Mesh Repair Of Hernia Research Articles

Severe Anaphylaxis Following Intradermal Test Dose of Ceftriaxone

Abstract Ceftriaxone is a third-generation cephalosporin antibiotic used commonly for treating infections; however, hypersensitivity reactions, including anaphylaxis, occur in approximately 1%–3% of patients. Anaphylaxis can vary from minor skin rashes to life-threatening events affecting multiple organ systems, making it challenging for anesthesiologists. We present a case of severe anaphylaxis resulting in anaphylactic shock after an intradermal test dose of ceftriaxone in a 55-year-old female undergoing umbilical hernia mesh repair. The patient was a well-controlled hypertensive who came with stable vital signs before surgery. However, soon after administering the test dose, she began to exhibit asystole and unresponsiveness; hence, cardiopulmonary resuscitation immediately commenced, along with intravenous administration of adrenaline. Although consciousness returned, she failed to show palpable pulses while maintaining adequate respiratory effort. She was put on 100% oxygen with noninvasive ventilation and managed on noradrenaline and adrenaline infusions due to significant hypotension. After 6 days in critical care, the patient’s condition improved, allowing for weaning from the ventilator and eventual discharge. This incident, despite a negative history of allergy testing, points to the unpredictable nature of drug hypersensitivity and the importance for anesthesiologists and surgical teams to be keen on monitoring patients. As there was normal recovery with adequate left ventricular function, we did not think in terms of any other cause. Clear documentation of such reactions is essential for future medical care, underlining the importance of complete allergy reviews to avoid similar life-threatening events. This case is also an important reminder about the vigilance that should be maintained during the perioperative period.

Assessing the Safety of Mesh Repair in Strangulated Groin Hernias: A Systematic Review and Meta-Analysis.

The use of mesh in emergency repair of complicated groin hernias has been a subject of discussion for decades. While it is now generally accepted that mesh could safely be used in incarcerated (irreducible) and obstructed hernias (without strangulation), with wound infection rates comparable to suture repairs, the use of mesh in strangulated hernias involving bowel resection is still controversial. The aim of this study, therefore, was to analyse the safety of mesh use in strangulated hernias with ischaemic bowel at the time of surgery.A literature search was carried out using relevant keywords. The study was conducted in accordance with the Preferred Reporting Items forSystematic Reviewsand Meta-Analyses (PRISMA) 2020 framework anddata analysis was done using the Review Manager version 5.4 (The Cochrane Collaboration, Oxford, UK) meta-analysis software.Seven studies comprising 1,159 patients who had emergency surgery for strangulated groin hernias were analysed. A pooled random effect meta-analysis did not show any significant difference in the surgical site infection rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) = 0.39-1.96, p = 0.75), seroma formation (OR = 3.39; 95% CI = 0.70-16.43; p = 0.13), and hernia recurrence (OR = 0.33; CI = 0.05-2.22; p = 0.26) between the two groups. The long-held concern that mesh could not be safely used in strangulated groin hernias has not been validated by the results obtained from this systematic review and meta-analysis. However, more randomised controlled trials in this clinical area would need to be carried out to further validate the results of this study.

Enhanced chitosan and Carboxymethylcellulose scaffolds with natural fiber reinforcement for hernia repair meshes

AbstractChitosan (Chi) and carboxymethylcellulose (CMC) scaffolds, with and without reinforcement by Luffa cylindrica (Lc) or Asclepias curassavica (Ac), were synthesized to evaluate their potential application as hernia repair meshes. These meshes are crucial as they provide structural support to weakened tissues, reducing the risk of hernia recurrence and promoting faster recovery. They improve patient outcomes by enhancing the durability and effectiveness of hernia repairs. Chi scaffolds exhibited lower porosity compared to CMC scaffolds, with fiber inclusion enhancing porosity. The CMC4‐Ac scaffold demonstrated the highest porosity at 67.2%, which is crucial for supporting cell growth and tissue regeneration. All scaffolds exhibited exceptional hydration levels, which is vital for cell growth. Scanning electron microscope (SEM) images revealed open pores in the CMC4 scaffolds, which enhances tissue formation. Tensile strength tests indicated that all scaffolds surpassed the minimum requirements, with CMC4‐Ac standing out for its exceptional properties. CMC scaffolds showed greater degradation, which was mitigated by fiber reinforcement. Chi scaffolds absorbed more Croton draco extract (Cdext) but exhibited lower release rates compared to CMC scaffolds. No hemolytic and non‐cytotoxicity effects were observed. CMC4‐Ac emerged as the most promising scaffold due to its superior properties, making it suitable for hernia repair meshes.

Elective complex ventral hernia repair in contaminated fields: A propensity score–matched analysis of long-term quality of life and outcomes between different prostheses

BackgroundRandomized studies have endorsed nonabsorbable prosthetics for contaminated ventral hernia surgery, yet the broader applicability and impact on patient-reported outcomes are still questioned. Here, we evaluated the long-term outcomes of elective contaminated ventral hernia repairs (based on Centers of Disease Control and Prevention [CDC] wound classification) using real-world data from a multicenter US cohort, focusing on quality of life and postoperative pain. MethodsThe Abdominal Core Health Quality Collaborative database was queried for patients undergoing elective contaminated (CDC class II–IV) ventral hernia repair (2013–2023). After propensity matching, we compared long-term differences in patient-reported quality of life and pain scores (by HerQLes and PROMIS questionnaires) among those who underwent repair with nonabsorbable, absorbable synthetic, and biologic mesh. ResultsA total of 1,073 patients were included, of whom 920 (86%), 56 (5%), and 97 (9%) underwent repair with nonabsorbable, absorbable synthetic, and biologic mesh, respectively. Among them, the median age was 62 years (interquartile range [IQR] 53–70), and 523 (49%) were male. The median length and width of the defect were 20 cm (IQR 12–25) and 13 cm (IQR 8–16), respectively. A transversus abdominis release was performed in 716 patients (67% of all cases). In most cases, the mesh was positioned in the retro-rectus (85%) and/or the preperitoneal space (45%). Before and after propensity matching (n = 185), the change from baseline in HerQLes and PROMIS scores at 6 months and at 1, 3, 5, and 6 years was comparable between different types of mesh. Lastly, there were no differences in readmission, surgical site infection, or surgical site occurrence at 30 days. Recurrence at 1 year was also comparable among groups. ConclusionIn the long term, there were no differences in quality of life or pain scores with nonabsorbable, absorbable synthetic, or biologic mesh for elective ventral hernia repair in contaminated fields.

Robotic Pauli repair of parastomal hernia.

Robotic retro-muscular mesh repair of parastomal hernia (PH) is possible with transversus abdominis release. The aim of this study is to report mid-term results with this method. Patients who underwent surgery for PH were enrolled in a prospective study. Patients with concomitant midline hernia also underwent Rives repair. Polypropylene meshes with an absorbable buffer mesh were used in the retro-muscular pocket-except PTFE was chosen for inflammatory bowel disease patients. Follow-up was by telephone and physical examination and CT if suspicion of complication. Of the 56 included ostomy patients, 44 had colostomies, 10 had ileostomies, and two had urostomies. Thirty-nine percent had a concomitant hernia, and 25% had recurrent PH. The mean operating time without accessory repair was 156min (SD 37), and with accessory repairs 220min (SD 62). One bowel lesion and one vascular injury to the stoma occurred, prompting intraoperative stoma revision without postoperative morbidity. Postoperative complications ensued in 12 patients (23%). One patient had stoma necrosis after 3weeks and the stoma was relocated. One patient had a mesh infection, 3 patients temporary ileus, one patient hypovolemic renal failure, and two patients experienced a flare-up of their Crohn's Disease. One parastomal abscess was drained percutaneously. The median postoperative stay was 3days (1-21; mean 3.7days), and the readmission rate was 8.9%. The recurrence rate at mean and median 24months follow-up is 5.4%, two in ileostomy patients and one colostomy patient with unaltered bulging where CT shows a relatively large prolapse and recorded as a failure. Robotic Pauli repair has shown promising results. However, repair fails of PH at small bowel ostomies with short mesentery. ePauli/TAR is now the preliminary choice for eligible patients at our site. Comparative studies with the intraperitoneal mesh standard are needed.

Weighing the benefits: Exploring the differential effects of light-weight and heavy-weight polypropylene meshes in inguinal hernia repair in a retrospective cohort study

BackgroundInguinal hernia repair is a common surgical procedure, with more than 20 million cases yearly. Choice between mesh types varies in clinical practice. To compare light-weight polypropylene (LW-PP, 34–36 g/m2) and heavy-weight polypropylene (HW-PP, 95 ​g/m2) meshes. MethodsData from patients who underwent open inguinal hernia repair between 2020 and 2022. Selection criteria ensured homogeneity. Endpoints were to assess the impact of different mesh weights on overall health-related quality of life (HRQoL), using Short Form 36 (SF-36), and to monitor postoperative complications. ResultsTwo hundred patients were included in both groups. Lateral and direct hernias occurred in 60.5 ​% and 39.5 ​%. According to EHS, 31.5 ​%, 22.3 ​% and 46.2 ​% were classified as size 1, 2, 3. Follow-up showed similar HRQoL at 30-days, with a favorable trend towards LW-PP mesh offering fewer limitations, better comfort, and improved general health after 12-months. No difference in postoperative paresthesia, wound hematoma, and interference with daily activities. Conclusion1-year after surgery HRQoL evaluation highlights the non-inferiority of LW-PP. Mesh selection should be tailored, aiming at improving outcomes and postoperative comfort.

Laparo-endoscopic technique of management of a rare case of incarcerated urinary bladder hernia in a female

Abstract Inguinoscrotal hernia containing the urinary bladder is a rare entity, found in 1%–5% of inguinal hernias. We herein present a rare case of a 60-year-old female status post open hysterectomy who presented to emergency department with painful groin swelling and contrast enhanced computerized tomography of abdomen showed features of incarcerated urinary bladder hernia. She underwent emergency laparo-endoscopic bilateral inguinal hernia mesh repair. After extensive literature search, we believe that this is the first case report of incarcerated urinary bladder hernia in a female with infra-umbilical scar who underwent emergency laparo-endoscopic bilateral inguinal hernia mesh repair.

Open suture repair versus PermacolTM mesh repair of small ventral hernias in patients with end-stage kidney disease.

Ventral hernia is a common surgical problem among patients with end-stage kidney disease (ESKD), while the optimal repair technique for small ventral hernias is controversial. This study aimed to compare the outcomes of open suture repair versus biological mesh repair of small ventral hernias with defect size ≤2 cm in ESKD patients. Data from consecutive ESKD patients who underwent elective ventral hernia repair with defect size ≤2 cm at a single institution from January 2012 to January 2022 were retrospectively reviewed. Outcomes of open suture repair were compared to PermacolTM mesh repair. The primary outcome was recurrence rate. Secondary outcomes included post-operative complications, peri-operative and post-operative dialysis regimen. Forty-seven ventral hernia repairs were included, with 20 being suture repairs and 27 being PermacolTM mesh repairs. Median age at hernia repair was 60 (range 32-81) years old. Pre-operatively, 42 patients (89.4%) were on peritoneal dialysis (PD). Paraumbilical hernia (59.6%) was most common. Median hernia defect size was 15 mm (range 2-20 mm). Upon median follow-up of 56 (range 9-119) months, more patients in the suture repair group developed recurrence (30% vs. 0%, p = 0.004). Median time to recurrence was 10 (range 5-16) months. There was no wound or mesh infection. The majority of patients underwent intermittent PD peri-operatively and were able to resume on PD in the long run. Ventral hernia repair is indicated in ESKD patients even for small defects; repair with PermacolTM mesh was associated with a lower recurrence rate when compared to suture repair and post-operative morbidity was low.

A multicenter randomized controlled trial comparing short- and medium-term outcomes of novel biologics and lightweight synthetic mesh for laparoscopic inguinal hernia repair.

The use of biological graft in laparoscopic inguinal hernia repair (LIHR) has been controversial, and there is a lack of high-level evidence to confirm the value of biological graft in LIHR. The purpose of this study is to evaluate the effectiveness of a novel composite biologics in LIHR. A multicenter, single-blinded, randomized controlled clinical trial was designed. Fifty patients with unilateral primary inguinal hernia were randomly assigned to the experimental and control group (1:1). The experimental group was repaired with a non-crosslinked composite extracellular matrix from porcine urinary bladder matrix and small intestinal submucosa (UBM/SIS). The control group was repaired with a lightweight, large-pore, synthetic mesh. The primary endpoint was the effectiveness rate of hernia repair. The patients were followed up for four years. No significant difference was found between the experimental group and the control group in the effective rate of hernia repair (24/24[100%] vs 21/22[95.45%], RR, 0.4667; 95%CI, 0.3294-2.304; P = 0.4783). There was no fever, seroma, infection, groin pain, foreign body discomfort or recurrence in the experimental group during the follow-up. In the control group, there were 2 cases of seroma 14days after operation, 1 case of groin discomfort 60days after operation and one case of recurrence 410days after surgery. Compared with the lightweight synthetic mesh, the novel UBM/SIS graft has comparable short-term and medium-term effectiveness in LIHR, and the incidence of postoperative complications such as seroma groin discomfort is lower. Trial registration Clinical Trials Registry: ChiCTR1800020173.

Outcomes and complications of open mesh inguinal hernia repair in a district-level hospital in Bangladesh

Background: An inguinal hernia occurs when tissue protrudes through a weak spot in the abdominal muscles near the groin. Open mesh inguinal hernia repair aims to reinforce the abdominal wall with a mesh implant, reducing the risk of recurrence. This study aimed to assess the outcomes and complications of open mesh inguinal hernia repair. Methods: This cross-sectional study was conducted at the Department of Surgery, Moulvibazar 250 bed District Sadar Hospital from January, 2022 to July, 2023. As the study subjects, a total of 83 cases who had mesh repair for inguinal hernia were enrolled by using a purposive sampling technique. Data were analyzed using MS Office tools. Results: In this study, inguinal hernia recurrence was observed in 3 cases (3.6%), with 2 cases (2.4%) requiring reoperation. Intraoperatively, 96.4% (n=80) experienced no complications, while 1.2% (n=1) each suffered from injury to the spermatic cord and neurovascular structures. Postoperatively, over 10% of participants reported complications, including numbness (18.1%), hematoma (16.9%), scrotal swelling (15.7%), and seroma (13.3%). Conclusions: Recurrence and reoperation rates in open mesh inguinal hernia repair are relatively low. However, physicians should remain vigilant regarding potential postoperative complications such as numbness, hematoma, scrotal swelling, and seroma in patients undergoing this procedure.

Platelet-Rich Therapies in Hernia Repair: A Comprehensive Review of the Impact of Platelet Concentrates on Mesh Integration in Hernia Management.

Mesh-augmented hernia repair is the gold standard in abdominal wall and hiatal/diaphragmatic hernia management and ranks among the most common procedures performed by general surgeons. However, it is associated with a series of drawbacks, including recurrence, mesh infection, and adhesion formation. To address these weaknesses, numerous biomaterials have been investigated for mesh coating. Platelet-rich plasma (PRP) is an autologous agent that promotes tissue healing through numerous cytokines and growth factors. In addition, many reports highlight its contribution to better integration of different types of coated meshes, compared to conventional uncoated meshes. The use of PRP-coated meshes for hernia repair has been reported in the literature, but a review of technical aspects and outcomes is missing. The aim of this comprehensive review is to report the experimental studies investigating the synergistic use of PRP and mesh implants in hernia animal models. A comprehensive literature search was conducted across PubMed/Medline, Web of Science, and Scopus without chronological constraints. In total, fourteen experimental and three clinical studies have been included. Among experimental trials, synthetic, biologic, and composite meshes were used in four, nine, and one study, respectively. In synthetic meshes, PRP-coating leads to increased antioxidant levels and collaged deposition, reduced oxidative stress, and improved inflammatory response, while studies on biological meshes revealed increased neovascularization and tissue integration, reduced inflammation, adhesion severity, and mechanical failure rates. Finally, PRP-coating of composite meshes results in reduced adhesions and improved mechanical strength. Despite the abundance of preclinical data, there is a scarcity of clinical studies, mainly due to the absence of an established protocol regarding PRP preparation and application. To this point in time, PRP has been used as a coating agent for the repair of abdominal and diaphragmatic hernias, as well as for mesh fixation. Clinical application of conclusions drawn from experimental studies may lead to improved results in hernia repair.

A comparative study on effects of defect closure versus non-closure in laparoscopic totally extraperitoneal repair of direct inguinal hernia.

Totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair are the principal techniques in laparoscopic hernia repair. Seroma formation and pain are frequent complications of moderate-large size laparoscopic direct inguinal hernia mesh repair. This study was conducted to evaluate the feasibility of defect closure in moderate-large direct inguinal hernias and its effect on various outcomes. This is a prospective cohort study from September 2020 to August 2021, where a total of 88 patients with uncomplicated direct inguinal hernia (M3 or more) were enrolled in the study and divided into two equal groups of TEP defect closure and non-closure, and various outcome measures were noted. The majority of patients were male (94.31%), with a mean age range of 18-85 years, and had right-sided inguinal hernia (46.5%). Seroma formation at 10th POD in the defect closure and non-closure were 24% and 33% (p value: 0.225), which reduced to 11% and 18%, respectively, at 1 month (p value: 1.000). All seromas resolved within 6 months. Pain in VAS at 10th POD in the defect closure and non-closure were 1.55±0.571 and 1.38±0.527, respectively (p value: 0.121), which gradually decreased to 1.20±0.524 and 1.16±0.420 at a 6-month interval (p value: 0.689). The mean operative time in the bilateral and unilateral defect closure groups was 72.3±4.1 and 56.5±4.3 min, respectively, whereas that in the bilateral and unilateral defect non-closure groups was 62.3±3.7 and 45.7±3.6 min, respectively. The defect closure was found to have higher pain and less seroma formation at various intervals of time following TEP for moderate-large direct inguinal hernia. Although these findings were statistically insignificant, they may be clinically significant, and further studies with a larger sample size are suggested.

Oblique subcostal transverse abdominis plane block for postoperative pain control in patients undergoing open sublay mesh hernia repair: a prospective double-blind randomized placebo-controlled clinical trial

BackgroundA bilateral oblique subcostal transverse abdominis plane block may help provide perioperative analgesia and reduce opioid use in patients undergoing sublay mesh hernia repair, but its clinical value is unclear.MethodsIn...

A Comparative Study between Intra-Operative Difficulties and Early Postoperative Complications in Laparoscopic Inguinal Hernia Repair Using Conventional Polypropylene Mesh and 3D Mesh – A Meta-Analysis

Abstract Background The fundamental mechanism of abdominal wall hernia formation is the loss of structural integrity at the musculotendinous layer. The exact cause of inguinal hernia is still unknown but the factors contributing in its occurrence include; preformed congenital sac, chronic passive rise in the intra-abdominal pressure and weak abdominal wall. Objective To assess laparoscopic inguinal hernia repair using two different meshes: The conventional polyproline mesh and the three-dimensional (3D) mesh, as regard the operative application time, early post-operative complications including seroma, early pain, sensory impairment, surgical site infection (SSI) and hospital stay time using meta-analysis approach. Patients and Methods In our study ten trials included, three trials regarding 3d mesh versus conventional mesh in laparoscopic inguinal hernia repair including 9,118 participants were selected from electronic databases. Three trials regarding 3d mesh and four trials regarding polyprolene mesh. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Results There is significant heterogeneity among trials (P = 0.002, I2 = 84%), mean difference 1.17, 95% CI -2.18, 4.52 and there is no statistically significance z = 0.49. Conclusion There is no difference between conventional polyprolene and 3d mesh regarding intra- operative difficulties (operative time) and post-operative complications (chronic pain, recurrence, operative time and seroma).

Comparison of postoperative outcome of laparoscopic and open inguinal hernia mesh repair

Comparison of postoperative outcome of laparoscopic and open inguinal hernia mesh repair

Autoimmune/inflammatory syndrome induced by adjuvants in a patient after implantation of a polypropylene mesh for inguinal hernia repair (clinical case)

Aim. To report a clinical case of autoimmune/inflammatory syndrome, induced by adjuvants in patient after polypropylene mesh implantation for inguinal hernia repair.Materials and methods. Patient Z., male, 68 years old, was admitted to the hospital presenting muscle weakness and progressive dyspnoea. Interview and physical exam revealed signs of cognitive impairment and memory loss, proximal muscle weakness. Differential diagnosis was made to clarify genesis of symptoms, to rule out polymyositis, other systemic connective tissue diseases, oncologic diseases, hypothyroidism, infectious diseases.Results. Creatine kinase, thyroxine, thyreothropic hormone levels were normal. Clinical and immunological investigation revealed no data on polymyositis or any other systemic connective tissue disease. Yersiniosis, salmonellosis, malaria were ruled out. Chest CT scan, abdomen CT scan, gastroscopy, colonoscopy no data on the presence of malignant neoplasms. PSA level were normal. Electroneuromyography revealed signs of symmetrical axonal type damage to the motor portion of the ulnar nerves on both sides, and demyelinating type damage to the sensory portion. Prednisolone therapy was started at a dose of 40 mg per 24 hour (0.5 mg per kg), which lead to a significant clinical improvement. Based on the therapy response and positive diagnostic criteria (clinical manifestation after polypropylene mesh implantation, typical clinical manifestation – muscle weakness, chronic fatigue, cognitive impairment, neurological manifestations associated with demyelination) patient was diagnosed with autoimmune/inflammatory syndrome, induced by adjuvants (ASIA) after polypropylene mesh implantation for inguinal hernia repair.Conclusion. This clinical case report demonstrates possibility of a persistent course of the disease (symptoms were present for 15 years). Feature of this case is partial clinical improvement due to long-term uncontrolled dexamethasone use, which was prescribed empirically.

Treatment of chronic mini-thoracotomy wound pain and lung herniation with intercostal cryoablation and surgical mesh repair: a case report

BackgroundThe incidence of minimally invasive heart surgery via mini-thoracotomy (MT; right anterior thoracotomy) is on the rise, accompanied by an increase in post-MT intercostal nerve neuralgia and the risk of lung herniation through the incision site. While various methods have been proposed to address these issues, none have been commonly effective. In this case report, we attempted to simultaneously address these problems by performing intercostal cryoablation (IC) and mesh repair.Case presentationA 43-year-old male was referred to our hospital for chronic post-thoracotomy neuralgia following heart surgery via MT, involving patch closure of an atrial septal defect and tricuspid annuloplasty. He presented with intercostal nerve neuralgia and lung herniation accompanied by severe pain. Despite medication and lidocaine injections, there was no relief. Consequently, he underwent surgical treatment with IC for chronic MT wound pain and simultaneously underwent mesh repair for a lung hernia. He was discharged from hospital free of complications. Subsequently, he no longer required further pain medication and experienced a favorable recovery.ConclusionOur findings suggest that concurrent IC and mesh repair can effectively relieve chronic post-MT intercostal nerve neuralgia and severe lung herniation pain in patients who underwent MT surgery, leading to a decrease in opioid medication usage.

A Nutraceutical Combination of Bromelain and Boswellia Serrata Casperome® in Siben®: Effects on the Postoperative Course of Inguinal Hernioplasty with Mesh at One Year Follow up. A Randomized Multicentric Study.

We investigated the potential benefits of administering a nutraceutical combination of Bromelain (200 mg) and Boswellia serrata Casperome® (200 mg) on post-operative outcomes of hernioplasty with mesh. One hundred eighty patients (27 females, 153 males) were enrolled to undergo open tension-free hernioplasty with the use of Progrip®. Patients were randomized to receive either one tablet of Siben® (study group) or placebo (control group) on an empty stomach, every twelve hours for eleven postoperative days. All patients filled out a medical questionnaire focused on postoperative pain, based on the Visual Analogue Scale (VAS) scale and the Short Form-36 (SF-36) questionnaire, at time T0 (day of surgery) and T28 (28th day after surgery). One-year results showed a significant improvement in the primary postoperative outcome in the study group. Perception of pain was significantly reduced in the Siben® group compared with controls, both on the seventh (p < 0.05) and the twenty-first (p < 0.05) postoperative day. Patients included in the Siben® group also resumed daily activities and returned to work earlier than the controls. Moreover, results of the SF-36 indicated better Quality of Life (QoL) scores in the study group compared to the placebo group. Our analysis effectively demonstrates that the use of Siben® in open inguinal hernia mesh repair may improve short- and long-term surgical outcomes, contributing to a better QoL.

Laparoscopic repair for a recurrent epigastric incisional hernia following xiphoidectomy: A case report

Introduction: Xiphodynia is a rare musculoskeletal disorder characterized by epigastric or anterior chest pain, for which xiphoidectomy is considered as a definitive treatment. This procedure and its complications are not well researched, particularly within Australasian populations. We describe the novel laparoscopic incisional hernia repair from a xiphoidectomy complicated by recurrent epigastric hernias. Case Report: A 49-year-old female presented with chronic epigastric pain post-xiphoidectomy for xiphoidynia. The patient previously underwent open mesh repair for an incisional epigastric hernia, complicated by infection and subsequent removal of the mesh. A vacuum-assisted closure device was then utilized, followed by delayed primary closure. However, she experienced ongoing pain, a recurrent mass, and hypertrophic scarring, confirmed by abdominal computed tomography (CT) scan. Our laparoscopic approach involved a standard supine position with three ports and preperitoneal dissection similar to transabdominal preperitoneal (TAPP) hernia repair. The defect was 5 × 8 cm in size. A simple prolene mesh (9 × 12 cm) was secured with AsorbaTack and Glubran 2, followed by peritoneal closure with a 3/0 V-Loc suture. At two months follow-up, the patient had no evidence of recurrent hernia, no ongoing pain, and satisfactory wound healing. Conclusion: Laparoscopic surgical repair using a TAPP approach is a safe alternative to open repair of an incisional recurrent epigastric hernia post-xiphoidectomy.

LAPARASCOPIC VERSUS OPEN MESH REPAIR FOR RECURRENT INGUINAL HERNIA: A SYSTEMATIC REVIEW

Background: Inguinal hernia is one of the most common conditions seen in clinic, and is often treated through the general surgery department. Laparoscopic repair and open repair with mesh are the typical treatments for inguinal hernia, and both regimens have proved beneficial in treating inguinal hernia. However, recurrence, with a rate as high as 33, poses a significant problem to the effective treatment of inguinal hernia. The aim: This study aims to show about laparascopic versus open mesh repair for recurrent inguinal hernia. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 10 articles, whereas the results of our search on SagePub brought up 60 articles. The results of the search conducted for the last year of 2013 yielded a total 2 articles for PubMed and 14 articles for SagePub. The result from title screening, a total 1 articles for PubMed and 10 articles for SagePub. In the end, we compiled a total of 7 papers. We included five research that met the criteria. Conclusion: The laparoscopic approach is superior to the open mesh approach for the repair of recurrent inguinal hernia in some aspects, including the incision infection rate and length of hospital stay. However, more high-quality studies on the effects of laparoscopic and open mesh repair for the treatment of recurrent inguinal hernia are warranted.