Mesh Repair Research Articles

Comparative study of open onlay mesh repair versus laparoscopic intraperitoneal dual mesh repair for ventral hernia

Background: Ventral abdominal wall hernia surgery is a common procedure in the armamentarium of surgeons. The most common forms of these surgical procedures in adults are the repair of incisional hernias and surgery for paraumbilical hernias. Aims and Objectives: Open onlay mesh repair versus laparoscopic intraperitoneal dual mesh repair (intraperitoneal onlay mesh[IPOM]) for ventral hernia compared to the duration of surgery, post-operative pain, postoperative complications, post-operative hospital stay, return to normal activity, recurrence, and cosmesis. Materials and Methods: The prospective non-randomized study was done in the Maharani Laxmi Bai Medical College, Jhansi, between January 2021 and June 2022 including 100 patients was applied for treatment of ventral hernia repair. Fifty patients were subjected to Group A (open onlay mesh repair) and 50 patients were subjected to Group B (laparoscopic intraperitoneal dual mesh repair). Results: The mean surgery durations were significantly lower in laparoscopic repair when compared to open repair (P<0.001). Themean post-operative stay in the hospital was shorter for the laparoscopic group than for the open hernia group (10.28±2.100 vs. 8.02±1.378 days; P≤0.001). Return to activity or normal daily work is significantly lower in the laparoscopic group as compared to open repair of hernia (5.12±0.659 vs. 2.94±0.550 days; P<0.001). There were fewer post-operative complications with laparoscopy. Conclusion: Laparoscopic intraperitoneal dual mesh repair (IPOM) for ventral hernia in our experience was safe and resulted in fewer complications, shorter hospital stays, and better cosmesis results. Hence, it should be considered the better choice for ventral hernia repair.

Is mesh pore size in polypropylene meshes associated with the outcome in Lichtenstein inguinal hernia repair: a registry-based analysis of 22,141 patients

IntroductionExperimental data show that large-pored meshes reduce foreign body reaction, inflammation and scar bridging and thus improve mesh integration. However, clinical data on the effect of mesh porosity on the outcome of hernioplasty are limited. This study investigated the relation of pore size in polypropylene meshes to the outcome of Lichtenstein inguinal hernioplasty using data from the Herniamed registry.MethodsThis analysis of data from the Herniamed registry evaluated perioperative and 1-year follow-up outcomes in patients undergoing elective, primary, unilateral Lichtenstein inguinal hernia repair using polypropylene meshes. Patients operated with a non-polypropylene mesh or a polypropylene mesh with absorbable components were excluded. Polypropylene meshes with a pore size of 1.0 × 1.0 mm or less were defined as small-pored meshes, while a pore size of more than 1.0 × 1.0 mm was considered large-pored.Unadjusted analyses and multivariable analyses were performed to investigate the relation of pore size of polypropylene meshes, patient and surgical characteristics to the outcome parameters.ResultsData from 22,141 patients were analyzed, of which 6853 (31%) were operated on with a small-pore polypropylene mesh and 15,288 (69%) with a large-pore polypropylene mesh. No association of mesh pore size with intraoperative, general or postoperative complications, recurrence rate or pain requiring treatment was found at 1-year follow-up. A lower risk of complication-related reoperation tended to be associated with small-pore size (p = 0.086). Furthermore, small-pore mesh repair was associated with a lower risk of pain at rest and pain on exertion at 1-year follow-up.ConclusionThe present study could not demonstrate an advantage of large-pore polypropylene meshes for the outcome of Lichtenstein inguinal hernioplasty.

Parastomal Hernia: A Case Report, Repaired by Modified Laparascopic Sugarbaker Technique

Parastomal hernia is a frequent complication of intestinal stomata. Mesh repair gives the best outcomes, with the lattice embedded by means of laparotomy or laparoscopically. Laparoscopic modified Sugarbaker technique utilizing composite mesh Is most acknowledged in view of its low recurrence rate.

CASE REPORT ON OBSTRUCTED OBTURATOR RICHTER HERNIA MANAGED BY OPEN PREPERITONEAL MESH REPAIR

Introduction: Obturator hernia is rare abdominal hernia.It occurs when part of the pelvic contents protrude through the obturator foramen adjacent to Obturator vessels and nerve.It is a diagnostic challenge in the emergency department since the signs and symptoms are non-specific and the risk of strangulation is high in such hernias. It often occurs in elderly, emaciated and thin lean body mass women.The patient may present with intestinal obstruction with diffuse abdominal pain, nausea and vomiting and constipation,because of diagnostic difficulty they often present late and most of them are diagnosed introperatively. Case report: A 60 years old female patient presented to emergency General Surgery Department of GMERS Medical College Himmatnagar with pain in Right Groin region and diffuse pain abdomen and vomiting associated with constipation since 3 days,k/c/o Hypertension on medication Tab Amlodipine 5mg 1-0-0.On examination -Abdomen distended,tenderness present in Right groin region Abdominal girth 72 cm . Abdomen Xray revealed multiple air fluid levels ,USG Abdomen and pelvis suggestive of Right Groin Hernia and multiple dilated bowel loops with diameter of 3.5 mm suggestive of Intestinal Obstruction (Usg picture is uploaded in fig 2) and as patient was not affordable for CECT Abdomen and pelvis CECT Abdomen and pelvis was not done Discussion: Emergency lower midline exploratory laparotomy under General Anaesthesia was done and intraoperatively was diagnosed as Obstructed Obturator Hernia as the bowel was found to be protruding into Obturator foramen adjacent to Obturator vessels and Obturator nerve and the bowel was reduced from foramen and was found to be healthy ,single suture was taken over the coopers ligament and obturator foremen and peritoneum was closed as there was no bowel contamination preperitoneal space was created and 15X15 cm Macroporous light weight polypropylene Mesh was placed and fixed covering all the defects to prevent recurrence and any future groin and Inguinal hernia. Conclusion: Obturator Hernia is a rare form of abdominal hernia but can cause a severe Intestinal Obstruction if it not diagnosed and treated early bowel might result into ischemia and necrosis which can turn into a fatal complication.The elderly female with lean body mass and multiparous women presenting with diffuse pain abdomen and pain in Groin region with vomiting and constipation obstructed Obturator hernia and femoral hernia should always be kept as probable diagnosis.Radiological imaging may yield the diagnosis but in this case as patient was not affordable so ,CECT Abdomen with pelvis was not done and as patient Abdomen Xray had multiple air fluid levels .Emergency lower midline Exploratory laparotomy can be done and if obstructed bowel is found to be healthy then Preperitoneal mesh repair can be done and this procedure has got a good outcome increases the abdominal strength and has got a less recurrence chances.

Computational analysis of electrical stimulation to promote tissue healing for hernia repair at varying mesh placement planes.

Development of a tear in the abdominal wall allowing for protrusion of intra-abdominal contents is known as a hernia. This can cause pain, discomfort, and may need surgical repair. Hernias can affect people of any age or demographic. In the USA, over 1 million hernia repair procedures are performed each year. During these surgeries, it is common for a mesh to be utilized to strengthen the repair. Different techniques allow for the mesh to be placed in different anatomical planes depending on hernia location and approach. The locations are onlay, inlay, and sublay, with sublay being split into retromuscular or preperitoneal with sublay being the most commonly used. The use of an electrically active hernia repair mesh is of interest to model as electrical stimulation has been shown to improve soft tissue healing which could reduce recurrence rates. Theoretical 3D COMSOL models were built to evaluate the varying electric fields of an electrically active hernia repair mesh at each of the different anatomical planes. Three voltages were chosen (10, 20, and 30mV) for the study to simulate a low-level electrical signal and the electric field from a piezoelectric material at the tissue layers surrounding the mesh construct. Based on the model outputs, the optimal mesh placement location was the sublay-retromuscular as this location had the highest electric field values in the connective tissues and rectus abdominis muscle, which are the primary tissues of concern for the healing process and a successful repair.

Open intraperitoneal onlay mesh repair with anterior component separation as a bail-out procedure in the management of complex hernias.

Surgical repair of complex abdominal wall hernias remains technically demanding and is widely recognized as a risk factor for unfavorable outcomes with high recurrence and morbidity rates. The objective is to assess short- and long-term complications after open intraperitoneal onlay mesh (IPOM) repair combined with bilateral anterior component separation (ACS) for large and difficult incisional hernias, alongside evaluating hernia recurrence rates. This retrospective analysis utilized data sourced from Hospital electronic health records and a prospective database at an academic tertiary referral center. Data collection was carried out from patients operated between January 2006 and December 2017. Eligible patients had complex incisional hernias measuring at least 10cm in their transverse diameter and had an open IPOM repair with bilateral ACS. In our study group of 45 patients, the 30-day surgical site occurrence (SSO) rate was high (37.8%), primarily consisting of superficial postoperative complications as seroma (17.8%) and wound dehiscence (6.7%). Among six patients (13.3%), wound complications escalated to chronic infected mesh-related problems, leading to complete mesh removal in four cases (8.9%) and partial mesh removal in two cases (4.4%). Regarding long-term complications, five patients (11.1%) developed enterocutaneous fistula. The recurrence rate was modest [5 out of 41 (12.2%)] over a median follow-up period of 99 months. Despite a high SSO rate, application of the open IPOM technique with ACS could serve as a valuable rescue option for managing large and complex hernias, with acceptable hernia recurrence rates at long-term follow-up.

A rare complication of pediatric liver transplantation: Post-transplant diaphragmatic hernia.

Acquired post-transplant diaphragmatic hernia (PTDH) is a rare complication of liver transplantation (LT) in children. We aimed to present our experience in PTDH, and a possible causative background is discussed. Medical records of patients who had undergone diaphragmatic repair following LT between 2015 and 2023 were reviewed. Demographic information, details of primary diseases necessitating LT, transplantation techniques, and clinical findings associated with PTDH were evaluated. There were seven patients with PTDH. Median age at transplantation was 69 (range: 9-200) months. Five patients received a left lateral sector, one patient had a right lobe, and one had a left lobe graft. Time between LT and PTDH was 9 (2-123) months. One patient who was diagnosed in the postoperative 10th year was asymptomatic. Respiratory distress and abdominal pain were the main symptoms among all. All patients underwent laparotomy, and primary repair was performed in six patients, and one patient required mesh repair because of a large defect. Small intestine herniated in most cases. There were two complicated cases with perforation of the stomach and colonic volvulus. There is no recurrence or long-term complications for the median 60 (20-119) month follow-up period. PTDH is a rare but serious complication. Majority of symptomatic cases present within the first postoperative year, whereas some late-presenting cases may not be symptomatic. Inadvertent injury to the inferior phrenic vasculatures due to excessive use of cauterization for control of hemostasis may be a plausible explanation in those cases.

The Impact of Technical Innovations and Donor-Site Mesh Repair on Autologous Abdominal-Based Breast Reconstruction-A Retrospective Analysis.

Background: The aim of this study was to examine the potential benefit that may be achieved through the introduction of technical innovations and the incorporation of mesh for fascial donor site closure in uni- and bilateral autologous breast reconstruction with abdominal tissue. Methods: A retrospective single-center review of all breast reconstructions with a DIEP or MS-TRAM flap between January 2004 and December 2019 was performed. Donor and recipient site complications and operation times were evaluated before and after the implementation of coupler anastomoses, preoperative computed tomography angiography (CTA), indocyanine green (ICG) angiography, and the inclusion of mesh in donor site repair. Results: A total of 396 patients were included, accounting for 447 flaps. Operation time was significantly shorter in unilateral reconstructions after the implementation of CTA (p < 0.0001). ICG angiography significantly reduced the rates of partial flap loss (p = 0.02) and wound healing disorders (p = 0.02). For unilateral reconstructions, abdominal bulging or hernia was observed more often in MS1-TRAM flaps without synthetic mesh repair (p = 0.001), whereas conservatively treated seroma developed more frequently after mesh implantation (p = 0.03). Conclusions: Recent technological advancements developed over the past few decades have made a substantial impact on decreasing surgical duration and enhancing procedure safety.

Medium term (> 12 months) outcomes after laparoscopic hiatal hernia repair without conventional fundoplication using PH4B-mesh implant (Phasix™) in 176 reflux patients: experience and technique.

Hiatal mesh repair remains a controversial topic among anti-reflux surgeons. Biosynthetic mesh cruroplasty may prevent early recurrence while avoiding late esophageal erosion and strictures associated with non-resorbable materials. So far, medium-term results on hiatal PH4B (Poly-4-Hydroxybutyrate) mesh repair from high-volume centers are lacking. We analyzed the medium-term efficacy and safety of PH4B mesh cruroplasty in 176 consecutive patients (≥ 18years) with symptomatic hiatal hernias. Treatment failure was defined as the clinical recurrence of reflux symptoms. Patients could choose between mesh augmented hiatal repair (combined with a modified anterior hemifundoplication and fundophrenicopexy), Nissen fundoplication, and magnetic sphincter augmentation at their discretion. We also describe the surgical approach to mesh augmented hiatal repair used at our center. On average, patients were 55 (± 14) years old and followed up for 22 (± 7; sum: 3931) months. Treatment failed in 6/176 (3%, 95% CI: 2-7%) patients. The 24-month Kaplan-Meier failure estimate was 2.8% (95% CI: 0.4-5%). Each centimeter in hernia size increased the risk of failure by 52% (p = 0.02). Heavier patients (BMI > 27) had an 11% higher probability of clinical symptom recurrence (p = 0.03). The dysphagia and bloating/gas rate were 13/176 (7%), each. 8 (5%) patients required endoscopy due to dysphagia but without intervention. No serious complications, including mesh infection and erosion, or fatalities, occurred. Augmented PH4B mesh cruroplasty without conventional fundoplication shows excellent intermediate-term results in patients with reflux disease due to hiatal hernia. Around one in thirty patients experience treatment failure within 2years of surgery. Hernia size and overweight are key determinants of treatment failure.

Intraperitoneal Onlay Mesh (IPOM Plus) Repair Versus Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) Repair in Primary Ventral Hernias: Experience With 50 Cases in a Tertiary Care Hospital.

Background Primary ventral hernias are abnormal protrusions of abdominal viscera through the areas of weakness in the fascia of the abdominal wall. The aim of this study was to compare the benefits and complications, and the overall outcome in the Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) repair versus Intraperitoneal Onlay Mesh (IPOM Plus) repair in the management of primaryventral hernias. Methods After obtaining institutional ethical committee clearance, this prospective comparative study between IPOM Plus and eTEP-RS was conducted in a tertiary care hospital from December 2020 to January 2022. A total of 50 patients presenting with primary ventral hernias were included in the study, of whom 25 underwent IPOM Plusand 25 underwent eTEP-RS repairs. Group selection was doneby simple randomization using the lottery method. Patients more than 18 years of age with primary ventral hernias presenting with a hernial defect width less than 6 cm, consenting to the study, were included in the study. Patients who did not fulfill the inclusion criteria, strangulated/obstructed hernias, recurrent/incisional hernias, connective tissue disorders, skin infections, enterocutaneous fistulas, pregnancy, morbid obesity, and parastomal hernias were exclusion factors. Results The mean intraoperative duration in the eTEP-RS group (192.3 ± 16.20 min) was significantly higher than in theIPOM Plus group (102.6 ± 16.78min, p=0.001). The mean duration of hospital stay in the IPOM Plus group (5.9 ± 2.19 days) was longer than in the eTEP-RS group (4.6 ± 3.17 days, p=0.02). The mean postoperative pain scores, from the Visual Analogue Scale(VAS), on days 1, 7, and 90 were 3.2 ± 1.11, 2.64 ± 1.11, and 1.68 ± 1.46in the IPOM Plus group and 1.84 ± 0.688, 0.76 ± 0.66 and 0.08 ± 0.40 in the eTEP-RS group, respectively(p=0.001). Conclusion Despite being a technically easy procedure requiring less intraoperative time, IPOM Plus had several disadvantages, such as increased postoperative pain, longer duration of hospital stays, higher chances of wound site seromas, and higher rates of postoperative paralytic ileus.On the other hand, eTEP-RS was a more challenging procedure requiring more intraoperative time; however, it had several advantages: less postoperative pain, less duration of hospital stay, early recovery, and fewer chances of seromasand paralytic ileus.However, more robust data is required to compare and validate the differences between both procedures' short- and long-term outcomes.

Use of surgical procedure manager to standardise operation steps and monitor surgeon performance in open repair of inguinal hernia

AbstractObjectivesTo study the feasibility of using surgical procedure manager (SPM), a digital checklist platform, to standardise surgical steps of open hernia repair and monitor the operative performance.MethodologyA retrospective study on all open mesh repair of inguinal hernia under local anaesthesia from September 2019 to November 2021 at the Prince of Wales Hospital was performed. The operative outcomes of patients having operations with or without the use of SPM were compared. Procedures using SPM had operation steps shown as a digital checklist inside the theatre. The time used for each surgical step was recorded and analysed. The operative performance of the surgeons was analysed by observing the trend of the mean operation time over time.ResultsA total of 123 patients were recruited, of which 52 were using the SPM. The median age of patients was 75 (range 49–93) years. A decreasing trend in the mean operation time for dissection, mesh placement, wound closure and total operation time was observed in surgeries using SPM. There was no significant difference in the operation time, theatre time, total length of stay, blood loss and readmission rate between the SPM and non‐SPM groups. The proportion of basic surgical trainees as coached surgeons in the SPM group was significantly higher (SPM = 52% vs non‐SPM = 28%, P = .07).ConclusionsThe use of SPM did not significantly prolong the operation time and produce comparable operative outcomes in open hernia repair. It provided the additional advantage of standardising operation steps and monitoring the performance of surgical trainees during their training.

Use of polyglactin mesh coated with platelet-rich plasma for diaphragmatic defect healing in rabbits. Protocol for a Randomised Controlled Trial

Absorbable, biosynthetic scaffolds are a promising option for repair of diaphragmatic defects, since they are associated with less mesh-related complications than non-absorbable synthetic meshes. Coating of absorbable synthetic meshes with anti-inflammatory and healing agents, such as platelet-rich plasma (PRP), is a widely studied technique for improving mesh-tissue integration and reducing recurrence rate. The aim of this study is to investigate the synergic effect of a PRP-coated synthetic absorbable polyglactin mesh 2cmx2cm in healing of a diaphragmatic defect in an experimental rabbit model. Animals will be equally randomised in the PGM-PRP group (absorbable polyglactin mesh enriched with PRP) or the PGM group (use of absorbable polyglactin mesh only). Rabbits will undergo laparotomy under general anaesthesia and resection of a portion of the diaphragmatic central tendon 1cmx1cm. Samples will be euthanised on the 91th postoperative day and samples of 3cmx3cm will be harvested. The mesh-tissue integration will be assessed based on macroscopic, microscopic, immunohistochemical and morphometric parameters. The study is indesign stage and results are expected to be available by the end of the following year. High-quality evidence is expected regarding the synergic effect of PRP and synthetic absorbable polyglactin meshes in diaphragm repair.

Comparing Laparoscopic Total Extraperitoneal and Lichtenstein Mesh Repair for Inguinal Hernias: A Focus on Patient Outcomes.

This study aimed to evaluate post-operative outcomes by comparing factors such as post-operative pain, duration of hospitalization, time needed to resume normal and full activities, and complications between laparoscopic total extraperitoneal (TEP) and Lichtenstein tension-free mesh hernioplasty or repair (LMR) for inguinal hernias. A prospective study was conducted involving male patients undergoing either LMRor laparoscopic TEP mesh repair, with 30 patients in each group. The study assessed post-operative pain, duration of hospital stay, return to normal activities, and complications. Pain scores were monitored at regular intervals using a visual scale. Before discharge, patients' ability to perform self-care activities was evaluated using the Katz index of independence in activities of daily living. Outpatient follow-up was conducted on day 14, one month, three months, and six months post-surgery. Post-operative pain scores were significantly higher among LMR patients compared to TEP patients until the 14th day post-surgery (p < 0.001). However, pain levels became comparable after that. There were no notable differences in pain scores between unilateral and bilateral hernias. TEP patients experienced significantly shorter hospital stays (p < 0.001) and quicker resumptions of self-care (p < 0.001), light work (p < 0.02), and full work (p < 0.03) compared to LMR patients. Laparoscopic TEP repair offers advantages over Lichtenstein mesh repair in terms of reduced postoperative pain, shorter hospital stays, and faster recovery to normal activities. These findings can guide clinicians and patients in making informed decisions regarding hernia repair techniques.

Robotic transabdominal preperitoneal mesh repair of an inguinal hernia using the HugoTM Robotic Assisted Surgery system—a case report of the first Australian clinical experience in general surgery

Robotic transabdominal preperitoneal mesh repair of an inguinal hernia using the HugoTM Robotic Assisted Surgery system—a case report of the first Australian clinical experience in general surgery

Application of bridging mesh repair in giant ventral incisional hernia.

Achieving ideal abdominal wall reconstruction in giant ventral incisional hernia has been a challenging for surgeons. This study aimed to verify the safety and efficacy of bridging repair by comparing it with primary fascial closure (PFC) repair in the treatment of giant ventral incisional hernia. We retrospectively analyzed the clinical data of 92 patients with giant ventral incisional hernia who underwent mesh repair at our medical institution from January 1, 2014 to December 31, 2020. Patients were divided into 2 groups: the bridging repair group with 40 patients in whom repair was completed using the bridging technique and the PFC group with 52 patients in whom primary fascial closure was achieved and all patients underwent mesh reinforcement during the operation. The main outcome measures were recurrence rate and morbidity, especially intra-abdominal hypertension (IAH). Follow-up time of both groups lasted at least 24months after surgery. After a median of 46months and 65months of follow-up, respectively, in the two groups, bridging repair did not increase the long-term recurrence rate (2.56%) in the larger defect area group compared to the PFC group (1.96%). There were no significant differences in perioperative morbidity, IAH, incidence of postoperative chronic pain, and sensory impairment of the abdominal wall between both groups. The application of bridging surgery in the treatment of complex giant ventral incisional hernias is safe and effective and does not significantly increase the postoperative recurrence rate.

Mesh vs. non-mesh repair of type I hiatal hernias: a propensity-score matching analysis of 6533 patients from the Herniamed registry

IntroductionSurgical treatment of type I hiatal sliding hernias aims to control the gastroesophageal reflux symptoms and prevention of hernia recurrence. Usually, a cruroplasty is performed to narrow the hiatal orifice. Here, it remains controversial if a mesh reinforcement of the cruroplasty should be performed, since benefits as well as mesh-associated complications have been described.MethodsWe performed a propensity-score matching analysis with data derived from the Herniamed registry comparing patients undergoing laparoscopic type I hiatal hernia repair with and without synthetic mesh. We analyzed perioperative, intraoperative, and postoperative data including data derived from the 1-year follow-up in the registry.Results6.533 patients with an axial, type I hiatal hernia and gastroesophageal reflux are included in this analysis. Mesh augmentation of the hiatoplasty was performed in n = 1.252/6.533 (19.2%) of patients. The defect size in the subgroup of patients with mesh augmentation was with mean 16.3 cm2 [14.5; 18.2] significantly larger as in the subgroups without mesh augmentation with 10.8 cm2 [8.7; 12.9]; (p < 0.001). In patients with mesh hiatoplasty n = 479 (38.3%) Nissen and n = 773 (61.7%) Toupet fundoplications are performed. 1.207 matched pairs could be analyzed. The mean defect size after matching was with 15.9 cm2 comparable in both groups. A significant association was seen regarding recurrence (4.72% mesh vs. 7.29% non-mesh hiatoplasty, p = 0.012). The same relation can be seen for pain on exertion (8.78% vs 12.10%; p = 0.014) and pain requiring treatment (6.13% vs 9.11%; p = 0.010). All other outcome parameter showed no significant correlation.ConclusionsOur data demonstrate that mesh-reinforced laparoscopic type I hiatal hernia repair in larger defects is associated with significantly lower rates for recurrence, pain on exertion and pain requiring treatment.

Comparison between intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus) and intraperitoneal onlay mesh repair (IPOM) for ventral hernias

Aim. To evaluate the intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus) versus intraperitoneal onlay mesh (IPOM) for ventral hernias (VHs). Materials and methods. A total of 89 patients with VHs with a defect between 3–12 cm who underwent a surgery from 2018 to 2023 years were enrolled in this study. All of them were randomly assigned to two groups. Group 1 included 45 patients after intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus), Group 2 – 44 patients after intraperitoneal onlay mesh (IPOM). The distribution of patients by age, sex, body mass index (BMI), hernia type (primary VH, incisional hernia), American Society of Anesthesiologists (ASA) score was studied. Results. The differences in sex, mean age, patient distribution based on hernia type, BMI, ASA score and hernia orifice size were not statistically significant between the two groups. Therefore, both groups were comparable. The operative time in minutes was 73.17 ± 7.43 in Group 1 and 70.93 ± 8.84 in Group 2 (not statistically significant). The pain score 12 hours after surgery was 5.24 ± 0.60 in Group 1 comparing to 5.02 ± 0.45 in Group 2 (not statistically significant). The pain score 8 days after surgery was 2.88 ± 0.31 in Group 1 comparing to 2.75 ± 0.43 in Group 2 (not statistically significant). There was no significant difference concerning the incidence of early complications between the two groups. 41 (91.11 %) patients of Group 1 and 40 (90.9 %) patients of Group 2 were examined during a 22-month follow-up period. No complications were noted. Conclusions. Laparoscopic ventral hernia repair provides satisfactory results in terms of safety and efficacy. Thus, IPOM plus repair is safe, feasible and offers possible advantages over the standard IPOM technique as reported in the literature. Poor outcomes described in the literature are probably related to independent variables such as mesh and suture types as well as closure technique.

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.

The role of anterior gastropexy in elderly Japanese hiatal hernia patients.

As Japanese society ages, the number of surgeries performed in elderly patients with hiatal hernia (HH) is increasing. In this study, we examined the feasibility, safety, and potential effectiveness of the addition of anterior gastropexy to hiatoplasty with or without mesh repair and/or fundoplication in elderly Japanese HH patients. We retrospectively evaluated 39 patients who underwent laparoscopic HH repair between 2010 and 2021. We divided them into 2 groups according to age: the "younger" group (< 75years old, n = 21), and the "older" group (≥ 75years old, n = 18). The patient characteristics, intraoperative data, and postoperative results were collected. The median ages were 68 and 82years old in the younger and older groups, respectively, and the female ratio was similar between the groups (younger vs. older: 67% vs. 78%, p = 0.44). The older group had more type III/IV HH cases than the younger group (19% vs. 83%, p < 0.001). The operation time was longer in the older group than in the younger group, but there was no significant difference in blood loss, perioperative complications, or postoperative length of stay between the groups. The older group had significantly more cases of anterior gastropexy (0% vs. 78%, p < 0.001) and less fundoplication (100% vs. 67%, p = 0.004) than the younger group. There was no significant difference in HH recurrence between the groups (5% vs. 11%, p = 0.46). The addition of anterior gastropexy to other procedures is feasible, safe, and potentially effective in elderly Japanese patients with HH.

Suture repair versus mesh repair in elderly populations with incarcerated or strangulated groin hernia.

Tension-free hernia repair is the gold standard for groin hernia repair. However, the optimal surgical treatment for incarcerated or strangulated groin hernia in elderly populations is controversial. The aim of this study is to compare the clinical efficacy of mesh repair and suture repair in the treatment of incarcerated or strangulated groin hernia in elderly patients. Patients ≥ 65years who underwent urgent surgical repair for incarcerated or strangulated groin hernia from January 2012 to June 2022 were included. Patients' demographic data and postoperative outcomes were retrospectively analyzed. Patients with limited life expectancy were screened from the elderly population for subgroup analysis. A total of 103 patients (median age: 84years old, range 65-96; mean follow-up time: 36.8 ± 24.8months) were included, involving 42 cases in the suture repair group and 61 cases in the mesh repair group. Suture repair and mesh repair had similar lengths of ICU and hospital stay, and rates of small bowel resection, chronic pain, surgical site infection, and surgical-related death. However, suture repair had a significantly higher recurrence rate than mesh repair (7% vs. 2%, P = 0.04). In our subgroup analysis, for patients with limited life expectancy (41 patients; median age: 88yearsold, range: 80-96), suture repair had no statistical difference in postoperative outcomes compared with mesh repair. Mesh repair is suitable for elderly patients with acutely incarcerated or strangulated groin hernias. However, for elderly patients with limited life expectancy, suture repair and mesh repair showed similar clinical outcomes.