Hernia Recurrence Research Articles

Prospective randomized study comparing mesh displacement in enhanced-view totally extraperitoneal versus totally extraperitoneal laparoscopic inguinal hernia repair without mesh fixation.

In laparoscopic inguinal hernia repair, it is thought that the mesh can be displaced more in the enhanced-view totally extraperitoneal (eTEP) technique. The aim of this study was to compare eTEP and totally extraperitoneal (TEP) techniques without mesh fixation in terms of mesh displacement and hernia recurrence. Between December 2022 and April 2023, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups; eTEP group (n = 30) and TEP group (n = 30). There was without mesh fixation in both groups. Study was registered at http://Clinicaltrials.gov (NCT06070142). The mesh was marked with three radiopaque clips. Pelvic radiographs were performed to evaluate the displacement of the mesh. The primary outcome of this study was mesh displacement. In addition, this is the first study in the literature to compare eTEP and TEP techniques in terms of mesh displacement without fixation in laparoscopic inguinal hernia. There was no significant difference between the groups in terms of mesh displacement, recurrence, postoperative VAS scores, length of hospital stay, hematoma, and seroma formation. The operation time was higher in the eTEP group and was statistically significant. Without mesh fixation, the eTEP technique does not increase the risk of mesh displacement and recurrence. The eTEP technique can be safely applied without mesh fixation in laparoscopic inguinal hernia repairs. ClinicalTrials number: NCT06070142.

A single-centre, retrospective study of incisional hernia repair outcomes post kidney transplantation.

Incisional hernias (IH) after kidney transplantation (KTx) can cause significant morbidity in kidney transplant recipients (KTR). We aimed to report the outcomes of surgical repair of IH in KTR from our centre. We retrospectively analysed all the IH repairs in KTR from May 2018 to May 2023. We documented pre-transplant baseline characteristics, peri- and post-KTx events and outcomes and post-IH repair complications. We also documented length of stay, survival, and hernia recurrence post-IH repair. We performed 35 incisional hernia repairs in 34 KTR from May 2018 to May 2023 with an overall incidence of 1.63% symptomatic IH. Mean patient age was 56.7 ± 10.1 years and mean body mass index (BMI) 29.7 ± 6.49kg/m2. A history of previous hernia operation and open abdominal operations was present in 11.4% and 22.9% of the population, respectively. The types of repairs performed were primary (5.7%), onlay (62.9%), inlay (2.9%) and retromuscular sublay (28.6%). Mean hernia neck size was 8.9 ± 5.6cm. After IH repair, there was no perioperative mortality with an average 5.5 ± 3.9 days of length of stay. There were seven episodes (20%) of IH recurrence. There was a 6% of superficial wound dehiscence rate and a 3% of surgical site infection. Pearson's correlation test revealed that post-operative hernia recurrence was not related with neck size, post-transplant complications or pre- and post-transplant characteristics, as well as post-transplant outcome. The recurrence rate in our cohort was 20%. Known risk factors for IH in KTR as well as post-KTx events were not correlated with hernia recurrence or other post-hernia repair complications.

Role of sarcopenia in complex abdominal wall surgery: does it increase postoperative complications and mortality?

Sarcopenia is defined as the loss of skeletal muscle mass and is associated with an increased risk or morbidity and mortality in complex surgical patient populations. Its role in complex abdominal wall surgery (AWS) is yet to be determined. The aim of this study is to establish if sarcopenia has an impact on postoperative complications, mortality and hernia recurrence. Retrospective study of patients undergoing elective surgery for complex incisional hernias > 10cm (W3 of European Hernia Society classification) between 2014-2023. Sarcopenia was stablished as the skeletal muscle index (SMI), measured at L3 transversal section of a preoperative CT-scan. Previously defined literature-based SMI cutoff values were used: men ≤ 52.4cm2/m2, women ≤ 38.5cm2/m2. 135 patients undergoing complex AWS were included. Of them, 38 were sarcopenic (28.1%). The median follow-up time was 13months (IQR 12-25). In total, 11 patients died (8.1%). We found that sarcopenia was associated with a higher risk of mortality [HR 7.494 (95% CI 1.985-28.289); p 0.003]. There were no statistically significant differences in postoperative complications or hernia recurrence between both groups. Although sarcopenia does not seem to have an influence on hernia recurrence or the development of postoperative complications, whether local or systemic, in our study sarcopenia is associated with a higher risk of mortality after complex abdominal wall surgery. Nonetheless, with the results obtained in our study, we think that prehabilitation programs before complex AWS is advisable.

The current role of barbed sutures in fascial closure of ventral hernia repair: a multicenter study using the abdominal core health quality collaborative database.

Barbed sutures (BS) have been increasingly used in the last two decades across surgical disciplines but little is known about how widespread their adoption has been in ventral hernia repair (VHR). The aim of this study was to document the use of barbed sutures in VHR in a multicenter database with associated clinical and patient-reported outcomes. Prospectively collected data from the Abdominal Core Health Quality Collaborative database was retrospectively reviewed, including all adult patients who underwent VHR with fascial closure from 2020 to 2022. A univariate analysis compared patients with BS against non-barbed sutures (NBS) across the preoperative, intraoperative, and postoperative timeframes including patient-reported outcomes concerning quality of life and pain scores. A total of 4054 patients that underwent ventral hernia repair with BS were compared with 6473 patients with non-barbed sutures (NBS). Overall, BS were used in 86.2% of minimally invasive ventral hernia repairs and about 92.2% of robotic surgery compared to only 9.6% of open procedures. Notable differences existed in patient selection, including a higher BMI (32 vs 30.5; p < 0.001), more incisional hernias (63.3% vs 51.1%; p < 0.001), wider hernias (4cm vs 3cm; p < 0.001), and higher ASA score (p < 0.001) in patients with BS. Outcomes in patients with BS included a shorter length of stay (mean days; 1.4 vs 2.4; p < 0.001), less SSI (1.5% vs 3.6%; p < 0.001), while having similar SSO (7.6% vs 7.3%; p = 0.657), readmission (3.0 vs 3.2; p = 0.691), and reoperation (1.5% vs 1.45%; p = 0.855), at a longer operative time (p < 0.001). Hernia-specific questionnaires for quality of life (HerQLes) and pain in patients with BS had a worse preoperative score that was later matched and favorable compared to NBS (p = 0.048). PRO concerning hernia recurrence suggest around 10% at two years of follow-up (p = 0.532). Use of barbed sutures in VHR is widespread and highly related to MIS. Outcomes from this multicenter database cannot be reported as superior but suggest that barbed sutures do not have a negative impact on outcomes.

Enhanced chitosan and Carboxymethylcellulose scaffolds with natural fiber reinforcement for hernia repair meshes

AbstractChitosan (Chi) and carboxymethylcellulose (CMC) scaffolds, with and without reinforcement by Luffa cylindrica (Lc) or Asclepias curassavica (Ac), were synthesized to evaluate their potential application as hernia repair meshes. These meshes are crucial as they provide structural support to weakened tissues, reducing the risk of hernia recurrence and promoting faster recovery. They improve patient outcomes by enhancing the durability and effectiveness of hernia repairs. Chi scaffolds exhibited lower porosity compared to CMC scaffolds, with fiber inclusion enhancing porosity. The CMC4‐Ac scaffold demonstrated the highest porosity at 67.2%, which is crucial for supporting cell growth and tissue regeneration. All scaffolds exhibited exceptional hydration levels, which is vital for cell growth. Scanning electron microscope (SEM) images revealed open pores in the CMC4 scaffolds, which enhances tissue formation. Tensile strength tests indicated that all scaffolds surpassed the minimum requirements, with CMC4‐Ac standing out for its exceptional properties. CMC scaffolds showed greater degradation, which was mitigated by fiber reinforcement. Chi scaffolds absorbed more Croton draco extract (Cdext) but exhibited lower release rates compared to CMC scaffolds. No hemolytic and non‐cytotoxicity effects were observed. CMC4‐Ac emerged as the most promising scaffold due to its superior properties, making it suitable for hernia repair meshes.

Pooperacinių išvaržų gydymo naudojant tinklelį atokieji (daugiau negu penkerių metų) rezultatai: literatūros apžvalga

Introduction. Postoperative hernias occur in 10–15% of patients. Considering the increase in the incidence of complications with the number of operations it is crucial to choose the optimal surgical technique in order to control the complications rate. This literature review summarizes previous studies on the treatment of postoperative hernias with mesh, comparing complication and recurrence rates according to surgical technique and mesh position. Methods. A thorough search was conducted on the PubMed database to retrieve literature on recurrence, chronic pain, haematoma, seroma, and surgical site infections rates. The results were meticulously summarised and used to confidently compare open and laparoscopic surgical techniques, as well as “sublay” and “onlay/inlay” mesh positions in more than 5-year follow-up. Results. The analysis was conducted on five publications that met the selection criteria. The results showed that laparoscopically treated hernias had lower recurrence and chronic pain rates, but more frequent haematomas. The presence of wound infections, BMI &gt;30, treatment of recurrent postoperative hernias, multiple fascia lesions, enterotomy, larger abdominal wall defect and longer operative time were observed to be associated with higher recurrence rates. The position of the sublay mesh is associated with less frequent seromas, surgical infections, and recurrence compared to the onlay/inlay position. Studies have reported the superiority of large-pore lightweight polypropylene multifilament mesh over the same heavyweight mesh in managing postoperative hernias. Lightweight mesh is linked to a lower risk of hernia recurrence and higher compliance with the abdominal wall. Conclusion. Laparoscopic surgery is associated with lower rates of recurrence and chronic pain, but a higher frequency of haematomas. The sublay mesh position is associated with lower rates of seromas, surgical infections, and recurrence.

Impact of patient's sex on groin hernia repair: A systematic review and meta-analysis.

Groin hernia repair (GHR) is a performed procedure worldwide, with approximately 20million surgeries carried out each year. Despite being less common in females, there is a lack of research on how sex influences the outcomes of GHR. This systematic review and meta-analysis aim to assess how patient sex impacts results in GHR. We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We searched for studies up to October 2023 in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The studies included focused on sex outcomes for both robotic and open GHR procedures. Data extraction and quality assessment were conducted using the Risk of Bias in Non-Randomized Studies - Of Interventionstool. Our statistical analysis was performed using the metafor package in RStudio. After screening a total of 3917 articles, we identified 29 studies that met our criteria, comprising a total of 1,236,694 patients. Among them, 98,641 (7.98%) patients were females. Our findings showed that females had higher rates of hernia recurrence (RR 1.28), chronic pain (RR 1.52), and surgical site infections (SSIs) (RR 1.46) compared to males. Females showed a lower tendency to undergo minimally invasive surgery (MIS) with a relative risk of 0.82 (95% CI 0.69-0.97; p=0.02). Females tend to face higher rates of complications after GHR such as an elevated risk of chronic pain, recurrence, and surgical site infections (SSI). Moreover, they undergo fewer MIS options compared to males. These results underscore the importance of research to enhance outcomes for women undergoing GHR.

FREQUENCY OF RECURRENCE OF PARAUMBILICAL HERNIA AFTER MESH REPAIR

Para-umbilical hernia is a common abdominal wall defect, and mesh repair is widely used to reduce recurrence rates. However, recurrence remains challenging in clinical practice, especially after elective mesh repair procedures like the Onlay technique. Objective: To determine the frequency of recurrence of para-umbilical hernia following mesh repair using the Onlay technique. Methods: This cross-sectional study was conducted in the Department of Surgery, SMBBMC, Lyari, Karachi, from March 1, 2024, to August 30, 2024, following ethical approval from the institutional review board. A total of 125 patients, aged 18-65 years, were diagnosed with para-umbilical hernia via clinical examination and abdominal ultrasound and undergoing elective mesh repair (Onlay technique) were included through non-probability consecutive sampling. After informed consent was obtained, data on age, BMI, smoking status, diabetes (fasting blood sugar &gt;126 mg/dl or use of antidiabetic drugs), and hernia size (assessed by a consultant radiologist via ultrasound) were documented. Statistical analysis evaluated the recurrence rate and its association with clinical variables. Results: The average age of the participants was 48.68 ± 14.4 years, with a male predominance (55%). The overall recurrence rate following mesh repair was 52%. Stratification of recurrence based on age, gender, BMI, smoking status, and diabetes history revealed no statistically significant associations with the recurrence rate. Conclusion: The recurrence rate of para-umbilical hernia following mesh repair with the Onlay technique was high, at 52%, notably higher than that reported in the existing literature. Further research is needed to identify potential factors contributing to this elevated recurrence rate.

Safety of hernia sac resection in inguinal herniorrhaphy for patients on peritoneal dialysis: a case series.

Peritoneal dialysis (PD) is a risk factor for inguinal hernia, and herniorrhaphy on PD might be complicated by PD fluid.Although sac resection should contribute to preventing indirect hernia recurrence, the safety on PD has not beendescribed. This case series describes the detailed surgical procedures and long-term outcomes of 16 cases ofinguinal herniorrhaphy on PD. Results are shown as median (range). The age was 67.5 (53-83) years. Beginning atthe 6th case, we omitted interim hemodialysis and performed the Lichtenstein procedure. We performed sac excisionin the 14 patients. No complication related to PD was found. The follow-up period was 41.5 (4-124) months. Norecurrence occurred. They could continue PD for 21.5 (4-103) months after surgery. The total PD duration was 38.5(18-152) months. In conclusion, inguinal herniorrhaphy with sac resection may not compromise safety even forpatients on PD and achieve the expected PD duration without recurrence.

Five-Year Outcomes from a Prospective Study on Safety and Efficacy of Phasix ST Mesh Use at the Hiatus During Paraesophageal Hernia Repair.

Laparoscopic paraesophageal hernia (PEH) repair has a high hernia recurrence rate. The aim of this study was to assess the 5-year hernia recurrence rate after PEH repair using a combination of bioresorbable mesh and advanced surgical techniques to address tension as needed in a prospective group of patients. In 2016, a prospective database was established for 50 patients undergoing primary, elective PEH repair with a new bioresorbable mesh (Phasix ST). Intraoperatively, tension was addressed with Collis gastroplasty and diaphragm relaxing incisions as needed. All 50 patients from the initial study were tracked and asked to return for objective follow-up. Recurrence was considered present for any hernia more than 2 cm in size. Objective follow-up was conducted in 27 of the original 50 (54%) patients at a median of 5.25 years after their PEH repair. Before the 5-year follow-up, 5 patients had a known recurrent hernia. Objective evaluation at 5 years identified an additional 3 recurrences, for a total recurrence rate of 25% (8 of 32 patients). The hernia recurrence rate in patients with a Collis gastroplasty was significantly lower than in those without a Collis (7% vs 54%, p = 0.008). Two patients underwent reoperation for hernia recurrence. No patient had a mesh infection or mesh erosion. The combination of Phasix ST Mesh and tension-reducing techniques during PEH repair led to a 25% hernia recurrence rate at 5 years. The addition of a Collis gastroplasty led to significantly fewer hernia recurrences and is indicative of the potential for esophageal shortening in many patients with a PEH. The long-term safety and efficacy of Phasix ST Mesh in combination with surgical technique for PEH repair is confirmed.

Comparative anatomic and symptomatic recurrence outcomes of diaphragmatic suture cruroplasty versus biosynthetic mesh reinforcement in robotic hiatal and paraesophageal hernia repair.

Hiatal and paraesophageal hernia (HH/PEH) recurrence is the most common cause of failure after gastroesophageal anti-reflux surgery. Crural reinforcement with mesh has been suggested to address this issue, but its efficacy remains debated. In this study, we aimed to determine the impact of biosynthetic mesh reinforcement compared to suture cruroplasty on anatomic and symptomatic hernia recurrence. Data of patients who underwent robotic HH/PEH repair with suture cruroplasty with or without biosynthetic mesh reinforcement between January 2012 and April 2024 were retrospectively reviewed. Gastroesophageal reflux disease symptoms and anatomic hernia recurrence were assessed at short-term (3months to 1year) and longer-term (≥ 1year) follow-up. Symptomatic hernia recurrence was defined as having both anatomic recurrence and symptoms. Out of the 503 patients in the study, 308 had undergone biosynthetic mesh repair, while 195 had suture-only repair. After the surgery, both groups demonstrated comparable improvements in symptoms. Short-term anatomic hernia recurrence rates were 11.8% and 15.6% for mesh and suture groups, respectively (p = 0.609), while longer-term rates were 24.7% and 44.9% (p = 0.015). The rates of symptomatic hernia recurrence in the same group were 8.8% and 14.6% in the short-term (p = 0.256), and 17.2% and 42.2% in longer-term follow-ups (p = 0.003). In the repair of medium and large-size hernias, mesh reinforcement resulted in a 50.0% relative risk reduction in anatomic hernia recurrences and a 59.2% reduction in symptomatic hernia recurrences at ≥ 1-year follow-up. After more than a year of follow-up, it has been found that using biosynthetic mesh for medium and large hiatal or paraesophageal hernia repair significantly reduces the likelihood of both anatomic and symptomatic recurrence compared to using only suture cruroplasty. These findings strongly support the use of biosynthetic mesh to manage larger hernias. However, further long-term multicenter randomized studies are needed to provide more conclusive evidence.

Open versus robotic retromuscular ventral hernia repair: outcomes of the ORREO prospective randomized controlled trial.

Robotic retromuscular ventral hernia repair (rRMVHR) potentially combines the best features of open and minimally invasive VHR: myofascial release with abdominal wall reconstruction (AWR) with the lower wound morbidity of laparoscopic VHR. Proliferation of this technique has outpaced the data supporting this claim. We report 2-year outcomes of the first randomized controlled trial of oRMVHR vs rRMVHR. Single-center randomized control trial of open vs rRMVHR. 100 patients were randomized (50 open, 50 robotic). We included patients > 18 y/o with hernias 7-15cm with at least one of the following: diabetes, chronic obstructive pulmonary disease (COPD), body mass index (BMI) ≥ 30, or current smokers. Primary outcome was occurrence of a composite outcome of surgical site infection (SSI), non-seroma surgical site occurrence (SSO), readmission, or hernia recurrence. Secondary outcomes were length of stay, any SSI or SSO, SSI/SSOPI, operative time, patient reported quality of life, and cost. Analysis was performed in an intention-to-treat fashion. Study was funded by a grant from Society of American Gastrointestinal and Endoscopic Surgeons. 90 patients were available for 30-day and 62 for 2-year analysis (rRMVHR = 46 and 32, oRMVHR = 44 and 30). Hernias in the open group were slightly larger (10 vs 8cm, p = 0.024) and more likely to have prior mesh (36.4 vs 15.2%; p = 0.030), but were similar in length, prior hernia repairs, mesh use, and myofascial release. There was no difference in primary composite outcome between oRMVHR and rRMVHR (20.5 vs 19.6%, p = 1.000). Median length of stay was shorter for rRMVHR (1 vs 2days; p < 0.001). All patients had significant improvement in quality of life at 1 and 2years. Other secondary outcomes were similar. There is no difference in a composite outcome including SSI, SSOPI, readmission, and hernia recurrence between open and robotic RMVHR.

Extended Lichtenstein Repair for an Additional Femoral Canal Hernia.

The Lichtenstein procedure is one of the most performed surgeries worldwide. However, proper examination to exclude a femoral hernia is often not performed, resulting in a high number of missed hernias. For patients in whom a femoral hernia is suspected pre- or intraoperatively, we describe a novel surgical technique of a femoral extension to the classic Lichtenstein repair. We aim to investigate its safety and clinical outcome. Methods: The femoral-extended Lichtenstein is applied when a femoral hernia is suspected. The fascia transversalis is opened, the lacunar ligament incised, and the hernia reduced. A self-gripping mesh covers the femoral orifice equally on all sides. In a prospective single-center study, we compared 50 consecutive femoral-extended to 50 classic Lichtenstein repairs, evaluating operative time, patient-reported pain (intensity, duration), and recurrence. Results: The technique seems feasible and safe. Apart from 3 min additional surgical time, no difference in pain scoring or hernia recurrence was observed between both groups. Conclusions: We successfully introduced a femoral-extended Lichtenstein repair for patients with suspected femoral herniation.

SP1.1 - The effect of mesh fixation on post-operative pain and recurrence in laparoscopic inguinal hernia repair

Abstract Aims To evaluate post-operative pain and inguinal hernia recurrence following laparoscopic totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) techniques. Secondly, in TAPP approach to compare outcomes with method of mesh fixation. Methods 545 patients underwent elective laparoscopic inguinal hernia repair in a single centre, between October 2015 and April 2023. Surgical approach and method of mesh fixation was obtained from operation note. Patients were contacted retrospectively via telephone call. Post-operative pain was assessed using a scale (1-10). Chronic pain defined as pain persisting beyond 3 months. Hernia recurrence defined as new groin lump at site of previous repair. Results 545 patients underwent surgery. 212 did not answer follow-up call, 43 declined to take part in study and 22 had died. 268 analysed; 167 underwent TEP and 101 TAPP inguinal hernia repair. Groups were similar in age and gender. Initial post-operative pain score in TEP group was 4.7 (range 1-10) as compared with 4.5 (range 1-10) in TAPP group.13.8% experienced chronic pain, score of 2.9 (range 2-5) in TEP group compared with 16.8%, score of 2.7 (range 2-5) in TAPP group. Hernia recurrences were similar between groups; 4.8% and 4% respectfully. Neither mesh-fixation or non-fixation techniques were found to affect post-operative chronic pain (p=0.8). Patients undergoing tacker fixation reported less hernia recurrence, 1.7% and 5.1% respectfully. No significant difference noted between absorbable and metallic tackers in terms of chronic post-operative pain and recurrence. Conclusion Mesh placement without fixation produced similar post-operative pain but a higher hernia recurrence than mesh-fixation techniques.

WP1.11 - Total Extra Peritoneal (TEP) Inguinal hernia repair is safe and feasible for recurrent inguinal hernia post Total Extra Peritoneal repair "TEP on TEP is possible”

Abstract This abstract share our experience in surgical management of recurrent inguinal hernia post total extra peritoneal (TEP) repair by utilizing the same approach TEP. Methods Two patients with recurrent inguinal hernia post TEP were consulted for laparoscopic VS open approach, and both opted for the laparoscopic approach, understanding the higher risk of conversion. Result The first case of 62y male with recurrent left inguinal hernia after bilateral TEP. The second case of 69y male with recurrent left inguinal hernia post lap TEP repair. Standard three lower midline ports technique, no balloon spacer was used. The first and most important step was developing the plane above the previous mesh. 20 ml of 1 % xylocaine and 1/200000 was instilled in the extra peritoneal space to minimize oozing. Separating the previous mesh from the inferior epigastric artery and posterior wall of rectus muscle, down into bony lard marks and cord structures was performed using suction and sharp dissection with minimal diathermy. All landmarks were exposed in the three zones, before utilizing anatomical mesh. Both patients stayed overnight and operation time was 84 and 90 minute respectively. Three months follow up showed no recurrence or significant pain. Conclusion To our knowledge, this is first study describe the use of TEP on TEP. It suggests that TEP should not be excluded in patients with previous posterior mesh repair, emphasizing the importance of proper consultation. The abstract calls for further cases and studies to assess the efficacy and safety of this approach.

EP281 - Outcomes of the Abdominal Wall Reconstruction in a District General Hospital

Abstract Background The aim of this study was to explore the outcomes of abdominal wall reconstruction surgery by assessing postoperative complications and recurrence. Methods This is a retrospective case series. All patients who underwent abdominal wall reconstruction between 2018 and 2023 were included and followed up for complications and recurrence till January 2024. Patient demographics, operative parameters and postoperative complications were extracted in an Excel sheet, and data analysis was performed with SPSS 27 software. Results Forty-two patients were included in this study with a median age of 61.5 (34-83) and 1.2: 1 female: male gender distribution. Moreover, 41% of the included patients had a BMI &amp;gt; 35, and 47.6% were smokers. The type of hernia was incisional in 50% and recurrent hernia in 31%, and the defect size was &amp;gt; 10 centimetres in 48% of the included cohort. The type of operation was as follows: Rives-Stoppa (50%), TAR (24%), and combined procedure (26%). additionally, only 18% had their operation laparoscopically, and the position of mesh was retro-rectus in 88% of the cases. Post-operative complications were SSI (11.9%), seroma (28.6%), haematoma (7.1%), re-operation (9.5%), entero-cutaneous fistula (2.4%), and Hernia recurrence (4.7%) at a median follow-up of 42.5 months. Length of hospital stay was &amp;lt; 5 days in 48% of patients. Conclusion The Component separation technique is an excellent approach to repairing complex incisional hernia with excellent results (&amp;lt;5% recurrence rate). Abdominal reconstruction is feasible in district general hospital settings.

EP366 - A single surgeon experience of total extraperitoneal inguinal hernia repair in a district general hospital

Abstract Methods This was a retrospective review of a prospectively collected and maintained data on elective TEP hernia repairs. All theatre list has been collected prospectively. All patient who had inguinal hernia repair between 2004 and 2021 has been identified from the list. The notes of all Patients who had laparoscopic hernia repair were reviewed including the operative notes, postoperative complications, and any subsequent referral to the surgical department at the Trust to see any recurrence. The data collections included age, sex, type of the mesh, fixing device, primary or recurrent, unilateral or bilateral and conversion to open procedure. Since 2014 all notes were electronic and restored on evolve application. Result All patients records were retrieved from the electronic database system. Out of this cohort, some of patients records were missing. The mesh was not fixed in primary hernia if it was small or medium size, but it was fixed in primary large direct hernia to reduce the risk of blowing in of the mesh inside the defect. Our results showed a recurrence rate with acceptable incidence of post operative pain and wound related complications compliant with the NICE guidance. Conclusion A TEP repair for both primary and recurrent inguinal hernia has a minimal recurrence rate when performed by the specialists in this area giving full attention to the details.

SP1.2 - Laparoscopic versus Robotic ventral hernia repair: a systematic review and meta-analysis comparing the perioperative outcomes randomised controlled trials

Abstract Objective The objective of this meta-analysis is to compare the perioperative surgical outcomes and cost-effectiveness of robotic incisional/ventral hernia repair (RIVHR) versus laparoscopic incisional/ventral hernia repair (LIVHR). Methods Randomised control trials (RCTs) reporting perioperative outcomes and costs in patients undergoing RIVHR versus LIVHR were selected from medical electronic databases and meta-analysis was conducted under the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Four RCTs on 337 patients reporting perioperative outcomes and cost comparison were included. In the random effect model analysis, the duration of operation [standardized mean difference (SMD) -48.07, 95%, CI (-78.06, -18.07), z = 3.14, p = 0.002] was shorter and cost was lower [SMD 0.82, 95%, CI (-1.48, -0.16), z = 2.45, p = 0.01] in the LIVHR group but with significant statistical heterogeneity. However, the variables of hernia recurrence [risk ratio (RR) 2.29, 95%, CI (0.73, 7.12), z = 1.43, p = 0.15] and surgical site complications [RR 0.85, 95%, CI (0.48, 1.50), z = 0.55, p = 0.58] were statistically similar in both groups without any statistical heterogeneity among the included studies. Conclusion The RIVHR does not offer any superiority over LIVHR in all perioperative variables and it is not cost effective. Due to the paucity of the RCTs, a major multi-centre RCT is needed to validate these findings.

Assessing the effect of body mass index on perioperative outcomes and short-term recurrence after paraesophageal hernia repair.

Previous assessments suggest that surgical results of paraesophageal hernia (PEH) repair were negatively impacted by increasing levels of obesity. A better understanding of the association of obesity on outcomes of PEH repair will support surgeons making evidence-based decisions on the surgical candidacy of individual patients. This single institution retrospective cohort study included 884 consecutive patients with giant PEH undergoing surgical repair between 1 January 2000 and 30 June 2020. Preoperative body mass index (BMI) was documented at the time of surgery. Main outcomes included perioperative blood loss, length of hospital stay, major complications, early hernia recurrence, and mortality. The mean (standard deviation [SD]) age at surgery was 68.4 (11.1), and 645 (73.0%) were women. Among the 884 patients, 875 had a documented immediate preoperative BMI and were included in the analysis. Mean (SD) BMI was 29.24 (4.91) kg/m2. Increasing BMI was not associated with increased perioperative blood loss (coefficient, 0.01; 95% confidence interval [CI], -0.01 to 0.02), prolonged length of stay (coefficient, -0.01; 95% CI, -0.02 to 0.01), increased incidence of recurrent hernia (odds ratio [OR], 1.03; 95% CI, 0.95-1.10), or increased major complications (OR, 0.93; 95% CI, 0.82-1.05). The 90-day mortality rate was 0.3%. Furthermore, when compared with the normal weight group, overweight and all levels of obesity were not related to unfavorable outcomes. No association was found between BMI and perioperative outcomes or short-term recurrence in patients undergoing PEH repair. Although preoperative weight loss is advisable, a higher BMI should not preclude or delay surgical management of giant PEH.

Higher rates of recurrence and worse quality of life in obese patients undergoing inguinal hernia repair.

Prior investigations regarding the effect of obesity on inguinal hernia repair have been mixed. The aim of our study was to retrospectively compare perioperative outcomes, recurrence rate, and quality of life between obese and non-obese patients undergoing inguinal hernia repair. Patients who underwent inguinal hernia repair by any approach at a single institution were identified from a prospectively maintained quality database. Patients with a body mass index (BMI) greater than or equal to 30kg/m2 were considered obese. Quality of life was measured with the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CSS) surveys. Differences between obese and non-obese patients were assessed using independent samples t-tests, Wilcoxon rank-sum, and chi-square tests. Between 2010 and 2021, a total of 5575 patients underwent inguinal hernia repair. Fifteen percent of patients were identified as obese (835 patients, mean BMI 33.2 ± 3.3kg/m2). A significantly higher percentage of obese patients were diabetic, and operative time and estimated blood loss were higher in the obese group (all p < 0.001). Rates of hernia recurrence in obese patients was significantly more likely than in non-obese patients (4.2% vs 2.0%, p < 0.001). Up to 2 years postoperatively, a greater percentage of obese patients reported worse quality of life on the SOMS and more bothersome symptoms on the CCS. Inguinal hernia repair in obese patients is a more technically challenging operation. Long-term follow-up revealed a greater risk of hernia recurrence and worse quality of life up to 2 years postoperatively in this patient population.