Mesh Implantation Research Articles

COMPARATIVE HISTOLOGICAL CHARACTERISTICS OF CHANGES IN ANTERIOR ABDOMINAL WALL TISSUES AFTER IMPLANTATION OF «CAPROMESH» MESH IN COMBINATION WITH PRP AND «LIGHT» POLYPROPYLENE MESH IN AN EXPERIMENT

A systematic review of a recently published meta-analysis shows that laparoscopic and open allogeneoplasty is a safe procedure with relatively short-term and long-term results. A new minimally invasive technique has been developed that allows the mesh to be placed in the retroperitoneal space through a small transhernial incision, avoiding signifi cant trauma to the abdominal wall and contact with the abdominal cavity. However, this type of operation does not involve fi xation of the mesh in the retromuscular space, which can lead to a number of complications. The analysis of the obtained results determines the relevance of this study.Objective. To compare the features of the ultrastructural reaction of the tissues of the muscle- aponeurotic layer of tissues to the implantation of «Capromesh» in combination with PRP and polypropylene meshes in an experiment.Material and methods. The study was conducted on 16 same-sex pigs of the Vietnamese breed weighing at least 10 kg, which were divided into 2 groups. Histological and ultrastructural changes in the tissues of the muscle- aponeurotic layer of the anterior abdominal wall after implantation in the retromuscular space of «Capromesh» in combination with PRP (plasma enriched with growth factors) and polypropylene meshes were studied in the experiment.The results. A signifi cant diff erence in tissue reactions at diff erent times of the experiment on the implanted material was proven. The conducted microscopic and electron microscopic studies after the implantation of the «Capromesh» mesh in combination with PRP established that starting from the 7th day of the experiment, the infl ammatory changes in the tissues of the muscle- aponeurotic layer are not as signifi cant as during the implantation of the polypropylene mesh. Starting from the 14th day of the experiment, the signs characterizing the reduction of the infl ammatory reaction and the more intense formation of fi brous structures around the mesh material are much better expressed. On the 21st day of the experiment, at the microscopic and electron microscopic levels, a signifi cantly smaller number of areas of leukocyte infi ltration, intensive vascularization from the formation of collagen fi bers with the participation of fi broblasts around the «Capromesh» mesh material in combination with PRP was established.Conclusions. The conducted micro- and ultrastructural studies determined the priority of using the «Capromesh» mesh in combination with PRP under the conditions of material selection when performing retromuscular allogeneoplasty.

Якість життя як критерій ефективності хірургічного лікування генітальних пролапсів, поєднаних із лейоміомою матки

Criteria for choosing the volume of surgical intervention in patients with genital prolapse combined with uterine leiomyoma have not been developed. Purpose - to evaluate quality of life after hysterectomy with and without correction of genital prolapse. Materials and methods. 120 patients were examined. In the Control (I) Group (n=40), hysterectomy was performed without correction of genital prolapse, in the other two groups - hysterectomy and correction of genital prolapse using a mesh implant by the method of pectopexy (the Group II, n=40) or lateral fixation (the Group III, n=40). The PFDI-20, PISQ and PD-QOL questionnaires were used to assess the quality of life after the operation. Statistical analysis was performed with SPSS Version 21.0. Results. Significant differences in the average number of points were registered in the Group II and Group III - 45.39±27.02 and 49.78±17.24 points respectively; p<0.001. The sexual function index also significantly increased: from 18.93±14.61 to 24.85±12.19 points in the Group II and from 17.55±10.64 to 24.30±13.92 points in the Group III (р=0.01). During the analysis 12 months post surgery, attention was drawn to reliable differences in the average estimates of the impact of manifestations of genital prolapse on the quality of life (the PD-QOL questionnaire), physical and social limitations, interpersonal relationships and emotional problems in the Group II/Group III compared to patients in the Group I (p<0.05). Conclusions. The data we obtained allow us to talk about the effectiveness of simultaneous correction of genital prolapse with hysterectomy using mesh implants. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Comprehensive Treatment of Disseminated Fibrous Cavernous Pulmonary Tuberculosis with Extrapleural Thoracoplasty by Mesh Implant

The objective: to increase the effectiveness of comprehensive treatment of patients with advanced fibrous cavernous pulmonary tuberculosis using the new method of extrapleural upper-posterior thoracoplasty with a mesh implant.Subjects and Methods. It was an open, prospective, randomized, controlled study of treatment outcomes of 233 patients with fibrous cavernous pulmonary tuberculosis who had contraindications to resection surgery. Patients were divided into three groups depending on the type of thoracoplasty: thoracoplasty with a mesh implant was performed in 70 patients, thoracoplasty according to Bjork - in 60 people, and traditional upper-posterior thoracoplasty - in 103 patients.Results. In operated patients, additional support with a mesh implant during the formation of a new pleural dome reduced pathological flotation of chest organs, which prevented decreased respiratory function, the right heart overload, and protected from the development of bronchopulmonary complications in the early postoperative period. The chances of cavity healing and sputum conversion by the discharge from hospital increased by 3,3 times (OR=3,3; 95% CI 1,6-6,7), a year later by 3,0 times (OR=3,0; 95% CI 1,48-7,5); in the long-term assessment it increased chances of survival by 4,8 times (OR=4,8; 95% CI 1,4-16,4) versus the Bjork operation and traditional upper-posterior thoracoplasty.

Long term observation of de novo adipogenesis using novel bioabsorbable implants with larger size in a porcine model

IntroductionThe regeneration of adipose tissue in patients after breast cancer surgery would be desirable without the use of growth factors or cells to avoid potential recurrence and metastasis. We reported that prolate spheroidal-shaped poly-L-lactic acid (PLLA) mesh implants of approximately 18-mm polar diameter and 7.5-mm greatest equatorial diameter containing collagen sponge (CS) would be replaced by regenerated adipose tissue after implantation, thereby suggesting an innovative method for breast reconstruction. Our study aimed to evaluate the adipose tissue regeneration ability of implant aggregates in a porcine model. MethodsWe prepared implant aggregates consisting of thirty PLLA mesh implants containing CS packed in a woven poly (glycolic acid) bag. The implant aggregates were inserted under the mammary glands in the porcine abdomen for a year. Single and double groups were classified by inserting either one or two implant aggregates on each side of the abdomen, respectively. ResultsIn both groups, the volume of the implant aggregates decreased over time, and the formation of adipose tissue peaked between 6 and 9 months. Histologically, the formation of adipose tissue was confirmed in the area that was in contact with native adipose tissue. ConclusionsOur implant aggregates could induce the autologous adipose tissue after long term implantation in vivo, without the use of any growth factor or cell treatment, presenting a potential novel method of breast reconstruction.

Development of new bioabsorbable implants with de novo adipogenesis

Poly-L-lactic acid (PLLA) mesh implants containing collagen sponge (CS) were replaced with autologous adipose tissue regeneration in vivo. Herein, we investigated the optimal external frames and internal fillings using poly (lactic-co-ε-caprolactone) (P (LA/CL)), PLLA, and low-molecular-weight PLLA (LMW-PLLA) as the external frame and polyglycolic acid (PGA) nanosheets and CS as the internal filling. We prepared six implants: P (LA/CL) with PGA nano, PLLA with PGA nano, PLLA with CS, PLLA with 1/2 CS, PLLA with 1/4 CS, and LMW-PLLA with CS, and evaluated adipogenesis at 6 and 12 months using a rat inguinal model. The internal spaces in the P (LA/CL) and LMW-PLLA implants collapsed at 6 months, whereas those in the other four implants collapsed at 12 months. Adipose tissue regeneration was not significantly different between the PLLA-implanted groups at 6 and 12 months and was greater than that in the P (LA/CL) with PGA nano and LMW-PLLA with CS groups. The PGA nanosheet inside PLLA was comparable to the CS inside PLLA in the regeneration of adipose tissue and macrophage infiltration. In summary, PLLA is a promising external frame material in which the internal space can be replaced with adipose tissue. Thus, PGA nanosheets are an alternative internal filling material for adipose tissue regeneration.

Transversalis fascia suture reinforcement may facilitate the performance of electrospun P(LLA-CL) nanoscale fibrinogen mesh in inguinal hernia repair: a prospective single-center cohort study

The aim of this study was to evaluate a new electrospun P(LLA-CL) nanoscale fibrinogen mesh performance in real-world clinical practice. A prospective, single-center evaluation of Lichtenstein inguinal hernia repair using electrospun P(LLA-CL) nanoscale fibrinogen mesh in elderly patients with comorbid diseases was conducted between 2020 and 2022. A suture reinforcement of transversalis fascia was applied before mesh implantation. Hernia recurrence, pain score and overall complication rate were measured. A total of 52 inguinal hernias in 48 patients were included. The age of patients ranged from 33 to 95 years, with a median of 78 years. Comorbid conditions included cardiopulmonary disease, organ dysfunction, anticoagulant use, diabetes and smoking. By optimizing the physical condition perioperatively, all patients finished treatment successfully. Four cases recurred secondary to direct hernias or combined hernias and were diagnosed in the first 24 case cohort during follow-up. With surgical procedural modification involving strengthening the posterior inguinal floor by reef-up suturing of the transversalis fascia and the inferior edge of mesh slit to accommodate the spermatic cord, no further recurrence was diagnosed. Postoperative pain was mild and the pain score decreased three months after surgery compared to 1 week after surgery (p = 0.0099). No severe complications occurred, while seroma occurred in six cases. Electrospun P(LLA-CL) nanoscale fibrinogen mesh is safe and effective in repairing inguinal hernias in elderly patients with comorbid disease. A strengthening of the transversalis fascia by suturing may enhance the performance of this mesh.

Choice of Polymer, but Not Mesh Structure Variation, Reduces the Risk of Bacterial Infection with Staphylococcus aureus In Vivo.

Synthetic mesh material is of great importance for surgical incisional hernia repair. The physical and biochemical characteristics of the mesh influence mechanical stability and the foreign body tissue reaction. The influence on bacterial infections, however, remains ill-defined. The aim of the present study was to evaluate the influence of a modified mesh structure with variation in filament linking on the occurrence of bacterial infection that is indicated by the occurrence of CD68+, CD4+, and CD8+ cells in two different materials. A total of 56 male Sprague Dawley rats received a surgical mesh implant in a subcutaneous abdominal position. The mesh of two different polymers (polypropylene (PP) and polyvinylidenfluoride (PVDF)) and two different structures (standard structure and bold structure with higher filament linking) were compared. During the implantation, the meshes were infected with Staphylococcus (S.) aureus. After 7 and 21 days, meshes were explanted, and the early and late tissue responses to infection were histologically evaluated. Overall, the inflammatory tissue response was higher at 7 days when compared to 21 days. At 7 days, PP meshes of the standard structure (PP-S) showed the strongest inflammatory tissue response in comparison to all the other groups. At 21 days, no statistically significant difference between different meshes was detected. CD8+ cytotoxic T cells showed a significant difference at 21 days but not at 7 days. PP meshes of both structures showed a higher infiltration of CD8+ T cells than PVDF meshes. CD4+ T helper cells differed at 7 days but not at 21 days, and PVDF meshes in a bold structure showed the highest CD4+ T cell count. The number of CD68+ macrophages was also significantly higher in PP meshes in a standard structure when compared to PVDF meshes at 21 days. The inflammatory tissue response to S. aureus infection appears to be highest during the early period after mesh implantation. PP meshes showed a higher inflammatory response than PVDF meshes. The mesh material appears to be more important for the risk of infection than the variation in filament linking.

EFFECTIVENESS OF SYNTHETIC IMPLANTS FOR GENITAL PROLAPSE SURGERY

The aim of the study is to evaluate the effectiveness of synthetic implants for genital prolapse surgery in women of different age groups.
 Materials and Methods. 139 patients underwent genital prolapse surgery, vaginal approach, with synthetic mesh and biologic grafts. For the anterior, posterior and complete reconstruction of the vaginal walls, two mesh implants were used: Pelvix (Lintex, Russia) and Prolift (Ethicon Women´s Health and Urology, Johnson and Johnson Company, USA). The size of mesh implant was adapted to each particular case.
 Results. The most common intraoperative complication was intraoperative blood loss. During pelvic floor reconstruction with mesh implants, it was 1.8 times and 1.5 times higher in reproductive age and perimenopause respectively, compared with grafts. In postmenopause, there was a tendency to greater blood loss in surgeries with biological grafts. In reproductive age, the frequency of early postoperative complications was the same for mesh and non-mesh repair. In perimenopause, complications were three times more often for mesh repair, and in postmenopause, complications were observed in every third examined patient, regardless of the repair used. Late postoperative complications (pelvic pain and dyspareunia) occurred more often for biological graft: in reproductive age – twice, in perimenopause – 1.5 times, and in postmenopause – 5 times as frequently as for mesh.
 Conclusion. Prolapse surgery with synthetic implants is effective, safe and justified in terms of pathogenesis.

Management of mesh infection after open inguinal hernia repair.

Objective: To analyze the outcomes of mesh infection management following inguinal hernia repair. Study Design: Retrospective Cohort study. Setting: Department of Surgery, Khyber Medical University Institute of Medical Sciences DHQ Teaching Hospital Kohat. Period: January 2022 to December 2022. Material & Methods: Patients who had mesh implants for the correction of inguinal hernias were the subjects of this study. The hospital notes of these patients were retrospectively evaluated, and data concerning the patients' presentations, types of prior hernia repairs, types of mesh used, operative findings, and complications following mesh infection repair. Results: During the study period, 40 patients reported with mesh related infections among patients with history of inguinal hernia repair. Out of these 40 patients, 37 (92.5%) were male and 3 (7.5%) female. The mean age was reported to be 52.8±6.4 years. The mean duration of inguinal hernia repair was 10.8±4.2 months. All patients were examined for possible causes for the mesh infection and it was found that unincorporated polypropylene was the commonest possible factor behind mesh infection and reported in 18 (45.0%) cases. Follow up record of patients for at least 6 months was evaluated following mesh infection management and 32 (90.0%) patients reported no complications. Conclusion: Outcomes of mesh infection management following inguinal hernia repair were good. Clinical judgment is necessary to determine the extent of mesh removal.

Анатомічні та функціональні результати після хірургічного лікування поєднаної лейоміоми матки з генітальним пролапсом

More than 41% of women aged 50-79 suffer from pelvic organ prolapse. Genital prolapse is combined with uterine leiomyoma in approximately 20% of cases, which necessitates a differentiated approach to the treatment. Purpose - to compare the anatomical and functional results of surgical treatment of women with uterine leiomyoma combined with genital prolapse, who underwent hysterectomy with and without prolapse correction. Materials and methods. 80 patients with genital prolapse combined with uterine leiomyoma were examined and divided into three groups. In the Control (I) Group (n=40), hysterectomy was performed without correction of genital prolapse, in the other two groups - hysterectomy and correction of genital prolapse using a mesh implant by the method of pectopexy (the Group II, n=40) or lateral fixation (the Group III, n=40). Anatomical and functional outcomes were assessed 6 and 12 months postoperatively using the POP-Q and the questionnair PFDI-20 and PISQ-12. Statistical analysis was performed with SPSS Version 21.0. Results. In women of the Groups II and III, POP-Q parameters significantly improved 6-12 months after surgery compared to the initial level, while in patients of the Group I, 1 year after surgery, negative dynamics of changes in points Aa, Ba and indicators of pb and Tvl were established. Anatomical success, which is POP-Q stage 0-1 one year after surgery and does not require further surgical treatment, was 82.5% in the Group II and 85% in the Group III. The frequency of improvement of pelvic functions according to PEDI-20 and the state of sexual function according to PISQ-12 6 months after the operation was significantly higher among women of the Groups II and III comparing to the Group I. Conclusions. The obtained data testify to the anatomical effectiveness of simultaneous hysterectomy and correction of genital prolapse using mesh implants. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

IMMUNOHISTOCHEMICAL TRENDS OF THE CONSEQUENCES OF MESH AND AUTODERM IMPLANTATION INTO THE ANTERIOR ABDOMINAL WALL IN RATS

This research involves a comparative study of the immunohistochemical features of the inflammatory response of the anterior abdominal wall tissues after implantation of the autoderm and polypropylene mesh in rats. The object of the study were 36 Wistar rats, which were divided into two groups of 18 specimens each. In the first group, a polypropylene mesh was implanted; in the second group, de-epithelialized skin (autoderm) was implanted. On days 3, 7, 14, 30, and 90, we studied: CD68 as a pan-macrophage marker, CD3 as a pan-lymphocyte marker, and Bcl-2 the apoptosis regulator. Statistical analysis was performed using the Spearman-Rho-Test. The peak of an acute inflammatory response in the tissues after the implantation of polypropylene mesh and autoderm occurs 72 hours after the surgery. Arresting of acute inflammatory response after autodermal implantation is achieved 30 days after surgery. A specific reaction of the anterior abdominal wall tissues to polypropylene, in contrast to the autoderm, is the formation of a persistent chronic inflammatory response 90 days after the operation, which is due to the starting biodegradation of the synthetic implant. The Spearman-Rho-Test showed a highly significant correlation between CD68 and CD3 (r = 0.341, p = 0.001). A high correlation was found between CD68 and Bcl-2 (r = 0.195, p = 0.033) and CD3 and Bcl-2 (r = 0.220, p = 0.021). CD3, CD68 and Bcl-2 markers give evidence of the severity of the inflammatory response.

Parastomal hernias: the current state (review)

Every year there is an increase in the number of patients with intestinal stoma, which leads to an increase in the incidence of parastomal hernias (PSH). More than 50% of ostomy patients develop a parastomal hernia two or more years after radical surgery. To date, there are many surgical options for PSH, however, a unified algorithm for choosing an operational technique has not been evolved.The purpose of this review is to study modern surgical methods for the treatment of PSH and their late results, to determine the optimal approach and benefits.The review of the literature showed that in all cases of surgical treatment of PSH it is necessary to use mesh implants. The optimal technique for PSH hernioplasty is the laparoscopic version of Sugarbaker due to the low risk of recurrence and technical simplicity. In patients with large and giant PSH or hernia recurrence, STORRM is the technique of choice; classical stoma transposition is not used due to the high risk of recurrence. The use of Pauli/ePauli technique demonstrates a low recurrence rate, but there are no late results in this category of patients.

Predictors for surgical site infection in patients undergoing therapeutic or prophylactic intra-abdominal onlay mesh (IPOM) implantation in clean and contaminated surgical fields

BackgroundProphylactic intra-abdominal onlay mesh (IPOM) implantation has been shown to reduce the rate of fascial dehiscence and incisional hernia. However, surgical site infection (SSI) in presence of an IPOM remains a concern. The aim of this study was to assess predictors for SSI following IPOM placement in hernia and non-hernia abdominal surgery in clean and contaminated surgical fields.MethodsObservational study including patients undergoing IPOM placement at a Swiss tertiary care hospital 2007–2016. IPOM implantation was performed in hernia and non-hernia elective and emergency abdominal surgery, including contaminated and infected surgical fields. The incidence of SSI was prospectively assessed by Swissnoso according to CDC criteria. The effect of disease- and procedure-related factors on SSI was assessed in multivariable regression analysis, adjusting for patient-related factors.ResultsA total of 1072 IPOM implantations were performed. Laparoscopy was performed in 415 patients (38.7%), laparotomy in 657 patients (61.3%). SSI occurred in 172 patients (16.0%). Superficial, deep, and organ space SSI were found in 77 (7.2%), 26 (2.4%), and 69 (6.4%) patients, respectively. Multivariable analysis revealed emergency hospitalization (OR 1.787, p = 0.006), previous laparotomy (1.745, p = 0.029), duration of operation (OR 1.193, p < 0.001), laparotomy (OR 6.167, p < 0.001), bariatric (OR 4.641, p < 0.001), colorectal (OR 1.941, p = 0.001), and emergency (OR 2.510, p < 0.001) surgery, wound class ≥ 3 (OR 3.878, p < 0.001), and non-polypropylene mesh (OR 1.818, p = 0.003) as independent predictors for SSI. Hernia surgery was independently associated with a lower risk for SSI (OR 0.165, p < 0.001).ConclusionThis study revealed emergency hospitalization, previous laparotomy, duration of operation, laparotomy, as well as bariatric, colorectal, and emergency surgery, abdominal contamination or infection, and usage of non-polypropylene mesh as independent predictors for SSI. In contrast, hernia surgery was associated with a lower risk for SSI. The knowledge of these predictors will help to balance benefits of IPOM implantation against the risk for SSI.Graphical abstract

Late Frontal Bone Reconstruction Using Three-Dimensional Printed Models for Titanium Mesh Customization: A Case Series

The convex frontal bone is covered by thin skin rendering its reconstruction cosmetically challenging. Customized alloplastic implants provide better contouring than autologous bone, yet their high cost and availability limit their application. We assess customized titanium mesh implants pre-contoured using patient specific 3-D printed models for late frontal cranioplasty. We retrospectively analyzed the prospectively collected cases of unilateral frontal titanium mesh cranioplasty with 3-D printing assisted preplanning from 2017 to 2019. We used two 3-D printed patient specific skull models for preoperative planning: the mirrored normal model for implant contouring, and the defect model for edge trimming and fixation planning. The endoscope was used in four cases for percutaneous mesh fixation. We documented postoperative complications. We assessed the reconstruction symmetry clinically, and radiologically on postoperative computed tomography. 15 patients were included. The duration after previous surgery ranged from 8-24 months. Four patients developed complications that were managed conservatively. Favorable cosmetic outcomes were achieved in all patients. Pre-contouring of titanium mesh implants using in-house 3-D printed models could optimize cosmetic and surgical outcomes in late frontal cranioplasty. Preoperative planning could permit minimal access surgery that could be aided by the endoscope in select cases.

Anatomic and functional results of ventral biological mesh rectopexy for posterior pelvic floor disorders.

Ventral mesh rectopexy (VMR) is the gold standard for rectal prolapse surgery, but the type of mesh reinforcement is still a matter of debate. The aim of this study was to assess the anatomic and functional results of a single center cohort of patients receiving ventral rectopexy with biological mesh compared to a reference group who had implantation of synthetic mesh. We also assessed the predictive factors for recurrence. Seventy patients (2015-2021) were included in the biological mesh group and were compared to a reference group of 345 patients operated on with a synthetic mesh (2004-2017). In the biological mesh group, the mean age of patients was 65 years (53-72). The main disorders of the posterior pelvic floor were rectal prolapse (30 cases) or rectocele (37 cases). Two patients had solitary rectal ulcer syndrome and one had internal prolapse. VMR was performed by a laparoscopic approach with robotic assistance in 93%. After a median follow-up of 12 (4.5-23) months, the anatomic recurrence rate was 10%. The median satisfaction score assessed in a telephone interview by a semi-quantitative scale from 0 to 10 was 7. Compared to the synthetic group, neither the morbidity rate (Dindo>2) (0.6% synthetic versus 1.4% biological mesh), nor the recurrence rate (12% synthetic versus 10% biological (ns) with an average interval of 13.5 versus 14 months, respectively) were statistically significantly different. VMR with biological mesh represents an alternative to synthetic mesh. Despite its resorbable nature, biological mesh does not seem to increase the risk of recurrence and offers satisfying functional results after a medium term follow-up.

High Adherence of Oral Streptococcus to Polylactic Acid Might Explain Implant Infections Associated with PLA Mesh Implantation.

The aim of this study was to evaluate and compare the biofilm formation properties of common pathogens associated with implant-related infections on two different implant material types. Bacterial strains tested in this study were Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis, and Escherichia coli. Implant materials tested and compared were PLA Resorb × polymer of Poly DL-lactide (PDLLA) comprising 50% poly-L-lactic acid and 50% poly-D-lactic acid) and Ti grade 2 (tooled with a Planmeca CAD-CAM milling device). Biofilm assays were done with and without saliva treatment to evaluate the effect of saliva on bacterial adhesion and to mimic the intraoral and extraoral surgical routes of implant placement, respectively. Five specimens of each implant type were tested for each bacterial strain. Autoclaved material specimens were first treated with 1:1 saliva-PBS solution for 30 min, followed by washing of specimens and the addition of bacterial suspension. Specimens with bacterial suspension were incubated for 24 h at 37 °C for biofilm formation. After 24 h, non-adhered bacteria were removed, and specimens were washed, followed by removal and calculation of adhered bacterial biofilm. S. aureus and E. faecalis showed more attachment to Ti grade 2, whereas S. mutans showed higher adherence to PLA in a statistically significant manner. The salivary coating of specimens enhanced the bacterial attachment by all the bacterial strains tested. In conclusion, both implant materials showed significant levels of bacterial adhesion, but saliva treatment played a vital role in bacterial attachment, therefore, saliva contamination of the implant materials should be minimized and considered when placing implant materials inside the body.

OC-120 ROBOTIC TRANSABDOMINAL RETROMUSCULAR RECTUS DIASTASIS (R-TARRD) REPAIR - A NEW APPROACH

Abstract Aim To present our innovative robotic approach for the treatment of rectus diastasis with concurrent primary or incisional ventral hernias. Material &amp; Methods We performed 45 r-TARRD repairs for symptomatic rectus diastasis with concomitant associated ventral/incisional umbilical and/or epigastric hernias. Data on patient demographics, type of hernia, operative time, complications, recurrence rate and hospital stay were retrospectively analyzed. Follow-up was scheduled at 1 month, 6 months and 1 year after surgery. Results 45 patients (13 M, 32 F) underwent r-TARRD repair. Mean age was 54,8 years (range 31–68) and mean BMI was 26,74 Kg/m2 (range 21,1–31). Mean ASA was 2,2 (range 1–3). In all patients we used a polypropylene mesh 25×15 cm, properly shaped. Mean operative time was 192 min (range115–260). Mean hospital stay 4,2 days (range 2–7). No conversion to laparoscopy or open surgery and no major complications occurred. At 1 month follow up one mesh infection (2,22%) was observed and it was treated conservatively. Four recurrences (8,88%) were reported at 1 year follow up. Conclusions Robot-assisted TARRD repair is conceived as a novel alternative minimally invasive procedure for RD with concurrent midline defects ensuring a primary fascial defect closure and mesh implantation in a sublay position with a wide overlap. It is important to better evaluate the suture that should be used to perform the repair and multicenter studies with standardization of patient's demographics, RD characteristics and long-term follow-up outcomes are mandatory to assess the effectiveness and durability of r-TARDD repair.

OC-027 RANDOMISED CONTROLLED TRIAL OF THE DESARDA TECHNIQUE AND SUTURE REPAIR FOR OBSTRUCTED INGUINAL HERNIA

Abstract Aim Open inguinal hernia repair remains one of the most commonly performed operations worldwide. For elective surgery, mesh implantation is an established global ‘gold standard’. However, for emergency repair of obstructed hernia, non-mesh techniques may be utilised. We designed a randomised controlled trial to compare the open, non-mesh ‘Desarda’ against non-mesh suture darn repair in the treatment of obstructed inguinal hernias. Materials &amp; Methods A prospective randomized controlled trial was undertaken between Feb and Aug 2020 at the Emergency Unit, of a busy hospital in a resource-constrained setting. To identify a true difference in operating time, a sample size of 100 patients was calculated using WHO calculator. Exclusion criteria were patients ASA 3+ or with recurrent or strangulated intestine; ethical approval was obtained from the hospital Ethics’ Committee and informed consent obtained from all participants. Randomisation was by the sealed opaque envelope method. Data analysis by SPSS version 25 using Student t-test; p-value ≤0.05 was considered significant. Results Total 100 patients were included (71 male and 29 female). Mean age of patients: 39.1 years±6.1SD. Mean operative time was significantly lower in Desarda group (50.5±1.7) compared to sutured repair (58.8±2.1SD) p=0.000. Intra-operative and immediately postoperative complications were not identified in any of the patients. Patient reported outcomes will be reviewed at the 2-year point. Conclusion In this RCT of emergency repair of obstructed inguinal hernia, Desarda's repair was safe and effective and took significantly less surgical time compared to a standard sutured darn repair. Longer term, patient reported outcomes are awaited.

OC-091 PREVENTION OF PARASTOMAL HERNIAS WITH 3D FUNNEL MESHES IN INTRAPERITONEAL ONLAY POSITION

Abstract Introduction In patients with permanently intended terminal ostomies, parastomal hernias (PSHs) occur on a frequent basis. Various strategies have been evaluated, but there is still a lack of evidence with regard to the best surgical technique for PSH- prevention Methods We conducted a retrospective analysis of prospectively collected data of 98 patients, who underwent elective permanent ostomy formation between 2009 and 2019 by means of prophylactic implantation of a specially designed three-dimensional funnel mesh in intraperitoneal onlay position. Results PSH developed in five (5.1%) of 92 patients available for follow-up (88 by CT-scan). No mesh-related complications were encountered and none of the implants had to be removed. Ostomy-related complications had to be noted in eight (8.2%) cases. Follow-up time was a median 38 (range 12–60) months. Conclusion The prophylactical implantation of a funnel mesh implant in IPOM technique during initial formation of a terminal enterostomy is safe, highly efficient and comparatively easy to perform. As opposed to what can be achieved with purely keyhole meshes regardless of their position in relation to the abdominal wall layers, the inner boundary areas of the ostomy itself can be well covered and protected from the surging viscera with the 3D design and there is no weak point at the lateral edge of the stoma as is typical for the sugarbaker access. A further improvement could be achieved by lengthening the tunnel by the manufacturer in order to counteract the shrinkage of the implant.

OC-005 COMPARISON OF POSTOPERATIVE PAIN: BIOLOGICAL VERSUS SYNTHETIC MESH SIX MONTHS AFTER LAPAROENDOSCOPIC HERNIA REPAIR – RESULTS OF THE RANDOMIZED, MULTICENTER, SELF-CONTROLLED BIOLAP TRIAL

Abstract Aim A remaining problem after hernia surgery is the occurrence of chronic pain. Up to now, the use of synthetic meshes is the standard procedure, but there is raising evidence that biological meshes could be advantageous concerning occurrence of chronic pain without the disadvantages of a life-long implant. The BIOLAP trial compares synthetic and biological meshes in laparoendoscopic inguinal hernia repair. To test the hypothesis that the use of biological meshes results in significantly less pain postoperatively than the use of synthetic meshes, without an increased recurrence rate, patients with bilateral primary inguinal hernias were included. Patients received biological mesh on one side and synthetic mesh on the other. Materials and Methods In 21 German hernia centres, 982 hernias were treated using TEP or TAPP techniques. In addition to the study endpoints (recurrence rate within 2 years, pain intensity after 6 months), demographic and perioperative data as well as intraoperative and postoperative complications were recorded. Results Recruitment was successfully completed in February 2021. Six month after laparoendoscopic hernia repair there is no significant difference in pain occurrence comparing biological to synthetic mesh implants. Furthermore general demographics of the patients with bilateral primary inguinal hernias are evaluated. Conclusion The study provides data from 982 hernia operations dependent of the mesh material used. According to the study protocol, at the current time pain intensity after 6 months comparing both mesh materials has been evaluated as the first endpoint. Further study endpoints will be evaluated after completion of the two-year follow-up phase.