Laparoscopic Mesh Research Articles

7419 Vaginally Assisted Laparoscopic Sacrocolpopexy

<h3>Study Objective</h3> The objective of this video is to demonstrate the surgical technique for attaching sacrocolpopexy mesh using a vaginal approach. We will highlight the steps of the procedure and discuss findings in the literature to support this approach. <h3>Design</h3> Surgical video recording of vaginal and laparoscopic procedures to demonstrate the steps of this technique for prolapse repair. <h3>Setting</h3> Operating Room <h3>Patients or Participants</h3> 69-year-old female with stage III anterior and apical pelvic organ prolapse who desired surgical management. <h3>Interventions</h3> Total vaginal hysterectomy, followed by mesh attachment via a vaginal approach for stage III pelvic organ prolapse. Laparoscopic sacrocolpopexy was then performed in the routine fashion. Excellent apical support was noted at completion of the procedure. <h3>Measurements and Main Results</h3> Vaginal mesh attachment after hysterectomy and prior to laparoscopic sacrocolpopexy has shorter mean operating room times with no significant difference in complication rates or anatomic outcomes. Mesh exposure is not significantly higher in those who have vaginal mesh attachment vs. laparoscopic mesh attachment. <h3>Conclusion</h3> Vaginally attached mesh prior to laparoscopic sacrocolpopexy is an efficient way to perform minimally invasive sacrocolpopexy in patients with stage 3 or greater pelvic organ prolapse, and with the appropriately selected patient, allows for same day discharge.

Increased cost burden associated with robot-assisted rectopexy: do patient outcomes justify increased expenditure?

Robot-assisted surgical techniques have flourished over the years, with refinement in instrumentation and optics allowing for adaptation and increasing utilization across surgical fields. Transabdominal rectopexy with mesh for rectal prolapse may stand to benefit significantly from the use of a robotic platform. However, increased operative times and immediate associated costs of robotic surgery may provide a counterargument to widespread adoption. To determine which approach to the treatment of rectal prolapse, laparoscopic or robotic, is more cost effective and provides better outcomes with fewer complications, a retrospective review was performed at a single tertiary care academic institution from May 2013 to December 2020. Twenty-two patients underwent transabdominal mesh rectopexy through a robot-assisted DaVinci platform (Intuitive Sunnyvale, CA), and thirty through a laparoscopic platform. Main outcome measures included operative, hospital, and total cost as defined by total charges billed. Secondary outcomes included rate of recurrence, intra-operative complications, median operative time, post-operative complications, average hospital length of stay, inpatient pain medication usage, and post-operative functional outcomes. Cost analysis for robot-assisted versus laparoscopic rectopexy demonstrated operating room costs of $46,118 ± $9329 for the robotic group, versus $33,090 ± $15,395 (p = 0.002) for the laparoscopic group. Inpatient hospital costs were $60,723 ± $20,170 vs. $40,798 ± $14,325 (p = 0.001), and total costs were $106,841 ± $25,513 vs. $73,888 ± $28,129 (p ≤ 0.001). When secondary outcomes were compared for the robotic versus laparoscopic groups, there were no differences in any of the aforementioned outcome variables except for operative time, which was 79min longer in the robotic group (p ≤ 0.001). Robot-assisted mesh rectopexy demonstrated no clinical benefit over traditional laparoscopic mesh rectopexy, with significantly higher operative and hospital costs. A reduction in the acquisition and maintenance costs for robotic surgery is needed before large-scale adoption and implementation of the robotic platform for this procedure.

Hernia mesh infection treatment following the repair of abdominal wall hernias: A single-center experience.

The mesh-based repair of abdominal wall hernias is a commonly employed approach as it is easy to implement and associated with low rates of hernia recurrence. However, the occurrence of hernia mesh infections following such repair can be extremely serious, and no clinical consensus regarding the optimal treatment of such infections has been established. This study was thus developed to review the management of hernia mesh infection cases treated at our center, summarizing the demographic and clinical characteristics of affected patients and summarizing our associated therapeutic experiences. Data pertaining to 64 cases of hernia mesh infections treated at our center were retrospectively reviewed. Data were obtained from patient medical records, including general situation, hernia type, prior hernia repair approaches, type of mesh, and postoperative condition. Other reviewed outcomes include bacteriological and imaging findings, as well as treatment outcomes. In cases where conservative management was not successful, the approach to mesh removal (laparoscopic vs. open) was made based on the primary surgical approach and the type of material used for the repair. In total, 42 patients underwent primary open inguinal hernioplasty (including plug repair, preperitoneal mesh repair, and Lichtenstein repair), while 11 patients underwent laparoscopic repair (9 transabdominal preperitoneal, TAPP and 2 totally extraperitoneal,TEP), and 11 patients with incisional hernias underwent the intraperitoneal onlay mesh (IPOM) procedure. Six patients exhibited mesh erosion of the internal organs. Of these patients, 38 underwent mesh removal via open debridement, while 9 underwent laparoscopic exploration and open debridement, and 1 underwent laparoscopic mesh removal. No patients exhibited serious postoperative sequelae, serious complications, or mortality after the treatment of mesh infections.One patient experienced postoperative infection recurrence following partial mesh removal, with the appearance of a small fistula. Hernias recurred in 2 patients following mesh removal, and 1 patient underwent repair via laparoscopic IPOM. While conservative treatment can cure early mesh infections, there is nonetheless a risk that these infections will recur. In view of the variety of surgical intervention of abdominal wall hernias at present,treatment of mesh infection should be individualized. Our findings suggest that hernias repaired via the placement of mesh in the preperitoneal space can more readily contribute to internal organ erosion and late-onset infections, with open debridement often being unable to completely remove the mesh without causing collateral damage. Laparoscopic exploration is an effective and minimally invasive approach to detecting internal organ involvement and removing the infected hernia mesh from affected patients.

Laparoscopic mesh placement during inguinal hernia repair: a meta-analysis of two methods of repair.

There are several modifications in the technique for the placement of mesh during laparoscopic inguinal hernia repair. One of these is a slit on the mesh to surround the cord structures which proponents of it suggest that it decreases the recurrence rate due to better anchoring of the mesh and lower risk of displacement. There is only low-level evidence in current literature examining the two methods. The present study aimed to provide stronger evidence in establishing whether the slit mesh technique is superior to the non-slit mesh technique. The reporting of this systematic review was guided by the standards of the preferred reporting items for systematic review and meta-analysis statement and registered with PROSPERO (ID: CRD42022300629). Eligible studies had to compare the two methods of mesh placement slit Vs nonslit in laparoscopic Inguinal hernia repair and also report on at least one outcome. The outcomes were expressed in odd ratios with their 95% confidence intervals. Where significant heterogeneity existed a random effects model was used otherwise a fixed effects model was used. Five studies met the criteria for inclusion in quantitative analysis. Overall, there were 10 (1.5%) recurrences in the slit group compared to 12 (2.5%) in the non-slit group OR 0.62, 95% CI (0.27-1.41). There was no difference in the incidence of post-operative bleeding (OR 1.21, 95%CI 0.4-3.66), seroma formation (OR1.5, 95% CI 0.81-2.76), or post-operative neuralgia (OR 0.98, 95%CI 0.11-8.92) between the two groups. There was no difference between the two methods.

Evaluation of Perioperative and Quality of Life Outcomes Along with Cost Effectiveness in Laparoscopic Transabdominal Retrorectus Mesh Repair for Ventral Hernia: A Prospective Observational Study

Introduction: Laparoscopic ventral hernia repair has its advantages of reduced postoperative complication and early return to work. Owing to the need of a cost-effective technique with similar perioperative outcomes, transabdominal retro-rectus mesh repair (TARM) is a suitable and less expensive alternative compared with other methods of laparoscopic ventral hernia repair. Methods: Patients with primary (n = 7) or incisional (n = 17) hernia were selected to be operated on using TARM procedure. Quality of life was evaluated in terms of time to return to usual routine work, the sensation of mesh (using Carolinas Comfort Scale, CCS), tolerance to early oral feed, formation of seroma, suture site infection and hernia recurrence. Results: The average defect size was 2.8 cm with a mean BMI was 28.17 kg/m2. The average duration of surgery was 165 mins. Mean postoperative pain score after 1 day, 1 week, 1 month, 3 months and 6 months were 3.5, 2, 0.58, 0.5 and 0 respectively. Seroma formation occurred in 6 (25%) and hematoma in 1 (4%) patient. The mean time to resumption of daily activities was 6.25 days. Mean CCS after 1 month and 3 months are 30 and 16.2 respectively. No cases of recurrence or chronic pain were observed during 6 months follow-up. Conclusion: Laparoscopic TARM appears to be a feasible, safe and cost-effective method of ventral hernia repair due to standard laparoscopic instruments used, no contact with bowel and use of plain polypropylene mesh respectively.

OC-037 HERNIA DEFECT CLOSURE IN POLYPROPYLENE BASED LAPAROSCOPIC HERNIOPLASTY TO AVOID SEROMA FORMATION AND HERNIA RECURRENCE: A PROSPECTIVE COHORT STUDY

Abstract Aim This is a Prospective Cohort study, to assess a preventive effect, through closing hernia defect in laparoscopic mesh hernioplasty with polypropylene based best hands-on surgical method. The study could provide promising outcomes with diminishing seroma formation and recurrence rate. Methods The study were conducted from April 2017 to until date. The study persuaded with nearly 328 cases from Tertiary Care Centre who underwent laparoscopic trans-abdominal and extraperitoneal patch plasty (TAPP) (TEPP). Hernia defect closure were performed through this polypropylene mesh and deployment using sutures to all patients. The primary outcomes regarding seroma formation, recurrence of hernia, Pre-operative status and post-operative complications was all observed and recorded. Results About 328 indirect and direct hernia defects were recruited and indulged for study. All the defect closure operations by polypropylene mesh hernioplasty for all types of hernia repair exhibited high success rate, without hernia reccurrence and minimal seroma formation. Conclusions The closure of Hernia defect in laparoscopic polypropylene mesh hernioplasty explicated to be secure and effective technique and would significantly decrease post-operative incidence of seroma formation without increasing hernia recurrence risks, chronic and acute pain. The approach can be recommended for scrotal or larger hernia repair as well.

Assessing the Impact of Vaginal Hysterectomy with Vaginal Mesh Attachment on Outcomes and Complications during Minimally Invasive Sacrocolpopexy

To compare mesh complications and failure rates after 1 year in laparoscopic minimally invasive sacrocolpopexy (MISC) with ultralightweight mesh attached vaginally during total vaginal hysterectomy (TVH), laparoscopically if posthysterectomy (PH), or laparoscopically during supracervical hysterectomy. Single-center retrospective cohort study. Tertiary referral center. Women with symptomatic pelvic organ prolapse who elected for MISC. Laparoscopic MISC with ultralightweight mesh attached vaginally during TVH, laparoscopically if PH, or laparoscopically during supracervical hysterectomy. Composite failure was defined as recurrent prolapse symptoms, prolapse past the hymen, or retreatment for prolapse. Between 2010 and 2017, 650 patients met the inclusion criteria with 278 PH, 82 supracervical hysterectomy, and 290 vaginal hysterectomy patients. Median follow-up was similar for all groups (382 days vs 379 vs 345; p=.31). The majority in all groups were white (66.6%), nonsmokers (74.8%), postmenopausal (82.5%), and did not use estrogen (70.3%). Mesh complications did not differ among groups (1.6% PH, 2.5% supracervical hysterectomy, 2.2% vaginal hysterectomy; p >.99). There was no difference in anatomic failure (5% PH, 1.2% supracervical hysterectomy, 2.1% vaginal hysterectomy; p=.07), reoperation for prolapse (1.4% vs 1.2% vs 0.7%; p=.57), or composite failure (9.0% vs 3.7% vs 4.8%; p=.07). TVH with vaginal mesh attachment of ultralightweight mesh had similar adverse events, mesh exposure rates, and failure rates to those of laparoscopic PH sacrocolpopexy or supracervical hysterectomy with laparoscopic mesh attachment.

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.

Laparoscopic Suture versus Ventral Mesh Rectopexy for the surgical Treatment of Internal Rectal Prolapse

Laparoscopic Suture versus Ventral Mesh Rectopexy for the surgical Treatment of Internal Rectal Prolapse

To Compare Outcome of Open Versus Laproscopic Repair for Primary Ventral Hernias

Background: Primary ventral and incisional abdominal wall hernias are frequent conditions that necessitate surgery, and both types of hernias can be treated utilizing an open or laparoscopic technique. Improvements in laparoscopy have also been linked to a decrease in pain scores. Methodology: A dual setting study was conducted from July 2017 to June 2019 at Peshawar medical college with collaboration of Lady Reading Hospital and Hayatabd Medical Complex, Peshawar and was conducted on a total of 120 patients who were diagnosed with ventral hernia. A random number table created by a computer indicated repair of an open ventral hernia technique (group 1, n = 60) or laparoscopy (group 2, n = 60). Results: Among 60 patients in the laparoscopy group, there were 37 cases of PUH, 15 cases of epigastric hernia, 8 cases of umbilical hernia, and among 60 cases of open abdominal hernia, including 31 cases of PUH, 19 cases of hernia in the abdomen. upper abdomen, and 10 cases of umbilical hernia. Wound-related complications were most commonly seen in the open procedure group of patients. Conclusion: This has led to broad acceptance of the laparoscopic surgery, and advantages particularly in order to decrease the post-operative mortality and morbidity, time of operation, bleeding and the duration of hospital stay along the ability to execute the surgery on the obese people and with abdominal scarred individuals. Keywords: Incisional hernia, Laparoscopic mesh repair, Open mesh repair, Primary ventral hernia.

Management and Outcomes in Gastric Volvulus: A Tiered Approach

Abstract Introduction Gastric volvulus is a rare yet life-threatening condition requiring urgent attention. In this case series and literature review, we present the difficulties in management and outcome in patients with gastric volvulus and suggest a tiered framework to guide management. All consecutive cases at a single institution presenting between January 1, 2010, and June 30, 2020, were included. Chi-squared analyses were undertaken to compare outcomes across different groups. A total of 48 patients presented with gastric volvulus; the median age was 78 years (interquartile range [IQR]: 69–84) and 70.8% were female. Most patients had an ASA score of III (n = 19/48, 39.6%) or IV (n = 14/48, 29.2%). In total, 62.5% (n = 30/48) underwent laparoscopic surgery and mesh was used in 40.0%. Eighteen patients (37.5%) were not suitable candidates for surgery or declined surgery. The median length of stay in those undergoing surgery was 4 days (IQR: 2–6). The complication rate in this cohort was 26.7% (n = 8/30). Of these eight patients, four had postoperative nausea, and four others suffered from pneumothorax, wound hematoma, intra-abdominal bleeding, or intra-abdominal collection. The patient who had a serious intra-abdominal bleed returned to operating room and required blood transfusions on day 1 postsurgery. The readmission rate in the surgery group was 6.6% (n = 2/30), both of who had prolonged nausea and were treated symptomatically. The overall 30-day morality in the surgical group was 3.3%. Over a follow-up period of 37 months, 10.0% had a recurrence of hernia, all of who were managed conservatively. Gastric volvulus is a surgical emergency that is associated with a high rate of morbidity and mortality. A tiered treatment algorithm based on urgency can help deliver timely treatment and standardize care. One in 10 patients post–gastric volvulus repair will have recurrence of para-oesophageal hernia but can be treated conservatively.

Treatment of recurrent rectal prolapse after a laparoscopic ventral mesh rectopexy.

Treatment of recurrent rectal prolapse after a laparoscopic ventral mesh rectopexy.

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.

WE5.3 Emergency laparoscopic “hybrid” IPOM+ repair of incarcerated umbilical hernia in patient with BMI 62 and small bowel obstruction; a case study

Abstract Background Large abdominal incisions in obese patients are associated with considerable rates of systemic and wound complications. Recently published European Hernia Society guidelines recommend laparoscopic intraperitoneal on-lay mesh (IPOM) repair for large hernia defects and patients at higher risk of wound morbidity, ideally with closure of the defect and a 5 cm overlap. Case Presentation: We report on a 69-year-old, morbidly obese (BMI 62), comorbid woman who presented as an emergency with a 5-day history of vomiting and abdominal pain. A pre-operative computed tomography (CT) scan confirmed small bowel obstruction secondary to a ventral abdominal wall hernia. Operative findings confirmed an obstructed paraumbilical hernia containing small bowel and omentum. A laparoscopic “hybrid” IPOM+ repair was performed, with a generous overlap. She recovered uneventfully with no surgical complications. Discussion: Minimally-invasive surgical techniques are preferred for obese patients with evidence suggesting lower perioperative complications and recurrence rates compared with open repair. However, additional challenges must be taken into consideration including; surgeon expertise, timing of operation, surgeon ergonomics, distortion of surface anatomical landmarks, need for higher pneumoperitoneum pressures and the physiological effects of this on the patient. Conclusion With preoperative planning, our case study demonstrates that IPOM ventral hernia repair remains a viable option for severely obese patients even in emergency presentations. The closure of the defect is recommended whenever feasible. Addition of the hybrid approach (excision of the sac with a limited incision after the laparoscopic closure) reduces the risk of postoperative seromas.

Laparoscopic and robot-assisted suture versus mesh hysteropexy: a retrospective comparison

Introduction and hypothesisOur study was aimed at comparing the outcomes of laparoscopic and robot-assisted laparoscopic suture-based hysteropexy (SutureH) versus sacral hysteropexy using mesh (MeshH) for bothersome uterine prolapse. Our hypothesis is that MeshH is more successful and provides better uterine support than SutureH.MethodsA retrospective cohort study of 228 consecutive women who underwent re-suspension of the uterus using uterosacral ligaments (SutureH n=97) or a “U-shaped” mesh from the sacral promontory (MeshH, n=132). Surgery was performed by laparoscopy or robot-assisted laparoscopy. Subjects were assessed at baseline, 1 year, and beyond 1 year. The null hypothesis, that SutureH and MeshH have similar success, was based on a composite outcome (“composite success”), and that they provide the same level of uterine support, was based on POP-Q point C at 1 year. “Composite success” was defined as: POP-Q point C above the hymen; absence of a vaginal bulge; no repeat uterine prolapse surgery or pessary placement. Other outcomes included improvement in symptomology using Patient Global Impression of Improvement, POP-Q point C change and complications.ResultsFollow-up data were available for 191 out of 228 women. “Composite success” was not significantly different between MeshH and SutureH groups (81.7% vs 84.5%, p=0.616). MeshH provided better elevation of the uterus than SutureH (point C change: −7.38cm vs −6.99cm; p<0.001). Similar symptom improvement and low complications occurred in both groups.ConclusionsLaparoscopic and robot-assisted laparoscopic suture hysteropexy and mesh sacral hysteropexy provide women with minimally invasive, durable surgical options for uterine preservation. “Composite success” was similar in the two groups, but MeshH provided better uterine support than SutureH. However, SutureH gives women an effective mesh-free option.

Open versus laparoscopic intraperitoneal on-lay mesh repair: A comparison of outcomes in small ventral hernia

PurposeThe ideal surgical treatment of small ventral hernias (defect less than 4 cm) is still debatable. In our study, we sought to compare the outcomes of open versus laparoscopic intraperitoneal on-lay mesh (IPOM) repair in small ventral hernias. MethodsPatients with a single ventral hernia defect of less than 4 cm undergoing surgical mesh repair between January 2016 and September 2018 were prospectively registered for this study. The minimum follow-up duration was 12 months. Patient demographics, operative findings and regular post-operative follow-up details including recurrence rates and complications were recorded and analysed. Results41 patients underwent laparoscopic IPOM repair and 47 patients underwent open IPOM repair. The mean age for both groups is similar with no significant difference. The mean hernia defect size for the laparoscopic group is 2.8 cm (±0.8) whereas the mean hernia defect size for the open repair group is 2.1 cm (±0.4). The mean surgery duration for open IPOM repair was significantly shorter (59 min (±17) vs 74 min (±26); p = 0.001). There was no significant difference in the incidence of seroma formation and surgical site infections post-operatively. There was also no significant difference in both groups in terms of chronic pain and recurrence at 1-year follow-up. ConclusionOpen IPOM repair for small ventral hernias may be superior to laparoscopic IPOM repair due to the shorter operative duration, single incision, and no additional risk of port-site hernias. There was no difference in chronic pain, wound infection and recurrence rate between the two groups.

An Evaluation of the Evidence Guiding Adult Midline Ventral Hernia Repair.

Purpose: Several guidelines have been published in recent years to guide the clinician in ventral hernia repair. This review distils this advice, critically assesses their evidence base, and proposes avenues for future study. Methods: A PUBMED search identified four guidelines addressing midline ventral hernia repair published by major surgical societies between 2016 and 2020. The studies used to inform the advice have been critically appraised, including 20 systematic reviews/meta-analyses, 10 randomized controlled trials, 32 cohort studies, and 14 case series. Results: Despite a lack of randomized controlled trials, case heterogeneity, and variation in outcome reporting, key themes have emerged. Preoperative computed tomography scan assesses defect size, loss of domain, and the likely need for component separation. Prehabilitation, frailty assessment, and risk stratification are beneficial in complex cases. Minimally invasive component separation techniques, Botox injection, and progressive pneumoperitoneum represent novel techniques to promote closure of large fascial defects.Rives-Stoppa sublay mesh repair has become the “gold” standard for open and minimally invasive repairs. Laparoscopic repair promotes early return to functional status. The enhanced-view totally extraperitoneal approach facilitates laparoscopic sublay mesh placement, avoiding mesh contact with viscera. Robotic techniques continue to evolve, although the evidence at present remains immature.Synthetic mesh is recommended for use in clean and clean-contaminated cases. However, optimism regarding the use of biologic and biosynthetic meshes in the contaminated setting has waned.Conclusions: Surgical techniques in ventral hernia repair have advanced in recent years. High-quality data has struggled to keep pace; rigorous clinical trials are required to support the surgical innovation.

PRIMARY LUMBAR HERNIA: CASE SERIES WITH TECHNICAL DESCRIPTION OF LAPAROSCOPIC MESH REPAIR.

BACKGROUND: Primary Lumbar hernias are rare posterolateral abdominal wall defect. Rarity of disease and by virtue of its location there is no standard consensus for surgical options and traditionally it is approached through open repair. Therefore, we report a series of 10 patients from two institutions who underwent successful Laparoscopic mesh repair of Lumbar hernias with technical description of surgery. AllSTUDY DESIGN: patients with primary lumbar hernias total number of 10 who presented to two institute over a period of 12 years (Feb 2010 to April 2022) and underwent Laparoscopic mesh repair were included in the study. Data collected regarding intraoperative and postoperative course with 2-24 months postoperative follow up were reviewed retrospectively. All of the 10 patients underwent Laparoscopic repair withRESULTS: polypropylene mesh placement over the defect in retroperitoneal space without the primary closure of defect. All patients had uneventful intraoperative and postoperative course with average length of hospital stay of 1.3 days. No complications were reported and there was no recurrence during follow up for 2-24 months. Lumbar hernia being a rare entity, there is lack of sufcient data precludes aCONCLUSION: standardized approach. On the basis of data from our case series of 10 patients we believe Laparoscopic mesh repair for primary lumbar hernia is the best available treatment option considering it safe, effective, gives intraoperatively better visualization of anatomy even at difcult retroperitoneal space and uneventful postoperative course with decreased hospital stay and no recurrences in follow-up.

Satisfactory medium-long term patient reported outcomes after laparoscopic single-mesh sacrohysteropexy.

There is scarce information on the effectiveness of the laparoscopic single mesh sacrohysteropexy (smSHP). Attachment of a single sheet of flat mesh posteriorly to the cervix provides less mesh use and a less invasive distal mesh fixation. To assess medium to long-term follow-up results of patients who underwent laparoscopic smSHP utilising a less invasive technique with single sheet flat mesh. In the present retrospective cohort study, the data of 71 women who underwent laparoscopic smSHP for apical uterine prolapse with or without colporrhaphy (anterior and/or posterior) at the urogynaecology unit of a university hospital between January 2008 and January 2020 was reviewed. Data was collected on demographics, presenting symptoms, preoperative findings, surgery, and postoperative outcomes. Medium to long-term patient-reported outcomes. The median age of the study population was 44 years. Median follow-up duration was 5 years (1-12). Symptomatic recurrence over time and repeat surgery rates were 13.1% and 3.1% respectively. Comparison of the pre-operative and medium to long-term evaluation scores of the pelvic floor distress inventory-20 (PFDI-20) and assessment of the patient global impression of improvement (PGI-I) revealed long-standing improvement in pelvic floor dysfunction. Laparoscopic smSHP appears to be successful and safe with low recurrence and complication rates and provides satisfactory patient reported outcomes. Medium to long-term patient-reported outcomes based on PFDI-20 and PGI-I surveys are satisfactory following smSHP.

Efficiency and safety of laparoscopic ventral mesh rectopexy (a systematic review)

Aim: to assess the efficacy and safety of laparoscopic ventral mesh rectopexy in patients with rectocele and rectal prolapse. Materials and methods: a systematic review of the literature on the efficacy and safety of laparoscopic ventral mesh rectopexy in patients with rectocele and/or rectal prolapse. After compiling a search query, 2716 publications were found in the PubMed, MEDLINE, EMBASE, Scopus, Cochrane library, CENTRAL, ISI Web of Science and eLibrary databases. Twenty-four papers were selected according to the inclusion criteria for the review, with a total number of 2101 operated patients. Results: the follow up period after surgery ranged 30.1 (12-74) months. In 20 of 34 studies, the median age of patients was over 60 years, with a median of 62.1 years. The mean operative time was 122.3 minutes (85 to 200 minutes). Complications were revealed in 138 patients (6.5 % observations), recurrence — in 4.1 %. A significant improvement in the symptoms of obstructive defecation was noted in 79.6 %. Conclusion: laparoscopic ventral mesh rectopexy is an effective method for posterior pelvic floor compartment prolapse in terms of both anatomical and functional results. It is safe and has a low risk of complications. However, further research is required to develop indications for the use of this proctdure as a “gold standard”.