Mesh Placement Research Articles

Single-stage computer-assisted approach for tumour resection and functional restoration of Brown class III maxillary defects—titanium mesh and zygomatic implants combined with vascularized anterolateral thigh flap

The functional restoration of Brown class III maxillary defects is a challenging endeavour in oral and maxillofacial surgery. Conventional reconstruction techniques with osseous free flaps have certain limitations, such as the need for multiple operations and greater patient morbidity. This study introduces a single-stage computer-assisted approach for tumour resection and functional restoration of these defects using titanium mesh, zygomatic implants, and a vascularized anterolateral thigh flap (ALTF). Virtual surgical planning was used to simulate tumour resection, titanium mesh placement, and zygomatic implant insertion. Surgery was performed under the guidance of mixed reality and surgical navigation. The tumour was resected by total hemimaxillectomy, and the reconstruction was performed using a pre-bent patient-specific titanium mesh for the orbital floor and two zygomatic implants placed and exposed through tunnels in an ALTF. The ALTF survived without any perioperative complications. A fixed prosthesis with built-in titanium frame was delivered 4 months postoperatively. At the 1-year follow-up, there was no tumour recurrence, the implants were osseointegrated, and aesthetics and masticatory function were satisfactory. An occlusal force of 155 N was attained on the reconstructed side, compared to 127 N on the non-surgical side.

Transversus abdominis release with biosynthetic mesh for large ventral hernia repair: a 5-year analysis of clinical outcomes and quality of life.

Transversus abdominis release (TAR) may provide an optimal plane for mesh placement for large ventral hernias requiring medial myofascial flap advancement. Long-term outcomes of TAR for large ventral hernia repair (VHR) remains under-studied. This study aims to assess longitudinal clinical outcomes and quality of life (QoL) following large VHR with TAR and resorbable biosynthetic mesh. Retrospective review of clinical outcomes and prospective QoL was performed for patients undergoing VHR with poly-4-hydroxybutyrate mesh and TAR from 2016 to 2021. Patients with ≤ 24months of follow-up, defects ≤ 150cm2, and parastomal hernias were excluded. Cost-related data was collected for each patient's hospital course. QoL was compared using paired Wilcoxon signed-rank tests. Twenty-nine patients met inclusion criteria. Median age and BMI were 61years (53.2-68.1years) and 31.4kg/m2 (26.1-35.3kg/m2). Average hernia defect was 390cm2 ± 152.9cm2. All patients underwent previous abdominal surgery and were primarily Ventral Hernia Working Group 2 (58.6%). Two hernia recurrences (6.9%) occurred over the median follow-up period of 63.1months (IQR 43.7-71.3months), with no cases of mesh infection or explantation. Delayed healing and seroma occurred in 27 and 10.3% of patients, respectively. QoL analysis identified a significant improvement in postoperative QoL (p < 0.005), that continued throughout the 5-year follow-up period, with a 41% overall improvement. Cost analysis identified the hospital revenue generated was approximately equal to the direct costs of patient care. Higher costs were associated with ASA class and length of stay (p < 0.05). Large VHR with resorbable biosynthetic mesh and TAR can be performed safely, with a low recurrence and complication rate, acceptable hospital costs, and significant improvement in disease-specific QoL at long-term follow-up.

A Comparative Study of Retrorectus Mesh Placement Versus Properitoneal Mesh Placement in Open Repairs of Ventral Hernias.

Background Ventral hernias affect millions of patients each year.Surgery is the main line of management and various techniques have been advocated; however, mesh repair has become the norm and different approaches have been described regarding the plane ofmesh fixation, but none of them are standardized. Open repair is commonly practiced, and the two most commonly performed methods are retrorectus and properitoneal mesh placement. Objectives To comparethe postoperative outcomes between the retrorectus plane and the properitoneal plane of fixation of mesh in open ventral hernia repair. Methods Between September 2018 and August 2020, 56 patients with midline ventral herniaadmitted to Ramaiah Hospital, Bengaluru were chosen for this prospective comparative study. Group A had 28 patients who underwent open retrorectus mesh repair and 28 patients in Group B underwent open properitoneal mesh repair. The postoperative outcomes were studied in terms of operating time, postoperative complications, and early recurrence at the end of six months and 24 months post-surgery. Results The operative time for retrorectus mesh placement was significantly lower than properitoneal mesh placement. The latter had a higher complication rateoverall with an incidence of 18%, with seroma being the most common complication; however, the difference in complication rates was not statistically significant.Skin necrosis was identical in both groups and 0% of cases in both groups had SSI or mesh infection. Three patients (10.71%) in the retrorectus group and two patients (7.10%) in the properitoneal group developed recurrence at 24 months follow-up. Conclusion Retrorectus mesh repair and properitoneal mesh repair in open ventral abdominal hernias have equally good postoperative outcomes.

Strategies for closing the posterior rectus sheath during enhanced view totally extraperitoneal Rives-Stoppa repair.

The popularity of endolaparoscopic extraperitoneal repairs has been on the rise due to advantages such as sublay mesh placement and early return to daily activities. However, the procedure requires overcoming a learning curve, and with increased adoption, new complications have emerged. One significant complication is the rupture of the posterior rectus sheath (PRS). In this article, we present our modifications of the technique to reduce tension during PRS closure. The study included 105 patients who underwent endolaparoscopic extraperitoneal repairs for ventral hernias using two different techniques. Group A (n = 68) underwent the original technique, whereas Group B (n = 37) underwent the modified technique. The modifications in Group B included preserving the peritoneal bridge between the two PRS and the hernia sac, conducting a complete dissection of the space of Bogros and adopting a transverse or oblique closure of PRS along the lines of least tension. To assess the efficacy of these modifications in preventing PRS rupture, we compared the results of both groups. Our findings indicate that following all the technical steps of the modified technique resulted in a reduced need for transversus abdominis release for PRS closure and a lower incidence of PRS rupture in the postoperative period. However, to further validate the effectiveness of these modifications, a larger follow-up period and a bigger sample size are required. The adoption of the modified technique can help achieve a tension-free PRS closure.

Rives-Stoppa Retromuscular Repair for Incisional Hernia

There is no consensus on the optimal method of ventral hernia repair and the choice of techniques is typically dictated by a combination of patient factors and surgeon expertise. Component separation techniques allow medial advancement of the rectus abdominis muscle to create a midline tension-free fascial closure. In this case, we describe a posterior component separation with retrorectus mesh placement, also known as a Rives-Stoppa retromuscular repair. With low morbidity and mortality, this technique provides a durable repair with low rates of recurrence and surgical site infection while providing dynamic muscle support and physiologic tension, preventing eventration, and allowing incorporation of mesh into the existing abdominal wall.

Feasibility of totally extraperitoneal inguinal hernia repair in patients with previous prostatectomy.

Laparoscopic totally extraperitoneal inguinal hernia repair (TEP) surgery technique includes three key steps: reaching the preperitoneal space, reducing hernias, and placement of mesh. However, reaching the preperitoneal space can be complicated in patients with previous lower abdominal surgeries. This study aimed to assess the feasibility of laparoscopic inguinal TEP in patients with previous prostatectomies. Inguinal hernia patients who underwent laparoscopic TEP between January 2015 and February 2021 at Koç University Faculty of Medicine, Department of General Surgery, were included in this retrospective study. The operations were performed by five senior surgeons experienced in laparoscopy. Patients were divided into two study groups, as the radical prostatectomy (RP) group which included patients with previous prostatectomy non-RP which included patients without previous radical prostatectomy. Operative time (OT), length of hospital stay (LOS), and postoperative complications were compared within two groups. Three hundred and forty-nine patients underwent laparoscopic TEP, and 27 had previous prostatectomies. Among them, 190 patients had unilateral inguinal hernias, and 159 had bilateral inguinal hernias. Mean age of the patients in the non-RP and RP groups was 58.1 ± 14.7 and 73.9 ± 9.6 years, respectively. Only one (3.7%) case was complicated with urinary tract infection in the RP group, and 10 (3.1%) were complicated in the non-RP group. Complications for the non-RP group include hematomas in six cases, urinary tract infection in three cases, and urinary retention in one case. No significant difference in mean operative time was seen between non-RP and RP groups (p= 0.43). There was no significant difference in the means of the length of hospital stay between the two groups (p= 0.7). Laparoscopic TEP in patients with a previous prostatectomy can be performed safely without prolonging the operative time and increasing the length of hospital stay.

The Effects of Tissue Healing Factors in Wound Repair Involving Absorbable Meshes: A Narrative Review.

Wound healing is a complex and meticulously orchestrated process involving multiple phases and cellular interactions. This narrative review explores the intricate mechanisms behind wound healing, emphasizing the significance of cellular processes and molecular factors. The phases of wound healing are discussed, focusing on the roles of immune cells, growth factors, and extracellular matrix components. Cellular shape alterations driven by cytoskeletal modulation and the influence of the 'Formin' protein family are highlighted for their impact on wound healing processes. This review delves into the use of absorbable meshes in wound repair, discussing their categories and applications in different surgical scenarios. Interleukins (IL-2 and IL-6), CD31, CD34, platelet rich plasma (PRP), and adipose tissue-derived mesenchymal stem cells (ADSCs) are discussed in their respective roles in wound healing. The interactions between these factors and their potential synergies with absorbable meshes are explored, shedding light on how these combinations might enhance the healing process. Recent advances and challenges in the field are also presented, including insights into mesh integration, biocompatibility, infection prevention, and postoperative complications. This review underscores the importance of patient-specific factors and surgical techniques in optimizing mesh placement and healing outcomes. As wound healing remains a dynamic field, this narrative review provides a comprehensive overview of the current understanding and potential avenues for future research and clinical applications.

636 Internal Dislocation of Scapula Following Ivor Lewis Oesophagectomy - a Case Report

Abstract Internal dislocation of scapula is a known but rare complication following traumatic thoracic injury and lung resection. We report a case and the management in a 69-year-old Caucasian man who underwent a stage two Ivor Lewis oesophagectomy for a T3N1M0 oesophageal adenocarcinoma. Post-operatively, the patient required an FiO2 of 60% and two days later placing on Optiflow to maintain adequate oxygen saturations. A CT thorax on day 5 post-op demonstrated a marked chest well deformity with intrathoracic dislocation of the scapula on the site of thoracotomy, 4th rib displacement downwards into the pleural cavity, left basal atelectasis and a pneumothorax; there was no evidence of anastomotic leak or perforation. Following an unsuccessful trial of conservative management using chest drains, a decision was made for surgical exploration and repair. Intra-operatively, the redo thoracotomy from pervious surgical excision revealed that the initial suture had given way allowing the scapula to dislocate into the thoracic cavity; this was subsequently released, adhesions to the lung dissected and pleural effusion drained. The defect in the posterior section of the 4th rib, was closed using a double-layered 15 x 15 cm prolene mesh, which was further secured to the ribs above and below. Post-operative care with pain management and ionotropic support was required in the intensive care unit, and later ongoing chest physiotherapy for basal atelectasis. This case demonstrated the importance of considering rare thoracic complications after oesophagectomy and early decision for re-operation, with the placement of an inlay mesh shown to be effective.

982 Abdominal Wall Reconstruction Following Full Thickness Bilateral Rupture of the Rectus Abdominis

Abstract Introduction Rupture of the rectus abdominis is a rarely seen condition and there is no consensus its management. Case Description A 20-year-old male presented with severe lower abdominal pain that occurred during exercise (i.e., ‘burpees’). MRI revealed full-thickness bilateral rupture of the rectus abdominis. Abdominal wall reconstruction involved bilateral rectus muscle repair using plastic surgical techniques and placement of a biosynthetic mesh (Phasix ST from BD) in the retrorectus plane. Postoperatively, our patient could walk pain-free at 3 weeks, jog pain-free at 10 weeks, and run up to 2 miles at 25 weeks. Literature Review There is no consensus on how to manage this rare injury or whether surgical or conservative treatment yields better results. Pubmed, Medline and Embase databases were searched to identify relevant studies using the following MeSH terms, “rectus abdominis” and “rupture”, as well as their free text counterparts. The search resulted in 391 articles. Manual cross-referencing was performed, limiting the included articles to 8 for review. 6 out of the 8 selected articles discussed management using conservative means, while only 2 cases were managed surgically. Interestingly, no other exercise-related cases in the literature were managed surgically. Instead, all exercise related cases were managed conservatively, while traumatic cases were managed surgically. Among both surgically and conservatively treated patients, all patients returned to normal levels of activity. Conclusions Full-thickness, bilateral rupture of the rectus abdominis can occur during exercise. Intervention depends on the size and severity of the injury, but surgical and conservative treatment yield similar results.

Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention-A EHS, ESCP and EAES Collaborative Project.

Objective: To perform a systematic review and meta-analysis on the effectiveness of prophylactic mesh for the prevention of parastomal hernia in end colostomy, with the ultimate objective to summarize the evidence for an interdisciplinary, European rapid guideline. Methods: We updated a previous systematic review with de novo evidence search of PubMed from inception up to June 2022. Primary outcome was quality of life (QoL). Secondary outcomes were clinical diagnosis of parastomal hernia, surgery for parastomal hernia, and 30day or in-hospital complications Clavien-Dindo ≥3. We utilised the revised Cochrane Tool for randomised trials (RoB 2 tool) for risk of bias assessment in the included studies. Minimally important differences were set a priori through voting of the panel members. We appraised the evidence using GRADE and we developed GRADE evidence tables. Results: We included 12 randomized trials. Meta-analysis suggested no difference in QoL between prophylactic mesh and no mesh for primary stoma construction (SMD = 0.03, 95% CI [-0.14 to 0.2], I2 = 0%, low certainty of evidence). With regard to parastomal hernia, the use of prophylactic synthetic mesh resulted in a significant risk reduction of the incidence of the event, according to data from all available randomized trials, irrespective of the follow-up period (OR = 0.33, 95% CI [0.18-0.62], I2 = 74%, moderate certainty of evidence). Sensitivity analyses according to follow-up period were in line with the primary analysis. Little to no difference in surgery for parastomal hernia was encountered after pooled analysis of 10 randomised trials (OR = 0.52, 95% CI [0.25-1.09], I2 = 14%). Finally, no significant difference was found in Clavien-Dindo grade 3 and 4 adverse events after surgery with or without the use of a prophylactic mesh (OR = 0.77, 95% CI [0.45-1.30], I2 = 0%, low certainty of evidence). Conclusion: Prophylactic synthetic mesh placement at the time of permanent end colostomy construction is likely associated with a reduced risk for parastomal hernia and may confer similar risk of peri-operative major morbidity compared to no mesh placement. There may be no difference in quality of life and surgical repair of parastomal hernia with the use of either approach.

Learning curves of robotic extended totally extraperitoneal (eTEP) hernia repair among two surgeons at a high-volume community hospital: a cumulative sum analysis.

Robotic extended totally extraperitoneal hernia (eTEP) repair is a novel technique for minimally invasive ventral hernia repair with retromuscular placement of mesh. This study aimed to evaluate the learning curve for robotic eTEP hernia repair using risk-adjusted cumulative sum (RA-CUSUM) analysis for two general surgeons-one with dedicated fellowship training in robotic eTEP technique (surgeon 2) and another without robotic eTEP-specific training (surgeon 1). We conducted a retrospective analysis of 98 patients undergoing robotic eTEP hernia repair from July 2020 to February 2022 for two surgeons. RA-CUSUM method was applied to the overall operative time (OT) in minutes, adjusting for transversus abdominis release (TAR). Figures 3 (surgeon 1) and 4 (surgeon 2) illustrate the three phases in the RA-CUSUM graphs of OT. For surgeon 1, the cases for each phase were determined: phase 1 (1 to 12), phase 2 (13 to 24), and phase 3 (25 to 51). For surgeon 2, the three phases were similarly determined as 1 to 8, 9 to 32, and 33 to 47, respectively. A significant (p = 0.017) difference existed for the OTs between phases 1 (262 ± 69) and 3 (192 ± 63.0) for surgeon 1. OT compared to the risk-adjusted value stabilized after case 12 and decreased after case 24 for surgeon 1; it began to decrease after case 8 for surgeon 2. The initial learning curve for surgeon 1 reached its plateau after 12 cases, shorter than comparable studies. This was likely due to the surgeon's intentional focus on learning this technique through courses, proctoring, and active mentorship. The flat learning curve seen in surgeon 2's series illustrates the value of experience gained during fellowship training. Our data support that, given the right resources and support, a short learning curve for eTEP is attainable for community surgeons without prior training in the technique.

Current Surgical Management of the Inguinal Hernias

Definition: Inguinal hernias are characterized by the protrusion of tissues through a weakness in the abdominal wall in the inguinal region. They are divided into direct and indirect hernias, with anatomical differences influencing the choice of surgical technique. Types of Hernias and Surgical Management: The surgical approach is based on individual and symptomatic considerations. Asymptomatic hernias may be observed, while symptomatic ones usually require intervention. Mesh repair is a common technique, with both open and laparoscopic repair options. The choice is based on the patient's anatomy and the surgeon's experience. Complications: Despite progress, recurrences remain a concern. Careful selection of technique and attention to mesh placement can reduce this rate. Postoperative complications, such as infections and chronic pain, are also concerns to consider. Discussion: The discussion focuses on the choice between open and laparoscopic repair techniques. Adaptation to the patient's individual conditions, such as age and comorbidities, is essential. Research and innovation continue to play a crucial role in improving outcomes and preventing complications. Conclusions: The surgical management of inguinal hernias is a balance between tradition and innovation. Collaboration between surgeons and constant research are critical to advancing the field. The individualized approach and continuous improvement of techniques and materials will continue to provide patients with a better quality of life and more positive outcomes in the future.

Comparative Study between Onlay and Sublay Placement of Polyproline Mesh in Ventral Hernia Repair

Abstract Background Ventral hernia repair is one of the most common surgical operations performed all over the world. Onlay and sublay mesh repairs are the commonly performed techniques for the same. However, the debate still continues about the superiority of both techniques over each other. The aim of this study was to compare the outcome of the onlay versus sublay mesh repair for ventral hernia. Aim of the Work The purpose of this study is to compare between two techniques of mesh placement in uncomplicated ventral hernias, onlay (mesh on external oblique) versus sublay (mesh in the retromuscular space) regarding complications (superficial skin infection, seroma collection, operative time, hospital stay and 18 months recurrence rate. Patients and Methods The study frame is two years starting from August 2019 to August 2021 in general surgery department at Ain shams university hospital a. Total 60 adult patients who are scheduled to undergo hernioplasty for ventral abdominal wall hernias, 30 are included group A (onlay) and 30 in group B (sublay). Results Maior wound infection was 10% in the onlay group in coparison by the 3.3% of sublay group. Seroma is 33.3% in onlay group while 26.7% in sublay group. Recurrence rate is 6.7% in onlay while 3.3%in sublay group. Conclusion Our study revealed that ventral hernias are common in females more than males mainly in the fifth decade of life. Although there are many methods in repair such herniorraphy which associated with a high rate of recurrence so mesh repair is the best in such cases. We have found that sublay hernioplasty is better than onlay hernioplasty according to the post-operative complications such as recurrence, seroma formation and wound infection. However sublay hernioplsaty takes longer operative time than the onlay technique due to the disscection to get the retromuscular space, no significant statistical difference in the operative time., no significant blood loss and hospital stay between the two techniques.

Ostomy Closure With Prophylactic Anterectus Mesh Placement: An Underappreciated, but Valuable Tissue Plane in Hernia Surgery.

Ostomy Closure With Prophylactic Anterectus Mesh Placement: An Underappreciated, but Valuable Tissue Plane in Hernia Surgery.

232 The inGuinal heRnia OperatIon Notes (GROIN) Quality Improvement Project

Abstract Aims Accurate and comprehensive operation notes are crucial for patient safety, quality assurance and medico-legal purposes. Inguinal hernia repair is one of the most common surgical procedures. Thus, operative documentation should be precise and standardised. The GROIN project aims to improve the quality of inguinal hernia operation notes using evidence-based proformas and an operation note composition software. Method We retrospectively reviewed operation notes of inguinal hernia repair performed at our institution between August and November 2022. Operation notes were assessed against the Royal College of Surgeons' Good Surgical Practice standard, consisting of 18 items. Results The operation notes from 89 cases were reviewed. High-scoring items included: operation name (100%), operative findings (99%), surgeon's name (99%), closure technique (98%), operation date (90%) and signature (90%). Postoperative instructions were sufficiently detailed in 79% of cases. Regarding mesh placement, 63% of notes described mesh size and type, whereas 30% documented only the mesh type. The lowest-scoring items were: venous thromboembolism prophylaxis (31%), designation as elective or emergency (22%), operative diagnosis (6%), and estimated blood loss (2%). Conclusions We identified several areas for improvement in inguinal hernia operation notes based on our results. The next step of the GROIN project is to standardise operation note creation by implementing an evidence-based template, which will be delivered through a novel operation note composition software. This will allow accurate record-keeping and efficient operative data extraction analysis. Efforts to standardise operative notes and enhance their quality on a national and international level are imperative for patient safety.

Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a 5–10-year follow-up of the randomized controlled multicenter study

PurposeIn this long-term follow-up of a prospective, randomized, and multicenter study, we compare the results of a group receiving laparoscopic incisional ventral hernia repair using intraperitoneal onlay mesh (LG) to a group receiving a hybrid hernia repair where open closure of fascial defect was added to intraperitoneal mesh placement (HG).MethodsOriginally, 193 patients with 2–7 cm incisional hernias were randomly assigned to either the LG or HG during the 30-month recruitment period in 2012 to 2015. Long-term follow-up was conducted 5–10 years after surgery to evaluate hernia recurrence rate and quality of life (QoL).ResultsIn all, 65 patients in the LG and 60 in the HG completed the long-term follow-up with a median follow-up period of 87 months. Recurrent hernia was detected in 11 of 65 patients (16.9%) in the LG and 10 of 60 patients (16.7%) in the HG (p > 0.9). Kaplan–Meier analysis demonstrated a recurrence rate approaching 20% in both groups, with similar curves. Three patients in the LG (4.6% and five patients in the HG (8.1%) had undergone re-operation due to recurrence (p = 0.48). There was no difference in patient-reported QoL measured using the SF-36 questionnaire. Mean pain scores were similar between groups, mean numeric rating scale (NRS) 0 to 10 being 1.1 in the LG and 0.7 in the HG (p = 0.43).ConclusionFascial closure did not reduce hernia recurrence rate in this study population, even though it has been shown to be beneficial and recommended in surgery guidelines. In the long term, recurrence rate for both groups is similar.

Bringing Artificial Intelligence to the operating room: edge computing for real-time surgical phase recognition.

Automation of surgical phase recognition is a key effort toward the development of Computer Vision (CV) algorithms, for workflow optimization and video-based assessment. CV is a form of Artificial Intelligence (AI) that allows interpretation of images through a deep learning (DL)-based algorithm. The improvements in Graphic Processing Unit (GPU) computing devices allow researchers to apply these algorithms for recognition of content in videos in real-time. Edge computing, where data is collected, analyzed, and acted upon in close proximity to the collection source, is essential meet the demands of workflow optimization by providing real-time algorithm application. We implemented a real-time phase recognition workflow and demonstrated its performance on 10 Robotic Inguinal Hernia Repairs (RIHR) to obtain phase predictions during the procedure. Our phase recognition algorithm was developed with 211 videos of RIHR originally annotated into 14 surgical phases. Using these videos, a DL model with a ResNet-50 backbone was trained and validated to automatically recognize surgical phases. The model was deployed to a GPU, the Nvidia® Jetson Xavier™ NX edge computing device. This model was tested on 10 inguinal hernia repairs from four surgeons in real-time. The model was improved using post-recording processing methods such as phase merging into seven final phases (peritoneal scoring, mesh placement, preperitoneal dissection, reduction of hernia, out of body, peritoneal closure, and transitionary idle) and averaging of frames. Predictions were made once per second with a processing latency of approximately 250ms. The accuracy of the real-time predictions ranged from 59.8 to 78.2% with an average accuracy of 68.7%. A real-time phase prediction of RIHR using a CV deep learning model was successfully implemented. This real-time CV phase segmentation system can be useful for monitoring surgical progress and be integrated into software to provide hospital workflow optimization.

Prevention of incisional hernia after kidney transplantation: study protocol for a randomized controlled trial

BackgroundIncisional hernia is a common complication after kidney transplantation with an incidence of 1.6–18%. Concerning non-transplant patients, a recently published meta-analysis describes a reduction of the incidence of incisional hernia of up to 85% due to prophylactic mesh replacement in elective, midline laparotomy. The aim of our study is to show a reduction of the incidence of incisional hernia after kidney transplantation with minimal risk for complication.Methods/designThis is a blinded, randomized controlled trial comparing time to incisional hernia over a period of 24 months between patients undergoing kidney transplantation and standardized abdominal closure with or without prophylactic placement of ProGrip™ (Medtronic, Fridley, MN, USA) mesh in an onlay position. As we believe that the mesh intervention is superior to the standard procedure in reducing the incidence of hernia, this is a superiority trial.DiscussionThe high risk for developing incisional hernia following kidney transplantation might be reduced by prophylactic mesh placement. ProGrip™ mesh features polylactic acid (PLA) microgrips that provide immediate, strong and uniform fixation. The use of this mesh combines the effectiveness demonstrated by the macropore propylene meshes in the treatment of incisional hernias, a high simplicity of use provided by its capacity for self-fixation that does not increase significantly surgery time, and safety.Trial registrationClinicalTrials.gov NCT04794582. Registered on 08 March 2021. Protocol version 2.0. (02–18-2021).

Improved patient-reported outcomes after open preperitoneal inguinal hernia repair compared to anterior Lichtenstein repair: 10-year ACHQC analysis

IntroductionThe Lichtenstein repair has been synonymous with “open” inguinal hernia repair (IHR) for 40 years. However, international guidelines have suggested that posterior mesh placement results in advantageous biomechanics and reduced risk of nerve-related chronic pain. Additionally, the use of local anesthetics has been shown to reduce postoperative pain and complication risks. An open transrectus preperitoneal/open preperitoneal (TREPP/OPP) repair combines posterior mesh placement with the use of local anesthetic and as such could be the ideal repair for primary inguinal hernia. Using the Abdominal Core Health Quality Collaborative (ACHQC) registry, we compared open anterior mesh with open posterior mesh repairs.MethodsWe performed a propensity score matched analysis of patients undergoing open IHR between 2012 and 2022 in the ACHQC. After 1:1 optimal matching, both the TREPP/OPP and Lichtenstein cohorts were balanced with 451 participants in each group. Outcomes included patient-reported quality of life (QoL), hernia recurrence, and postoperative opioid use.ResultsImprovement was seen after TREPP/OPP in EuraHS QoL score at 30 days (OR 0.558 [0.408, 0.761]; p = 0.001), and the difference persisted at 1 year (OR 0.588 [0.346, 0.994]; p = 0.047). Patient-reported opioid use at 30-day follow-up was significantly lower in the TREPP/OPP cohort (OR 0.31 [0.20, 0.48]; p < 0.001). 30-day frequency of surgical-site occurrences was significantly higher in the Lichtenstein repair cohort (OR 0.22 [0.06–0.61]; p = 0.007). There were no statistically significant differences in hernia recurrence risk at 1 year, or rates of postoperative bleeding, peripheral nerve injury, DVTs, or UTIs.ConclusionOur analysis demonstrates a benefit of posterior mesh placement (TREPP/OPP) over anterior mesh placement (Lichtenstein) in open inguinal hernia repair in patient-reported QoL and reduced opioid use.

Spontaneous Lumbar Hernia: A Case Report

Lumbar hernias are rare, and the diagnosis can be easily missed. Acquired lumbar hernias can occur spontaneously; however, they are increasingly being reported due to trauma or flank surgery. A good history and examination can aid in diagnosis with imaging confirming the condition. Hernia repair can be laparoscopic or through open surgical approaches. We report a case of primary spontaneous lumbar hernia which was managed by an open approach to close the defect with retromuscular mesh placement.