Mesh Implantation Research Articles

Инфильтративный эндометриоз рубцов после родоразрешающих операций

This article presents two clinical cases of infiltrative scar endometriosis after cesarean delivery and episiotomy at spontaneous vaginal delivery. The infiltrative form of post-operative scar endometriosis is an indication for surgical treatment, presenting a complicated surgical challenge due to the extent of infiltration and involvement of the surrounding tissues. The restoration of the infiltration area also poses certain difficulties. For this purpose, mesh implants are used to help replace and reconstruct the tissues of the anterior abdominal wall and therefore reduce the risk of post-operative hernia formation. Key words: infiltrative scar endometriosis, diagnosis, surgical treatment, mesh implant

A novel 3D printed type II silk fibroin/polycaprolactone mesh for the treatment of pelvic organ prolapse.

Pelvic organ prolapse (POP) is one of the common diseases in middle-aged and elderly women, caused by weakened pelvic floor muscle ligament tissue support. Pelvic floor reconstruction with mesh implantation has been proven to be an effective treatment for POP. However, traditional non-degradable and inflexible pelvic floor implantation meshes have been associated with pain, vaginal infections, and the need for additional surgeries. In this study, novel meshes with pre-designed structures were fabricated with solution-based electrohydrodynamic printing (EHDP) technology, using a series of polycaprolactone/silk fibroin composites as bioinks. The PCL/SF mesh mechanical performances were particularly enhanced with the addition of silk II, leading it to obtain higher adaptability with soft tissue repair. The mesh containing SF showed more robust degradation performance in the in vitro degradation assay. Furthermore, biocompatibility tests conducted on mouse embryonic fibroblasts (NIH/3T3) revealed enhanced cell affinity. Finally, the biocompatibility and tissue repair properties of PCL/SF mesh were verified through the implantation of meshes in the muscle defect site of mice. The results demonstrated that the 3D printed PCL/SF mesh prepared by EHDP exhibits superior mechanical properties, biocompatibility, biodegradability, as well as ligament and muscle fiber repair ability. The novel implantable meshes are promising for curing POP.

EVALUATION OF POSTOPERATIVE PAIN IN PRESERVATION AND ELECTVE DISSECTION OF THE ILIOINGUINAL NERVE IN INGUINAL HERNIOPLASTY

The use of mesh techniques in the treatment of inguinal hernias significantly reduce recurrences. However the incidence of  inguinodinia still present significant complication. The study was designed as a randomized, prospective, unilaterally blind clinical study. Forty male patients were included, to whom hernioplasty by Lichtenstein method with implantation of polypropylene mesh was performed. Patients were divided into 2 groups of twenty patients each. In first one the technique of the ilioinguinal preservation was used, and in the second one dissection of the ilioinguinal nerve was performed. At appropriate time points two types of scales were used to assessed the intensity of the pain: Numeric scale of pain (NSP) and Stanford pain scale (SPS).Data from 40 patients have been analyzed, of which 20 with preservation and 20 with dissection of the ilioinguinal nerve. Inguinodynia was present in two patients, one in each group, i.e. 5%, which indicates that there was no significant difference in the occurrence of inguinodynia in the group with preservation and dissection of the ilioingvinal nerve. No single direction can yet be given as to whether it is better to preserve or dissect the inguinal nerves, and there is also division over whether, if a neurectomy should be performed, it should be limited to the IIN or a triple neurectomy should be performed. Key words: inguinodinia, inguinal hernia, mesh techniques.

ЭФФЕКТИВНОСТЬ ЛЕЧЕНИЯ ЛЕГОЧНЫХ ГРЫЖ С ИСПОЛЬЗОВАНИЕМ СЕТЧАТОГО ИМПЛАНТА У БОЛЬНЫХ, ПЕРЕНЕСШИХ ПНЕВМОНЭКТОМИЮ ПО ПОВОДУ ТУБЕРКУЛЕЗА

Objective: to assess effectiveness of surgical treatment for mediastinal lung hernias using a polymeric mesh implant in patients after pneumonectomy due to TB. Materials and methods. Polymeric mesh implants were installed to 15 patients, which developed mediastinal lung hernias after pneumonectomy due to TB. Four of these patients underwent lung hernia plasty along with resection of the only lung, where single or multiple tuberculomas were detected. The assessment of treatment effectiveness was based on the features of early and late (after 3 months) postoperative period, dyspnea severity by the mMRC scale, radiological and spirometric data, and blood gases. The resection samples were studied morphologically to determine activity of TB process in the only lung. Results. The effectiveness of treatment for mediastinal lung hernias was 93%. Technical success was achieved in 100% of patients. The complications in the postoperative period were lessthan 7% (one case). Dyspnea decreased by 46% by the mMRC scale. The medians of FVC and FEV1 decreased by 12.8% and 11.6% respectively, the median of PaO2 increased by 6 mm Hg (9% of the baseline value). The median of the shifted lung tissue volume (V cm3) decreased by 57%. Active TB process was observed in the resection samples of the single lung. Conclusion. Anterior mediastinal plasty using a polymeric mesh implant is a safe and highly effective method of treatment for mediastinal lung hernias. Timely use of this method postpneumonectomy patients is necessary to obtain positive treatment outcomes.

Perioperative prevention of complications in surgery of ventral hernias

To improve perioperative algorithm of prevention of complications in patients with ventral and incisional hernias via differentiated choice of mesh implants and hernia repair technique. The study included 144 patients with abdominal wall hernia, who were divided into two representative groups. Original algorithms for choosing the method of hernia repair depending on type and position of mesh implant, as well as methods of perioperative prevention of complications are proposed. These algorithms significantly reduced the incidence of postoperative wound complications after sublay hernia repair and posterior separation with TAR.

Модификация операции Нейгебауэра–Лефора у пациенток пожилого и старческого возраста

This article presents an original method of surgical treatment of complete uterine prolapse (a modification of the Neugebauer–Le Fort operation) in elderly and senile patients using titanium tape mesh implants, which contribute to strengthening and firm consolidation of the vaginal walls, elevation and stabilization of the postoperative position of pelvic organs (uterus, vaginal walls, bladder). Key words: complete uterine prolapse, elderly and senile age, modification of Neugebauer–Le Fort operation, titanium implants

Treatment of ventral hernias in patients with morbid obesity

The review is devoted to the treatment of ventral hernias in patients with morbid obesity. This issue is important due to significant number of such patients and no unambiguous clinical recommendations. The advantages of simultaneous surgery (with bariatric intervention) are obvious, i.e. lower risk of postoperative hernia incarceration and no need for re-hospitalization with another intervention. High risk of bariatric population makes it necessary to minimize surgery time and surgical trauma. A staged approach with reducing body weight surgically or conservatively before hernia repair is often chosen. Hernia repair should be performed using laparoscopic or robotic techniques with obligatory use of mesh implants. Panniculectomy or abdominoplasty as the main surgery is a valid option. Currently, it is necessary to develop clear criteria for selecting patients with morbid obesity for staged and simultaneous treatment of ventral hernias.

Paraesophageal hernia: the state of the problem and controversial issues. Review

The literature review focuses on the controversial issues regarding the treatment of paraesophageal hernia. The limitations of the current classification of hiatal hernias are highlighted. It is irrelevant and does not meet clinical needs. Objective criteria for its improvement are proposed. Data on the prevalence and course of hiatal hernias are given. Their pathogenetic factors and diagnostic methods are underlined. Considerable emphasis is placed on the paraesophageal hernia treatment strategies in patients with an asymptomatic and mildly symptomatic clinical course of the disease. Arguments are presented in favour of both wait‑and‑see tactics and planned hernioplasty. The choice of hernioplasty technique, especially in the case of giant hernias, the feasibility and indications for the use of mesh implants depending on their shape and composition, and the potential complications of allogenioplasty are the main topics for discussion. The problem of selecting a fundoplication method is addressed while weighing the advantages and potential side effects of employing various fundoplication modifications. The effects of correcting a short esophagus and eliminating the axial pressure on the esophageal hiatus are thoroughly evaluated, as these conditions increase the risk of hernia recurrence.
 The authors concluded that there are many controversial issues in the treatment of paraesophageal hernia. A consensus is needed on the classification of paraesophageal hernias, which would meet the urgent needs of choosing the method of operative delivery, and, in particular, the definition of the concepts of «large hernia» and «giant hernia.» Further research is required on issues such as the indications for operative treatment of paraesophageal hernias, especially in the case of asymptomatic large hernias and incarcerated hernias; the feasibility of using implants for plastic surgery of the esophageal hiatus; the choice of a fundoplication method; the diagnosis and correction of a short esophagus; and methodology for evaluating long‑term treatment outcomes.

Influence of polypropylene mesh degradation on tissue inflammatory reaction.

Polypropylene degradation in vivo appears as mesh surface cracking and peeling. This aging process of the mesh, resulting in the lack of bio-stability, contradicts the requirement of biocompatibility. However, to date, it is still not clearly established how much this mesh degradation influences the local tissue response with subsequent clinical consequences. This study aims to find out whether mesh degradation is correlated with elevated inflammatory tissue reaction through analyzing 100 human PP meshes explanted from the pelvic floor. A degradation classification method, based on standard pathological H&E stained slides of the explanted mesh via light microscope, was developed to classify the mesh degradation into four classes (no, mild, moderate and severe degradation). The peri-filamentary tissue inflammatory reaction was analyzed by scoring the expression of the most common cell markers for the innate immune reaction: CD68 as marker for macrophage, CD86 for M1 subtype, CD163 for M2 subtype, CD3 for T-lymphocyte and CD15 for neutrophil granulocytes. The correlation between immune cell expression, degradation classification and time of implantation of the meshes are evaluated with Spearman-Rho-Test. Mesh degradation worsens significantly (p < .001) with longer time of implantation. The increasing tendency of CD68 expression by mesh with higher degradation class indicates that the number of macrophages increases with worsening mesh degradation. The significantly increased expression of CD163 and CD3 cell by severely degraded mesh demonstrate the increased number of M2 and T-Lymphocyte when mesh degradation becomes severe. None of the inflammatory cells show the usual declining expression with longer time of implantation. The result of this study suggests that the degradation of PP mesh results in an elevated local inflammatory reaction in female pelvic floor. A material with better bio-stability for mesh implant in pelvic floor is required.

Regenerative Properties of Polypropylene Mesh Coated with Thiotriazoline and L-arginine

Restoration and strengthening of soft tissue structures of the musculoskeletal system underlie the principles of regenerative medicine to improve treatment results and prevent possible complications. Influencing various parts of the regenerative process, it is possible to correct the recovery time, the morphological properties of the scar, and, as a result, the clinical results of treatment. We have proposed using a polypropylene mesh (PM) impregnated with a metabolitotropic solution to restore damaged and strengthen weakened structures. The work aimed to study the effect of PM with metabolite impregnation on the regeneration process of soft tissues. A series of morphological and biochemical studies were carried out on laboratory animals. The degree of inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) mRNA expression was studied as indicators of tissue ischemia and their trophism in correlation with morphological changes in the zone of mesh implantation. Using a PM with a metabolitotrope increases the expression of eNOS mRNA by 10.8 times, and iNOS mRNA - reduces by 3.6 times. Morphologically coated PM causes a pronounced inflammatory effect, followed by a pronounced proliferation of connective tissue fibers around the mesh elements. Particular attention is drawn to the growth of the microvasculature and the increase in the number of anastomoses - 10.3% of the relative area compared to 8.8% in the group using PM without a metabolite. The metabolitotropic impregnation improves oxygenation and trophism of damaged soft tissues, which helps to stimulate regeneration.

Absorbable mesh in a contaminated field: hernia repair outcomes.

Hernia repair mesh aids in the stability of incisional hernia repair and can reduce the need for subsequent operations. There is, however, debate among surgeons over which type of hernia mesh-synthetics, biologics, or biosynthetics-is indicated as best for specific patients. A retrospective case review comparing surgical outcomes based on wound class and mesh materials may provide insights into this question. This study evaluates patient outcomes using biosynthetic mesh based upon CDC wound classification. Following Institutional Review Board approval, the local National Surgery Quality Improvement (NSQIP) databases were queried for open ventral hernia repaired with absorbable mesh implants from January 2013-December 2017. Factors for comparison included patient demographics, operative details, and an analysis of clinical outcomes. Our study identified 112 ventral hernia repair cases with absorbable mesh placement, 32% (n = 36) were wound classes II-IV. Higher wound class correlated statistically with diabetes (33.3%), prior hernia repair (61.1%), and parastomal hernia (44.4%). Higher wound classes were associated with more emergent presentations, involved bowel resection more frequently, required larger mesh implants, increased post-operative surgical site infections, and wound disruption. Increasing wound class was also associated with longer hospital stays and greater need for readmission (38.9% vs. 11.8%). Compared to patients with clean wounds, biosynethic mesh repair patients with contaminated wounds exhibited more emergent presentations, increased incidence of bowel resection, increased mesh size, and more readmissions. Despite these peri-operative outcomes, hernia recurrence rates among biosynethic mesh hernia repair were similar in CDC class II-IV patients as class I.

Plasma-Induced Diallyldimethylammonium Chloride Antibacterial Hernia Mesh.

A hernia is a pathological condition caused by a defect or opening in the muscle wall, which leads to organs pushing through the opening or defect. Hernia recurrence, seroma, persistent pain, tissue adhesions, and wound infection are common complications following hernia repair surgery. Infection after hernia mesh implantation is the third major complication leading to hernia recurrence. In order to reduce the incidence of late infections, we developed a polypropylene mesh with antibacterial properties. In this study, knitted polypropylene meshes were exposed to radio-frequency plasma to activate their surfaces. The antibacterial monomer diallyldimethylammonium chloride (DADMAC) was then grafted onto the mesh surface using pentaerythritol tetraacrylate as the cross-linker since it is able to engage all four functional groups to form a high-density cross-linked network. The subsequent antibacterial performance showed a 2.9 log reduction toward Staphylococcus aureus and a 0.9 log reduction for Escherichia coli.

Practical Mouse Model to Investigate Therapeutics for Staphylococcusaureus Contaminated Surgical Mesh Implants

IntroductionThe use of prosthetic mesh in hernia repair provides a powerful tool to increase repair longevity, decrease recurrence rates, and facilitate complex abdominal wall reconstruction. Overall infection rates with mesh are low, but for those affected there is high morbidity and economic cost. The availability of a practicable small animal model would be advantageous for the preclinical testing of prophylactics, therapeutics, and new biomaterials. To this end, we have developed a novel mouse model for implantation of methicillin-resistant Staphylococcus aureus–infected surgical mesh and provide results from antibiotic and immunotherapeutic testing. Materials and MethodsImplantation of surgical mesh between fascial planes of the mouse hind limb was used to approximate hernia repair in humans. Surgical mesh was inoculated with methicillin-resistant Staphylococcus aureus to test the efficacy of antibiotic therapy with daptomycin and/or immunotherapy to induce macrophage phagocytosis using antibody blockade of the CD47 “don't eat me” molecule. Clinical outcomes were assessed by daily ambulation scores of the animals and by enumeration of mesh-associated bacteria at predetermined end points. ResultsA single prophylactic treatment with daptomycin at the time of surgery led to improved ambulation scores and undetectable levels of bacteria in seven of eight mice by 21 days postinfection. Anti-CD47, an activator of macrophage phagocytosis, was ineffective when administered alone or in combination with daptomycin treatment. Ten days of daily antibiotic therapy begun 3 days after infection was ineffective at clearing infection. ConclusionsThis fast and simple model allows rapid in vivo testing of novel antimicrobials and immunomodulators to treat surgical implant infections.

Three-Dimensional Printed Polycaprolactone Mesh in Pediatric Cranial Vault Remodeling Surgery.

The surgical management of craniosynostosis has greatly evolved with improvements in both technology and understanding of the disease process. Some drawbacks remain regarding bone regeneration within the surgical bony gaps. Generally, bony gaps improve in the 12 to 24 months after surgery, but some gaps may remain for longer and cause deformity and/or require additional bony reconstruction. These considerations make tissue-engineered bone very attractive. Novel 3-dimensional printed bioresorbable mesh implants made of Polycaprolactone (PCL) can be used to fill the surgical bony defects. The authors seek to investigate how the use of a 3-dimensional printed biodegradable PCL mesh applied to bony defects in cranial vault surgery affects bone healing. Case series analysis of 8 pediatric patients who have undergone surgical intervention using PCL mesh implants for reconstruction of bony defects during craniosynostosis correction surgery. Radiological evaluation of 3 patients at random time points between 9 and 12 months postoperative revealed persistent bony gaps in areas where PCL mesh was laid. One patient who underwent a subsequent cranial vault surgery at 9 months was found to have less bone regeneration in the defect area where PCL mesh was used when compared with an adjacent area where a particulate bone graft was used. Based on our experience, the use of PCL mesh on its own did not augment bone regeneration. It is possible that a greater amount of time or increased vascularization of the scaffold is required, which supports the concept of regenerative matching axial vascularization or the further addition of osteogenic factors to increase the rate of bone formation.

Evaluating sexual function among women after recurrent pelvic organ prolapse transvaginal mesh repair

We aimed to evaluate women’s sexual function before and after pelvic organ prolapse (POP) surgery utilising light transvaginal mesh after a prior hysterectomy. Only sexually active women with recurrent cystocele stage 3–4 according to POP-Q, who had previously undergone vaginal hysterectomy with anterior native tissue repair without apical fixation, were enrolled in the study. Women with previous mesh implant POP surgery, persistent vaginal infection or pelvic inflammatory disease were excluded. All patients were surgically treated between 2012 and 2015 using single-incision transvaginal mesh Calistar A. Sexual function was evaluated before a surgery and two years postoperatively. The assessment was accomplished via the standardised validated Czech translation of PISQ-12SF questionnaire. For each patient, age, BMI and parity were monitored. Out of all (89) eligible patients, 48 patients met inclusion criteria and were subsequently enrolled in our study. Two years postoperatively, 31 women (79.5%) improved their PISQ-12 score; five (12.8%) had equivalent scores, and three patients (7.7%) reported lower scores. Overall PISQ-12 score was 37.1 ± 2.6 postoperatively with a 2.9 ± 2.3 statistically significant positive difference compared to the score preceding surgery. The majority of patients undergoing surgery using Calistar A experienced a significant improvement in sexual function. IMPACT STATEMENT What is already known on this subject? Pelvic organ prolapse has a significant impact on women’s sexual functioning in an adverse manner. Mesh implant repair is associated with lower rates of prolapse awareness and prolapse re-operation; however, it is linked with safety concerns. One of these concerns is the negative impact on women’s sexual function. Evaluative study results following sexual function among women with mesh implant transvaginal repair are contradictory. What do the results of this study add? The results showed, that contrary to finding some of the previous studies, transvaginal mesh implant use could benefit patients with previous native tissue POP surgery failure with a low risk of sexual function deterioration. What are the implications of these findings for clinical practice and/or further research? The study provides clinical data for vaginal mesh implants on women’s sexual function in the mid-term outcome. These data can be crucial for selecting the right POP surgical technique and evaluating its benefits and risks.

Comparative Evaluation of Biomechanical Characteristics of Acellular Dermal Matrix for Hernioplasty

Background. With the introduction of synthetic mesh implants into clinical practice, the recurrence rate of postoperative ventral hernias was signifi cantly reduced. The extensive use of synthetic implants led to the development of specifi c complications. The development of biological implants, based on extensively purifi ed decellularized collagen matrix of xenogeneic origin is highly relevant due to the fact that, unlike synthetic analogues, they have a biological origin and biodegrade in a natural way, gradually being replaced with newly formed connective tissue. The use of bioprostheses reduces the risk of complications.Objectives. To conduct a comparative evaluation of the biomechanical characteristics of acellular dermal matrix, obtained by detergent-enzymatic decellularization, and commercially distributed Permacol™ matrix.Methods. Acellular dermal matrix (ADM) was created by using samples of native skin of pig of Landras breed aged 4 months. The dermis was processed by means of detergent-enzymatic method. In order to evaluate and compare the mechanical properties of acellular dermal matrix, the biological samples were divided into 2 groups of 15 samples each. The fi rst group included acellular dermal matrix samples, the second group — native samples of pigs unprocessed dermis. The control group consisted of samples of PermacolTM Surgical Implant, xenotransplant for hernioplasty approved for use in the Russian Federation (Covidien, France). All samples were tested wet using universal testing instrument Instron 1122. MedCalc Statistical Software (Belgium) was used for statistical processing of the study results.Results. In the present study, pig dermis was processed using a detergent-enzymatic method to produce ADM. Routine histological examination confi rmed the removal of all cellular elements, and at the same time it was proven that the native structure of the dermis remained intact during its processing. The mechanical characteristics of xenogenic ADM were further determined. Its tensile strength was 9.1 ± 0.6 MPa (910 N/cm2 ), elongation to break was 21.1 ± 2.3%, and elastic modulus was 50.0 ± 1.6 MPa. These characteristics largely corresponded to the strength characteristics of native pig dermis and far exceeded the necessary physiological parameters. PermacolTM control was tested in two directions (longitudinal and transverse). In the longitudinal direction, the sample had higher mechanical characteristics: strength — 12.0 ± 1.7 MPa, elongation to break — 29.7 ± 2.4%, stiffness modulus — 47.2 ± 6.5 MPa. In the transverse direction, all indicators were 1.5–2 times lower.Conclusion. The developed xenogeneic biological implant in the form of ADM demonstrates rather good characteristics of plasticity, tensile strength and elasticity, to be used as a biological endoprosthesis for plasty of hernia defects of the abdominal wall of any size and shape.

Analysis of postoperative complications after open scar hernia hernioplasty - a retrospective analysis of a patient cohort.

The aim of this study was to analyse complications associated with inicisional hernia repair surgery and to assess individual risk factors for surgical site infections occurring at the Department of Surgery of the University Hospital Kralovske Vinohrady in 2015. We analysed 138 patients with a focus on risk factors that potentially increase the risk of postoperative infectious complications such as mesh implantation, smoking, diabetes mellitus, ischemic heart disease, malignancies, immunosuppressive therapy and urgency of the procedure. Based on multivariate logistic regression analysis, acute surgery proved to be a risk factor for infection, and in the ad hoc Fisher test, the ratio was 2.73. Diabetes mellitus as a risk factor reached the limit of significance (p=0.071). No other variables were associated with an increased risk of surgical site infections. Acute surgery was assessed as a significant risk factor for postoperative wound infection. On the contrary, mesh repair was not associated with an increased risk of infection.

De novo pain and relief of pain after abdominal synthetic mesh implants

Introduction:This study assessed the incidence, severity and risk factors for pain after abdominal mesh usage in pelvic floor prolapse surgery. Methods:Prospective observational cohort study (NCT01598467, clinical trials.gov) performed in a tertiary referral center for patients with gynecological prolapse. Women undergoing robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy for the treatment of pelvic organ prolapse were​ included (2014–2018). Primary outcome was presence and degree of pre- and postoperative pain. Secondary outcomes were quality of life, dyspareunia and risk factors for postoperative pain. Pre- and postoperative interviews and validated questionnaires were used to assess pain severity and location. A Numeric rating scale (NRS; 0-10; 0 no pain and 10 highest pain score) was included in the questionnaire. ‘De novo pain’, ‘ongoing pain’ and ‘resolved pain’ were respectively described as: Pain solely present postoperatively, pain present both pre- and postoperatively and pain present preoperatively, but resolved postoperatively. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the quality of life Pelvic Floor Impact Questionnaire (PFIQ-7) were used. Results:115 subjects who underwent abdominal mesh implant surgery were included. Mean follow-up duration was 12.8 3.7 months. The preoperative prevalence of patient self-reported pain was 52%, postoperative self-reported pain was 24%. De novo pain was found in 4.3%. Self-reported ongoing pain was noted in 18%. In 29%of patients the pain had resolved after surgery. Preoperative pain and previous intra-abdominal surgery were identified risk factors for postoperative pain (intra-abdominal surgery OR 3.6, 95% CI 1.2-10.7; preoperative NRS pain score OR 1.4, 95% CI 1.1-1.7). Less women reported dyspareunia postoperatively (49% versus 36%). Total PFIQ-7 scores decreased significantly (Total PFIQ-7: -49) postoperatively, indicating improvement in quality of life. Conclusion:Pain is mostly reduced or resolved and less dyspareunia is reported after abdominal pelvic floor surgery with mesh implants for pelvic organ prolapse.

P-047 PERINEAL HERNIA: RECTUS ABDOMINIS MUSCLE FLAP REPAIR

Abstract Aim Perineal hernia (PH) is a rare complication of pelvic surgeries. We present two cases of male patients with symptomatic PH following abdominoperineal resection (APR), repaired with rectus abdominis muscle flap. Cases presentation N1: 66-year male, 1 year after laparoscopic-assisted APR was treated with rectus abdominis muscle flap repair (RAM) by open abdominal approach. In postoperative period, heavy bronchitis leaded to the disruption of the muscle flap and need of reoperation. The patient healed completely two months after the repair. No recurrence of PH within 5 years has been registered. N2: 64-year male, underwent chemoradiotherapy and open APR for rectal carcinoma. 2 years later, CT showed a PH and 2cm wide mass suspicious of cancer recurrence in pelvis. By the open abdominal – perineal approach, the mass of recurrence was excised, and PH was repaired with vertical rectus abdominis muscle flap (VRAM). The postoperative period was uneventful and 1 year after the surgery, the patient is cancer and PH free. Discussion Treatment of more advanced carcinomas or wide use of radiotherapy can lead to an increased number of PH. Abdominal, perineal or combined approaches exists. The pelvic floor reconstruction is mostly realized by mesh implantation or flap repair. In our presented cases, we took advantage of long existing cooperation with plastic surgeon team and chose rectus abdominis muscle flap reconstruction. We proved its feasibility and good effect on PH repair. Conclusion Perineal hernia repair is challenging. No consensus regarding the ideal method exists. Every case must be assessed individually.

OC-020 INCISIONAL HERNIA REPAIR WITH MESH REIMAGINED: PILOT STUDY USING ABDOMINOPLASTY AS PERMANENT AUTOLOGOUS BIOLOGICAL REINFORCEMENT IN HERNIA REPAIR

Abstract Aim EHS consensus recommends mesh implantation for all incisional hernia (IH) repairs, regardless of size. We propose considering abdominoplasty in the algorithm for IH repairs wherein the plicated fascia functions as a permanent autologous biologic onlay repair over the primary repair of the IH. Materials &amp; Methods Four patients with midline IHs underwent abdominoplasty. Their IHs were first closed primarily with #2–0 permanent suture. Next, a two-layer anterior plication of the overlying fascia was performed with permanent suture. No mesh was implanted. Patients were followed up post operatively to monitor for hernia recurrence. Results All patients were female with average age 51 years. All had at least one midline IH (1cm-1.7cm wide). Three (75%) had recurrent IHs. Three (75%) had diastasis recti. Patients were followed at 1 year, with no (0%) recurrence. Conclusion Abdominoplasty may be a safe and effective alternative for IH repair compared to traditional mesh-based repair. In effect, the patient's own plicated fascia functions as a permanent autologous biologic onlay reinforcement to the IH repair. Meanwhile, the plication may reduce tension off the primary defect closure, thus reducing recurrence. Our pilot study in small IHs showed no hernia recurrence one-year postoperatively after abdominoplasty. Thus, abdominoplasty may serve as an alternative surgical option to a subset of patients with IH. We aim to judiciously expand indications for abdominoplasty for IH repair to address wider defects in select candidates. We hope our experience will supplement the current algorithm for IH repairs by providing a non-mesh alternative.