Lightweight Mesh Research Articles

Does defect size matter in abdominal wall reconstruction with successful fascial closure?

BackgroundConflicting literature suggests that larger defects in abdominal wall reconstruction both increase the risk of recurrence and have no impact on recurrence. In our prior work, hernias with defect areas ≥100 cm2 were associated with increased discomfort, operative time, and length of stay but not recurrence or reoperation. Our goal was to determine if defect size, even in giant hernias, would impact recurrence after mesh repair with complete fascial closure. MethodsA prospectively maintained hernia database was reviewed for clean, abdominal wall reconstruction with fascial closure and synthetic mesh. Patients were grouped and compared by defect area: moderate hernias <200 cm2 (LT200) and giant hernias ≥200 cm2 (GT200). ResultsOf 984 patients, 607 LT200 (average area: 92.8 ± 60.8 cm2) were compared with 377 GT200 (average area: 363.2 ± 196.7 cm2). LT200 and GT200 had similar mean age, body mass index, and smoking rate, but GT200 had higher rates of diabetes (22.1% vs 27.9%; P = .040), recurrent hernias (52.7% vs 63.4%; P = .001), preoperative Botox (0.7% vs 8.8%; P < .001), component separation (23.4% vs 59.9%; P < .001), panniculectomy (8.7% vs 15.4%; P = .001), and negative-pressure incisional vacuum placement (5.9% vs 13.5%; P < .001). GT200 had increased mesh size (753.5 ± 367.1 vs 1168.2 ± 412.0 cm2; P < .001), operative time (147.8 ± 55.7 vs 205.3 ± 59.9 minutes; P < .001), and length of stay (5.1 ± 3.2 vs 6.9 ± 4.4 days; P < .001). GT200 had more wound complications (24.7% vs 36.1%; P < .001) and readmissions (9.1% vs 15.1%; P = .004) but similar recurrence rates (3.0% vs 3.7%; P = .520) over the mean follow-up of 30.1 ± 38.9 and 23.0 ± 33.6 months for LT200 and GT200, respectively. On multivariable regression, previous abdominal wall reconstruction, lightweight mesh, and wound complications independently predicted recurrence; component separation was protective, but defect size was not predictive of recurrence. ConclusionGT200 required more complex measures to achieve fascial closure and resulted in increased length of stay, wound complications, and readmissions; however, GT200 had the same recurrence rate as smaller defects when fascial closure was achieved.

Pooperacinių išvaržų gydymo naudojant tinklelį atokieji (daugiau negu penkerių metų) rezultatai: literatūros apžvalga

Introduction. Postoperative hernias occur in 10–15% of patients. Considering the increase in the incidence of complications with the number of operations it is crucial to choose the optimal surgical technique in order to control the complications rate. This literature review summarizes previous studies on the treatment of postoperative hernias with mesh, comparing complication and recurrence rates according to surgical technique and mesh position. Methods. A thorough search was conducted on the PubMed database to retrieve literature on recurrence, chronic pain, haematoma, seroma, and surgical site infections rates. The results were meticulously summarised and used to confidently compare open and laparoscopic surgical techniques, as well as “sublay” and “onlay/inlay” mesh positions in more than 5-year follow-up. Results. The analysis was conducted on five publications that met the selection criteria. The results showed that laparoscopically treated hernias had lower recurrence and chronic pain rates, but more frequent haematomas. The presence of wound infections, BMI &gt;30, treatment of recurrent postoperative hernias, multiple fascia lesions, enterotomy, larger abdominal wall defect and longer operative time were observed to be associated with higher recurrence rates. The position of the sublay mesh is associated with less frequent seromas, surgical infections, and recurrence compared to the onlay/inlay position. Studies have reported the superiority of large-pore lightweight polypropylene multifilament mesh over the same heavyweight mesh in managing postoperative hernias. Lightweight mesh is linked to a lower risk of hernia recurrence and higher compliance with the abdominal wall. Conclusion. Laparoscopic surgery is associated with lower rates of recurrence and chronic pain, but a higher frequency of haematomas. The sublay mesh position is associated with lower rates of seromas, surgical infections, and recurrence.

COMPARATIVE ANALYSIS OF ANATOMICAL SHAPED AND STANDARD FLAT MESH IN TRANSABDOMINAL PREPERITONEAL (TAPP) INGUINAL HERNIA REPAIR: EARLY OUTCOMES

Abstract Background Mechanical fixation in transabdominal preperitoneal inguinal hernia mesh repair (TAPP) is associated with pain syndrome and mesh migration may occur without flat protheses fixation. An anatomical shaped mesh (4DTM Cousin Biotech) using no fixation would improve the pain syndrome. Method A retrospective case study, that included 100 patients and 200 TAPP performed from 2019 to 2023. This study was conducted to compare laparoscopic inguinal hernia repair with (group A) or without mesh fixation (group B) regarding outcomes using two different mesh technologies: well-established flat macroporous partially absorbable mesh and the anatomical shaped partially absorbable lightweight mesh (4DTM Cousin Biotech). Results Recurrence rates, postoperative outcomes, and complication rate and type were analyzed to provide insights into the performance of each mesh in TAPP. There was statistically significant difference in postoperative early pain, assessed via VAS score, 3 days after surgery (group A versus group B; 3,4 ± 1.46 vs. 4 ± 1.6, P &amp;lt;0.001) and a week after surgery (group A versus group B; 1.5 ± 0.9 vs. 2.5 ± 0.6, P &amp;lt;0.001). Operative time, on average, was longer in group B (92 ± 12. vs. 79 ± 20 min, P &amp;lt;0.001). Conclusion The study results revealed that laparoscopic TAPP inguinal hernia repair with anatomical shaped mesh without fixation is safe and feasible with no increase in recurrence rate. In addition, it offers an improvement of operation time than TAPP mesh fixation. However, further study with a longer follow-up will be needed to confirm the results.

Assessment of mesh shrinkage using fibroblast-populated collagen matrices: a proof of concept for in vitro hernia mesh testing

PurposeThis study uses free-floating contractile fibroblast-populated collagen matrices (FPCMs) to test the shrinkage of different hernia mesh products. We hope to present this model as a proof of concept for the development of in vitro hernia mesh testing—a novel technology with interesting potential.MethodsFPCMs were formed by seeding Human Dermal Fibroblasts into collagen gels. FPCMs were seeded with three different cell densities and cast at a volume of 500 μl into 24-well plates. Five different mesh products were embedded within the collagen constructs. Gels were left to float freely within culture media and contract over 5 days. Photographs were taken daily and the area of the collagen gel and mesh were measured. Media samples were taken at days 2 and 4 for the purposes of measuring MMP-9 release. After 5 days, dehydrated FPCMs were also examined under light and fluorescence microscopy to assess cell morphology.ResultsTwo mesh products—the mosquito net and large pore lightweight mesh were found to shrink notably more than others. This pattern persisted across all three cell densities. There were no appreciable differences observed in MMP-9 release between products.ConclusionsThis study has successfully demonstrated that commercial mesh products can be successfully integrated into free-floating contractile FPCMs. Not only this, but FPCMs are capable of applying a contractile force upon those mesh products—eliciting different levels of contraction between mesh products. Such findings demonstrate this technique as a useful proof of concept for future development of in vitro hernia mesh testing.

IMMERSIVE TEXTILE ENVIRONMENTS. ESCAPE INTO THE AIR

Installation art became an important phenomenon in the 20th century. In the 21st century, installations become immersive and involve the widespread use of participatory practices and increased physical contact with the viewer. One of the new trends in contemporary art that emerged in the first decades of the 21st century was the creation of floating, large-scale immersive textile structures or soft “environmental sculpture.” The objects are multivariate “walk-in” labyrinths, knitted or woven from fiber materials. The first steps in creating lightweight mesh structures were mastered by architects in the 1960s. Based on the bold decisions of their predecessors, contemporary artists Toshiko Horiuchi Macadam, Ernesto Neto, Tomas Saraceno, the group “Nume/For Use” and others laid the foundation for immersive textile installations - cyclopean webs of different types of structures and compositional solutions. The purpose of this study is to analyze modern textile immersive “walk in” labyrinths. An attempt was made to understand the reasons for the appearance of these artistic objects, their features and fundamental principles of execution were identified. The antiquity and reliability of textile practices, the properties of the fiber and the wide range of its aesthetic qualities have made textiles indispensable in the creation of installations of this kind. The deep metaphorical nature of the material evokes multiple connotations among the participants involved in the artistic process, enriches the range of their experiences, and awakens the intensity significance of meanings. In addition, the viewer gets the opportunity to have a unique experience and gains personal and subjective experience. Immersive textile installations have become a space for artistic expression and reflect a wide range of contradictions in the modern world.

Partially absorbable composite mesh versus non-absorbable polypropylene mesh in laparoscopic repair of inguinal hernia in a tertiary care center

Background: The choice of mesh is far more important than the technique used as a determinant of patient outcome. Randomized studies have compared polypropylene and modified composite mesh (polypropylene and polyglactin) and found decreased foreign body reactions and post-operative complications and improved long-term quality of life with the use of composite mesh. However, a limited number of studies have been done comparing the early outcomes such as inguinodynia, the presence of a seroma or hematoma, foreign body sensation, testicular problems, and the return to normal work activities. Aims and Objectives: The primary objective was to assess and compare the early outcome of non-absorbable polypropylene mesh vs. partially absorbable composite mesh in laparoscopic inguinal hernia repair. The secondary objective was to compare the complications associated with both types of mesh hernioplasty. Materials and Methods: A total of 50 cases of elective reducible indirect inguinal hernia patients admitted to the Department of Surgery, VIMSAR, Burla, were included in our study. The total group was split into Group A and Group B of 25 cases each. All patients underwent laparoscopic inguinal hernia repair transabdominal prepeitoneal. The partially absorbable composite lightweight meshes are used in Group A, and the non-absorbable polypropylene meshes are used in Group B. After surgery, comparison between the two groups was made on the basis of parameters such as age distribution, inguinodynia, analgesia, foreign body sensation, presence of a lump (hematoma or seroma), return to work activities, and recurrence. Results: The mean age of patients is 50.24 ± 12.994 years. The majority of the patients were in the age group of 51–60 years. Initially, there was no significant difference in transient neuralgia between the two groups, but after 6 weeks, Group A had significantly less pain. Foreign body sensation is significantly more in Group B, but later, this was not significant. Conclusion: Based on the results of this study, composite mesh may be recommended for use in laparoscopic inguinal hernia repair owing to the less pain, less foreign body sensation, and earlier return to work.

Outcomes of Lightweight Mesh Sacrocolpopexy for Pelvic Organ Prolapse Repair

Objective: The research objective is to present and evaluate 3 years of experience in sacrospinal fixation using polypropylene mesh in the surgical treatment of genital prolapse in women. Methods: This retrospective study evaluated perioperative and mid-term outcomes in 68 women who underwent transvaginal sacroscopic cervicocolpopexy with lightweight polypropylene mesh for stage II-IV prolapse with apical involvement. Anatomical outcomes, complications, and symptoms were assessed using POP-Q staging and validated questionnaires preoperatively and at 12 and 36 months postoperatively. Results: No intraoperative complications were observed. In the long-term postoperative period, the following were observed: vaginal wall erosion in transvaginal Mesh-systems placement along the postoperative suture line at 2.9 % (2/68), and chronic pelvic pain at 2.9 % (2/68). The percentage of anatomical success in restoring the position of the apical vaginal segment was 98.5 % (67/68) 12 months after surgery and remained unchanged after 36 months of follow-up.

Lightweight macroporous mesh can be used for corporal reconstruction during penile prosthesis surgery.

Options to reinforce or reconstruct the corpora cavernosa during penile prosthesis surgery are limited. Synthetic grafts may confer a higher infection risk. Lightweight macroporous mesh is a promising alternative due to better integration and tissue ingrowth. The study sought to report the first experience of using lightweight mesh to reinforce or reconstruct the corpora. The medical records of all patients undergoing insertion or revision of penile prosthesis between May 2016 and May 2021 were reviewed retrospectively. Patient characteristics, management, and outcomes were extracted in which mesh was used for corporal reconstruction. Poliglecaprone-25/polypropylene mesh (UltraPro) was used in all cases. The surgical technique and alternatives were summarized. The outcomes were infection rate, postoperative complications by Clavien-Dindo classification, and patient-reported outcomes. Mesh was required during penile prosthesis surgery in 21 men (median age 56 [range, 18-74] years). Reasons for reconstruction were severe corporal fibrosis (n = 6), impending erosion (n = 6), crossover/perforation (n = 6), congenital corporal agenesis (n = 2), and excision of Peyronie's plaque. All but 2 patients (with corporal agenesis) presented for revision penile prosthesis surgery with a median number of previous revision attempts of 2 (range, 1-5). Two (10%) patients required explant after a mean follow-up of 23 ± 8.7 months. One man developed infection of the device 2years after surgery, translating to an infection rate of 5% despite a high prevalence of diabetes (25%) in this cohort. Another required explantation due to debilitating chronic pain after 3months. Further revision surgery for stiction syndrome was required in a third patient. Finally, another man was not satisfied with the position of the pump within the scrotum or the axial rigidity of the device, despite a second opinion suggesting no issues with the device. All men were sexually active following surgery. A lightweight mesh can be considered to reinforce or reconstruct the corpora cavernosa in complex cases in which there are no alternative techniques available. This is the first study using a lightweight macroporous mesh for revision penile prosthesis surgery. This was a well-characterized cohort of patients. A larger cohort with 5-year follow-up would be preferable. These early results suggest that a lightweight macroporous mesh may be an acceptable synthetic graft for corporal reconstruction. Poliglecaprone-25/polypropylene mesh may be ideal because it is partially absorbable, easy to handle, and not bulky.

Does the Weight Matter? Short-Term Outcomes of Lightweight Versus Heavyweight Three-Dimensional Anatomical Mesh in Minimally Invasive Inguinal Hernia Repair.

Background: The type of mesh used in inguinal hernia repairs remains controversial. There are limited data looking at specific mesh-related complications. The objective of this study is to assess postoperative 90-day outcomes in lightweight (LW) and heavyweight (HW) anatomical mesh in minimally invasive inguinal hernia repairs. Methods: A retrospective single-center database was queried for all adult minimally invasive inguinal hernia repairs with anatomical mesh from July 2016 to March 2021. Demographics and surgical outcomes were analyzed. Univariate analysis and multivariate logistic regression were performed. Results: Six hundred forty-seven minimally invasive inguinal hernia repairs were performed with 423 (65.3%) using HW and 224 (24.7%) using LW mesh. There was no difference in mean body mass index between the groups (26.9 ± 4.2 kg/m2 in the LW group and 27.1 ± 4.2 kg/m2 in the HW group; P = .69). There was no difference in type of mesh fixation used in either group, with tacker being the most common. There was no difference in postoperative emergency department (ED) visit (P = .625), readmission rates (P = .562), or postoperative complications between the two groups. Fifty patients presented with seroma within 90 days. There were five recurrences in each group and only one surgical site infection in the LW within 90 days. Multivariate logistic regression was performed, and predictors of seroma formation included age (odds ratio [OR] 1.02; confidence interval [CI] 1-1.04; P = .02) and hypertension (HTN) (OR 1.8; CI 1.03-3.4; P = .039). HW mesh was not associated with seroma formation (OR 1.04; CI 0.5-1.9; P = .895). Similarly, HW mesh was not associated with surgical site occurrences (SSO) (OR 1.04; CI 0.5-1.8; P = .872). HTN was associated with SSO (OR 1.74; CI 1-3.05; P = .048). Conclusion: Our study did not favor the use of LW or HW mesh when comparing postoperative complications or clinical outcomes. HW mesh was not associated with either seroma formation or SSO.

MEsh FIxation in Laparoendsocopic Repair of Large M3 inguinal hernias: multicenter, double-blinded, randomized controlled trial—study protocol for a MEFI Trial

BackgroundInternational guidelines of groin hernia treatment strongly recommend to fixate the mesh in large M3 medial defects during TAPP/TEP procedures. The main purpose of fixation is to decrease the recurrence rate which is alarmingly high in case of those defects. In 2022, a team consisting of hernia surgeons and scientists from universities of technology conducted an experimental study with the use of 3D groin model to verify the hypothesis that fixation is not necessary in above cases. Experiment showed that rigid and anatomically shaped meshes are able to maintain its position in the groin without fixation. Similar conclusions were recently published in Swedish database registry analysis. To confirm above results, we decided to conduct a multicenter randomized controlled trial.MethodsMain objective of MEFI Trial is to verify the hypothesis that non-fixation of spatial, standard polypropylene meshes is non-inferior to fixation of flat, polypropylene lightweight meshes in M3 hernias by laparoendoscopic approach. Eleven large surgery centers in Poland having proficiency in laparoendoscopic groin hernia repairs were recruited for this study. Recurrence in 12-month follow-up was set as a primary endpoint. Pain sensation (Visual Analog Scale) and incidence of other complications (hematoma, seroma, SSI) were also noted. Based on the statistical analysis, minimal sample size in both arms was established at 83–102. The first arm (control) consists of patients undergoing a repair with the use of a flat, macroporous mesh with fixation using histoacryl glue. In the second arm, patients will be operated with the use of anatomically shaped, standard-weight mesh without fixation. Study will be double-blinded (patient/surgeon). After the dissection of preperitoneal space, surgeon will open a sealed envelope and find out which technique he will have to perform. Follow-up will be performed by Study Secretary (also blinded to the method used) via phone call 3 and 12 months after surgery.DiscussionBased on experimental study and recent registry analysis, we believe that the recurrence rate in both groups would be on the same level, giving hernia societies a strong argument for amending the guidelines.Trial registrationClinicalTrials.gov NCT05678465. Registered on 10 January 2023.

SP9.12 The Global Practice of Inguinal Hernia Repair Study (GLACIER): A survey of 1014 hernia surgeons

Abstract Introduction There are many variations in practices and preferences for inguinal hernia repair among surgeons globally. The purpose of the Global Practice of Inguinal Hernia Repair Study (GLACIER) was to capture these variations related to open, laparoscopic, and robotic inguinal hernia repair. Method A questionnaire-based survey on Survey Monkey® was created, and the link was shared freely on various social media platforms, personal email network of authors and email to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC). Results A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were equally preferred (43% and 47% respectively). Transabdominal pre-peritoneal repair (TAPP) is the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for minimally invasive approach. Repair with a mesh was preferred by 98% of the surgeons and synthetic monofilament light weight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and, 1% after minimally invasive repair. Only 10% of surgeons preferred open repair with local anaesthesia. Conclusion This survey identified similarities and variations in practice globally along with some discrepancies in inguinal hernia repair compared to best practice guidelines. It also identifies several key areas where more focus future research is required.

Comparison of Different Weight Meshes in Ventral/Incisional Hernia Repair, the Outcomes of Systematic Review and Meta-analysis.

The use of mesh is not without complications. Decreasing the mesh weight with the light-weight (LW) mesh may improve tissue growth and diminish mesh-related complications, yet, clinically, there are conflicting results regarding the influence of different weight meshes in ventral/incisional hernia repair. The aim of the present study is to compare the outcomes of different weight meshes for ventral/incisional hernia repair. The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies were published through January 1, 2022, using the keywords "heavy weight" "light weight" "mesh" "ventral hernia" "incisional hernia". All relevant articles and reference lists in these original studies were also obtained from the above databases. Eight trials (4 randomized controlled trials, 3 prospective studies, and 1 retrospective study) containing 1844 patients were included in the present meta-analysis. The pooled results showed that there was a significantly more rate of foreign body perception in the heavy-weight mesh group compared with the LW mesh group (odds ratio = 5.02, 95% CI: 1.05, 24.06). There was no significant difference concerning hernia recurrence, seroma, hematoma, surgical site infection, reoperation rate, chronic pain, quality of life, and hospital stay among different weight mesh groups. Different weight meshes showed similar clinical results in ventral/incisional hernia repair, except that, perception of foreign body was reported more frequently in the heavy-weight mesh group as compared with the LW mesh group. However, the long-term hernia recurrence with different weights of meshes needs to be reevaluated considering the relative short-term follow-up in these studies.

Are we following guidelines in inguinal hernia repair? An evaluation of practice patterns in the abdominal core health quality collaborative

Aim : The HerniaSurge Group established inguinal hernia repair guidelines to reduce recurrence and chronic pain. We evaluated whether the surgeons of the Abdominal Core Health Quality Collaborative (ACHQC) follow these guidelines and identify areas for improvement. Methods : A retrospective evaluation of data from the ACHQC database between 2013-2021 using 18,641 eligible subjects undergoing elective and emergent hernia repair with 30-day follow-up. Compliance with a given guideline was defined as following the recommendation in 70% of cases. Results : Twelve of 19 questions with available data met recommendations based on our above criteria. Eight recommendations with strong evidence and four recommendations with weak evidence were met. The recommendations not met were using the Shouldice technique for any non-mesh open inguinal herniorrhaphy, using local anesthesia for open repair of reducible inguinal hernias, using lightweight mesh, and avoiding the use of prophylactic antibiotics in laparoscopic herniorrhaphy. Conclusion : Despite varied techniques for inguinal hernia repair, surgeons of the ACHQC follow the majority of the recently published guidelines on the subject. While further research is needed to strengthen the existing guidelines, a standardized approach will facilitate this effort while aiming to reduce negative patient outcomes.

Sharp Feature-Preserving 3D Mesh Reconstruction from Point Clouds Based on Primitive Detection

High-fidelity mesh reconstruction from point clouds has long been a fundamental research topic in computer vision and computer graphics. Traditional methods require dense triangle meshes to achieve high fidelity, but excessively dense triangles may lead to unnecessary storage and computational burdens, while also struggling to capture clear, sharp, and continuous edges. This paper argues that the key to high-fidelity reconstruction lies in preserving sharp features. Therefore, we introduce a novel sharp-feature-preserving reconstruction framework based on primitive detection. It includes an improved deep-learning-based primitive detection module and two novel mesh splitting and selection modules that we propose. Our framework can accurately and reasonably segment primitive patches, fit meshes in each patch, and split overlapping meshes at the triangle level to ensure true sharpness while obtaining lightweight mesh models. Quantitative and visual experimental results demonstrate that our framework outperforms both the state-of-the-art learning-based primitive detection methods and traditional reconstruction methods. Moreover, our designed modules are plug-and-play, which not only apply to learning-based primitive detectors but also can be combined with other point cloud processing tasks such as edge extraction or random sample consensus (RANSAC) to achieve high-fidelity results.

An international survey of 1014 hernia surgeons: outcome of GLACIER (global practice of inguinal hernia repair) study.

The practice of inguinal hernia repair varies internationally. The global practice of inguinal hernia repair study (GLACIER) aimed to capture these variations in open, laparoscopic, and robotic inguinal hernia repair. A questionnaire-based survey was created on a web-based platform, and the link was shared on various social media platforms, personal e-mail network of authors, and e-mails to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC). A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were preferred by 43% and 47% of participants, respectively. Transabdominal pre-peritoneal repair (TAPP) was the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for a minimally invasive procedure. Ninety-eight percent of the surgeons preferred repair with a mesh, and synthetic monofilament lightweight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and 1% after minimally invasive repair. Only 10% of surgeons preferred to perform an open repair using local anaesthesia. This survey identified similarities and variations in practice internationally and some discrepancies in inguinal hernia repair compared to best practice guidelines, such as low rates of repair using local anaesthesia and the use of lightweight mesh for minimally invasive repair. It also identifies several key areas for future research, such as incidence, risk factors, and management of chronic groin pain after hernia surgery and the clinical and cost-effectiveness of robotic hernia surgery.

A modified Rives–Stoppa technique with composite mesh (FLaPp) in large incisional hernia: a multicentric retrospective cohort study

Summary Background Large incisional hernias (LIH) are challenging conditions, often necessitating complex surgical procedures such as transversus abdominis muscle release (TAR). We evaluated the feasibility and effectiveness of tension-free abdominal wall repair of LIH with an innovative modified Rives–Stoppa procedure employing a composite free lateral polypropylene (FLaPp) prosthesis. Methods Symptomatic patients affected by LIH and treated with FLaPp composite prosthesis between April 2010 and December 2016 were retrospectively analyzed. The FLaPp prosthesis is made up of two layers: an internal layer based on a polypropylene film that can be used in contact with the intestinal loops to address the posterior peritoneal defect, and an external layer based on a macroporous lightweight mesh, with which a classic repair according to Rives–Stoppa is carried out. Results Forty-three patients were enrolled in the study. All hernias were W3. Early complications were seroma (16.3%), hematoma (11.6%), wound infection (7.0%), and bowel injury (2.3%). Late complications were sinus tract (4.7%), occasional pain (2.3%), and stiff abdomen (9.3%). The median operative time was 126 min and median hospitalization was 8 days. At the median follow-up of 40 months (range 37.5–117), the recurrence rate was 9.3% (4/43). Conclusion Use of FLaPp mesh with a tension-free surgical approach is an effective strategy for managing LIH in selected cases with the presence of a posterior defect, with low rates of complications and recurrences.

Comparison of Early Postoperative Pain between Lightweight Mesh and Heavyweight Mesh in Lichtenstein Hernia Repair for Geriatric Patients at Rumah Sakit Siloam Karawaci from January 2018 - December 2019

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Inguinal hernias are one of the most often cases in surgery. Inguinal hernias are usually found in males rather than females. There are two types of meshes in inguinal hernia repairs: heavyweight and lightweight mesh. There were still a lot of differences in the outcome of each mesh that was used. Therefore, with various different post operative pain results from past research, the author expresses an interest to conduct a research on this topic towards geriatric patients&lt;strong&gt;.&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this cross-sectional comparative study, 45 patients using heavyweight mesh and 45 patients using lightweight mesh herniorrhaphy with Lichtenstein technique in inguinal hernias at RS Siloam Karawaci Lippo Village and RSU were reviewed retrospectively. Patient's data were taken from medical record using purposive-sampling method. Early Postoperative pain on day 1 until 7 were classified following the Visual Analogue Scale (VAS). Incidence of postoperative infection and seroma were assessed in both groups. Collected samples will be processed using Pearson's Chi-Squared test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;This study shows that there is a significant difference between the use of lightweight mesh in reducing moderate early postoperative pain for men above the age of 60 years old (p = 0.025) rather than the use of heavyweight mesh. Incidence of other postoperative complications such as infection and seroma have no statistically difference between both groups.&lt;/p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The use of lightweight mesh has the advantage in reducing early postoperative pain from herniorrhaphy using Lichtenstein technique rather than heavyweight mesh in men above 60 years old.

RECOMMENDATIONS FOR PERSONALIZE CHOICE OF HERNIA MESHES USED FOR INGUINAL HERNIA OPERATIONS

The abdominal hernias become more prevalent with age. The objective of this study was to investigate the choice of the proper brand of hernia mesh according to the age of the patients. Seventy-eight samples of fascia harvested from 19 fresh cadavers were subjected to uniaxial tension tests and divided into four groups according to age: Group A (up to 60 years), Group B (61–70 years), Group C (71–80 years) and Group D (81–90 years). Median stress–stretch ratio curves with respect to age and direction of loading were obtained. The elastic modulus of samples and the level of orthotropy (the ratio between tensile stress in the longitudinal and the transversal direction) were calculated at 5% strain. Uniaxial tensile tests were performed also using five standard meshes (Microval, Parietex Composite, Surgimesh, Surgipro, TecnoMesh) and five lightweight meshes (Optilene, Parietex, TiO2Mesh, Ultrapro, Vypro II). The elastic modulus and level of orthotropy at 5% strain were calculated. The results of the study showed that Parietex Composite, Microval and Vypro II are recommended for 71–80 years patients, while Parietex Light is recommended for patients up to 60 years.

(418) Corpora Cavernosa Reconstruction for Penile Prosthetics Surgery Using a Lightweight Mesh: A Viable Alternative? A Single Center Experience

Abstract Introduction Options for reconstruction of the corpora cavernosa are limited. Synthetic grafts like Dacron™ and GORE-TEX™ are used but have high infection rates. Lightweight macroporous mesh is a promising alternative due to better integration and surrounding tissue ingrowth. We present the first experience of using a lightweight mesh for this indication in a single high-volume institution. Objective To evaluate long term outcomes of corporal reconstruction using a lightweight mesh measuring where previous options had failed. Methods The medical records of all patients undergoing insertion or revision of penile prosthesis between May 2016 and November 2019 were reviewed retrospectively. Patient characteristics, management and outcomes (including patient satisfaction) including any complications were extracted with long term follow up (24-month minimum) Results Twenty patients required corpora cavernosa reconstruction during penile prosthesis surgery (median age 56, range 18 to 74 years). Reasons for reconstruction included severe corporal fibrosis due to multiple revisions and deficient tunica (n=7), impending erosion (n=6), congenital corporal agenesis (n=2), aneurysm of cylinder (n=1) ossified Peyronie’s disease plaque excision grafting (n=1) and crossover/perforation (n=3). All but two patients (with corporal agenesis) presented for revision penile prosthesis surgery. Coloplast Titan® OTR inflatable penile prostheses were used in all patients. Two patients (13%) required explant after a mean follow-up period of 7.4 months (+/−2.6 SEM). The first experienced erosion of the prosthesis through the distal corpora 6 months after surgery while the other required explant due to debilitating chronic pain after 3 months. There was no other complication (including infection). All patients (who did not require explantation) were satisfied with their penile prosthesis and are currently sexually active. Conclusions Our early results suggest that a lightweight macroporous mesh may be an alternative synthetic graft for corporal reconstruction in experienced high-volume hands experienced in revision, reconstruction and salvage procedures. The poliglecaprone-25/polypropylene mesh (ULTRAPRO®, Ethicon LLC, USA) is ideal because it is partially absorbable while providing a strong scaffold, easy to handle and not bulky. Further long-term follow-up is required, and with increasing advances in stem cell tissue engineering perhaps even better graft material choices will be available in the future. Disclosure No

P-013 No recurrence after 15 years prospective long-term follow-up of open Total ExtraPeritoneal / TransInguinaI PrePeritoneal (oTEP/TIPP) inguinal hernia repair

Abstract Aim Evaluation of long-term follow-up results after open transinguinal preperitoneal (TIPP) technique with preformed lightweight mesh (PLM). Method This unicentric study included all consecutive 102 patients(10 women, 92 men; 93 primary, 9 recurrent hernias) operated for a groin hernia by the same surgeon using the same technique between June 2008 – September 2009. All patients were postoperatively followed-up with a control after 1 month and a survey follow-up between 40 and 54 months after surgery with subsequent clinical control if something abnormal appeared in the survey in January 2013. Results up until January 2023 were retrieved from the Swedish Hernia Register. Results 102 hernia repairs - 54 in general, 48 in local anesthesia. Clinical control after 1 month: There was no infection of the mesh, no clinical recurrence. -No reoperations were required. Questionnaire follow-up: -95 patients (93%) were followed-up. Slight, not permanent pain in 8.8% of patients who did not require the consumption of systematic painkillers and are not limited in their activities. No reoperations have so far been recorded in the Swedish Hernia Register with 81 patients still alive in long-term follow-up . Discussion -No recorded recurrences after 15 years of follow-ups is encouraging. -This technique consisted of the placement of a patch in the preperitoneal space, which combines the benefits of the anterior approach (i.e., easy and safe technique, short learning curve, local anesthesia, low cost) and the preperitoneal placement of the mesh (less recurrence, less pain). This procedure is a good alternative to eTEP technique. PLM=PolysoftMesh/Bard