Macroporous Mesh Research Articles

Hernia Sac Preservation for Prevention of Transversus Abdominis Release in Laparoscopic Extended-Totally Extra Peritoneal Repair of Ventral Hernia: A Minimalistic Solution for a Formidable Challenge.

Background: Ventral hernia repair has always been an extensive and challenging surgery. The laparoscopic extended-Totally Extraperitoneal (E-TEP) technique of ventral hernia repair is gaining popularity due to the advantage of placing a large mesh in the retro rectus plane. When done through a Laparoscopic approach, the difficulty of the procedure is compounded by multiple factors such as obtaining retro muscular access, maintaining the retro muscular plane, crossing over to the contralateral retro muscular plane without entering intraperitoneally, suturing in a limited space, and manipulation of a large mesh in a constricted space for placement. In cases of large midline incisional hernias, dense adhesions to the previous surgical scar are often present. Despite having extremely satisfying outcomes, the aforementioned factors make the laparoscopic extended-total extraperitoneal repair of large midline ventral and incisional hernias an exceptionally challenging procedure. A tension-free midline approximation is the benchmark of ventral/incisional hernia surgery. In certain cases, this can be difficult to achieve due to multiple factors. For the purpose of attaining tension-free midline closure, component separation techniques (CST) have been explored and implemented. Of these, the posterior component separation technique of Transversus Abdominis Release (TAR) has gained popularity for reducing the tension of posterior rectus sheath during posterior midline closure in retro muscular repairs by adding a few centimetres of medial advancement. The main pitfall of TAR is its technical complexity, which may result in morbid complications when implemented incorrectly. Performing TAR laparoscopically compounds the complexity manyfold. Hence, to obviate the necessity to perform Laparoscopic TAR in cases of Laparoscopic E-TEP repair of large midline ventral and incisional hernias, we present that the technique of hernial sac preservation should be pre-emptively carried for all Laparoscopic ETEP repairs so that the necessity of performing TAR in select cases is reduced by aiding in the addition of final crucial centimetres of lengthening to the posterior rectus sheath for achieving posterior midline closure. This aids in the success of the procedure by preventing an additional complex procedure of TAR from being performed in an already challenging hernia repair technique of Laparoscopic E-TEP repair. Methods: We hereby report three cases of Ventral hernia repair in which Laparoscopic E-TEP repair was carried out and Hernial sac preservation technique was implemented successfully. Midline closure of the posterior rectus sheath was attained under reduced tension and a medium-weight macroporous polypropylene mesh was placed in the retro-rectus plane after measurement of the potential space. Patients were discharged uneventfully. Results: Patients were followed up for up to 6months postoperatively and were found to have no complications. Conclusion: In Laparoscopic E-TEP repair of midline ventral hernias, preservation of the hernial sac along with the posterior rectus sheath might aid in the prevention of performing a TAR in selected cases where posterior layer tension is present. Hernia sac preservation thereby aids in reducing operative time and preventing potential morbid complications.

Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis.

Use of macroporous synthetic mesh in contaminated ventral hernia repair has become more frequent. The objective of this study is to compare the outcomes of ventral incisional hernia repair with permanent synthetic mesh in contaminated fields to those in a clean field. The Abdominal Core Health Quality Collaborative registry, a prospectively updated longitudinal hernia-specific national database, was retrospectively queried for adults who underwent open ventral incisional hernia repair using light or medium-weight synthetic mesh and classified as clean (CDC Class I) or contaminated (CDC Class II/III). Univariate analysis was used to compare demographic information, hernia characteristics, and operative details. Odds ratios (OR) were calculated using multivariable logistic regression for the primary outcome of 30-day surgical site infection (SSI) and secondary outcomes of 30-day surgical site occurrence (SSO), SSO requiring procedural intervention (SSO-PI), and clinical recurrence at one year. 7219 cases met criteria for inclusion; 13.2% of these were contaminated. 83.4% of patients had follow-up data at 30days and 20.8% at 1year. The adjusted OR for 30-day SSI in contaminated fields compared to clean was 2.603 (95% CI 1.959-3.459). OR for 30-day SSO was 1.275 (95% CI 1.017-1.600) and 2.355 (95%CI 1.817-3.053) for 30-day SSO-PI. OR for recurrence at one year was 1.489 (95%CI 0.892-2.487).Contaminated cases had higher rates of mesh infection (3.9% vs 0.8%, p < 0.001) and mesh removal (7.3 vs 2.5%, p < 0.001) at 1 year. After adjusting for baseline differences, patients undergoing ventral incisional hernia repair using light or midweight synthetic mesh in contaminated fields have higher odds of 30-day SSI, SSO, and SSO-PI than those performed in clean wounds. The odds of recurrence did not statistically differ and further studies with long-term outcomes are needed to better evaluate the best treatment options for this patient population.

V-024 LAPAROSCOPIC ENHANCED-VIEW TOTALLY EXTRAPERITONEAL RIVES-STOPPA REPAIR (E-TEP RS). FIRST EXPERIENCE AT HOSPITAL UNIVERSITARIO DE CANARIAS

Abstract We present the case of a 55-years-old female with a personal history: high blood pressure, dyslipidemia, without previous abdominal surgeries. Height: 1,65 m; Weight: 62 Kg. BMI: 22,7. Clinical and ultrasound diagnosis of a painful and partially reducible ventral hernia M2 W1 (EHS Classification). It is programmed for hernia correction using the Laparoscopic Enhanced-View Totally Extraperitoneal Rives-Stoppa Repair (e-TEP RS) technique adapted to the hernia defect. Access is made to the left retrorectal space on the left flank, medial to the semilunar line but lateral to the epigastric vessels; dissection of the retrorectal space with a disector balloon on a 5 cm perimeter around the hernia defect; pneumoperitoneum; cross-over manoeuvre connecting the two retrorectal spaces with the medial preperitoneal space; dissection and reduction of the hernia sac; closure of the hernia defect with bearded reabsorbable suture. Implantation of polyvinylidene fluoride (PVDF) macroporous mesh in retrorectal space without using any type of fixation. A retromuscular closed-suction drain is then placed and the place is then desuflatted. The patient is discharged at 12 hours postoperative with in situ drainage, wich was removed in consultation 48 horas after surgery due to null debit. We present the first published case, in our latitude, of a e-TEP RS adapted to the hernia defect. It is a challenging but safe and effective technique as well as practically painless postoperative technique.

OC-017 INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE FOR THE LAPAROSCOPIC TREATMENT OF PRIMARY AND INCISIONAL VENTRAL HERNIA IN DAY SURGERY REGIME

Abstract IPOM technique is a well-established technique for the repair of primary and incisional ventral hernia; and outpatient regime is considered a cost-effective strategy without compromising the quality of care. In this retrospective observational study, we evaluated the application of IPOM technique through outpatient setting, with the use of a non-absorbable, transparent, light prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent polypropylene film. 179 consecutive procedures of primary and incisional hernia repair from 2011 to 2022 have been included in this study (149 with the above-mentioned composite meshes and 30 with other meshes, semi-absorbable and non-absorbable). All the procedures were performed through 3 abdominal trocars executing cold adhesiolysis to release the contents of the hernial sac without dissecting the latter. The abdominal wall was then prepared by blunt dissection to create the space for the mesh and to favor a prompt cell colonization. Mesh fixation was achieved using transparietal points and resorbable tackers. The primary outcomes of the study were the evaluation of any risk factors for conversion from outpatient regime to standard hospitalisation, and the hernia recurrence, in two subgroups: primitive hernias (n=72) and incisional hernias (n=107). Our clinical experience showed that IPOM technique through outpatient setting is a safe and effective approach. No statistically significant difference in the recurrence rate between the primitive and incisional hernias groups (5.9% vs 5.0%, p=0.80) was found. Moreover, we found a relationship between the rate of unexpected hospitalization and age of the patients, number of defects and hernia dimension.

P-101 EVALUATION OF PATIENTS’ QUALITY OF LIFE AFTER LAPAROSCOPIC INTRAPERITONEAL ONLAY MESH (IPOM) TREATMENT OF PRIMARY AND INCISIONAL VENTRAL HERNIA

Abstract IPOM technique is a well-established technique for the repair of primary and incisional allowing a less invasive treatment compared to open approach and improving patient satisfaction. In this retrospective observational study, we evaluated the application of IPOM technique with the use of a non-absorbable, transparent, light surgical prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent film. 82 procedures of primary and incisional hernia repair from January 2018 to January 2022 have been included in this study. All the procedures were performed through 3 abdominal trocars without dissecting the hernia sac. Mesh fixation was achieved using transparietal points and resorbable tackers. The primary outcome of the study was the evaluation of patients’ Quality of Life (QoL assessed with EHS QoL scale) in two subgroups: primitive hernias (n=34) and incisional hernias (n=48). The secondary outcomes of the study were the evaluation of recurrence rate and postoperative complications rate. In both groups we recorded a significative improvement in patients’ QoL related to pain at rest, pain during physical activity and aesthetic discomfort (p &amp;lt;0.01). In the included cohort population, the hernia recurrence was recorded in 4 cases (4.9%, at 10, 18, 24 and 24 moths, respectively), and 3 patients experienced postoperative complications (3.7%). The recorded postoperative complications included pain (n=1, 1.2%), seroma infection (n=1, 1.2%) and intestinal obstruction (n=1, 1.2%). Our clinical experience showed that IPOM technique is a safe and effective approach, and it allows to significantly improve the patients’ QoL after surgery.

V-057 INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE FOR THE LAPAROSCOPIC TREATMENT OF INGUINAL HERNIA

Abstract Laparoscopic treatment of inguinal hernia is a widely accepted technique, especially in the case of bilateral or recurrent inguinal hernias. The evolution of materials has led to the successful use of double layer prostheses for the intraperitoneal treatment of wall defects, significantly reducing the mesh-related complications. In this regard, the literature data and the availability of non-absorbable, transparent, light surgical prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent film, have led to the re-proposal of the IPOM technique also for the treatment of primary inguinal hernias. After the laparoscopic access in the abdomen using a 10 mm trocar in the umbilical region and two 5 mm trocars operating in the Iliac fossae, the hernia is reduced by returning the hernial contents to their original compartments and the hernial sac is closed with the possible lipoma using purse-string suture. Subsequently, a polypropylene composite prosthesis is then inserted into the abdomen, centered on the defect and fixed to the wall by tack and chemical glue. To date we have performed 10 procedures on 6 patients (4 with bilateral hernia). The longest follow-up is one year. The patients were all discharged the day after the surgery, reporting a mean postoperative pain score (assessed with EHS QoL scale) equal to 2 (range: 0–4), and the work resumption after a week in average. This technique, which is easy to perform and reproducible, can significantly reduce operating times and minimize complications related to the preparation of the peritoneal pocket.

P-120 LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA USING A NON-ABSORBABLE TRANSPARENT COMPOSITE PROSTHESIS TOTALLY IN POLYPROPYLENE - OUR EXPERIENCE

Abstract Introduction Incisional ventral hernia is one of the most common surgical complications after laparotomy. The aim of this retrospective observational study is an evaluation of clinical outcomes after laparoscopic repair of incisional hernias with a non-absorbable and transparent composite prosthesis composed of a macro-porous monofilament polypropylene mesh and a transparent polypropylene film. Materials and Methods 63 patients, from January 2016 to December 2021, were treated for incisional hernia at Center of minimal invasive surgery Nis, Serbia. The mesh was always positioned intraperitoneally after closing the defects and fixed with absorbable tacks and non-absorbable suture. Results In the considered cohort (54% female and 46% male) the median age and BMI were 54 years (range: 39–68) and 25,1 kg/m2 (range: 21.5–30.3), respectively. Concerning hernia position, 93.7% of the hernias were medial, 4.8% lumbar and 1.6% medio-lumbar. According to EHS classification, 58.7% of the hernias were W1, 36.5% W2 and 12.7% W3. The average duration of hospitalization was 2 days. The rate of early post-operative complications was 6.3%, including 1 seroma (1.6%) and 3 patients reporting pain (4.8%). At a median follow up of 48 months (range: 6–60) we registered 2 cases of hernia recurrency (3.2%, both at 36 months follow-up) and 1 case of bowel obstruction (1.6%). All the considered variables did not result statistically significative in relation to post-operative complications. Conclusion Our clinical experience showed that intraperitoneal treatment of incisional hernia using a transparent composite prosthesis. The minimally invasive procedure allows a fast postoperative recovery and a consequent low economical cost.

P-105 A UNIQUE AND MULTIDISCIPLINARY APPROACH TO ABDOMINAL DEFECT CORRECTION AFTER TRAM FLAP

Abstract Aim The Transverse Rectus Myocutaneous (TRAM) flap is a valid option in autologous breast reconstruction with acceptable aesthetic results, but the absence of the rectus muscle can be responsible for the discomfort and functional lost caused be the asymmetry of the abdominal wall with a slight bulge. It's also described that incisional hernias can develop following TRAM, and the management is often challenging. We want to present a case of a multidisciplinary surgery with immediate correction of the abdominal defect after the TRAM flap. Material and Methods We describe a case of a woman who, at the same surgical time, underwent skin-sparing mastectomy with immediate reconstruction with a TRAM flap and correction of the muscle defect of the abdominal wall with transverse abdominis release (TAR) with placement of a wide, macroporous polypropylene mesh with 48mg/m2 density in a retromuscular position. Results The association of the TAR with the placement of a wide mesh retromuscular allows a greater containment of intraabdominal force, with less bulging and better aesthetic results at the muscle donor site. Conclusion The correction of the muscle defect should be considered at the same time of the TRAM flap. The multidisciplinary approach in these cases can reduce the patient's surgical morbidity and allow better aesthetic and functional outcomes. Note: we use a DIPROMED®, BULEVB5050 mesh

P-078 LAPAROSCOPIC TREATMENT OF UMBILICAL HERNIA IN A COMMUNITY HOSPITAL SETTING

Abstract Introduction Umbilical Hernia is a common ventral hernia in the adult population. The classical approach was represented by open repair, but in recent years laparoscopic treatment is increasingly adopted and it can present some intraoperative and post-operative advantages. Materials and methods We prospectively analyzed a case series of 50 laparoscopic primary and incisional umbilical hernia repairs performed between January 1st, 2020, and December 31st, 2021. We collected data concerning age, sex, hernia defect size, operative time, and complications according to Clavien-DindoClassification, recurrence at 6 months, and 1-year follow-up. Results We performed laparoscopic umbilical hernia repairs in 50 patients (32males,18females);mean age52.1year-old(range30–82y.o.).Mean defect size was4.5cm(3–6.8cm).All procedures were performed under general anesthesia and with 5mm trocars and optic and under pneumoperitoneum pressure set until 10 mmHg as the maximum value. In all cases we applied a transparent, lightweight, ultra-thin, nonabsorbable surgical prosthesis in polypropylene, made by a monofilament macroporous mesh and a transparent film. and we performed closure of fascia with adsorbable stitches. Mean Operative time:40minutes(30–65min.).No complications and recurrences were reported. Conclusions Laparoscopic treatment of umbilical hernia is a safe and feasible procedure; indeed, we consider reducing hernia from the abdominal cavity generally better than the open approach and composite mesh positioning with direct fascial closure usually allows a satisfying repair of the defect.

BJS-03 DO WE NEED FIXATION OF THE MESH IN LAPAROENDOSCOPIC TECHNIQUES FOR M3 INGUINAL DEFECTS? AN EXPERIMENTAL STUDY

Abstract Background Hernia societies strongly recommend fixing the mesh in case of large M3 defects in laparoendoscopic repairs. The purpose is to reduce recurrence, which is alarmingly high for this defect. The authors conducted a research experiment to verify the hypothesis that it is possible to preserve the mesh in the operating field in large direct hernias (M3) without the need to use fixing materials. Method Authors conducted an experiment with scientists from Universities of Technology in a model that reflects the conditions in the groin area. By simulating conditions of the highest possible intra-abdominal pressure, they examined the mesh behavior within the groin and its ability to dislocate under the forces generated by this pressure. The experiment involved six spatial implants and one flat macroporous mesh. Results Heavyweight spatial meshes and lightweight spatial individualized mesh showed no tendency to dislocate or move directly to the gate, which was considered a rapid hernia recurrence. Lightweight Meshes, both spatial and flat, underwent significant migration and shifting towards the hernial gates. Conclusion Based on the results, we believe that mesh fixation is not the only alternative to preventing recurrence in complex defects. Similar effects can be achieved by using a larger, more rigid and anatomically fitted implant. The type of implant (rather than its fixation) seems to be a key factor from the point of view of mechanics and biophysics. Clinical trials confirming the results in vivo, will allow to supplement or amend the guidelines for the treatment of large inguinal hernias.

V-034 IPOM PLUS: IS THERE ANY PLACE LEFT? WHY WE (STILL) DO IT

Abstract Aim In this video, we want to share and discuss what we have learned from our 20-year experience in IPOM PLUS, for scheduled as emergencies Material and Methods We use only all 5 mm trocars, instruments, and 30-degree optics and we always use low intra-abdominal pressure - 10mmHg. The technical trick is to carefully prepare and manage the abdominal wall context, to free all the hernia areas. Results Our experience is almost more than 500 cases, elective as an emergency. In the last years, we normally use a prosthesis, made with a monofilament macroporous mesh and transparent film(with the film versus the intestine), with a 5 cm overlap. Besides the well known needed physical characteristics of the mesh, on the surgeon's side, a mesh should be smooth, stiff, wide enough to cover all the possible defects, easy to handle, and, especially for its possible use in laparoscopy, with a certain degree of and thickness just what it is needed to let it pass through a 5 mm trocar once rolled up. We use to close the defect to avoid serosa and SS - Morbidity and we use to fix the mesh with absorbable tackers. Above all we do believe in the diagnostic value of the technique, cause allows us to better see and judge the intraabdominal context Conclusions The advantages of laparoscopy rely on the minimal access and the possibility to manage and examine the abdominal context, especially in emergencies, close the defect, and fix the mesh with tackers.

Is mesh fixation necessary in laparoendoscopic techniques for M3 inguinal defects? An experimental study.

Although international guidelines recommend not fixing the mesh in almost all cases of laparoendoscopic repairs, in case of large direct hernias (M3) mesh fixation is recommended to reduce recurrence risk. Despite lack of high-quality evidence, the recommendation was upgraded to strong by expert panel. The authors conducted a research experiment to verify the hypothesis that it is possible to preserve the mesh in the operating field in large direct hernias (M3) without the need to use fixing materials. The authors conducted an experiment with scientists from Universities of Technology in a model that reflects the conditions in the groin area. By simulating conditions of the highest possible intra-abdominal pressure, they examined the mesh behavior within the groin and its ability to dislocate under the forces generated by this pressure. The experiment involved six spatial implants and one flat macroporous mesh. Heavyweight spatial meshes and lightweight spatial-individualized meshes showed no tendency to dislocate or move directly to the orifice, which was considered a rapid hernia recurrence. Lightweight meshes, both spatial and flat, underwent significant migration and shifting toward the hernial orifices. Based on the results, we believe that mesh fixation is not the only alternative to preventing recurrence in complex defects. Similar effects can be achieved using a larger, more rigid, and anatomically fitted implant. The type of implant (rather than its fixation) seems to be a key factor from the point of view of mechanics and biophysics. Clinical trials confirming the results in vivo will allow to supplement or amend the guidelines for the treatment of large inguinal hernias.

What's in a wrap?

What's in a wrap?

3D printed long-term structurally stable bioceramic dome scaffolds with controllable biodegradation favorable for guided bone regeneration

Alveolar bone loss and insufficient bone mass are major obstacles to the oral implant treatment. Guided bone regeneration (GBR) is an effective and widely used method to solve this problem. Titanium mesh with good 3D space maintenance ability shows excellent effect in the assistance of GBR. Unfortunately, such metal mesh needs to be removed by secondary operation, and the exposure after operation can’t be completely avoided. Thus, it is a big challenge to repair the alveolar bone defects with different shapes and sizes by customization. Herein, the wollastonite bioceramics without and with 6% magnesium doping (CSi, CSi-Mg6) were prepared to fabricate the macroporous dome-like meshes with different CSi/CSi-Mg6 mass ratio (0:100, 16:84, 32:68) via digital light processing-based 3D printing (DLP) technique. The mechanical parameters, biodegradable rate and osteogenic stem cell viability in vitro of the bioceramic scaffolds with different morphologies were also evaluated systematically. The macroporous bioceramic dome- or titanium mesh-assisted osteogenic potentials in the calcined bone granules were evaluated in the rabbit calvarial bone defect models. The experimental results showed that the scaffolds with 16%CSi exhibited satisfactory mechanical properties and promoted the proliferation and differentiation of osteogenic stem cells. The bioactive domes displayed significantly higher osteostimulate activity than the metal mesh in the calcined bone mineral granule systems. The appreciable CSi-Mg6 content (≥84%) in the dome scaffolds could maintain the porous structures after 16 weeks of implantation, and especially the presence of 16% CSi in the bioceramic dome may greatly balance the scaffold biodegradation and restoration treatment. Totally, the 3D printed nonstoichiometric wollastonite-based scaffolds are expected to be the promising candidates to replace titanium mesh in GBR.

Collagen Deposition and Inflammatory Response Associated with Macroporous Mesh Shrinkage in Incisional Hernia Repair: A Rat Model

Background: Mesh repair is the current recommendation for the treatment of incisional hernia; however, the best mesh has yet to be determined. The objective of this study was to compare the inflammatory response and collagen deposition in primary incisional hernia repair (P) and different macroporous mesh materials, including polypropylene with poliglecaprone (PP-PG), polyvinylidene fluoride (PVDF), and polyester (PE), using quantitative methods. Methods: Sixty male rats were divided into four groups. Anterior abdominal wall defects were created and either suture or mesh repair was done. Rats were euthanized on days 14, 90, and 180, and the gross findings were recorded. The inflammatory and collagen levels in the abdominal wall tissues were measured using enzyme-linked immunosorbent assay (ELISA). Results: The PE group demonstrated significant mesh shrinkage at 180 days. The extent of PE mesh shrinkage ranged from 22–42% (mean = 30.49%). At 14 days, the PVDF group had higher interleukin-6 (IL-6) levels than the PP-PG (P = .004) and PE groups (P = .019). At 90 days, the collagen type I (Col I) levels in the PE group were significantly lower than those in the others, and the collagen type I/III (Col I/III) ratios in the PE group were lower than those in the P group (P = .006). Conclusions: The persistently high IL-6 levels until 180 days and the decrease in Col I levels and Col I/III ratio at 90 days seem to predict mesh shrinkage at 180 days. The mesh induces high Col I levels, but those associated with low Col III levels should be preferred.

Macroporous Surgical Mesh from a Natural Cocoon Composite

Macroporous Surgical Mesh from a Natural Cocoon Composite

A Suture-less Underlay Ventral Herniorrhaphy Technique for High-Risk Complex Abdominal Wall Reconstruction.

Many factors increase the complexity of abdominal wall reconstruction including attenuated fascia, loss-of-domain, prior hernia surgeries, multiple fascial defects, enterocutaneous fistulas, and mesh infections. We describe our experience of using a suture-less mesh fixation underlay ventral herniorrhaphy technique to combat such issues in high-risk ventral hernia repair. This is a prospective-observational study. Patients from 2019 onward undergoing emergent or elective cases were included. The technique: A large porcine acellular-dermal-matrix (ADM) alone or sutured to a light-weight, macroporous polypropylene mesh is created and placed with ADM facing the bowel. Fibrin glue is sprayed over the mesh, fascia and skin closed. An abdominal binder is placed pre-extubation and left undisturbed for 5 postoperative days. Of 34 included patients, the average demographic was a Caucasian (62.9%) female (65.7%), with class-I or greater obesity (76.5%), hypertension (74.3%), dyslipidemia (48.6%), non-skin malignancy (40.0%), type II diabetes mellitus (34.3%), a ventral hernia working group class of III-IV (55.9%), a mean of 3 ± 2.2 prior surgeries, and mean fascial defect size of 12.3 x 13.5cm. Five were prior solid-organ transplant recipients. Four patients underwent simultaneous tumor extirpations and herniorrhaphy. Five cases (14.7%) were emergent. Removal of prior mesh was performed in 48.5% of cases-seven had infected mesh. Median length of stay was 7 days, with 141 days median follow-up time. Fifteen patients (44.1%) developed a complication. Hernia-specific complications were limited to healing problems. There were no recurrences. This technique is easy and safe to employ in patients requiring high-risk complex abdominal reconstructions with minimal hernia-specific complications.

Randomised controlled trial: standard lightweight mesh vs self-gripping mesh in Lichtenstein procedure

&lt;b&gt; Introduction:&lt;/b&gt; Lichtenstein hernioplasty has been a gold standard of hernioplasty for 30 years now. However, the procedure may be followed by an unacceptably high rate of chronic pain, numbness and discomfort. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; To compare outcomes of Lichtenstein repair using a Parietene ProGrip self-fixing mesh versus the standard lightweight macroporous mesh. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; As many as 141 patients with unilateral primary inguinal hernia participated in this single-centre, randomised, prospective, single-blind (patient-blinded) study. Randomisation yielded two treatment groups: control group of 88 patients treated with Lichtenstein method using lightweight standard mesh (LS) and study group of 53 patients receiving treatment with self-fixing mesh (PG). Patients were followed up for 6 months. Primary outcome was the presence and severity of postoperative pain at discharge, at 30 days and 6 months post-procedure. Other study parameters were: duration of the procedure, duration of hospitalisation, presence of early and late complications, time needed to return to full activity and patient satisfaction. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; No statistically significant differences in pain severity were demonstrated at discharge or at long-term follow-up. In the first 30 days post-procedure the patients in the PG group complained of pain of greater severity on the NRS (2.0 vs 1.4) (P = 0.0466). The duration of the procedure in the PG group was 9.4 minutes shorter than in the LS group (P = 0.0027). No statistically significant differences between the groups were found in other studied parameters. &lt;/br&gt;&lt;/br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Self-fixing mesh can be safely used in inguinal canal repair procedures. It significantly shortened the duration of the procedure but at the same time did not reduce the severity of pain, including the rate of chronic postoperative inguinal pain.

Prospective Evaluation of Laparoscopic Sacrocolpopexy with Concomitant Laparoscopic-Assisted Total Vaginal Hysterectomy

(1) Background: Sacrocolpopexy (SCP) with subtotal hysterectomy (SH) is a standard procedure for the treatment of utero-vaginal prolapse. Several disadvantages are associated with the remaining cervix; therefor, SCP with total hysterectomy (TH) may be preferred. According to some publications, SCP with concomitant TH is associated with higher rates of mesh extrusion. Our hypothesis is that mesh extrusion at the apex can be avoided through prevention of thermal injury and through vaginal cuff suturing when performing the laparoscopic sacrocolpopexy combined with a laparoscopic-assisted vaginal total hysterectomy (LAVH). (2) Methods: This prospective cohort study was performed from 2016 until January 2019 including women with a utero-vaginal prolapse undergoing laparoscopic SCP with LAVH. The SCP was performed utilizing a non-absorbable polypropylene macroporous mesh (EndoGYNious®). The primary outcome was the mesh extrusion rate after SCP with concomitant LAVH. The secondary outcome was the objective and functional outcome. (3) There were 50 women included in this prospective cohort. At follow up of 6–12 weeks postoperatively, no mesh extrusion was detected and objectified. Overall, all women showed excellent anatomical and functional outcome. The median time from surgery was 42 months. (4) Laparoscopic SCP with concomitant LAVH showed no increased risk of mesh extrusion and good objective and functional outcomes.

THE USE OF SURGICAL ADHESIVE AND SUTURE FIXING MESHES TO THE ABDOMINAL WALL: AN EXPERIMENTAL STUDY IN RATS.

ABSTRACT - BACKGROUND:Proper fixation of the surgical mesh determines the success of a herniorrhaphy. Understanding the inflammatory response and the mechanical properties of the mesh helps to define whether a fixation method is superior.AIM: This study aimed to evaluate the healing of defects in the abdominal wall of rats, comparing the repair of macroporous polypropylene meshes fixed with surgical glue and polypropylene thread.METHODS: In 20 Wistar rats, a defect was produced in the abdominal wall, with the integrity of the parietal peritoneum. For correction, the meshes were fixed with surgical glue (2-octyl cyanoacrylate) (subgroup C1), or polypropylene suture (subgroup C2). The two subgroups of 10 animals were euthanized on the 90th postoperative day, and the fragments of the abdominal wall were submitted to macroscopic, histological, and tensiometric analysis.RESULTS: Macroscopic analysis did not show any abnormalities. Tensiometry on the 90th postoperative day in subgroup C1 showed mean rupture tension of 28.47N and in subgroup C2 32.06N (p=0.773). The inflammatory process score revealed that both groups are in the subacute phase (p=0.380).CONCLUSION: The fixation of a polypropylene macroporous mesh to repair an abdominal wall defect can be performed with surgical glue (2-octyl cyanoacrylate) or polypropylene suture, both methods being equally effective.