Midline Incisional Hernia Research Articles

A systematic review and meta-analysis of randomized controlled trials for the management of ventral hernia: biologic versus synthetic mesh.

An abdominal wall hernia near the location of a prior surgical incision is referred to as an incisional hernia. A midline incisional hernia is the most prevalent form. The management of incisional hernia includes many options, from conservative to surgical. The surgeon might consider using a synthetic or biological mesh when discussing surgical options with patients. Our aim through this study is to comprehensively compare synthetic and biological mesh in terms of complication and infection rates for managing elective incisional hernia. This systematic review was designed and conducted using PRISMA guidelines. The literature was systematically searched in January 2023 using the following databases: MEDLINE, Cochrane, and EMBASE. Among the terms used to aid the search were the following: incisional hernia, ventral hernia, ventral herniorrhaphy, biologic mesh, polypropylene mesh, absorbable mesh, permanent mesh, biomaterial mesh, biological mesh, and synthetic mesh. The review of the literature resulted in a total of 3115 publications. By applying our criteria, six articles were included in this study, with 949 participants. Our meta-analysis showed the overall complication incidence displaying a significant difference favouring the synthetic mesh group (IV = 1.25, 95% CI 1.11-1.42, P = 0.0002). The operation failure rate, defined as hernia recurrence, also significantly favoured synthetic mesh (IV = 2.42, 95% CI 1.66-3.52, P < 0.00001). In conclusion, the present study found that the synthetic mesh proved superior in overall complication rate and operation failure compared to biologic mesh. However, it had no significant differences in other complications.

Posterior components separation with transversus abdominis release and sublay mesh reinforcement in large ventral hernia repair

AbstractAimVentral abdominal hernia is a prevalent condition among surgical patients. Large ventral hernias with defects &gt;10 cm that cannot be closed primarily, often with loss of domain requiring abdominal wall reconstruction, pose a surgical challenge. Our study aimed to evaluate the outcomes of posterior components separation (PCS) with transversus abdominis release (TAR) and sublay mesh reinforcement in large ventral hernia repair, particularly in terms of surgical site occurrences (SSOs) and hernia recurrence.Patients and MethodsOur study included 40 adult patients presented to Tanta University Hospitals with a large ventral hernia (defect width ≥10 cm) from December 2021 to January 2023. All patients were submitted to PCS with TAR and sublay mesh reinforcement.ResultsThe mean age of the study population was 47.32 (standard deviation [SD] 9.31) years (range 36–65 years) with a mean body mass index of 33.55 (SD 3.42) kg/m2 (range 28.35–38.72 kg/m2). The major risk factors were obesity (95.00%), smoking (45.00%), and multiparity (45.00%). Midline incisional hernia was the most common type in 28 patients (70.00%). Thirty‐four patients (85%) achieved successful midline closure, while six patients required additional anterior components separation technique to achieve tensionless midline closure and an onlay mesh for functional reconstruction. Post‐operative SSOs occurred in 12 patients (30.00%), with subcutaneous seroma in 8 patients (20.00%) and wound dehiscence and necrosis in 4 patients (10.00%). Two patients (5.00%) experienced recurrence after a mean follow‐up period of 19.25 (SD 3.52) months.ConclusionsPCS with TAR and sublay mesh reinforcement is a reliable and durable technique for complex ventral hernia repair with low morbidity and recurrence rates. However, long‐term clinical outcomes with more cases are required to properly evaluate this technique.

Pelvic Ring Reconstruction with an Osteocutaneous Fibula Flap for Abdominal Wall Repair in Adults with Bladder Exstrophy

AbstractAbdominal wall repair in adults with bladder exstrophy is challenging. We present a case of a 46-year-old woman with bladder exstrophy presenting with a large midline incisional hernia associated with a 13-cm hypoplasia of both pubic rami that precluded fixation of any abdominal mesh. A two-stage approach was adopted. First, a free vascularized osteocutaneous fibula flap was used to reconstruct the pelvic ring. After complete bone union 18 months later, a mesh was anchored to the fibula flap to restore the abdominal wall competence. After 2 years of follow-up, no hernia recurrence was observed, and the patient reported improved quality of life and self-esteem. This novel technique may provide long-term stability and good functional outcomes for reconstruction of the abdominal wall in selected adults with bladder exstrophy.

1082 Maximising Surgical Outcomes in Midline Incisional Hernia Repairs: Are We Employing Every Possible Optimisation?

Abstract Introduction Large midline Incisional hernia repair can involve complex surgery which poses many challenges, with a high recurrence and complication rate. The recently published European Hernia Society Guidelines has identified several risk factors contributing to the increased complications after surgical repair. We aim to assess the effect of these modifiable risk factors for adverse outcomes within our patient population. Method All adult patients who underwent a repair of midline incisional hernias larger than 3cm in a DGH hospital between July 2021 and July 2022 were included. Data on patient demographics, modifiable risks factors and complications were collected. Analysis was performed using Microsoft Excel. Results 26 patients (age: 64 [33-84] years; M:F, 9:17) underwent a midline incisional hernia repair were included. The average hernia size was 8cm. The average body mass index (BMI) was 33.1, seven were smokers and three had diabetes mellitus. Of the three patients who developed a recurrence, average BMI was 36 and two were smokers. None of the patients were counselled for weight loss or smoking cessation. Conclusions In our cross-sectional study, patients with a large hernia, high BMI, diabetes, a smoking history are associated with adverse outcomes. We aim to highlight and raise the awareness to surgeons who perform these repairs to counsel their patients on their modifiable risk factors and its associated risk of hernia recurrence. Preoperative optimisation improves surgical outcome and subsequently reduces healthcare costs.

Long-term patient-reported outcome measures (PROMs) after primary ventral or small midline incisional hernia repair.

Ventral hernia repair is a common elective surgical procedure lacking strong evidence for specific operative approaches. This study aimed to evaluate the outcomes of primary suture repair or polypropylene sandwich mesh repair for ventral hernias. The main outcome measures were the rate of hernia recurrence, and evaluation of long-term complications and patient-reported outcomes. This retrospective cohort study evaluated patient perceived recurrence and pain in patients who had undergone a primary ventral hernia (epigastric, supraumbilical, or umbilical) repair or small (≤20 mm) midline incisional hernia repair 10 years after the procedure. Short-term follow-up occurred up to 6 weeks after the initial operation, while long-term follow-up included patients who were reviewed clinically or interviewed via telephone at or beyond 3 years after the procedure. Most (75/100, 75.0%) patients had an extra-peritoneal sandwich mesh repair. Short-term follow-up showed minimal pain and normal activities for all patients (97/97, 100%). Long-term follow-up (median 12 years [IQR 11-13]) was achieved in 95.9% (93/97) of patients with only a small number reporting a slight bulge (5/93, 5.4%) and intermittent mild discomfort (8/93, 8.6%). Nine patients (9/97, 9.3%) experienced hernia recurrence, diagnosed at a median of 26 months [interquartile range, IQR, 7-58] post-operatively. These findings suggest that an open sandwich mesh technique is a safe and effective method for repairing primary ventral hernias and small midline incisional hernias and is associated with favourable long-term patient-reported outcomes.

The effect of preoperative botulinum toxin a injection on traction force during hernia repair: a prospective, single-blind study, intra-patient comparison using contralateral side as a control

PurposeVentral hernias are a common complication of laparotomy, posing challenges particularly when primary fascial closure is unattainable. Although chemical component separation using preoperative botulinum toxin A (BTX) injections has emerged as a promising adjunct, objective evidence of its efficacy remains limited. This study aimed to objectively assess the effect of preoperative BTX on traction force during ventral hernia repair.MethodsA prospective, single-blind study was conducted on patients with midline incisional hernias following liver transplantation. BTX was administered unilaterally, and the traction force required to medially advance the anterior rectus sheath was measured intraoperatively. Pre- and post-injection CT scans were analyzed for changes in hernia size and LAW muscle measurements. Statistical analyses were performed to evaluate traction force differences between BTX-injected and uninjected sides.ResultsTen patients underwent hernia repair with primary fascial closure achieved in all cases. Comparison of pre- and post-injection CT scans showed no significant changes in hernia size. LAW muscle length increased by 1.8 cm, while thickness decreased by 0.2 cm. Intraoperative traction force measurements revealed a significant reduction on the BTX-injected side compared to the uninjected side (p < 0.0001). The traction force ratio on the BTX-injected to the uninjected side averaged 57%, indicating the efficacy of BTX in reducing tension.ConclusionPreoperative BTX significantly reduces traction force during ventral hernia repair, highlighting its potential as an adjunctive therapy in complex cases. While challenges remain in patient selection and outcome assessment, BTX offers a promising avenue for enhancing abdominal wall reconstruction outcomes and reducing surgical complications.

The Madrid Posterior Component Separation: An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias.

In recent years, Posterior Component Separation (PCS) with the Madrid modification (Madrid PCS) has emerged as a surgical technique. This modification is believed to enhance the dissection of anatomical structures, offering several advantages. The study aims to present a detailed description of this surgical technique and to analyse the outcomes in a large cohort of patients. This study included all patients who underwent the repair of midline incisional hernias, with or without other abdominal wall defects. Data from patients at three different centres specialising in abdominal wall reconstruction was analysed. All patients underwent the Madrid PCS, and several variables, such as demographics, perioperative details, postoperative complications, and recurrences, were assessed. Between January 2015 and June 2023, a total of 223 patients underwent the Madrid PCS. The mean age was 63.4years, with a mean BMI of 33.3kg/m2 (range 23-40). According to the EHS classification, 139 patients had a midline incisional hernia, and 84 had a midline incisional hernia with a concomitant lateral incisional hernia. According to the Ventral Hernia Working Group (VHWG) classification, 177 (79.4%) patients had grade 2 and 3 hernias. In total, 201 patients (90.1%) were ASA II and III. The Carolinas Equation for Determining Associated Risks (CeDAR) was calculated preoperatively, resulting in 150 (67.3%) patients with a score between 30% and 60%. A total of 105 patients (48.4%) had previously undergone abdominal wall repair surgery. There were 93 (41.7%) surgical site occurrences (SSO), 36 (16.1%) surgical site infections (SSI), including 23 (10.3%) superficial and 7 (3.1%) deep infections, and 6 (2.7%) organ/space infections. Four (1.9%) recurrences were assessed by CT scan with an average follow-up of 23.9months (range 6-74). The Madrid PCS appears to be safe and effective, yielding excellent long-term results despite the complexity of abdominal wall defects. A profound understanding of the anatomy is crucial for optimal outcomes. The Madrid modification contributes to facilitating a complete retromuscular preperitoneal repair without incision of the transversus abdominis. The extensive abdominal wall retromuscular dissection obtained enables the placement of very large meshes with minimal fixation.

First report of robotic retromuscular incisional hernia repair with Hugo Ras™ surgical system.

Treatment of incisional hernia is a rapidly evolving field of surgery, with actual trends being oriented toward retromuscular/preperitoneal mesh placement. The diffusion of robotic surgery is constantly growing in different surgical specialties and is gaining widespread acceptance for abdominal wall reconstruction. Recently, novel robotic platforms have entered into the market. In this study, we present the first transabdominal retromuscular incisional hernia repair performed with the new Hugo RAS™ system (Medtronic, Minneapolis, MN, USA). The surgical team had previous robotic experience and completed an official 2-day session running incisional hernia repair on human cadaver lab. Operating room setting and trocar layout were planned. The patient presented a 4 × 4cm midline incisional hernia and was scheduled for transabdominal retromuscular incisional hernia repair at our Institution. A description of the operative room setup, robotic arm configuration and docking/tilt angles is provided. Docking time, operative time, and console time were 15, 95, and 75min, respectively. All the surgical steps were completed without critical surgical errors or high-priority alarms. Neither intraoperative complications nor conversion to open surgery was recorded. Postoperative course was uneventful and the patient was discharged on postoperative day 2. The safety and the feasibility of these procedures will require further analysis and larger patients' sample sizes for procedural standardization and potential integration into minimally invasive abdominal wall reconstruction programs.

Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed algorithm.

The precise indications for employing the anterior component separation technique (ACST) and the Transversus Abdominis Release (TAR) in abdominal wall reconstruction (AWR) remain uncertain, despite the undeniable value of both techniques. The aim of this study was to analyze the anterior fascial closure rate, postoperative wound morbidity, and hernia recurrence rate for both procedures according to the algorithm used for complex AWR. A retrospective analysis of prospectively collected data was carried out. Patients undergoing AWR for midline incisional hernias using either open or endoscopic ACST (E-ACST) or TAR between March 2013 and August 2022 were included. Patients with lateral hernia components were excluded. The surgical technique was depending on the pre- and intraoperative findings regarding hernia width and on the estimated traction to achieve anterior fascial closure (see algorithm). Initially, intermediate hernia defects ranging from approximately 10-14cm in width were repaired using E-ACST. However, as the study advanced, TAR became the preferred method for addressing these types of defects. Open ACST was consistently employed for defects wider than 14-15cm throughout the entire study duration. Outcomes of interest were anterior fascial closure, surgical site occurrences, and hernia recurrence rate. Follow-up was performed at 1month, 1year, and 2years. A total of 119 patients underwent AWR with CST: 63 patients (52.9%) were included in the ACST group and 56 patients (47.1%) in the TAR group. No significant differences were observed in patient and hernia characteristics. The use of botulinum toxin A (BTA) injection and preoperative progressive pneumoperitoneum (PPP) was more frequently used in the ACST group (BTA 19.0%, PPP 15.9% versus BTA 5.4%, PPP 1.8% for TAR patients). Anterior fascial closure was achieved in 95.2% of the ACST group and 98.2% of the TAR group (p = 0.369). The TAR group demonstrated a significantly lower SSO rate at one month (44.3% versus 14.3%, p < 0.001) and required fewer procedural interventions (SSO-PI) (31.1% versus 8.9%, p = 0.003). The recurrence rate at one year was low and there was no statistically significant difference between the two groups (ACST 1.8% vs TAR 4.5%, p = 0.422). Following a proposed algorithm, the anterior fascial closure rate was high and similar for both techniques. As postoperative wound morbidity is significantly increased after ACST, our findings support recommending TAR for defects up to 14cm in width, while favoring open ACST for larger defects.

Short-term outcomes of a multicentre prospective study using a "visible" polyvinylidene fluoride onlay mesh for the prevention of midline incisional hernia.

Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under magnetic resonance imaging (MRI). This is a prospective multicentre observational cohort study. Preliminary results from the first 3months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. Multivariate logistic regression was used. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. MRIs were performed 6weeks after treatment. Between July 2016 and June 2022, 185 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with the requirement of stoma being the only significant risk factor (OR = 7.59, p = 0.03). The formation of a seroma at 6weeks detected by MRI, was associated with body mass index (OR = 1.13, p = 0.02). The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to detect asymptomatic seromas during the early process of integration. This protocol was registered at ClinicalTrials.gov (NCT03105895).

Comparison of open and endoscopic posterior component separation with transversus abdominis release: a propensity score-matched study.

Posterior component separation with transversus abdominis release (TAR) is considered to be the optimal technique for large incisional ventral hernia repair. Endoscopic TAR (eTAR) that gets all the benefits of minimally invasive surgery (MIS) gives a possibility to enhance results of the treatment. The aim of our study was to make the comparison between open and endoscopic TAR procedures with an emphasis on frequency and severity of postoperative complications in comparable groups. All patients had midline incisional hernia and underwent either open (open TAR group) or endoscopic (eTAR group) Rives-Stoppa repair in combination with bilateral transversus abdominis release in Moscow City Hospital №1 from January 2018 to December 2022. A propensity score matching (PSM) was used to make groups comparable. Postoperative complications were classified according to Clavien-Dindo Classification, and Comprehensive complication index was calculated. We performed 133 open and endoscopic TAR separation for midline incisional hernia. After PSM analysis 51 patients were matched to each group. Overall surgical morbidity in the open TAR group (56.9%) was statistically significantly higher than in the eTAR group (29.4%) (p = 0.009). There were more severe complications (Clavien IIIa-V) in the open TAR group (11.8% vs. 0%, p = 0.027). Length of hospital stay after surgery was shorter in eTAR group (p < 0.001). The Comprehensive complication index in the open TAR group was significantly higher than in eTAR group, 8.7 (0-20.9) vs. 0 (0-8.7) (p = 0.011). Based on the data from our study, the entire MIS procedure including endoscopic TAR is a safe and optimal technique for surgery of midline incisional ventral hernia, requiring TAR separation in terms of reducing the rate of postoperative complications, their severity and hospital length of stay, compared to open TAR procedure.

Incisional hernia: open abdominal wall reconstruction. Current state of the technique and results

The treatment of complex midline hernias remains aparticular challenge. The currently refined knowledge of the anatomy in the cadaver laboratory and advancing clinical experience have changed our present approach. The aim of this review is to present adescription of the updated surgical procedures and outcomes. We favor the retromuscular or preperitoneal layer for mesh implantation, including the Rives-Stoppa procedure (sublay mesh) and posterior component separation with the Madrid modification. We operated on 334 complex midline incisional hernias: 6.3% retromuscular preperitoneal, 15% after Rives-Stoppa, 2.4% anterior component separation and 76% posterior component separation. Abridging procedure was used in 31%. Acomplication occurred in 35.3%, most of which were wound healing disorders (SSO). The average length of hospital stay was 7.2days. We recorded avery low incidence of long-term complications: 3.3% recurrence, 0.9% chronic pain (daily use of pain medication), 6% bulging, 1.8% chronic seroma and 2.6% chronic mesh infection. Despite the associated morbidity, retromuscular/preperitoneal treatment offers excellent long-term results.

Early Outcome after Sublay versus Onlay Polypropylene Mesh Repair for Ventral Midline Incisional Hernia - A Single Center Retrospective Analysis.

Onlay and retromuscular sublay mesh repairs are the most frequently used procedures in open repair of midline incisional hernias. The onlay placement of the mesh is simple and fast to perform, while the sublay retromuscular repair offers a supplementary protection against infection, but it is considered a more complicated procedure with a higher risk of early postoperative complications. The personal experience of the surgeons plays an important role in choosing the technique of mesh placement. This paper presents the results of a retrospective analysis of 220 consecutive patients operated on in the Surgical Clinic of the Mures Clinical County Hospital (Romania) between 31.01.2017 - 31.12.2019 with sublay or onlay polypropylene mesh repair for ventral midline incisional hernia. The patients were divided into two groups according to the position of the mesh. The two groups were identical in terms of age, sex distribution, incidence of comorbidities (obesity, diabetes mellitus, cardiac and respiratory diseases), number of previous operations and size of the defect (p value 0.05 for all the parameters). Results: Postoperative mortality was zero, with no statistically significant differences of the duration of the postoperative hospitalization between the two groups p 0.05. A total of 34 early reoperations were required for hematoma, skin necrosis, seroma, wound suppuration, and intestinal obstruction, with no statistically significant difference between the two groups (p 0.05 for the overall and separate incidence of each complication). The onlay placement of the mesh was associated with a later removal of the superficial drains p 0.0001 with a larger proportion of the patients who were discharged without removing the drains (group A 2/62 versus group B 141/168, p 0.0001). Conclusions: Both the onlay and the retromuscular sublay placement of polypropylene meshes may be used with good results for the treatment of midline incisional hernias. The lack of a supplementary early morbidity after the retromuscular sublay repair is an argument for a more frequent use of this technique which offers a supplementary protection against infection.

913 Role of Botulinum Toxin in the Medical Management of Respiratory Distress Secondary to Suspected Intraabdominal Hypertension After Abdominal Wall Reconstruction

Abstract Introduction Botulinum toxin (BTX) is a neurotoxin which causes functional denervation of muscles. Botulinum toxin type A (BTX) has been approved for a wide range of clinical applications. In addition, off-label preoperative injection of BTX is increasingly used for chemical component relaxation of the lateral abdominal wall muscles prior to abdominal wall reconstruction. Rationale Postoperative intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) with consequent organ dysfunction can be a potential complication after abdominal wall reconstruction. The IAH and ACS clinical practice guidelines suggest improving abdominal wall compliance in their medical management algorithm including neuromuscular blockade. Method Following an open retrorectus mesh repair with left component separation via transversus abdominis release of a midline incisional hernia, we report a case of postoperative respiratory distress and acute kidney injury suspected secondary to increasing intraabdominal hypertension due to ileus unresponsive to standard conservative measures including nasogastric tube insertion, use of prokinetic agents and judicious fluid management. We performed Botox A injection under ultrasound guidance to the lateral abdominal wall musculature. This resulted in improved abdominal wall compliance, consequent resolution of respiratory symptoms and reversal of acute renal injury with eventual resolution of ileus and a good post operative outcome. There was an increase in length of stay by 2 days compared to our average. The patient remains well at 3 months post operatively. Conclusions Botulinum Toxin A injection can be considered as adjunct in the medical management of IAH and ACS if it has not been used in the pre-operative setting.

A Comparative Study between Onlay versus Sublay Mesh Repair in Treatment of Midline Incisional Hernia

Abstract Background Incisional hernia is a common complication following laparotomy and is the most common indication for reoperation. However, the optimal approach for its repair is still a matter of debate. Aim of Study The aim of this study was to compare between onlay and sublay mesh repairs in treatment of midline incisional hernia regarding the operative technique and postoperative complications. Patients and Methods This randomized controlled prospective comparative study was conducted in general surgery department Ain-Shams University Hospital and Damanhour Medical National Institute in the period between November 2019 and April 2020. It included 40 patients with Midline incisional hernia who were randomly divided into two equal groups: A (treated with sublay repair) and B (treated with onblay repair). Results The mean operative time in group A was 104.2 minutes and in group B was 82.9 minutes. The mean time of drain removal in group A was 4.3 days while in group B was 13.6x days. Seroma formation after drain removal was not recorded in any patients of group A while it occurred in 4 patients in group B (20%). The other postoperative complications were comparable in both groups. During 6 months of follow up, hernia recurrence didn’t occurs in any patient in group A nor group B. Conclusion Sublay mesh repair of incisional hernia is a good alternative to onlay repair. It is applicable to all sites of incisional hernia with a low recurrence rate and acceptable complication rates.

Single-staged retromuscular abdominal wall reconstruction with mesh at the time of ostomy reversal: are we crossing the line? An ACHQC Analysis.

The most appropriate method of reconstructing the abdominal wall at the site of a simultaneous stoma takedown is controversial. The contaminatedfield, concomitant GI procedure being performed and presence of aherniaallcomplicate decision-making. We sought to describe the surgical approaches, mesh type and outcomes of concomitant abdominal wall reconstruction during stoma takedown in a large hernia registry. All patients who underwent stoma takedown with simultaneous hernia repair with retromuscular mesh placement from January 2014 to May 2022 were identified within the Abdominal Core Health Quality Collaborative (ACHQC). Patients were stratified by mesh type including permanent synthetic (PS), resorbable synthetic (RS) and biologic mesh. Association of mesh type with 30-day wound events and other complications and1-year outcomes were evaluated. There were 368 patients who met inclusion criteria.Eighty-nine patients had ileostomies, 276 colostomies and 3hadboth. Two hundred and seventy-nine (75.8%) patients received PS mesh, 46 (12.5%)biologic, and 43 (11.7%)RS. Seventy percent (259/368)had a parastomal hernia,75% (285/368) had a midline incisional hernia, and 48% (178/368) had both. All groups had similar preoperative comorbidities and the majority had atransversus abdominus release. All mesh groups had similar thirty-day SSI (13.2-14.3%), SSO (10.5-17.8%) and SSOPI (7.9-14.1%), p = 0.6. Three patients with PS mesh developed infected synthetic mesh and one PS mesh required excision. Four patients with PS developed an enterocutaneous fistula. Of these, only one patient was recorded as having both an enterocutaneous fistula and mesh infection. Thirty-day reoperation and readmission weresimilar across all mesh groups.Recurrence at 1-year was similar betweenmesh groups. Quality of life measured using HerQLes scores were higher at one year compared to baseline in all groups indicating improvement in hernia-specific quality of life. Early complication rates associated with simultaneous stoma takedown and abdominal wall reconstruction are significant, regardless of mesh type utilized. Concomitant surgery should be weighed heavily and tailored to individual patients.

Mechanical Parameters Influencing Recurrence in Ventral Midline Incisional Hernia Open Repair

Abstract Background Ventral midline incisional hernia (VMIH) is common and recurrence rates remain of concern after gold-standard open repairs. Personalized optimization and risk stratification are traditionally performed through preoperative considerations regarding patients’ general and medical status and occulting mechanical factors. Aims The aim of this retrospective observational cohort study is to identify mechanical parameters potentially influencing VMIH recurrence (VMIHR) after repair. Methods Data were derived from an institutional quality database. Patients who underwent VMIH open repair with retromuscular or preperitoneal non-absorbable mesh reinforcement, confirmed by an available preoperative CT scan for biomechanical measurements, between June 2012 – June 2020 in a single centre, were included. Exclusion criteria were non-open repairs, non-midline hernias, absence of preoperative scan, absence of mesh reinforcement, intraperitoneal/bridging mesh positions, biologic/biosynthetic mesh and use of component separation techniques. The main outcome was VMIHR, a symptomatic clinically confirmed recurrence re-operated in the same institution within 36 months maximum following primary open repair. Patients with/without recurrence were compared using standard analytic tools. Results Fourty-eight patients met the inclusion criteria of which 11 (23%) developed VMIHR. The following parameters were statistically significantly associated with VMIHR: smaller visceral fat surface (mean of 244.9 cm2 in the recurrence group vs 286.3 cm2 in non-recurrence group, p = 0.0295), smaller mesh length (17.2 cm vs 23 cm, p = 0.001), smaller total mesh surface (315.2 cm2 vs 550.1 cm2, p = 0.0095), coated meshes (p = 0.033), absorbable suture for mesh anchoring (p = 0.043) and a greater largest defect width/mesh width ratio (0.42 vs 0.29, p = 0.0146). Conclusions When focusing on mechanical parameters, non-modifiable and patient-related parameters seem to play a limited role. However, using uncoated meshes of larger dimensions (greater than/equal to 3.5x defect size) than suggested previously (defect size + 5cm) resulted in fewer recurrences. This may help to orientate further larger prospective trials.

OC-030 COMPARISON OF OUTCOMES OF THE EXTENDED-VIEW TOTALLY EXTRAPERITONEAL RIVES-STOPPA (ETEP-RS) AND THE INTRAPERITONEAL ONLAY MESH WITH DEFECT CLOSURE (IPOM-PLUS) FOR W1-W2 MIDLINE INCISIONAL HERNIA REPAIR

Abstract Aim This study aimed to compare the outcomes of the eTEP-RS and IPOM-plus procedures in W1 and W2 midline incisional abdominal wall hernia (IAWH) repairs performed by the same surgeon. Material and Methods Prospectively collected data of laparoscopic abdominal wall repairs performed on 61 patients with eTEP between November 2018 and April 2022 and on 67 patients with IPOM-plus between January 2016 and April 2022 were retrospectively analyzed. A total of 74 out of 128 patients, 30 in the eTEP-RS group and 44 in the IPOM-plus group, who underwent W1-W2 midline incisional hernia repair were included in the study. The mean follow-up was 24 months in the eTEP-RS group and 45 months in the IPOM-plus group. Results There was no statistically significant difference between the groups regarding age, sex, BMI, ASA score, or active smoking. The mean mesh area (MMA) and mesh/defect (M/D) ratio were higher in the eTEP-RS group (p &amp;lt;0.001 and p =0.004). In the eTEP-RS group, the hospital length of stay (LOS) (1.48 days vs. 2.58 days, p &amp;lt;0.001) and pain on the first and 10th postoperative days were significantly lower (p &amp;lt;0.001), while the operative time was significantly longer (p &amp;lt;0.001). There was no significant difference in terms of intraoperative complications (p =0.56), seroma formation (p =0.83), or recurrence (p =0.83). Conclusions The eTEP-RS technique has advantages over the IPOM-plus approach, such as a shorter LOS and less early postoperative pain with W1-W2 midline IAWH repair. However, the eTEP technique has a longer operative time.

OC-117 LIRA (LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY) TECHNIQUE FOR MIDLINE VENTRAL AND INCISIONAL HERNIAS: PRELIMINARY ANALYSIS OF A PROSPECTIVE SERIES

Abstract Objective To analyze the safety and efficacy of the LIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) technique by evaluating postoperative pain, complications (seroma, infection, etc.), bulging, and recurrence rate. Methods Prospective analysis of patients who underwent elective laparoscopic repair of midline ventral and incisional hernias with defects 4 to 8 cm wide (W2, EHS classification). Endpoints: Recurrence rate (primary endpoint). Secondary objectives: acute pain, postoperative seroma, infection, chronic pain, bulging and patient satisfaction. Results From 2020 to 2021, LIRA repair was performed in 12 patients (mean age 51-y, mean BMI: 33.5 kg/m2). Mean defect width: 5.9 cm. Rectus diastasis&amp;gt;5cm. was present in 6 patients. No intraoperative complications were observed. Tension-free closure was achieved in all patients. Mean operative time: 79 minutes. Postop clinical seroma: 4/12 patients (No intervention needed). Postoperative pain (VAS): 4 at 24h, 0.6 at one month, and 0 in those patients who have completed one year of follow-up. No clinical or radiological recurrences, nor trocar hernias have been observed. The degree of patient satisfaction is 9/10. No one complained of bulging. Conclusions Despite being a technically demanding procedure, the LIRA technique allowed a tension-free midline reconstruction of patients suffering from hernia defects smaller than 8 cm without relevant complications. Although the follow-up time is short, no recurrences or trocar hernias have been observed to date. Therefore, LIRA should be considered a safe and efficient therapeutic alternative in patients with ventral and incisional hernias type W2.

OC-129 A new surgical technique for repair of rectus diastasis and associated hernia: description and initial experience

Abstract Aim Rectus diastasis (RD) is a common pathology, usually associated with midline hernias. Preaponeurotic surgical repairs have been described with complications derived from extensive subcutaneous dissection or suprafascial mesh placement. Other techniques place preperitoneal mesh but midline plication is not performed, with aesthetic disadvantages. We describe a new technique for the correction of ventral hernias associated with RD with midline plication and preperitoneal mesh (MPPM) and report our initial experience. Material and Methods We reviewed patients with RD and associated hernia surgically treated using the MPPM technique at our hospital from June 2021 to July 2022. The minimum follow-up time was 6 months. Results Forteen patients with RD and associated hernia were surgically treated with MPPM technique, with an average age of 64.1 years (range 38–82 years), 71.4% male and 28.6% female. The mean BMI was 28.8 Kg/m2 (range 18.6–40.0 Kg/m2). Three women (21.3%) had a mean of 1,3 previous pregnancies (range 0–2 pregnancies). The most common types of associated hernia with RD were primary midline hernia (50%), incisional hernia (21.4%), and recurrent midline hernia (28.6%). Half of the RD (50%) were M1-3 and the other half M2-3 (50%) as well as W1 (50%) and W2 (50%). The mean diameter of associated hernia was 3,2 cm (range 1–6 cm). Hematoma was observed in one patient (7,1%) in the first 30 postoperative days. No reccurence was recorded in the follow-up time. Conclusions The MPPM technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with RD.