Mesh Repair Technique Research Articles

Learning and implementation of TransREctus sheath PrePeritoneal procedure for inguinal hernia repair

PurposeThe TransREctus sheath PrePeritoneal procedure (TREPP) was introduced as an alternative open and preperitoneal technique for inguinal hernia mesh repair, demonstrating safety and efficacy in retro- and prospective studies. However, little is known about the technique’s inherent learning curve. In this study, we aimed to determine TREPP learning curve effects after its implementation in high-volume surgical practice.MethodsAll primary, unilateral TREPP procedures performed in the first three years after implementation (between January 2016 and December 2018) were included out of a large preconstructed regional inguinal hernia database. Data were analyzed on outcome (i.e., surgical complications, hernia recurrences, postoperative pain). Learning curve effects were analyzed by assessing outcome in relation to surgeon experience.ResultsIn total, 422 primary, unilateral TREPP procedures were performed in 419 patients. In three patients a unilateral TREPP procedure was performed on both sides separated in time. A total of 99 surgical complications were registered in 83 procedures (19.6% of all procedures), most commonly inguinal postoperative pain (8%) and bleeding complications (7%). Hernia recurrences were observed in 17 patients (4%). No statistically significant differences on outcome were found between different surgeon experience (< 40 procedures, 40–80 procedures, > 80 procedures).ConclusionImplementation of TREPP seems not to be associated with a notable increase of adverse events. We were not able to detect a clear learning curve limit, potentially suggesting a relatively short learning curve among already experienced hernia surgeons compared to other guideline techniques.

Revisiting large complex ventral hernia repair: multimodal hybrid technique deploying preoperative Botulinum Toxin A injection, laparoscopic anterior components separation and open mesh repair.

In the past, various techniques had been described to repair large complex ventral hernias. Laparoscopic technique of components separation showed low complication rates and better overall outcome. Recently, Botulinum Toxin A (BTA) has shown benefit in achieving tension-free repair. We describe here our multimodal technique combining BTA injection, laparoscopic anterior components separation (LACS) and open mesh repair. Ten consecutive cases performed over 3years were studied. A standardised technique was used with a reasonably short learning curve. Patients who generally fit for general anaesthesia were offered surgery after detailed preoperative imaging work up and informed consent. Demographic details, preoperative risk stratification, intraoperative and postoperative outcomes were recorded and analysed. A structured step by step management strategy was adopted. Total ten (n = 10) cases with median age of 42.5years (range 28-76years), male to female ratio of 8:2 and median BMI of 32.6 were included. Three patients had pre-existing stomas. Median diameter of hernial defect was 10cm, IQR 4.8cm and range of 6-20cm. No intraoperative or immediate complications were observed. Median hospital stay was 6days. Two seromas (20%) and two return to theatre (20%) were observed. One recurrence (10%) was observed after median follow-up of 32months. No 90-day mortality was recorded. Multimodal technique of BTA injection, LACS and midline mesh repair is a reproducible, safe and effective option to repair large complex ventral hernias.

Comparison of Efficacy and Safety in Sublay versus Onlay Mesh Repair for Para-Umbilical Hernia: A Randomized Controlled Trial

Background: Ventral hernias, either spontaneous or post-surgical, represent a significant challenge in surgical practice. The recurrence rates after primary tissue repair, especially in larger hernias, necessitate the use of tension-free mesh repairs. However, the choice between onlay and sublay mesh repair methods remains a subject of debate, with each technique having its own set of advantages and drawbacks. Objective: The study aimed to compare the efficacy and safety of sublay versus onlay mesh repair techniques in the treatment of ventral hernias, with a focus on postoperative complications, pain, and treatment success rates. Methods: This randomized controlled trial was conducted from May 2023 to October 2023 at multiple surgical centers. It involved 120 patients, aged 18 to 70 years, undergoing ventral hernia repair. Patients were randomly allocated into two groups: Group A (60 patients) receiving onlay mesh repair and Group B (60 patients) receiving sublay mesh repair. The study assessed postoperative complications, including seroma, wound infection, and pain using the Visual Analogue Scale (VAS), as well as overall treatment efficacy. Data were analyzed using SPSS version 25.0, with a p-value of less than 0.05 considered statistically significant. Results: The mean age in Group A was 40.90±11.56 years, and in Group B, 40.55±11.63 years. Group A comprised 41.7% males and 58.3% females, while Group B had 46.7% males and 53.3% females. In Group A, seroma developed in 10%, wound infection in 15%, and postoperative pain in 18.3% of patients. Group B reported seroma in 3.3%, wound infection in 3.3%, and postoperative pain in 6.7%. The effectiveness of the treatment was 80% in Group A and 93.3% in Group B, with a notable difference in complication rates and success between the groups. Conclusion: The sublay mesh repair technique demonstrated superior outcomes in terms of lower complication rates and higher treatment efficacy compared to the onlay method. This suggests that the sublay approach may be more advantageous for ventral hernia repair, offering better patient outcomes with fewer postoperative complications.

Comparative Evaluation of Onlay vs Sublay Mesh in Treatment of Ventral Hernias

Abstract Background Hernias of the anterior abdominal wall, or ventral hernias have a various type that can be categorized into primary ventral hernias which include two subtypes lateral ventral hernia, and midline ventral hernias, and incisional hernias (acquired hernias) is another type according to the location, occur at the site of a pervious surgical scar. Objective To compare the outcome of the onlay versus sublay mesh repair for ventral hernias in terms of mean operative time, frequency of post-operative wound infection, seroma formation, hematoma formation, flap necrosis, mesh infection, hospital stay and time for drain removal. Patients and Methods This study will be conducted on 30 patients presenting to Ain shams University hospitals with uncomplicated ventral hernias starting from February 2021 till July 2021. Results Regarding the post operative complications, Seroma formation was more in the onlay group and this was statistically significant. Other post operative complications like wound infection, flap necrosis, Mesh infection, hematoma formation was more in the onlay group but were found to be statistically insignificant in the present study. Regarding the time taken for drain removal was more in the onlay group and this was statistically significant. Conclusion Sublay mesh repair is a good alternative to onlay mesh repair. This study advocates this method of ventral hernia repair, as it is applicable to all sites of ventral hernia. The mesh is mostly hidden and anchored behind the rectus sheath, the complication rate is low, and there is low recurrence rate. Finally, we suggest carrying out more trials on the sublay mesh repair technique to include bigger number of cases and longer period of follow-up.

SP9.12 The Global Practice of Inguinal Hernia Repair Study (GLACIER): A survey of 1014 hernia surgeons

Abstract Introduction There are many variations in practices and preferences for inguinal hernia repair among surgeons globally. The purpose of the Global Practice of Inguinal Hernia Repair Study (GLACIER) was to capture these variations related to open, laparoscopic, and robotic inguinal hernia repair. Method A questionnaire-based survey on Survey Monkey® was created, and the link was shared freely on various social media platforms, personal email network of authors and email to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC). Results A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were equally preferred (43% and 47% respectively). Transabdominal pre-peritoneal repair (TAPP) is the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for minimally invasive approach. Repair with a mesh was preferred by 98% of the surgeons and synthetic monofilament light weight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and, 1% after minimally invasive repair. Only 10% of surgeons preferred open repair with local anaesthesia. Conclusion This survey identified similarities and variations in practice globally along with some discrepancies in inguinal hernia repair compared to best practice guidelines. It also identifies several key areas where more focus future research is required.

A comparative study between laparoscopic trans-abdominal retromuscular repair and intraperitoneal onlay mesh repair techniques in ventral hernia

Background A hernia is a projection of an organ or part of an organ through a defect in the body wall. When compared to open procedures, laparoscopic ventral hernia repair has consistently demonstrated lower overall complication rates, shorter hospital stays, and faster return to work. Aim To compare the efficacy and safety between laparoscopic transabdominal retromuscular mesh (TARM) repair and laparoscopic (IPOM) repair in the treatment of patients with ventral hernia in Zagazig University Hospitals as a single center experience. Patients and methods This study is a prospective randomized clinical trial carried out upon 48 patients who were randomized by closed envelope method into two groups: Group (A): had undergone Laparoscopic TARM repair. Group (B): had undergone Laparoscopic IPOM repair. Results There was statistically significant variation between groups concerning cost which was significantly lower in laparoscopic TARM repair. Group B was lower regard intra operative complication rate but not significantly, but regard postoperative complication Group A significantly associated with Seroma and Group B significantly associated with Bulge. Complicated cases were significantly younger and wider regarding hernia width. Conclusion TARM repair technique was more time consuming but with less cost in comparison to the IPOM technique. TARM has the advantage of defect closure and avoiding mesh contact with abdominal viscera.

An international survey of 1014 hernia surgeons: outcome of GLACIER (global practice of inguinal hernia repair) study.

The practice of inguinal hernia repair varies internationally. The global practice of inguinal hernia repair study (GLACIER) aimed to capture these variations in open, laparoscopic, and robotic inguinal hernia repair. A questionnaire-based survey was created on a web-based platform, and the link was shared on various social media platforms, personal e-mail network of authors, and e-mails to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC). A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were preferred by 43% and 47% of participants, respectively. Transabdominal pre-peritoneal repair (TAPP) was the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for a minimally invasive procedure. Ninety-eight percent of the surgeons preferred repair with a mesh, and synthetic monofilament lightweight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and 1% after minimally invasive repair. Only 10% of surgeons preferred to perform an open repair using local anaesthesia. This survey identified similarities and variations in practice internationally and some discrepancies in inguinal hernia repair compared to best practice guidelines, such as low rates of repair using local anaesthesia and the use of lightweight mesh for minimally invasive repair. It also identifies several key areas for future research, such as incidence, risk factors, and management of chronic groin pain after hernia surgery and the clinical and cost-effectiveness of robotic hernia surgery.

Comparison of Post-Operative Pain after Lap Mesh Hernioplasty and Open Mesh Hernioplasty

Objective: To compare the outcome of two tension free methods of hernia repair: laparoscopic mesh repair versus open mesh technique in terms of severity of chronic post-operative pain. Material and methods: In this randomized controlled trial, total 100 male patients with inguinal hernia, age between 20-60 years were selected from Department of Surgery, Arif Memorial Teaching Hospital Lahore. Duration of study was 6 months (from April 2021 to October 2021). Chronic pain was compared between the groups. Results: In our study, mean age in group A and B was 41.84+8.92 years and 43.18+8.58 years respectively. Chronic pain was recorded in 4%(n=2) patients in Laparoscopic group (Group-A) and 28%(n=14) patients in Lichtenstein group (Group-B) while 96%(n=48) patients in Laparoscopic group (Group-A) and 72%(n=36) patients in Lichtenstein group (Group-B) had no chronic pain. Difference was significant (P=0.001). Pain intensity shows that 96%(n=48) patients in Laparoscopic group (Group-A) and 16%(n=8) patients in Lichtenstein group (Group-B) had no pain while moderate pain was reported in 4%(n=2) patients and 72%(n=36) patients respectively in Laparoscopic group and Lichtenstein group and severe pain was noted in Group-B as 12%(n=6), p value was 0.001. Group A was subjected to Laparoscopic Mesh repair and Group B hernia was repaired by Lichtenstein repair Conclusion: We concluded that laparoscopic mesh repair versus open mesh technique in terms of severity of chronic post-operative pain, laparoscopic mesh repair is found with significant lower pain. Keywords: Laparoscopic mesh repair, inguinal hernia, open mesh, severity of chronic post-operative pain.

A Comparative Study of Desarda's Technique with Lichtenstein Mesh Repair in Treatment of Inguinal Hernia

Introduction: European hernia society (EHS) published a guideline that recommended Lichtenstein method for inguinal hernia repair. Currently Lichtenstein method is considered the most popular method. Desarda repair technique was used for the first time in 2001 which is still not considered as a standard tissue-based technique for inguinal hernia repair. We compared Desarda's technique with Lichtenstein mesh repair technique in treatment of inguinal hernia repair. Objectives: To compare the outcome of standard mesh-based Lichtenstein technique with the tissue based Desarda technique in terms of pain. Materials and Methods: After taken approval from hospital ethical committee, 250 patients were enrolled in the study. Enrolled patients were divided into two group. Group A underwent hernia repair through Desarda technique &amp; group B will underwent hernia repair through Lichtenstein technique. Post-operative pain was assessed on day 7 and 30 by using visual analogue scale. All information was recorded on a pre-designed Proforma. The collected data from the patients through Proforma’s was entered in SPSS. Results: 250 patients were included in our study with mean age distribution 42.18+10.34 year. 82.8% patients were males while 17.2% were females. Mean SD of operative time for both groups (Desarda Group vs Lichtenstein Technique) were 23.41+ 0.17 vs 24.18 + 0.66. 111) patients (89%) 92 felt mild post-operative pain who were subjected to Group A while 14 (11%) patients suffered moderate post-operative pain with Mean SD 2.46+0.30. 88% patients felt post-operative pain who were subjected to Group B while 15 patients (12%) felt moderate post-operative pain with Mean SD 2.46+0.18 thus giving us almost same results as found in Group A. Conclusion: The results of inguinal hernia treatment with both Desarda and Lichtenstein technique are similar. So, we conclude the Desarda repair is as effective as the standard Lichtenstein procedure, allowing successful hernia repair without mesh in terms of pain. Keywords: Desarda's technique, Lichtenstein mesh, inguinal hernia

PREEMPTIVE DEEP TENSION SUTURING IN PREVENTION OF BURST ABDOMEN

Background :Burst abdomen is a major complication associated with contaminated or dirty surgeries, including emergency midline laparotomy. Possible causative factors involve wound sepsis, patients’ overall pressure inside the abdomen, and many system problems. Conventional oncosurgical approaches could prove inadequate, leading to evaluation of preventive methods, such as DTS, of minimizing such adverse outcomes. Objectives :To evaluate the level of success of deep tension suturing done before the primary closure of the abdomen against formation of burst abdomen, wound infection, and incisional hernia than mass closure techniques. Study design: A Cross sectional study. Place and duration of study. This Cross Sectional study was carried out at Setting: Done at Ziauddin Hospital, Civil Hospital- ward 06, and PAF Hospital, Karachi from Change the dates in duration of study as follows: January 2019 to Jan 2022 Methods: A Cross Sectional study which involved 100 adults who were posted for emergency midline laparotomy due to generalized peritonitis. Patients were divided into two groups: Group A: conventional mass closure Group B: closure with DTS. Both groups received simple polypropylene sutures for wound closure as in the standard mesh repair technique but not in group B they also received four deep tension sutures using the rubber tubing to distribute tension over wider areas of the tissue. Patients with diabetes, immunosuppression, or use of corticosteroids were excluded as a result. Results The age in years of the participants was 31.61 ± 9.31 years; the maximum age was 61 years, the minimum was 18 years. The observation was made that the incidence of burst abdomen in Group B was 4 and that of Group A was 18 (p&lt;0.05). Bacteremia was noticed in 10 Pt’s in Group B and 17 Pt’s in Group A(p&lt;0.05). Postoperative incisional hernia was identified in seven patients in Group A and none in Group B with p&lt;0.05. These outcomes show decreases in all of the primary complications when implementing DTS on the approaches as there were statistically significant improvements for all of them. Conclusion :The pro-active use of deep tension sutures in emergency midline laparotomy dramatically decreases the rate of burst abdomen, wound infection, and incisional hernia. As tension on the wound edges is reduced by DTS, the study shows that postoperative complications are preventable in high-risk surgeries, patient benefits maximized, and reoperations minimized.

Sugarbaker Versus Keyhole Repair for Parastomal Hernia: a Systematic Review and Meta-analysis of Comparative Studies

IntroductionParastomal hernia is a debilitating complication of stoma creation. Parastomal hernia repair with mesh reduces recurrence rates in open and laparoscopic settings. Recent comparative studies conflict with previously pooled data on optimal mesh repair technique. The objective of this study is to examine parastomal hernia recurrence rates after Sugarbaker and keyhole repairs by performing an updated systematic review and meta-analysis of comparative studies. MethodsA systematic review of PubMed, MEDLINE, EMBASE, the Cochrane database, SCOPUS, and the PROSPERO registry was performed according to PRISMA 2020 guidelines (PROSPERO ID: CRD42021290483). Studies comparing parastomal hernia recurrences after Sugarbaker and keyhole repairs were included. Studies with overlapping patient cohorts (duplicate data), non-comparative studies, studies that did not report the primary outcome of interest, and studies not in the English language were excluded. Study bias was assessed using the Newcastle–Ottawa scale. Pooled mean differences (MD), odds ratios (OR), and risk ratios (RR) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I2 statistic. Forest plots and funnel plots were generated. Study quality was analyzed using MINORS. Additional subgroup analysis of modern studies was performed. ResultsTen comparative studies published between 2005 and 2021 from 5 countries were included for analysis comprising 347 Sugarbaker repairs and 246 keyhole repairs. There were no differences in patient age, sex, or BMI between the groups. There was no difference between the groups regarding surgical site infection (OR 0.78; CI 0.31–1.98; P = 0.61) or post-operative bowel obstruction (OR 0.76; CI 0.23–2.56; P = 0.66). Sugarbaker repairs were significantly less often associated with parastomal hernia recurrence when compared to keyhole repairs (OR 0.38; CI 0.18–0.78; P = 0.008). There was no significant heterogeneity among the studies comparing parastomal hernia recurrence (I2 = 32%; P = 0.15). Quality analysis revealed a median MINORS score of 11 (range 6–16). Subgroup analysis of studies performed after the previously published pooled analysis (2015–2021) revealed no significant difference in parastomal hernia recurrence between the two groups (OR 0.58; CI 0.24–1.38; P = 0.22) with a significant subgroup effect (P = 0.05). ConclusionsThough there were lower rates of parastomal hernia recurrence with Sugarbaker repairs on overall analysis, this phenomenon disappeared on subgroup analysis of modern studies. Randomized controlled trials with contemporary cohorts would help further evaluate these repairs and minimize potential bias.

Mesh versus non-mesh repair of groin hernias: a rapid review.

Mesh is frequently utilized intraoperatively for the repair of groin hernias. However, patients may request non-mesh hernia repairs owing to adverse events reported in other mesh procedures. To inform surgical safety, this study aimed to compare postoperative complications between mesh and non-mesh groin hernia repairs and identify other operative and patient-related risk factors associated with poor postoperative outcomes. Ovid MEDLINE and grey literature were searched to 9 June 2021 for studies comparing mesh to non-mesh techniques for primary groin hernia repair. Outcomes of interest were postoperative complications, recurrence of hernia, pain and risk factors associated with poorer surgical outcomes. Methodological quality was appraised using the AMSTAR 2 tool. The systematic search returned 4268 results, which included seven systematic reviews and five registry analyses. Mesh repair techniques resulted in lower hernia recurrence rates, with no difference in chronic pain, seroma, haematoma or wound infection, compared to non-mesh techniques. Risk factors associated with increased risk of hernia recurrence were increased body mass index (BMI), positive smoking status and direct hernia. These were independent of surgical technique. Patients under 40 years of age were at increased risk of postoperative pain. Surgical repair of primary groin hernias using mesh achieves lower recurrence rates, with no difference in safety outcomes, compared with non-mesh repairs. Additional risk factors associated with increased recurrence include increased BMI, history of smoking and hernia subtype.

Sublay and overlay mesh repair in paraumbilical hernias– which surgery you will prefer??

Background: Paraumbilical hernia accounts for 33.9% of anterior abdominal wall hernia. Mesh can be applied onlay; on the anterior fascia, inlay; in the hernia defect, sublay; to retro-rectus or preperitoneal space or underlay; in the intraperitoneal position. Aims and Objectives: The objectives of the study are as follows:1) To compare the efficacy between sublay and onlay mesh repair for paraumbilical hernia. 2) To compare the safety between sublay and onlay mesh repair for paraumbilical hernia. Materials and Methods: A prospective study was conducted on 120 patients (60 in each group) patients. The patients were randomly allocated in two groups by lottery method. Patients in Group-A were subjected to sublay mesh repair procedure and patients in Group-B were subjected to onlay mesh repair procedure for paraumbilical hernia repair. Postoperatively, every patient was kept under observations for 3–4 days in ward and observed for complications. Postoperatively, all patients were followed at 10 days, 3 months, and 6thmonth to confirm efficacy and safety of the procedure. Results: The average age of Group-A was 39 years and 32 years in Group-B. In Group-A, 55% patients were female and 45% patients were male; whereas in Group-B, 60% patients were female and 40% patients were male. More over sublay mesh repair was effective in 82% patients on the bases of recurrence while this procedure was safe in 90% cases on the bases of complications whereas onlay mesh repair was effective in 90% patient’s cases on the bases of recurrence while this procedure was safe in 93% cases on the bases of complications. Conclusion: Onlay mesh repair technique is more effective, quick, and safe as compared to sublay mesh repair technique for the treatment of paraumbilical hernia.

Outcome and complications of Ventralex mesh repair in umbilical hernia

In recent time, various techniques have been applied for the hernia repair surgery. Considering the possibility of the recurrence rates up to 40%, umbilical and umbilical port hernias have been repaired without mesh for a long time. The repair of these hernias by the Ventralex hernia patch may decrease recurrent hernia rates. The aim of this study was to evaluate the outcome and complications of mesh repair in umbilical hernia by the Ventralex hernia patch. A total of 36 patients were studied retrospectively who underwent mesh repair surgery by the Ventralex hernia patch between April 2017 and October 2019 at Anower Khan Modern Medical College &amp; Hospital, Care Medical College &amp; Hospital and LABAID Specialized Hospital. They have also been evaluated for instant post-operative complications, recurrence rate &amp; pain. Short-term clinical outcomes were assessed during post-operative follow up at first and sixth week. One year long-term outcomes were assessed over telephone. In this study, there were 28 female and 8 male patients with the range of age from 24-68 years (Mean 41.5 ±8.36) having 27 umbilical hernias and 9 umbilical port hernias. No major short-term complications were found but early minor complications were found in 5 patients (13.89%). No pain or mild pain was reported in 31 patients after one week’s post-operative follow up. 34 patients reported being very satisfied with their repairs. In this study we found that the Ventralex hernia patch is an effective and easier technique for mesh repair in umbilical and umbilical port hernias. This technique can also save the operative time with less post-operative complications and better outcomes. BSMMU J 2021; 14(3): 79-84

To Study the Repair of Incisional Hernia by Preperitoneal Meshplasty

The preperitoneal mesh repair an excellent method called as Rive’s stoppa technique where mesh was placedbetween peritoneum and abdominal wall or rectus muscle and posterior rectus sheath(9). The main advantageof pre peritoneal mesh repair are - Less chance of mesh infection and erosion through skin because thegraft lies in preperitoneal plane between posterior rectus sheath and peritoneum, avoids adhesions, bowelobstruction, enterocutaneous fistula and erosion of mesh, minimal morbidity and duration of hospitalstay is less compared to other techniques. The main disadvantage is it is more time consuming, extensivepreparation of preperitoneal plane and surgical experience. In our study 30 patients of incisional hernia weresubjected to preperitoneal mesh repair by Rive’s stoppa technique.It was found that there were :1. Less number of postoperative complications.2. No recurrence was noticed in this study.3. Preperitoneal mesh repair had excellent long-term results with minimal morbidity.As Compared withother types of mesh repair techniques (in literature), the preperitoneal mesh repair is the gold standardtreatment for incisional hernia repair.

Irving Lichtenstein—Pioneer Hernia Surgeon and Civil Rights Champion

Lichtenstein’s tension-free inguinal hernia repair is one of the few procedures which had stood the test of time in this rapidly evolving world. Dr. Lichtenstein and his colleagues from the Lichtenstein Hernia Institute have come up with this most popular technique in 1984 which has become the gold standard of inguinal hernia surgery. He has also popularized the plug technique of mesh repair for femoral and recurrent inguinal hernias. Apart for his professional achievement, he was proud of his civil rights work. He was the chief fund raiser and donor for the American Civil Liberties Union. Dr. Lichtenstein’s story is a best example for the young surgeons to bring their innovative ideas to practice against all odds.

A COMPARITIVE STUDY OF ONLAY – SUBLAY MESHPLASTY (PHS) vs. LICHTENSTEIN MESHPLASTY OF INGUINAL HERNIA

Introduction: A Hernia is the protrusion of part of the abdominal contents beyond the abdominal wall's normal connes. In this study, an attempt is made to compare the results of two different modalities of hernia repair–Lichtenstein repair and repair of hernia with Polypropylene hernia system. Aim: The study aims to ascertain the Polypropylene hernia system's safety and benets for hernia repair against conventional Lichtenstein tension-free mesh repair technique. Materials and methods: The prospective clinical study comprises 30 patients presenting with inguinal hernia attending OPD and admitted to the General Surgery Department of King George Hospital, Visakhapatnam, during the study period of September 2018 to October 2020. Results: Age distribution between 10-90, most of the 50-70 age group (14 cases). Visual analog scale (VAS) score for PMR 4.55 ± 1.18 and LMR 6.06 1.27 (p-value &lt;0.05). Wound infection for PMR 1 case and LMR 2 cases. Duration of surgery for PMR 65.40 ± 7.84 and LMR 51.33 ± 13.51 (p-value &lt;0.05). Type of surgery and duration of hospital stay for PMR 4.93 ± 1.27 LMR 6.73 ± 2.12. Type of surgery and return to work for PMR 5.93 ± 1.27 and LMR 7.73 ± 2.12(p-value &lt;0.05).Recurrence in PMR 0 % and LMR 6.67%. Conclusion: PHS repair is superior to Lichtenstein mesh repair about safe, tension-free method, shorter hospital Stay, early return to work, least recurrence rates, and a high subjective success rate and satisfaction rate.

Long-Term Outcomes of Laparoscopic Repair of Ventral Hernia with Intraperitoneal Polypropylene Mesh

Hernias of the anterior abdominal wall are common cases general surgeons come across in their daily clinical practice. The current standard practice involves reinforcing the defect with a prosthetic mesh. With the advent of laparoscopy, the safety profile of intraperitoneal-uncoated polypropylene mesh has come under the scanner. In this study, we looked at long-term complications in terms of recurrence, clinically significant bowel adhesions causing obstruction, and enterocutaneous fistulization associated with the use of intraperitoneal polypropylene mesh. This is a retrospective study carried out on patients with ventral hernia operated with laparoscopic intraperitoneal onlay mesh repair with uncoated polypropylene mesh between January 2011 and December 2016. We included 223 patients in the study with a mean follow-up of 69.9 months. In our study, we had 3 (1.3%) patients with recurrence, 3 (1.3%) patients with subacute bowel obstruction, and 1 (0.4%) patient with chronic pain. None of the patients had enterocutaneous fistulization or chronic discharging sinuses. None of the patients with intestinal obstruction needed surgery for relieving the obstruction. The use of intraperitoneal polypropylene using the laparoscopic onlay mesh repair technique is safe and long-term complications in terms of recurrence, intestinal obstruction, and enterocutaneous fistula are minimal and acceptable.

Ventralex® ST Patch for Laparoscopic Repair of Ventral Hernias.

Introduction:The surgical approach for treating ventral hernia is still under debate, as well as the optimal devices to be used for such treatment. For small size defects, the tendency is to use the open approach, due to the lower cost/efficiency ratio. However, for medium-size defects, even though costlier, laparoscopy provides better results. The present study analyzes the results of a simple and effective laparoscopic technique for mesh repairing of small and medium size ventral defects using Ventralex® ST patch.Method:Between January 1, 2015 and January 31, 2020, 93 patients with ventral primary nonobstructive abdominal wall defects (up to 3 cm) treated laparoscopically using the intraperitoneal onlay mesh repair technique with Ventralex® patch (22 patients) and Ventralex® ST patch (71 patients). Results were prospectively analyzed based on postoperative complications, postoperative pain, recurrent hernia, and quality of life.Results:The technique was used in 60 patients with umbilical hernia (64.5%), 18 patients with juxta-umbilical hernia (19.3%), and 15 patients with epigastric hernia (16.1%). Out of these, 22 patients had nonreducible (nonobstructive) hernia. The median operating time was 55 minutes (range 40–80 min). Minor complications were recorded in 15 cases (16.1%). The mean hospitalization time was 1.24 days (range 1–2). After a median follow-up of 39 months (range 20–81), the recurrence rate was 11.1% and nil (p = 0.010), and other complaints were recorded in 11.1% and 3.3% of patients (p = 0.293), for Ventralex® patch and Ventralex® ST patch, respectively.Conclusions:In conclusion, the use of Ventralex® ST patch for laparoscopic intraperitoneal onlay mesh repair of small and medium size ventral hernia is simpler and more cost-effective than standard laparoscopic patches, with superior results when compared to Ventralex® patch.

Preperitoneal mesh repair in incisional hernia: a prospective study

Background: Incisional hernia is a common surgical condition encountered in day to day practice. Based on national operative statistics, incisional hernias account for 15 to 20% of all abdominal wall hernias. Of all hernias encountered incisional hernias can be the most frustrating and challenging to treat. This prospective study aims to assess the efficacy of preperitoneal mesh repair technique using polypropylene mesh in the management of incisional hernia.Methods: A total of 40 patients with incisional hernia undergone open preperitoneal polypropylene mesh repair. It had evaluated for post-operative complications and recurrence for six months to one-year post-surgery. The results had tabulated statistically analysed and compared with other published reports in the literature.Results: Out of 40 patients, the size of the defect, 10 patients had less than 2 cm, 28 patients had between 2.1-4 cm, 1 patient between 4.1-6 cm and 1 patient between 6.1-8 cm. The type of hernia, 32 patients had infra umbilical hernia, and 8 patients had a supraumbilical hernia. Post-operative complication 3 patients had seroma, 1 patient had edge necrosis, 1 patient had post-op ileus, and 1 patient had chronic pain. Based on follow up, 4 patients had followed until 6 months, 10 patients till 9 months and 26 patients till one year.Conclusions: Post-operative complications following open preperitoneal polypropylene mesh repair are considerably less compared to other techniques of mesh repair and showed no recurrence among its subjects during the follow-up period, and longer follow-up is required to draw a definitive conclusion.