Non-absorbable Synthetic Mesh Research Articles

THE INCIDENCE OF ADDITIONAL HERNIA DEFECTS IN A DIASTATIC LINEA ALBA, NOT REPORTED ON PRE-OPERATIVE CT IMAGING

Abstract Aim Patients with ventral primary or incisional hernias with significant recti diastasis are frequently refered to abdominal wall reconstruction (AWR) services. We audited the rate of incidental intra-operative ventral defects related to diastatic linea alba. Method A retrospective analysis of a prospectively maintained database was carried out from March 2023 to January 2024. All patients who underwent AWR using a minimally invasive approach (MIS) were included. Data on the following variables were collected: sex, age (years), BMI (kg/m2), length of hospital stay (LOS, days), operative time (hours), and ventral defects. Results 27 patients underwent MIS AWR (22 robotic; 8 laparoscopic). Male to female ratio was 16:11. Median age was 58 years (IQR 48–66) and BMI 36 kg/m2 (IQR 32–37). All patients underwent eTEP retro-rectus Rives-Stoppa + diastasis plication using macroporous polypropylene non-absorbable synthetic mesh. Median operating time was 3.3 hours (IQR 3.1–3.5) and LOS was 2 days (IQR 1–2). 1 (3%) patient had laparoscopic converted to open procedure due to bowel involvement. 13 (48%) of patients had extra defects associated with diastatic linea alba which were not visualized in pre-operative cross-sectional imagining. Conclusion When compared to a local repair, the MIS AWR approach in patients with ventral hernias and significant diastasis is justified when considering the high likelihood of synchronous linea alba defects and therefore a risk for future recurrence. These extra defects are rarely detected on pre-operative cross-sectional images. In addition, the plication of diastasis during AWR allows surgeons to recreate a more functional linea alba.

DEVELOPING A ROBOTIC ABDOMINAL WALL RECONSTRUCTION SERVICE IN THE UK – SINGLE CENTRE EXPERIENCE

Abstract Aim A minimally invasive approach (MIS) to complex abdominal wall reconstruction (CAWR) is expanding and offers advantages in enhanced recovery. We report our single-centre experience in the introduction of Robotic CAWR. Methods A retrospective analysis of a prospectively maintained database was carried out from March 2023 to January 2024. All patients undergoing CAWR using a MIS approach were included. Data was collected for the following: sex, age (years), BMI (kg/m2), length of hospital stay (LOS, days), operative time (hours), and post-operative complications. Results 30 patients underwent MIS CAWR (22 robotic; 8 laparoscopic). Male to female ratio was 18:12. The median age was 59 years (IQR 47–66) and BMI 36 kg/m2 (IQR 32–37). Operations included eTEP retro-rectus Rives-Stoppa (RS) + diastasis plication +/- TAR repair using macroporous polypropylene non-absorbable synthetic mesh. Three patients (10%) had TAR and another 3 (10%) had simultaneous inguinal hernia repairs. The median operating time for RS was 3.3 hours (IQR 3.1–3.5) whilst 7.5 hours (IQR 7.2–7.8) for RS + TAR. The median LOS was 2 days (IQR 1–2). Seven (23%) patients developed post-operative urinary retention requiring catheterization. 1 (3%) patient developed a post-operative chest infection. Twenty-two of 27 (82%) patients undergoing MIS Rives Stoppa required oral post-operative analgesia only. 1 (3%) patient had laparoscopic converted to open procedure due to bowel involvement. Conclusion MIS/Robotic CAWR is a safe approach and can be performed in a similar length of time to open procedures. However, LOS is significantly reduced and patients can be successfully managed with oral analgesia.

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

How often is prophylactic parastomal mesh placement performed after rectal resection without sphincter preservation? An analysis of German nationwide hospital discharge data among 41,697 patients

PurposeThe European Hernia Society guidelines of parastomal hernias, published in 2017, strongly recommend prophylactic synthetic non-absorbable mesh upon the construction of a permanent end colostomy to reduce the incidence of parastomal hernias. This study aims to evaluate the implementation of the guidelines in Germany.MethodsThis is a retrospective multicentric analysis conducted in December 2022 at the University Hospital Brandenburg an der Havel. Anonymous data on rectal resection without sphincter preservation in the period 2010–2020 were extracted from the German nationwide hospital discharge data set. Individuals with a hernia and < 18 years old were excluded. Another exclusion criterion was a performed colectomy or proctocolectomy with an ileoanal pouch and placement of an absorbable mesh. The primary endpoint was the annual rate of prophylactic parastomal mesh placement following rectal resection without sphincter preservation in Germany. Cases reporting both non-absorbable mesh placement and rectal resection without sphincter preservation were considered prophylactic mesh insertions.ResultsA total of 41,697 patients received a rectal resection without sphincter preservation and without non-absorbable mesh placement. Among these individuals, 27,089 were male and 14,608 were female. The rate of reoperations (3.1%) and the length of hospital stay (25.3 days ± 19.32) remained almost constant during these 10 years. The rate of prophylactic mesh placement was increasing from 0.2% (n = 8) in 2010 to 6.4% (n = 198) in 2020.ConclusionsCurrently, only the minority of patients who have undergone rectal resection without sphincter preservation receive prophylactic mesh insertion.

OC-110 LAPAROSCOPIC RETROMUSCULAR INGUINAL HERNIA (LRMIHR) REPAIR USING PHASIX TM AND POLYPROPYLENE MESH: 5 YEARS OUTCOME

Abstract Background and objective Inguinal hernia routinely repaired with synthetic non-absorbable mesh. However, chronic pain may affect the success of flow recurrence. In contrast, using absorbable mesh and keeping its integrity for nine months as Phasix TM may be a suitable replacement for the synthetic non-absorbable mesh. This work assesses the results and cost of TAPP repair using Phasix TM &amp; lightweight Polypropylene mesh. Methods Laparoscopic retromuscular inguinal hernia repair (LRMIHR) was performed from January 2015 to January 2023 with Institutional review board approval for 58 patients, 1 female and 57 males. The average age is 55.8, with a 27.5 mean BMI. The study was done in the hospital by one surgeon. Studying post-operative pain, reaction, mesh sensation discomfort, recurrence, and cost. Results In 5 years follow-up, the outcome is comparable without the non-significant advantage of absorbable mesh. Moreover, the cost of absorbable mesh (Phasix ST) is higher. Conclusion No clinical advantage of absorbable mesh in repairing the inguinal hernia. However, using phasix TM may have a place in repairing female and sports hernias. Further work is needed to evaluate phasix in hernia inguinal in a prospective multicenter trial.

Parastomal hernia prevention with permanent mesh in end colostomy: failure with late follow-up of cohorts in three randomized trials

PurposeShort-term results have been reported regarding parastomal hernia (PH) prevention with a permanent mesh. Long-term results are scarce. The objective was to assess the long-term PH occurrence after a prophylactic synthetic non-absorbable mesh.MethodsLong-term data of three randomized controlled trials (RCTs) were collected. The primary outcome was the detection of PH based exclusively on a radiological diagnosis by computed tomography (CT) performed during the long-term follow-up. The Kaplan–Meier method was used for the comparison of time to diagnosis of PH according to the presence of mesh vs. no-mesh and the technique of mesh insertion: open retromuscular, laparoscopic keyhole, and laparoscopic modified Sugarbaker.ResultsWe studied 121 patients (87 men, median age 70 years), 82 (67.8%) of which developed a PH. The median overall length of follow-up was 48.5 months [interquartile range (IQR) 14.4–104.9], with a median time until PH diagnosis of 17.7 months (IQR 9.3–49.0). The survival analysis did not show significant differences in the time to development of a PH according to the presence or absence of a prophylactic mesh neither in the overall study population (log-rank, P = 0.094) nor in the groups of each technique of mesh insertion, although according to the surgical technique, a higher reduction in the appearance of PH for the open retromuscular technique was found (log-rank, P = 0.001).ConclusionIn the long-term follow-up placement of a non-absorbable synthetic prophylactic mesh in the context of an elective end colostomy does not seem effective for preventing PH.

P-029 A NOVEL USE OF FULLY ABSORBABLE PHASIXTM MESH FOR LAPAROSCOPIC INGUINAL HERNIA REPAIR

Abstract Background An inguinal hernia is repaired usually with synthetic non-absorbable mesh resulting in collagen formation leading to chronic inflammation, and fibrosis with significant reductions in hernia recurrence. However, chronic pain may affect quality of life. The new mesh introduced to minimize complications. Poly-4-hydroxybutyrate (P4HB) mesh starts to degrade in 12–18 months. We are reporting our results of TAPP inguinal hernia repair using P4HB mesh (PhasixTM Bard in, Murray Hill, NJ). Method A pilot study is carried-out for laparoscopic TAPP repair for inguinal hernia using P4HB mesh assessing the recurrence rate and chronic pain for 30 months with IRB approval (E-19–3735). The study was conducted from 24 Jan 2016 to July 2017. The study included postoperative pain, reactions, mesh sensation, discomfort, and recurrence. Results Laparoscopic TAPP inguinal repair using P4HB mesh for 15 patients. 14 male and 1 female patient were involved, average age 55.8 years old,and an average BMI of 27.4 kg/m2. No recurrence or mesh sensation encountered except one patient has mild chronic inguinal pain for one year without affecting his usual activity. Conclusion Laparoscopic TAPP inguinal hernia repair using PhasixTM mesh is safe to use in combined direct (medial) and indirect (lateral) inguinal hernia with no recurrence. The use of P4HB absorbable mesh led to less chronic pain and discomfort. However, longer follow-up and a higher number of patients are needed to allocate the status and the place of P4HB in the world for inguinal hernia repairs.

Slowly absorbable mesh versus standard care in the management of contaminated midline incisional hernia (COMpACT-BIO): a multicentre randomised controlled phase III trial including a health economic evaluation

IntroductionIncisional hernia (IH) is the most frequent mid-term and long-term complication after midline laparotomy. The current standard treatment includes repair using a mesh. In a contaminated field, the use of...

P084 MESH USE IN THE UNITED STATES: MESH TYPES AND THEIR INDICATIONS

Abstract Aim Synthetic non-absorbable mesh repair is considered standard of care for most hernias in the United States (US). The introduction of biologic absorbable mesh in the 2000’s has changed this practice and now novel synthetic absorbable and hybrid meshes are available. We aim to describe US trends of mesh use. Material and Methods We surveyed the Abdominal Core Health Quality Collaborative database for all repairs using mesh from 2012 to 2021. Mesh types and indications were analysed. Results Among 47,555 patients who underwent hernia repair with mesh, the majority were with synthetic non-absorbable meshes (96%). Absorbable mesh was placed in 2,039 (4%) patients and included biologic absorbable (893, 44%), synthetic absorbable (1,070, 52%), and hybrid (76, 4%) meshes. Synthetic non-absorbable mesh use was significantly predominant in all wound classes, including dirty/contaminated wounds (P &amp;lt; 0.01) [Figure 1]. Over time, we noted a trend toward lower incidence of absorbable and hybrid mesh use, from 18% to 2% (P &amp;lt; 0.01). Interestingly, we noted a relative increase in annual incidence of absorbable and hybrid mesh use in clean wounds, from 20% to 63% (P &amp;lt; 0.01) [Figure 2]. Figure 1Mesh type used in each wound classFigure 2Absorbable mesh use in clean vs. not clean wounds. Conclusions In the United States, synthetic non-absorbable meshes are commonly used during hernia repairs in dirty and contaminated fields. At the same time, there is a significant increase in the use of absorbable and hybrid meshes in the repair of hernias with clean wound classification. The costs and long-term outcomes of such surgeon choices have yet to be validated.

SP3.2.7 Surgical techniques in emergency hernia repair - what are we doing? Findings from the MASH study

Abstract Aims There is limited evidence to guide the emergency management of acutely symptomatic abdominal wall and groin hernias (ASH) and there is a lack of consensus on optimal surgical technique. This study aimed to explore surgical techniques used to repair ASH. Methods A prospective 12-week cohort study (NCT04197271) recruited adult patients with ASH across 23 UK sites. Baseline characteristics, quality of life, management strategy and 30/90-day outcomes were collected. For those undergoing surgery, detailed information was recorded on: time to surgery, anaesthetic technique, grade of surgeon, intraoperative findings, antibiotic use, operative approach, repair technique (mesh vs suture), mesh/suture type and position and whether bowel resection/stoma formation was required. Results Of the 264 patients recruited, 214 (82%) underwent acute repair within 48 hours of admission. 95% underwent open repair, with 93% under general anaesthetic. 5% of inguinal and femoral hernias had laparoscopic repair. Mesh was used in 89% of inguinal hernias vs 29% of umbilical hernias. The majority (86%) used a synthetic non-absorbable mesh (94% inguinal, 84% umbilical). Mesh placement varied widely for epigastric and umbilical hernia, with onlay used most commonly (24%). Similar variation was seen in suture choice. 8% developed an SSI by 30 days, the majority of which were in umbilical repairs. One patient developed early hernia recurrence (umbilical) requiring surgery. Conclusions This data demonstrates variation in the surgical management of ASH, especially with the use of mesh. Laparoscopic surgery was uncommon. Further studies are required to clarify optimal technique strategies in the emergency setting.

1225 How Are Acutely Symptomatic Hernias Repaired in The UK? Surgical Techniques from The MASH Study

Abstract Aim Minimal evidence exists guiding the emergency management of acutely symptomatic abdominal wall and groin hernias (ASH) and there is a lack of consensus on optimal surgical technique. The aim of this study was to explore surgical techniques used in the repair of ASH. Method A prospective 12-week cohort study (NCT04197271) recruited adult patients with ASH across 23 UK sites. Baseline characteristics, quality of life, management strategy and 30/90-day outcomes were collected. For those undergoing surgery, detailed information was recorded on: time to surgery, anaesthetic technique, grade of surgeon, intraoperative findings, antibiotic use, operative approach, repair technique (mesh vs suture), mesh/suture type and position, and whether bowel resection/stoma formation was required. Results Of the 264 patients recruited, 214 (82%) underwent acute repair within 48 hours of admission. 95% of patients underwent open repair, 93% under general anaesthetic. Mesh was used in 89% of inguinal hernia repair vs 29% umbilical hernia repair. The majority (86%) used a synthetic non-absorbable mesh (94% inguinal, 84% umbilical). Mesh placement varied widely for epigastric and umbilical hernia, with onlay used most commonly (24%). Similar variation was seen in suture choice. 8% of patients developed an SSI by 30 days, the majority which were in umbilical repairs. One patient developed early hernia recurrence (umbilical) requiring surgery. Conclusions This data demonstrates variation in the surgical management of ASH, especially with the use of mesh. Laparoscopic surgery was uncommon. Further studies are required to clarify optimal technique strategies in the emergency setting.

Long-term outcomes of primary cystocele repair by transvaginal mesh surgery versus laparoscopic mesh sacropexy: extended follow up of the PROSPERE multicentre randomised trial.

To compare the effectiveness and safety of laparoscopic sacropexy (LS) and transvaginal mesh (TVM) at 4 years. Extended follow up of a randomised trial. Eleven centres. Women with cystocele stage ≥2 (pelvic organ prolapse quantification [POP-Q], aged 45-75 years without previous prolapse surgery. Synthetic non-absorbable mesh placed in the vesicovaginal space and sutured to the promontory (LS) or maintained by arms through pelvic ligaments and/or muscles (TVM). Functional outcomes (pelvic floor distress inventory [PFDI-20] as primary outcome); anatomical assessment (POP-Q), composite outcome of success; re-interventions for complications. A total of 220 out of 262 randomised patients have been followed at 4 years. PFDI-20 significantly improved in both groups and was better (but below the minimal clinically important difference) after LS (mean difference -7.2 points; 95% CI -14.0 to -0.05; P = 0.029). The improvement in quality of life and the success rate (LS 70%, 61-81% versus TVM 71%, 62-81%; hazard ratio 0.92, 95% CI 0.55-1.54; P = 0.75) were similar. POP-Q measurements did not differ, except for point C (LS -57 mm versus TVM -48 mm, P = 0.0093). The grade III or higher complication rate was lower after LS (2%, 0-4.7%) than after TVM (8.7%, 3.4-13.7%; hazard ratio 4.6, 95% CI 1.007-21.0, P = 0.049)). Both techniques provided improvement and similar success rates. LS had a better benefit-harm balance with fewer re-interventions due to complications. TVM remains an option when LS is not feasible. At 4 years, Laparoscopic Sacropexy (LS) had a better benefit-harm balance with fewer re-interventions due to complications than Trans-Vaginal Mesh (TVM).

Parestomal hernia repair. Prospective observational study based on the Spanish Registry of Incisional Hernia (EVEREG)

IntroductionThe results of parastomal hernia (PH) repair based on data from registries are scarce. The objective of this work is to analyze the data collected on PH in the National Registry of Incisional Hernia (EVEREG) and thus evaluate current practices and results in PH repair. MethodsData from the PH cohort recorded in the period from July 2012 to June 2018 are analyzed. Complications, recurrences and associated factors of the entire PH cohort are analyzed, regardless of the type of stoma they are associated with. Subsequently, the same PH group analysis was performed in relation to a colostomy (larger group). Results353 PH were studied. Of these, 259 (73%) were PH in the context of a terminal colostomy, 74 (21%) in the context of a terminal ileostomy, and 20 (6%) in the context of a ureteroileostomy (Bricker). The global mean age was 68.7 ± 11.1 years and 135 (38%) patients were female. The open approach and elective surgery were predominant (78% and 92% respectively); 99% were repaired with a non-absorbable synthetic mesh. Global postoperative complications were high (30.6%). As well as, the global recurrence (27.5%) after a mean follow-up of 9.4 months. ConclusionsPH repair is infrequent. PH surgery seems to be associated with a high percentage of postoperative complications and recurrence.

Comparison of postoperative infection after emergency inguinal hernia surgery with enterectomy between mesh repair and non-mesh repair: a national database analysis.

Synthetic non-absorbable mesh is used for elective inguinal hernia repair but is not commonly used for incarcerated or strangulated inguinal hernia requiring enterectomy to reduce the risk of surgical-site infection. This study aimed to evaluate the safety of synthetic non-absorbable mesh repair in patients with incarcerated or strangulated inguinal hernia requiring enterectomy versus non-mesh repair. We analyzed patients with incarcerated or strangulated inguinal hernia with enterectomy from April 2012 to March 2017 using a nationwide inpatient database in Japan. We conducted overlap propensity score-weighted analyses to compare surgical-site infection (SSI), duration of anesthesia, antibiotic use at > 3days after surgery, postoperative hospital stay, and 30day readmission. Two sensitivity analyses were performed. First, we compared the proportions of patients requiring wound culture at ≥ 3days after surgery. Second, we performed overlap propensity score-weighted logistic regression analyses for surgical-site infection. We identified 668 eligible patients, comprising 223 patients with mesh repair and 445 with non-mesh repair. Overlap propensity score-weighted analyses showed no significant differences between the mesh repair and non-mesh repair groups for SSI (2.5 vs. 2.8%, P = 0.79). Secondary outcomes did not differ significantly between the groups. Proportion of wound culture at ≥ 3days after surgery was similar in the two groups (11.1 vs. 14.6%, P = 0.18). Logistic regression analysis showed no significant association between mesh repair and SSI (odds ratio, 0.93; 95% confidence interval, 0.34-2.57). Synthetic non-absorbable mesh use may be safe for incarcerated or strangulated inguinal hernia requiring enterectomy.

Ventral hernia repair with synthetic mesh in a contaminated field: a systematic review and meta-analysis.

The use of mesh in ventral hernia repair becomes especially challenging when associated with a contaminated field. Permanent synthetic mesh use in this setting is currently debated and this discussion is yet to be resolved clinically or in the literature. We aim to systematically assess postoperative outcomes of non-absorbable synthetic mesh (NASM) used in ventral hernia repair in the setting of contamination. A literature search of PubMed, Embase, Scopus, Cinahl, and Cochrane Library identified all articles from 2000-2020 that examined the use of NASM for ventral hernia repair in a contaminated field. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Qualitative analysis was completed for all included studies using a modified Newcastle-Ottawa scale. Of 630 distinct publications and 104 requiring full review, this study included 17 articles published between 2007 and 2020. Meta-analysis demonstrated absorbable mesh was associated with more HR (OR 1.89, 1.15-3.12, p = 0.008), SSO (OR 1.43, 0.96-2.11, p = 0.087), SSI (OR 2.84, 1.85-4.35, p < 0.001), and unplanned reoperation (OR 1.99, 1.19-3.32, p = 0.009) compared to NASM. The use of NASM for ventral hernia repair in a contaminated field may be a safe alternative to absorbable mesh, as evidenced by lower rates of postoperative complications. This review counters the current clinical paradigm, and additional prospective randomized controlled trials are warranted.

Prophylactic Onlay Mesh Implantation During Definitive Fascial Closure After Open Abdomen Therapy (PROMOAT): Absorbable or Non-absorbable? Methodical Description and Results of a Feasibility Study.

Introduction: Incisional hernia development after open abdomen therapy (OAT) remains a common complication in the long run. To demonstrate the feasibility, we describe our method of prophylactic onlay mesh implantation with definitive fascial closure after open abdomen therapy (PROMOAT). To display the feasibility of this concept, we evaluated the short-term outcome after absorbable and non-absorbable synthetic mesh implantation as prophylactic onlay.Material and Methods: Ten patients were prospectively enrolled, and prophylactic onlay mesh (long-term absorbable or non-absorbable) was implanted at the definitive fascial closure operation. The cohort was followed up with a special focus on incisional hernia development and complications.Results: OAT duration was 21.0 ± 12.6 days (95% CI: 16.9–25.1). Definitive fascial closure was achieved in all cases. No incisional hernias were present during a follow-up interval of 12.4 ± 10.8 months (range 1–30 months). Two seromas and one infected hematoma occurred. The outcome did not differ between mesh types.Conclusion: The prophylactic onlay mesh implantation of alloplastic, long-term absorbable, or non-absorbable meshes in OAT showed promising results and only a few complications that were of minor concern. Incisional hernias did not occur during follow-up. To validate the feasibility and safety of prophylactic onlay mesh implantation long-term data and large-scaled prospective trials are needed to give recommendations on prophylactic onlay mesh implantation after OAT.

Reparación de la hernia paraestomal. Estudio observacional prospectivo basado en el Registro Español de Hernia Incisional (EVEREG)

IntroductionThe results of parastomal hernia (PH) repair based on data from registries are scarce. The objective of this work is to analyze the data collected on PH in the National Registry of Incisional Hernia (EVEREG) and thus evaluate current practices and results in PH repair. MethodsData from the PH cohort recorded in the period from July 2012 to June 2018 are analyzed. Complications, recurrences and associated factors of the entire PH cohort are analyzed, regardless of the type of stoma they are associated with. Subsequently, the same PH group analysis was performed in relation to a colostomy (larger group). Results353 PH were studied. Of these, 259 (73%) were HP in the context of a terminal colostomy, 74 (21%) in the context of a terminal ileostomy, and 20 (6%) in the context of a ureteroileostomy (Bricker). The global mean age was 68.7±11.1 years and 135 (38%) patients were female. The open approach and elective surgery were predominant (78% and 92% respectively); 99% were repaired with a non-absorbable synthetic mesh. Global postoperative complications were high (30.6%). As well as, the global recurrence (27.5%) after a mean follow-up of 9.4 months. ConclusionsPH repair is infrequent. PH surgery seems to be associated with a high percentage of postoperative complications and recurrence.

Study Of Incisional Hernia At A Tertiary Care Teaching Hospital

Incisional hernia affects all age groups and involve both male and females. It can be defined as hernia which protrudes through surgical wound which was healed incompletely. Management of incisional hernia requires operative intervention most of the times it may laparoscopic repair with synthetic non-absorbable mesh or open anatomical repair.In partnership with Jawaharlal Nehru Medical College AVBR Hospital (Datta Meghe Institute of Medical Sciences) Sawangi (Meghe), Wardha, Maharashtra, this work was performed in the Department of General Surgery at Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre ,Hingna , Nagpur. Over a period of 1 year 59 cases of diagnosed incisional hernia were included.33 males and 26 females were included. The mean age was years. Most common cause of Incisional Hernia (IH) post-operative wound infection(49.15%). In maximum cases history suggestive of emergency surgery(86.44%).Type of incision suggests maximum cases in midline incision (55.93%) followed by Pffanensteils incision (28.81%).Open mesh hernioplasty was the common procedure (57.62%) ,Lap mesh hernioplasty done in (25.42%)cases and (16.94%) cases were treated by suture repair. There was no evidence of recurrence in laparoscopic repair as open mesh hernioplasty has a recurrence rate of 03.57% and suture repair cases showed 33.33% recurrence.Incisional Hernia and its occurrence can be taken care of by implementing all standard aseptic precautions thereby avoiding chances of infection at the time of primary surgery wherein thorough peritoneal wash, proper techniques of wound closure and use of appropriate antibiotics is recommended. Management of IH with Laparoscopic mesh repair has its own advantage in terms of less hospital stay, negligible rate of recurrence though it is not cost effective at present scenario.

Abstract P6-14-06: Prepectoral direct to implant reconstruction following nipple sparing mastectomy using the TiLOOP bra pocket

Abstract Aim: Evaluation of safety, cosmetic outcome and patients satisfaction following nipple sparing mastectomy with prepectoral direct to implant reconstruction using the TiLOOP® Bra Pocket. Background: TiLOOP® Bra Pocket is a new surgical tool consisting of a large-pore, non-absorbable synthetic mesh made from titanized monofilament polypropylene thread. It is used for immediate prepectoral implant reconstruction to fix the implant on the pectoralis major muscle and to avoid implant rotation. Material and methodes: Between October 2017 and February 2019, 57 patients underwent nipple sparing mastectomy in the certified breast cancer centre, at the AGAPLESION Markus Hospital, Frankfurt, Germany. Data was collected in a prospective registry. All of the patients underwent a prepectoral direct to implant reconstruction using the new TiLOOP® Bra Pocket. We present the first analysis of this prospective unicentric registry. To measure and to analyse the cosmetic outcome and patients’ satisfaction, the BREAST-Q questionnaire was used, an established modular questionnaire to assess patient reported outcome (PRO). Results: All of the 57 patients were available for postoperative analysis. In 35/57 (61%) of the cases a seroma occured and was worth to be punctured. The median number of punctures was 4. The volume was 70 ml in average. Seven patients had a postoperative hematoma and had to undergo another surgical procedure. Three patients developed a skin necrosis or severe wound healing problem due to bad quality of the soft tissue and skin mantle and had to undergo implant explantation. One patient suffered from implant infection but could be treated conservatively. The analysis of patients’ reported outcome via the BREAST-Q resulted in a high satifaction rate regarding the cosmetic outcome. Conclusion: Direct to implant reconstruction with prepectoral implant position by using the TiLOOP® Bra Pocket is a very promising surgical approach. In comparison to a subpectoral implant reconstruction it reduces the duration of surgery, avoids a jumping breast phenomenon and causes less postoperative pain, moreover, it leeds to a high patient satisfaction rate and shows a moderate complication rate. Follow up of our patients will continue. The next analysis will be done after 24 months. Citation Format: Marc Thill, Viviane van Haasteren, Katharina Kelling. Prepectoral direct to implant reconstruction following nipple sparing mastectomy using the TiLOOP bra pocket [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-06.

A Novel Use of Fully Absorbable PhasixTM Mesh for Laparoscopic Inguinal Hernia Repair

Background and Objectives:An inguinal hernia is usually repaired with synthetic nonabsorbable mesh, resulting in collagen formation, chronic inflammation, and fibrosis, with significantly reduced hernia recurrence. However, chronic pain may affect the quality of life. Poly-4-hydroxybutyrate (P4HB) mesh was introduced to minimize complications, and starts to degrade in 12–18 months. This study assesses the consequences and results of patients undergoing transabdominal preperitoneal (TAPP) inguinal hernia repair using P4HB mesh (PhasixTM, C.R. Bard Inc., Murray Hill, NJ, USA).Methods:We performed a pilot study of laparoscopic TAPP repair for inguinal hernias using P4HB mesh in 15 patients (14 male and one female) with an average age of 55.8 y, and an average body mass index of 27.4 kg/m2. We assessed the recurrence rate and patients' chronic pain for 30 months, with institutional review board approval (E-19–3735). The study was conducted from January 2016 to July 2017 in Medical City, King Saud University. We measured postoperative pain, reactions, mesh sensation, discomfort, and recurrence.Results:In 15 patients, we encountered no recurrence or mesh sensation, except in one patient, who experienced mild chronic inguinal pain for one year, without activity restrictions.Conclusion:Laparoscopic TAPP inguinal hernia repair using P4HB mesh is safe for combined, direct (medial), and indirect (lateral) inguinal hernia, with no recurrence. P4HB absorbable mesh caused less chronic pain and discomfort. Longer follow-up, more patients and 15 patients repaired using synthetic mesh are necessary to assess the utility of P4HB for inguinal hernia repair globally.