectively analyzed Results 11 patients who were deemed suitable for day surgery preoperatively were included in the analysis. Median age was 48.3 years. Defect sizes ranged from 3–6 cm. 5 patients had more than 1 midline defect, 1 patient had a spigelian hernia and 1 patient had bilateral inguinal hernias which were repaired. 7 patients were successfully managed as day case eTEP-RS. 1 patient required a conversion to open RS due to additional, large defects found intraoperatively, 1 patient stayed for 1 night for urinary retention, 1 patient was drowsy and could not be discharged on the day of surgery and 1 patient was converted to IPOM repair. There were no postoperative complications or recurrences. Conclusion Ambulatory eTEP is feasible, safe and effective in selected patients.

Less postoperative pain and shorter length of stay after robot-assisted retrorectus hernia repair (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for small or medium-sized ventral hernias.

The optimal repair of ventral hernia remains unknown. We aimed to evaluate the results after robotic-assisted laparoscopic transabdominal repair with retrorectus mesh placement (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for patients with small- or medium-sized ventral hernia. This was a retrospective cohort study of consecutive patients undergoing elective rRetrorectus or IPOM repair for small or medium-sized primary ventral or incisional hernias. The primary outcome was the postoperative need for transverse abdominis plane (TAP) block or epidural analgesia, secondary outcomes were length of stay and postoperative complications. All patients were followed for 30days postoperatively. A total of 59 patients were included undergoing rRetrorectus (n = 27) and IPOM (n = 32). Patients in the two groups were comparable in terms of age, sex, comorbidities, smoking status, body mass index (BMI), and type of hernia. The median fascial defect area was slightly larger in the rRetrorectus group (9 cm2 vs. 6.2 cm2, P = 0.031). The duration of surgery was longer for rRetrorectus (median 117.2min. vs. 84.4, P = 0.003), whereas the postoperative need for TAP block or epidural analgesia was less after rRetrorectus compared with IPOM (3.7% versus 43.7%, P = 0.002). There were no severe complications or reoperations after either procedure. The length of stay was shorter after rRetrorectus (median 0 vs. 1day, P < 0.001). rRetrorectus was associated with reduced postoperative analgesic requirement and shorter length of stay compared with laparoscopic IPOM. Registration Clinicaltrial.gov: NCT05320055.

Comparison of outcomes of laparoscopic hernioplasty with and without fascial repair (IPOM-Plus vs IPOM) for ventral hernia: A retrospective cohort study

BackgroundIntra-peritoneal onlay mesh (IPOM) repair, a type of Laparoscopic Ventral Hernia Repair (LVHR), comprises bridging the defect from the peritoneal side with a composite mesh. Recently, IPOM-Plus has become the recommended type of LVHR in which the defect in the fascia is sutured before placing the mesh. Materials and methodsThis study is a retrospective cohort study conducted at Shree Birendra Hospital (SBH), Nepal. Patients who had undergone IPOM-Plus or IPOM during the past five years (Aug 2016 to Aug 2021) were selected. Data regarding demographics, intraoperative and post-operative outcomes were collected from individual case sheets. Recurrence of hernia was checked at six-month follow-up. Data analysis was performed using SPSS version 25 taking a p-value of <0.05 as statistically significant. ResultsA total of 130 patients were included in this study, out of which 73 patients had undergone IPOM (Group I) and 57 patients underwent IPOM-Plus (Group II). In both the groups, there were no statistical difference in age, sex and Body Mass Index (BMI) of the patients. Hernia defect size among Group I and II varied significantly (p-value < 0.001). The mean operative time for Group II (111.05 ± 28.14 min) was significantly higher than Group I (80.00 ± 27.96 min) (p-value < 0.001). Hernia recurrence within six months was higher in Group I (15.1%) than Group II (3.5%) (p-value = 0.029). The adjusted odds ratio (AOR) for six-month recurrence after IPOM repair was 14.86 (95% CI: 2.51–87.85, p-value = 0.003) times higher than that after IPOM-Plus repair. ConclusionsAlthough the operative time and length of hospital stay is longer, IPOM-Plus repair has shown better outcomes regarding six-month recurrence compared to IPOM repair.

A propensity-score matched analysis of ventral-TAPP vs. laparoscopic IPOM for small and mid-sized ventral hernias. Comparison of perioperative data, surgical outcome and cost-effectiveness

PurposeLaparoscopic techniques have been used and refined in hernia surgery for several years. The aim of this study was to compare an established method such as laparoscopic intra-peritoneal onlay mesh repair (lap. IPOM) with ventral Transabdominal Preperitoneal Patch Plasty (ventral-TAPP) in abdominal wall hernia repair.MethodsPatient-related data of 180 laparoscopic ventral hernia repairs between June 2014 and August 2020 were extracted from our prospectively maintained database. Of these patients, 34 underwent ventral-TAPP and 146 lap. IPOM. After excluding hernias with a defect size > 5 cm and obtaining balanced groups with propensity-score matching, a comparative analysis was performed in terms perioperative data, surgical outcomes and cost-effectiveness.ResultsPropensity-score matching suggested 27 patients in each of the two cohorts. The statistical evaluation showed that intake of opiates was significantly higher in the lap. IPOM group compared to ventral-TAPP patients (p = 0.001). The Visual Analogue Scale (VAS) score after lap. IPOM repair was significantly higher at movement (p = 0.008) and at rest (p = 0.023). Also, maximum subjective pain during hospital stay was significantly higher in the lap. IPOM group compared to ventral-TAPP patients (p = 0.004). No hernia recurrence was detected in either group. The material costs of ventral-TAPP procedure (34.37 ± 0.47 €) were significantly lower than those of the lap. IPOM group (742.57 ± 128.44 € p = 0.001). The mean operation time was 65.19 ± 26.43 min in the lap. IPOM group and 58.65 ± 18.43 min in the ventral-TAPP cohort. Additionally, the length of hospital stay in the lap. IPOM cohort was significantly longer (p = 0.043).ConclusionVentral-TAPP procedures represent an alternative technique to lap. IPOM repair to reduce the risk of complications related to intra-peritoneal position of mesh and fixating devices. In addition, our study showed that postoperative pain level, material costs and hospital stay of the ventral-TAPP cohort are significantly lower compared to lap. IPOM patients.

A Comparative Study between E-TEP vs IPOM Hernia Repair

Background: A ventral hernia is a hernia which can be occur at any location along the midline (vertical center) of the abdomen wall. It can be classified as spontaneous (primary) or acquired (secondary). Also, there are basically 3 types of ventral hernia and these are: Epigastric or stomach area hernia, Umbilical or belly button hernia and the Incisional hernia.Material &amp; Methods:This was a prospective observational comparative study. The total sample size for this study 38 and among these 18 cases were from e-TEP and 20 cases were from IPOM. The study period was from December 2019- December 2021. The stratified sampling method was followed for this study as an eligibility criterion for age of the respondents was set for this study.Results:The presence of co-morbidities was found in both e-TEP and IPOM. High blood pressure was seen in 7(38.89%) cases in e-TEP and 8(40%) cases in IPOM and followed by stroke in 4(22.22%) and 5(25%), Hypothyroidism in 1(5.56%) and 1(5%), Cancer in 2(11.11%) and 2(10%), Diabetes in 4(22.225) and 4(20%). Location of Hernia in right 7(38.89%) and 8(40%) and in left side was 11(61.11%) and 12(60%). In assessing the condition of disease, it was found that ventral hernia was in 4(22.22%) and 5(25%), Umbilical hernia in 6(33.33%) and 6(30%), Epigastric hernia 8(44.44%) and 9(45%). The Mean and SD of Defect size of lesion 71.4±47.1 and 76±53.2.Conclusions:The above study showed that the e-TEP repair had shown promising results and was being widely accepted. It results less presence of co-morbidities and less complications when compared to IPOM repair.

Endoscopic and endoscopically assisted mini or less open sublay mesh repair (EMILOS and MILOS) of abdominal wall hernias: Update and 10-year experience of a single insitution

Introduction: Abdominal wall hernia and incisional hernia repair are among the most frequent operations in general surgery. However, despite the use of mesh and other recent improvements, the open mesh techniques and laparoscopic IPOM repair have specific disadvantages and risks. Materials and Methods: To minimize complications of the existing open and laparoscopic techniques we developed the endoscopic Mini- or Less Open Sublay (EMILOS) and endoscopically assisted Mini- or Less Open Sublay (MILOS) concept. We report on our large series of minimally invasive sublay repair of and ventral incisional hernias. The operation is performed transhernially with light-holding laparoscopic instruments either under direct, or endoscopic visualization, while the abdominal wall is circumferentially elevated with retractors. An endoscopic light tube was developed to facilitate this approach (Endotorch,TM Wolf Company). Each MILOS operation can be converted to standard total extraperitoneal gas endoscopy (EMILOS repair) once an extraperitoneal space of at least 8 cm has been created. The technique allows minimal invasive repair of ventral hernias with concomitant rectus diastasis. In large eventrations E/MILOS m. transversus abdominis release (TAR) can be performed. All MILOS operations were prospectively documented in the German Hernia registry Herniamed. Technical modifications and improvements from the inception of the E/MILOS concept including variants of the EMILOS technique are addressed. Results: The total and surgical complication rates of 1745 E/MILOS incisional hernia operations were 4.6% and 3.1%, respectively. The reoperation rate was 1.7%. Haemorrhage, seroma, enterotomy, infection and bowel obstruction were detected in 1.0, 0.9, 0.2, 0.3 and 0.4 percent of the cases, respectively. The recurrence rate after one year was 1.2%. Chronic pain at rest, at activities and chronic pain requiring therapy was reported in 3.8, 7.4 and 3.6 percent, respectively. Conclusion: The MILOS technique allows minimally invasive transhernial repair of incisional hernias using large retromuscular / preperitoneal meshes with low morbidity. The technique is reproducible, cost effective, easy to standardize and combines the advantages of open sublay and the laparoscopic IPOM repair.

The place of laparoscopic IPOM repair in the surgical treatment of midline ventral hernias — lessons learned from seven years of prospective experience. Perioperative and early postoperative results

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Так как LapIPOM в настоящее время оспаривается новыми минимально инвазивными экстраперитонеальными методами пластики вентральных грыж, представляется целесообразным опубликовать подробный анализ результатов LapIPOM, который может помочь точнее определить место этой операции в спектре методов лечения вентральных грыж. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Проанализирована проспективная группа из 247 пациентов,<i></i> 70 (28,3%) мужчин, которым была выполнена LapIPOM по поводу первичной или послеоперационной срединной вентральной грыжи. Выполнены 253 лапароскопические герниопластики IPOM (80 при послеоперационных и 173 при первичных грыжах). Описана стандартизированная техника операции. Прослежены периоперационные и ранние послеоперационные (до 30 сут) результаты, которые сравнивали с таковыми сопоставимых серий, опубликованных за последние два десятилетия. <h3>РЕЗУЛЬТАТЫ</h3> Средняя длительность операции при первичных грыжах составила 47 мин, при послеоперационных — 82 мин. Частота энтеротомий достигала 2,5% при послеоперационных грыжах и 0 при первичных грыжах, в среднем 0,79%. Глубокой инфекции в области хирургического вмешательства не было, поверхностная составила менее 2%. Средняя оценка послеоперационной боли по аналоговой шкале при выписке была 2,91. Повторных госпитализаций и операций, связанных с хирургическим лечением грыж, за 30-дневный послеоперационный период не было. <h3>ЗАКЛЮЧЕНИЕ</h3> Краткосрочное наблюдение за пациентами показывает, что LapIPOM в рамках показаний имеет ряд преимуществ перед другими видами герниопластики: она выполняется относительно быстро, легко воспроизводится, сохраняет целостность неизмененных отделов брюшной стенки и сопровождается минимальными осложнениями.

One and done? Repair of recurrent hernias after prior Myofascial release

BackgroundMyofascial release (MFR) techniques, including retromuscular hernia repair, are often considered one-time repairs. We report recurrent ventral hernia repair (RVHR) in patients with prior MFR, focusing on redo-RM repair. MethodsRetrospective analysis of all patients undergoing RVHR after prior MFR. Primary outcomes were operative time, surgical site infection (SSI), surgical site occurrence (SSO), and 20-month recurrence. Results111 RVHR were performed after MFR. For patients with prior external oblique release (EOR, n = 31), transversus abdominis release (TAR) was used for repair in 13. For patients with prior TAR/PCS (posterior component separation) (n = 22), EOR (n = 2) and redo-TAR (n = 3) were employed with comparable results. Prior retromuscular (RM) repair was performed in 92 patients. Redo-RM (n = 32) and intraperitoneal onlay mesh (IPOM; n = 38) were most common. Operative time was longer for redo-RM. SSI (12.5 vs 7.9%), SSO (40.1 vs 39.5%), and recurrence (18.8 vs 16.2%) were similar for redo-RM and IPOM repair. ConclusionRVHR after prior MFR does not preclude additional MFR. Redo-RM VHR outcomes are similar to those repaired with other techniques.

A prospective, multicenter trial of a long-term bioabsorbable mesh with Sepra technology in cohort of challenging laparoscopic ventral or incisional hernia repairs (ATLAS trial)

BackgroundThis prospective, multicenter, single-arm, open-label study evaluated P4HB-ST mesh in laparoscopic ventral or incisional hernia repair (LVIHR) in patients with Class I (clean) wounds at high risk for Surgical Site Occurrence (SSO). MethodsPrimary endpoint was SSO requiring intervention <45 days. Secondary endpoints included: surgical procedure time, length of stay, SSO >45 days, hernia recurrence, device-related adverse events, reoperation, and Quality of Life at 1, 3, 6, 12, 18, and 24-months. Results120 patients (52.5% male), mean age of 55.0 ± 14.9 years, and BMI of 33.2 ± 4.5 kg/m2 received P4HB-ST mesh. Patient-reported comorbid conditions included: obesity (86.7%), active smoker (45.0%), COPD (5.0%), diabetes (16.7%), immunosuppression (2.5%), coronary artery disease (7.5%), chronic corticosteroid use (2.5%), hypoalbuminemia (0.8%), advanced age (10.0%), and renal insufficiency (0.8%). Hernia types were primary ventral (44.2%), primary incisional (37.5%), recurrent ventral (5.8%), and recurrent incisional (12.5%). Patients underwent LVIHR in laparoscopic (55.8%) or robotic-assisted cases (44.2%), mean defect size 15.7 ± 28.3 cm2, mean procedure time 85.9 ± 43.0 min, and mean length of stay 1.0 ± 1.4 days. There were no SSOs requiring intervention beyond 45 days, n = 38 (31.7%) recurrences, n = 22 (18.3%) reoperations, and n = 2 (1.7%) device-related adverse events (excluding recurrence). ConclusionP4HB-ST mesh demonstrated low rates of SSO and device-related complications, with improved quality of life scores, and reoperation rate comparable to other published studies. Recurrence rate was higher than expected at 31.7%. However, when analyzed by hernia defect size, recurrence was disproportionately high in defects ≥7.1 cm2 (43.3%) compared to defects <7.1 cm2 (18.6%). Thus, in LVIHR, P4HB-ST may be better suited for small defects. Caution is warranted when utilizing P4HB-ST in laparoscopic IPOM repair of larger defects until additional studies can further investigate outcomes.

P056 RETROSPECTIVE ANALYSIS OF LONG-TERM INCIDENCE, RISK FACTORS AND SURGICAL REPAIR OF VENTRAL INCISIONAL HERNIAS AFTER LIVER TRANSPLANTATION

Abstract Aim “Assess risk factors and incidence of ventral incisional hernia (VIH) following liver transplantation (LT).” Material and Methods “Retrospective analysis of clinical or radiological signs of VIH during a systematic ten year follow up after liver transplantation. Descriptive statistics and a binary logistic regression analysis were performed to identify possible risk factors.” Results “Between 01/2007-12/2017, 708 LT were performed in 660 patients at our institution. Following LT, 122 patients (18.5%) had a VIH as identified per clinical examination. Further to this, 85 patients (12.9%) had CT findings consistent with VIH adding to a total of 207 (31.4%) patients with VIH after LT. Male gender (p &amp;lt; 0.001), BMI (p &amp;lt; 0.001), age at LT (p &amp;lt; 0.001), alcohol induced cirrhosis (p = 0.032) and reoperation after 180 days following LT (p = 0.007) were identified as risk factors in a multivariate analysis. An incisional hernia repair was performed in 76 patients (11.5%) at 22.9 months (median, 5.7-101.5). Laparoscopic IPOM repair was performed in 46 (60.5%) patients and 30 patients had an open hernia repair including 26 (34.2%) with mesh augmentation and 4 (5.3%) with primary closure. Five patients (6.6%) needed a reoperation for postoperative complications related to hernia repair. Recurrent VIH occurred in 12 (15.8%) patients. In 131 patients, no hernia repair was performed because of only mild clinical symptoms, patient preference and/or poor general condition.” Conclusions “The incidence and burden of incisional hernia following LT is significant. Many cases of VIH are clinically mild but radiomorphologically manifest.”

P127 ROBOTIC TRANSABDOMINAL RETRO-RECTUS HERNIA REPAIR VS. LAPAROSCOPIC INTRAPERITONEAL ONLAY MESH REPAIR: IMPROVING POSTOPERATIVE OUTCOMES

Abstract Aim “The optimal repair technique for small and medium-sized ventral hernias in obese patients remains unknown. We aimed to evaluate results after robotic-assisted laparoscopic transabdominal repair with retro-rectus mesh placement (rTARUP) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM).” Material and Methods “Retrospective cohort study of consecutive patients undergoing rTARUP or IPOM repair for small or medium-sized primary ventral and incisional hernias. The primary outcome was postoperative need for transverse abdominis plane (TAP) block or epidural catheter, and secondary outcomes were 30-day complications, and length of stay. All patients underwent elective surgery and were followed for 30 days postoperatively.” Results “A total of 27 patients (rTARUP) and 32 (IPOM) were included. Patients in the two groups were comparable in terms of age, sex, comorbidities, smoking status, body mass index (BMI), and type of hernia. The median BMI was 32.4 kg/m2 and the fascial defect area was comparable (rTARUP median 16.8 cm2 vs. IPOM 11.7 cm2, P = 0.303). The duration of surgery was longer in the rTARUP group (median 117.2 min. vs. 84.4, P = 0.003), whereas the postoperative need for TAP block or epidural analgesics was less in the rTARUP group compared with IPOM (n = 14 vs. n = 1, P = 0.002). There were no severe complications or reoperations in the two groups. The length of stay was shorter in the rTARUP group (median 0 vs. 1 days, P &amp;lt; 0.001).” Conclusions “rTARUP was associated with reduced postoperative analgesic requirement and shorter length of stay compared with laparoscopic IPOM.”