Lateral Hernia Research Articles

A comparative study of modified Bassini's repair and lichtenstein repair for indirect inguinal hernia in young age population

Background: Inguinal hernia surgery has significant world-wide diversity in management. European Hernia Society guidelines 2020, for management of groin hernias recommends the use of open non-mesh repair in specific patients or types (e.g. young males with lateral hernia)as an acceptable alternative to a Lichtenstein technique. The present study deals with the comparison of intra operative, postoperative course and clinical outcome of modified bassinis repair (non mesh) and Lichtenstein repair [mesh repair] for indirect inguinal hernia in young age population. Methods: Observational analytical prospective cohort study, conducted in General Surgery, Peoples hospital, Bhopal from November 2022 to February 2024. Patient of indirect inguinal hernia in the age (16-35 years) group and operated by either Modified Bassinis (Group A, n=34) or lichtenstein hernia repair (Group B, n=48). The above study arms group were studied and compared. Results: Mean duration of surgery among Group A patients was 62.65 minutes and 57.19 minutes in Group B. Seropurulent discharge among 2.9% patients in Group A and 4.2% in Group B and superficial SSI among 2.9% patients in Group A and 4.2% in Group B was reported. Chronic post-operative pain VAS score was assessed at end of 2nd week, end of 1 month and end of 3 months with statistically no significant among two groups. Conclusions: Our study did not demonstrate any significant difference of one repair method over the other. However, an Individualized approach for cases with a customized strategy is recommended for surgical management of hernia.

"Fully endoscopic preperitoneal ascending suprapubic approach for minimally invasive repair of anterior and lateral abdominal wall hernias".

The aim of this work is to describe the rational, feasibility and clinical and Quality-of-life improvement results of a fully endoscopic preperitoneal repair for midline and lateral abdominal wall hernias, starting from the space of Retzius in a "bottom-to-up" approach. An observational prospective data-collected and quality of life study is performed in selected patients with less than 10cm. in diameter midline and lateral abdominal wall hernias. A suprapubic upward e-TEP technique from a previously dissected Retzius space, is performed in all cases. The surgical goal is to perform a total free-tension abdominal wall reconstruction followed by a prosthetic hernioplasty. Clinical Data is classified in preoperative, intraoperative, and postoperative variables, including a quality-of-life clinical evaluation based on an improvement of HerQLes score. A total of 30 patients underwent this approach from September 2017 to October 2022 in a single-surgeon practice. A total restoration of the previous abdominal wall anatomy and a prosthetic repair were achieved in all cases. The mean operative time was 142.53min, with a significant shorter time in lateral hernias approach. Minor complications (Clavien-Dindo I) were collected in 10% of the patients. Major complications (Clavien-Dindo IIIb) occurred in 6.66% of the patients. The mean pain at discharge was 1.83 VAS, with a significant lower pain in M-eTEP approach for lateral hernias. The mean hospital stay was 42.4h. No seroma, hematoma, chronic pain, or recurrence was observed in the mean follow-up (20.33months). A clinical and quality of life improvement was found in 92.9% of the patients, measured by a minimal clinical important difference (MCID) between preoperative and postoperative HerQLes score. Despite being a technically demanding approach, the results obtained by this approach are compatible in safety and feasibility with other minimally invasive preperitoneal hernia repair techniques, in addition to obtaining a significant improvement in the quality of life of patients.

Preoperative botolinum toxin A (BTA) and intraoperative fascial traction (IFT) in the management of complex abdominal wall hernias

IntroductionPreoperative botolinum toxin A (BTA) administration to the lateral abdominal wall has been widely used since its introduction for treating complex abdominal wall defects and loss of domain (LOD) hernias. Intraoperative fascial traction (IFT) is an established technique for complex abdominal wall hernias exceeding a width of 10 cm and has also shown auspicious results. We present our single center data including 143 consecutive cases combining both techniques from 2019 to 2023. Aim of the study was to develop an algorithm for a tailored approach for very large and complex ventral abdominal wall hernias.MethodsConsecutive patients treated with preoperative BTA and IFT from August 2019 to December 2023 were identified in our prospectively maintained database and reviewed retrospectively. Metrics included intraoperative findings and short-term (30 days) postoperative outcomes.Results143 patients were included in our retrospective analysis. The mean age was 58.9 years and 99% of all patients had an ASA Score of II or III with a mean body mass index of 32.4 kg/m2. The mean intraoperative reduction of fascia-to-fascia after BTA and IFT was 9.81 cm. 14 patients either had a lateral defect or a combination of a midline and lateral hernia. An additional uni- or bilateral transverse abdominis release (TAR) was necessary in 43 cases (30.1%). The overall surgical site occurrence rate (SSO) was 30.1% of which 13.8% were surgical site infections (SSI). Re-operation and SSO rates were significantly higher if an additional TAR was performed (both p = 0.001; α = 0.05).ConclusionsIFT in combination with BTA is a transformative and clinically proven tool in the surgeons’ toolbox. It might be an easier, and less invasive alternative to other available techniques in many cases, but it should not be looked at as an ultimate stand-alone method to treat all complex W3 hernias.

581. SURGICAL TREATMENT OF ACUTE SYMPTOMATIC POST-ESOPHAGECTOMY DIAPHRAGMATIC HERNIA

Abstract Background Post esophagectomy diaphragmatic hernia (PEDH) is a rare, often asymptomatic condition, but it can also present as a life-threatening complication leading to emergency treatment. Acute onset of symptoms such as epigastric pain, shortness of breath and evidence of serious complications like strangulation, necrosis or perforation of the herniated organs represent an indication for emergency surgery. The aim of the present study is to report the experience of a tertiary care center for esophageal disease and to describe the clinical and surgical management of acute-onset PEDH treated in an emergency setting. Methods A retrospective analysis of a prospectively collected database of esophagectomies for cancer (hybrid, open, transhiatal or minimally invasive) performed at our Institution between January 2013 to June 2022 was performed. Early PEDH was defined as onset within 90 days from surgery. All patients with acute presentation of volvulus, ischemia, respiratory dysfunction or perforation were treated surgically by two expert surgeons. Results Among 357 patients, 10 had an urgent PEDH requiring surgery within 24 hours after onset of symptoms. Early PEDH was diagnosed in 5 patients (median time 4 days) and 3 of them had a concomitant diagnosis of anastomotic leak. Late hernia was treated at median time of 249 days. Organ resection was performed in 4 patients. Surgical access was laparoscopy in 8 patients, open and thoracotomy in 2. Cruroplasty was performed in 8 cases. Mortality was 0%. Recurrence was 10%. No preoperative risk factors for PEDH were identified (Table 1). Conclusions Diaphragmatic hernia could be a challenging complication after esophagectomy, that could present either as an early or late complication. Its early recognition is of paramount importance given its association with anastomotic leak or strangulation. Laparoscopic repair should be considered as the approach of choice in high-volume centers and cruroplasty with or without mesh positioning should be evaluated.

Robotic-assisted surgery for lateral ventral hernias - experience of robot-assisted methods for retromuscular and preperitoneal abdominal wall reconstruction.

Due to the proximity to bony structures and the complex anatomy of the three-layered lateral abdominal wall, the surgical treatment of lateral ventral hernias is technically demanding. With this study we would like to demonstrate how lateral abdominal wall hernias can be treated using new robotic surgical techniques with extraperitoneal mesh placement. The purpose of this study is to demonstrate that the application of the robot in minimally invasive treatment of lateral abdominal wall hernias is safe and efficient. A retrospective analysis of all patients who underwent robotically-assisted lateral ventral hernia repair surgery from June 2019 to December 2023 was performed. A total of 50 ventral hernias were operated robotically due to a lateral hernia in the study period. 45 patients had an incisional hernia and 5 patients a primary spighelian hernia. 27 patients had only lateral findings, whereas 23 patients had combined hernias with lateral and medial hernial defects. 18 patients were treated with a preperitoneal mesh (r-vTAPP). 31 patients required TAR to achieve complete fascial closure and sufficient mesh overlap (24 extraperitoneal approach r-eTAR/7 transperitonel approach r-TAR). One patient had to be converted intraoperatively from a planned preperitoneal mesh to an intraperitoneal mesh repair (r-IPOM). The median hernia defect area was 71cm² (3-375cm²). The median mesh size was 600cm² (150-1290cm²). The median mesh defect ratio (MDR) was 10 (2,33-133,33). Five postoperative complications were encountered (10%). Two reoperations (4%) were required. The utilization of new robotic surgical techniques provides a safe minimally invasive treatment option even for complex lateral ventral hernias that previously posed difficulties in surgical management. The early postoperative results show promising outcomes.

Posterolateral approaches to the thoracic spine for calcific disc herniation: is wider exposure always better?

To compare the costotransversectomy (CTV) and transpedicular (TP) approaches versus the transfacet (TF) approach for the surgical treatment of calcific thoracic spine herniations (cTDH), in terms of surgical and clinical outcomes. Surgical approaches for cTDH are debated. Anterior approaches are recommended, while posterolateral approaches are preferred for non-calcific, paramedian, and lateral hernias. Currently, there is limited evidence about the superiority of a more invasive surgical approach, such as CTV or TP, over TF, a relatively less invasive approach, in terms of neurological outcome, pain, and surgical complications, for the treatment of cTDH. A retrospective, observational, monocentric study was conducted on patients who underwent posterolateral thoracic approaches for symptomatic cTDH, between 2010 and 2023, at our institute. Three groups were drafted, based on the surgical approach used: TF, TP, and CTV. All procedures were assisted by intraoperative CT scan, spinal neuronavigation, and intraoperative neuromonitoring. Analyzed factors include duration of surgery, amount of bone removal, intraoperative blood loss, CSF leak, need of instrumentation for iatrogenic instability, degree of disc herniation removal, myelopathy recovery. Afterwards, a statistical analysis was performed to investigate the bony resection of the superior posterior edge of the vertebral soma. The primary outcome was the partial or total herniation removal. This study consecutively enrolled 65 patients who underwent posterolateral thoracic surgery for cTDH. The TF approach taking the least, and the CTV the longest time (p < 0.01). No statistical difference was observed between the three mentioned approaches, in terms of intraoperative blood loss, dural leakage, post-resection instrumentation, total herniation removal, or myelopathy recovery. An additional somatic bony resection was successful in achieving total herniation removal (p < 0.01), and the extent of bony resection was directly proportional to the extent of hernia removal (p < 0.01). No statistically significant differences were highlighted between the TP, TF, and CTV regarding the extent of cTDH removal, the postoperative complications, and the neurological improvement. The described somatic bone resection achieved significant total herniation removal and was directly proportional to the preop against postop anteroposterior diameter difference.

ROBOT-ASSISTED EXTRAPERITONEAL VENTRAL HERNIA REPAIR—EXPERIENCE FROM THE FIRST 160 CONSECUTIVE OPERATIONS WITH LATERAL eTEP AND eTAR TECHNIQUES

Abstract Background As in various other surgical domains, robotically assisted procedures have become integral in the management of ventral hernias in recent years. The employment of robotic technology enables the integration of minimally invasive techniques with retromuscular mesh placement. Beyond the conventional transabdominal approach, these surgical interventions can alternatively be executed in a total extraperitoneal fashion. The objective of this study is to demonstrate that robotic total extraperitoneal management of abdominal wall hernias is safe and efficient. Method A retrospective analysis encompassing all patients who underwent robotic surgery for ventral hernia repair utilizing the extraperitoneal eTEP technique with a lateral approach was conducted. The study period spanned from December 2019 to December 2023. Results Over the study period, a total of 160 patients underwent surgical intervention utilizing the lateral robotic eTEP technique. Among these cases, 43 patients required a lateral extension of retro-rectal dissection through extraperitoneal transversus abdominis release (eTAR) due to either the hernia size or lateral hernia localization. In every instance, an uncoated synthetic mesh was positioned in the retromuscular location, accompanied by complete fascial closure. The median hernia defect area was 25 cm² (2.25–375 cm²). The median mesh size was 540 cm² (225–1350 cm²). The median mesh defect ratio (MDR) was 21 (2.3–150). Two conversions (1.72%) were necessary. One intraoperative and seven postoperative complications were encountered (5%) out of which two required reoperations (1.72%). Conclusion The robotic extraperitoneal eTEP technique enables a retromuscular mesh placement in a minimally invasive approach. With the possibility of combination with a transversus abdominis release, even complex findings can be treated using this technique.

Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed algorithm.

The precise indications for employing the anterior component separation technique (ACST) and the Transversus Abdominis Release (TAR) in abdominal wall reconstruction (AWR) remain uncertain, despite the undeniable value of both techniques. The aim of this study was to analyze the anterior fascial closure rate, postoperative wound morbidity, and hernia recurrence rate for both procedures according to the algorithm used for complex AWR. A retrospective analysis of prospectively collected data was carried out. Patients undergoing AWR for midline incisional hernias using either open or endoscopic ACST (E-ACST) or TAR between March 2013 and August 2022 were included. Patients with lateral hernia components were excluded. The surgical technique was depending on the pre- and intraoperative findings regarding hernia width and on the estimated traction to achieve anterior fascial closure (see algorithm). Initially, intermediate hernia defects ranging from approximately 10-14cm in width were repaired using E-ACST. However, as the study advanced, TAR became the preferred method for addressing these types of defects. Open ACST was consistently employed for defects wider than 14-15cm throughout the entire study duration. Outcomes of interest were anterior fascial closure, surgical site occurrences, and hernia recurrence rate. Follow-up was performed at 1month, 1year, and 2years. A total of 119 patients underwent AWR with CST: 63 patients (52.9%) were included in the ACST group and 56 patients (47.1%) in the TAR group. No significant differences were observed in patient and hernia characteristics. The use of botulinum toxin A (BTA) injection and preoperative progressive pneumoperitoneum (PPP) was more frequently used in the ACST group (BTA 19.0%, PPP 15.9% versus BTA 5.4%, PPP 1.8% for TAR patients). Anterior fascial closure was achieved in 95.2% of the ACST group and 98.2% of the TAR group (p = 0.369). The TAR group demonstrated a significantly lower SSO rate at one month (44.3% versus 14.3%, p < 0.001) and required fewer procedural interventions (SSO-PI) (31.1% versus 8.9%, p = 0.003). The recurrence rate at one year was low and there was no statistically significant difference between the two groups (ACST 1.8% vs TAR 4.5%, p = 0.422). Following a proposed algorithm, the anterior fascial closure rate was high and similar for both techniques. As postoperative wound morbidity is significantly increased after ACST, our findings support recommending TAR for defects up to 14cm in width, while favoring open ACST for larger defects.

PUNCTURE LASER MICRODISCECTOMY IN THE TREATMENT OF SEQUESTERED HERNIATION OF LUMBAR INTERVERTEBRAL DISCS

Objective. to improve the results of treatment of sequestered herniation of lumbar intervertebral discs by the puncture laser microdiscectomy (PLM) method. Methods. During the period from 2000 to 2023, 132 patients with sequestered lumbar disc herniations were operated on by the PLM method. There were 88 males and 34 females. The age of the patients was from 23 to 64 (42.3 ± 3.5) years. Surgeries were performed using a C-arc operating fluoroscope. The laser pulse duration — 0.3–0.5 sec, and radiation exposure — 500–600 J. Approach to the sequestrum was mainly posteromedian transdural. For laterally located sequestra, posterolateral approach was used. The efficacy of PLM was assessed by pain intensity reduction according to the VAS scale one month after surgery, and according to the McNab scale 3 months after surgery. Results. One month after PLM, the maximum reduction of radicular pain intensity was noted in patients with posteromedian hernias, to a lesser extent — with paramedian hernias, and the least pronounced — with lateral hernias. However, no statistically significant differences in pain intensity one month after surgery depending on hernia location were found (p &gt; 0.05). As for the intensity of lumbar pain, in all groups, regardless of hernia location, it significantly decreased and did not exceed 1 point after one month. 3 months after surgery, 95 (71.9 %) patients had an excellent result according to the McNab scale, 13 (9.8 %) — good, 7 (5.3 %) — satisfactory, 17 (12.8 %) — unsatisfactory, indicating that the PLM method of sequestered hernias can be quite effective in a certain selection of patients. According to our data, positive results can reach 81.8 % (95 % CI 74.2–87.9 %) (CI — confidence interval). Conclusions Sequestered hernias, which can be operated by the PLM method, should not exceed 9 mm in height on axial sections, should have a smooth rounded lenticular shape without signs of migration. The positive effect of PLM of sequestered hernias reached 81.7 %. The results were better with PLM of posteromedian hernias.

No Reason to Use Mesh in Groin Hernia Repair in Adolescents.

Groin hernias are common and hernia repair is one of the most frequent surgical procedures performed worldwide. Despite this, there is no international guideline on the management of groin hernias in adolescents. Mesh reinforcement is used for repair in adults but not in young children. Adolescents, positioned between these age groups, pose unique challenges for surgeons due to their varying growth patterns. Placing a synthetic mesh in growing patients is a concern, particularly in relation to chronic pain. Traditionally, the hernia literature has defined adults as individuals aged 18years and above. Considering that growth can continue until age 19, this review proposes a revised definition of adolescence for patients with groin hernias encompassing ages 10 to 19. Symptomatic groin hernias in adolescents should be repaired with an open non-mesh technique because of acceptable recurrence rates and the desire to avoid introducing synthetic foreign materials into young patients with ongoing growth potential. Watchful waiting is suggested for asymptomatic groin hernias, postponing repair until the adolescent has become a fully grown adult and symptoms from the hernia develop. Most groin hernias in adolescents are lateral hernias, but before pursuing a watchful waiting strategy in females, an ultrasound or magnetic resonance imaging scan is suggested to rule out the presence of a femoral hernia that may need repair.

The clinical applications of D-type parastomal hernia repair surgery.

This study investigated the use of a modified laparoscopic repair of paraostomy hernia technique, called "D-Type parastomal hernia repair surgery" which combines abdominal wall and extraperitoneal stoma reconstruction, in patients with parastomal hernia (PSH) following colorectal stoma surgery. The aim was to determine whether D-type parastomal hernia repair surgery is a promising surgical approach compared to the traditional laparoscopic repair technique (Sugarbaker method) for patients with PSH. PSH patients were selected and retrospectively divided into two groups: the study group underwent D-type parastomal hernia repair, while the control group underwent laparoscopic Sugarbaker repair. Clinical data from both groups were analyzed. Compared to control group (n = 68), the study group undergoing D-type stoma lateral hernia repair had significant increase in total operative time (98.82 ± 12.37min vs 124.61 ± 34.99min, p < 0.001). The study group also showed better postoperative stoma bowel function scores in sensory ability, frequency of bowel movements, and clothing cleanliness without a stoma bag (p = 0.037, 0.001, 0.002). The treatment cost was significantly higher in the control group (3899.97 ± 260.00$ vs 3215.91 ± 230.03$, p < 0.001). The postoperative recurrence rate in the control group was 26.4%, while in the study group, it was 4.3%, with a significant statistical difference (p = 0.024). In terms of long-term postoperative complications, the study group had an overall lower incidence compared to the control group (p = 0.035). Other parameters showed no significant differences between the two groups. The study suggests that D-type parastomal hernia repair surgery is a safe and feasible procedure. Compared to traditional surgery, it can reduce the recurrence of lateral hernia, improve postoperative stoma bowel function, and save medical resources.

Characteristics of patients with recurrent hernia in a single institution

Background: Hernia repair is one of the most common surgical procedures performed to treat with many treatments worldwide. However, there were recorded cases where the hernia recurred even though the patient had undergone hernia repair surgery. Various factors contribute to hernia recurrence, such as gender, age, body mass index, physical activity, comorbidities, location, and the period of hernia recurrence. This study presented characteristics of recurrent hernia patients in a single institution, especially at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Methods: This research is a cross-sectional study that analyzes secondary data extracted from medical records at Dr. Wahidin Sudirohusodo Hospital, Makassar. All patients enrolled in this study have met the inclusion and exclusion criteria. Results: A total of 177 patients’ data were collected, statistically processed in the form of tables and pie charts, and analyzed. It was identified that the characteristics of patients who experienced hernia recurrence in locations dominated by male sex (87%), with the adult age category dominating this case (46%). Patients with overweight and normal BMIs had the highest percentage of 27%, respectively. Unemployed patients (33%), self-employed (27%), and retired (13.3%) dominated patients with hernia recurrence. Most of the patients had comorbidities (10 people/ each of 6.7%). Patients with lateral hernia dominate the cases of hernia recurrence (80%). The largest hernia recurrence range time was &lt;2 years (54%). Conclusion: Patients with male, adult, overweight and normal BMI, unemployment, and with comorbidity dominated cases recurrent hernia. Patients with lateral hernia locations dominate cases of hernia recurrence.

Totally extraperitoneal repair of groin hernia in liver transplant patients: a case series study (TOHER).

The present study aims to describe the feasibility and the postoperative results of groin hernia repair in liver transplant patients using a totally extra-peritoneal (TEP) repair approach. From May 2022 to March 2023, liver transplant patients with groin hernia underwent TEP groin hernia repair, by the single common senior experimented surgeon. Background information, intraoperative findings, postoperative complications, postoperative pain, health, and well-being were registered. Thirteen TEP approach groin hernioplasties were performed in 10 patients, completing the procedure in all cases without the need for conversion either to open or transabdominal preperitoneal approaches. 70% of surgical explorations revealed multiple hernia defects: lateral hernias in all patients, medial defects in 62%, and femoral defects in 30.8%. Median hospital stay was 1day [range (0.3)], with 30% treated as outpatients. Post-surgical complications occurred in 30% of cases: 1 hematoma and 2 seromas. Postoperative pain and physical functioning scored 100 (IQR 44) and 90 (IQR 15), respectively. TEP groin hernioplasty is safe and feasible for liver transplant patients, with low complication rates, short hospital stays, and a significant proportion treated as outpatients. The posterior approach allows comprehensive repair of myopectineal defects, crucial due to associated hernial defects.

Increased risk for incisional hernia following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

The incidence of incisional hernias (IH) after midline laparotomy varies from 11% to 20%. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is potentially prone to hernias because a Xiphoid to pubis laparotomy incision performed on patients who have undergone previous abdominal surgeries with the addition of chemotherapy and its related adverse effects. We performed a retrospective analysis on a prospectively maintained single institution database from March 2015 to July 2020. The inclusion criteria were patients who underwent CRS-HIPEC and had at least 6 months postoperative follow-up with post-operative cross-sectional imaging study. Two hundred and one patients were included in the study. All patients underwent CRS-HIPEC with resection of previous scar and umbilectomy. Fifty-four patients were diagnosed with IH (26.9%). The major risk factors for IH in multivariate analysis were higher American society of Anesthesiologists score (ASA) (OR 3.9, P = 0.012), increasing age (OR 1.06, P = 0.004) and increasing BMI (OR 1.1, P = 0.006). Most of the hernia sites were median (n = 43, 79.6%). Eleven (20.4%) patients had lateral hernias due to stoma incisions or drain sites. Most of the median hernias were at the level of the resected umbilicus 58.9% (n = 23). Five (9.3%) of the patients with IH necessitated an urgent surgical repair. We have demonstrated that more than a quarter of the patients after CRS-HIPEC suffer from IH and up to 10% of them may require surgical intervention. More research is needed to find the appropriate intraoperative interventions to minimize this sequela.

OC-075 RADIOLOGIC TRANSVERSUS ABDOMINIS MUSCLE RETRACTION AFTER UNILATERAL TRANSVERSUS ABDOMINIS RELEASE VIA ETEP

Abstract Aim Our principal aim is to determine the retraction distance (RD) of the transverse abdominis muscle after unilateral endoscopic transversus abdominis release (eTAR) for the treatment of midline and lateral hernias, and compare it with the same patient contralateral unreleased side. Material and Methods We performed a retrospective analysis of a prospective database collection. We defined the RD as the measure between the lateral edge of the rectus abdominis muscle and the medial edge of the transversus abdominis muscle at the level of L3-L4 and at the defect´s maximum diameter. RD was measured pre and postoperatively and compared in the eTAR side with the contralateral (non- eTAR) side. Results 94 midline and 63 lateral hernias underwent hernia repair via endoscopic totally extraperitoneal (eTEP). Thirtyfive patients required unilateral TAR, including 1 primary and 34 incisional hernias. Lateral (65,7%) and medial (34,3%) defects were both included. The mean hernia defect was 49mm transverse diameter and 52mm longitudinal. We compared the postoperative RD at L4, obtaining 45,8mm on the eTAR side and 42,2mm on the non-eTAR side (p=0,284). At the defect site a mean of 38,3mm on the eTAR side was compared with 35,5mm (p=0.363). In our series we didn't find any statistically significant differences in the transversus muscle retraction after unilateral eTAR when compared with the unreleased side. Conclusions eTAR is a safe technique especially during the treatment of lateral hernias, allowing a proper mesh placement without significant transverse muscle retraction.

V-026 LAPAROSCOPIC TAPP REPAIR: IS IT REALLY FEASIBLE IN A RE-RECURRENT HERNIA?

Abstract Aim Describe a step by step laparoscopic transabdominal preperitoneal (TAPP) repair of a re-recurrent incisional lumbar hernia. Material &amp; Methods This is the case of a 72-year-old man who had a previous traumatic right lumbar hernia initially approached by laparoscopic intra-peritoneal onlay mesh repair (IPOM) and its recurrence approached by open onlay mesh repair. CT-scan revealed a lumbar hernia on the right with a neck size of 40 mm. The hernia sac measured 65 mm and contained part of the right colon inside, without signs of incarceration nor dilated intestinal loops. According to the European Hernia Society classification for incisional abdominal wall hernias, the patient had a lateral hernia (L4 W2). Results Lateral incisional hernias are limited by the inguinal region inferiorly, the costal margin superiorly, the lateral margin of the rectal sheath medially and the lumbar region laterally. Due to their low incidence and the resulting lack of expertise in the treatment of this abdominal wall defect, surgical treatment poses a challenge- Conclusion The repair of a recurrent hernia is a daunting task, even more so of a re-recurrent one. By choosing to perform a TAPP repair, we were able to prove a laparoscopic re-do repair is feasible even faced with weakened tissues and distorted anatomy.

P-060 PREFORMED PATCH VS. FLAT PREPERITONEAL MESH FOR PRIMARY AND INCISIONAL HERNIA: A PROPENSITY-SCORE MATCHED ANALYSIS

Abstract Aim The MORPHEUS trial (Ponten et al. [2018]) reported better outcomes with a flat preperitoneal polypropylene mesh compared with a preformed patch for primary midline hernia repair. The aim was to evaluate our results with these meshes and to explore the recurrence factors. Material &amp; Methods Observational retrospective study of patients undergoing hernia repair in a tertiary referral center. The preformed patch (PP) was used since April 2013, and the flat preperitoneal mesh (FPM) since March 2016. Recruitment finished in December 2021. A 3:1 Propensity-Score matching was performed to select cases for analysis. Results A total of 156 patients were analysed, 117 with PP and 39 with FPM. There were no differences in baseline characteristics, patients’ comorbidities, rates of midline (96.6% vs. 71.4%) or lateral hernias (3.4% vs. 28.6%) or in the proportion of primary (70.9% vs. 69.2%) and incisional hernias (29.1% vs. 30.8%) in PP and FPM groups, respectively. The median hernia defect was 2.5 cm (IQR: 2–3.22). There was a higher rate of defect closure in FPM (100%; 39/39) compared with PP group (12.8%; 15/117). The recurrence rate was higher in the PP group, with 16.2% (19/117), compared to 2.6% (1/39) in the FPM group (p: 0.027) with a median follow-up of 33.6 months (IQR: 14.2–48.7). In logistic regression, there were no statistically significant differences between meshes (OR: 0.136 [CI95%: 0.018-1.050]), while BMI was a risk factor for recurrence and the defect closure was a protective factor. Conclusion Mesh choice did not influence hernia recurrence.

V-028 HYBRID (LAPAROSCOPIC AND OPEN) REPAIR WITH REVERSE TAR TO TREAT A LATERAL INCISIONAL HERNIA WITH DENERVATION OF THE RIGHT ABDOMINAL MUSCLES

Abstract Aim Lateral incisional hernias with denervation of the muscles of the abdominal wall are a problem difficult to solve. The repair of the defect does not guarantee a functionality of the abdominal muscles if the lack of force of the abdominal wall is not solved. With the technique we present there is a minimally invasive reinforcement of the mid lateral wall affected. Material and Method 54 yo female. Previous surgeries: biliary cystadenoma 2014 by Makuuchi laparotomy (2 surgeries), Ooforectomy 2011, Hysterectomy 2013, Mamoplasty 2001, 3 vertebral surgeries. Six months after the surgery she felt a growing lump in the right side of the incision. Physical exam: right lateral incisional hernia and small umbilical hernia. Asymmetry of the abdominal wall because of flaccidity of the right abdominal muscles. Ultrasound Voluminous incisional hernia in the right flank dependent of the right transverse sub-costal incision with a hernia ring of 20mm and hernia sac 60mm of diameter increasing with Vasalva maneuvers. Surgical technique Hybrid approach laparoscopic and lateral by e-TEP to dissect the retrorectal bilateral space and lateral preperitoneal approach with reverse TAR. A macroporous polipropilene preperitoneal mesh is placed from the right psoas to left semilunar line and from top to bottom of the abdominal wall. Result Discharged 2nd po. day without complications. 5 months after surgery she has a symmetric abdominal wall without recurrence. Conclusion Hybrid technique to repair lateral hernias with denervation allows a wide repair with low morbidity and good tolerance with excellent result in abdominal functionality.

Open vs. minimally invasive sublay incisional hernia repair. Is there a risk of overtreatment? EVEREG registry analysis

IntroductionIncisional hernia (IH) is a very common surgical procedure. Registries provide real world data. The objective is to analyze the open and minimally invasive (MIS) sublay technique (with or without associated components separation [CS]) in IH cases from the EVEREG registry and to evaluate the evolution over time of the techniques. MethodsAll patients in EVEREG from July 2012 to December 2021 were included. The characteristics of the patients, IH, surgical technique, complications and mortality in the first 30 days were collected. We analyzed Group 1 (open sublay vs MIS sublay, without CS), Group 2 (open sublay vs MIS sublay, with CS) and Group 3 where the evolution of open and MIS techniques was evaluated over time. Results4867 IH were repaired using a sublay technique. Group 1: 3739 (77%) open surgery, mostly midline hernias combined (P = .016) and 55 (1%) MIS, mostly lateral hernias (LH) (P = .000). Group 2: 1049 (21.5%) open surgery and 24 (0.5%) MIS. A meaningful difference (P = .006) was observed in terms of transverse diameters (5.9 (SD 2.1) cm for the MIS technique and 10.11 (SD 4.8) for the open technique). The LH MIS associated more CS (P = .002). There was an increase in the use of the sublay technique over time (with or without CS). ConclusionIncreased use of the sublay technique (open and MIS) over time. For some type of hernia (LH) the MIS sublay technique with associated CS may have represented an overtreatment.

Técnica sublay abierta vs. mínimamente invasiva en el tratamiento de la hernia incisional. ¿Hay riesgo de sobretratamiento? Análisis del registro EVEREG

IntroductionIncisional hernia (IH) is a very common surgical procedure. Registries provide real world data. The objective is to analyze the open and minimally invasive (MIS) sublay technique (with or without associated components separation [CS]) in IH cases from the EVEREG registry and to evaluate the evolution over time of the techniques. MethodsAll patients in EVEREG from July 2012 to December 2021 were included. The characteristics of the patients, IH, surgical technique, complications and mortality in the first 30 days were collected. We analyzed Group1 (open sublay vs. MIS sublay, without CS), Group2 (open sublay vs. MIS sublay, with CS) and Group3 where the evolution of open and MIS techniques was evaluated over time. ResultsFour thousand eight hundred and sixty seven IH were repaired using a sublay technique. Group1: 3,739 (77%) open surgery, mostly midline hernias combined (P=.016) and 55 (1%) MIS, mostly lateral hernias (LH) (P=.000). Group2: 1,049 (21,5%) open surgery and 24 (0.5%) MIS. A meaningful difference (P=.006) was observed in terms of transverse diameters (5,9 [SD: 2.1]) cm for the MIS technique and 10.11 [SD: 4.8] for the open technique). The LH MIS associated more CS (P=.002). There was an increase in the use of the sublay technique over time (with or without CS). ConclusionIncreased use of the sublay technique (open and MIS) over time. For some type of hernia (LH) the MIS sublay technique with associated CS may have represented an overtreatment.