Retrorectus Repair Research Articles

Active smoking increases risk of wound complications in robotic enhanced-view totally extraperitoneal (eTEP) retro-rectus ventral hernia repairs.

Tobacco smoking increases risk of complications after open hernia repair, however it is unknown whether this is true in minimally invasive hernia repair. We aim to determine whether there are differences in complication rates between smokers and non-smokers after robotic eTEP retrorectus repair. Our study included 102 patients who underwent robotic eTEP retrorectus repair of ventral hernias at a single institution from November 2019 to October 2022. Data collected included demographics, smoking status, operative details and outcomes. Patients were sorted into groups based on smoking status and outcomes were compared using ANOVA and chi-squared to test for significance. Out of 102 patients, 18 were currently smoking, 38 were former smokers, 56 had ever smoked, 46 had never smoked and 84 were not currently smoking. Those who had ever smoked were more likely to endorse alcohol use compared to never smokers (60.7 vs 37%, p = 0.0169) and COPD was significantly more common in current smokers compared to not current smokers (p = 0.00025) and ever smokers compared to never smokers (p = 0.0037). Average follow up was 59.17days and there was only one recurrence, which occurred in a never smoker. Initial analysis showed no difference in any complication. We excluded asymptomatic seromas that never required intervention due to clinical insignificance and repeat analysis showed current smokers had a significantly higher rate of surgical site occurrences (SSO) compared to patients not smoking at the time of their operation (p = 0.012). There was no difference between ever smokers and never smokers (p = 0.77). There remained no difference in any other complication. Active smoking at the time of robotic eTEP increases the risk of clinically significant surgical site occurrences. This same increase is not seen in former smokers suggesting that smoking cessation should be encouraged before minimally invasive hernia repair.

Slowly absorbable mesh in sublay ventral hernia repair in contaminated fields.

In the past years, there has been increasing evidence that supports the use of permanent mesh in contaminated wounds. Given this increased evidence, the indications to opt for slowly absorbable "biosynthetic" prostheses have been questioned. To address this, we compared the outcomes of slowly absorbable mesh in contaminated cases in a well-matched multicentric cohort. The Abdominal Core Health Quality Collaborative (ACHQC) database was queried for patients undergoing elective ventral hernia repair in Centers for Disease Control (CDC)-III operations (2013-2022). We compared demographics, hernia characteristics, and postoperative outcomes among types of mesh. We used propensity score matching to adjust for sex, diabetes, body mass index, smoking status, and operative time between mesh groups. Patients within other CDC classes and those with mesh positioned elsewhere than retro-rectus/preperitoneal space were excluded. A total of 760 patients were included in the analysis. Slowly absorbable synthetic mesh (SA) was utilized in only 7% of the cases, while permanent (P) and biologic (B) mesh in 77% and 16%, respectively. After matching, 255 patients were studied. There was no difference in surgical site occurrence (8% SA, 16% P, 10% B, p = 0.27), surgical site infection (20% SA, 17% P, 12% B p = 0.54), surgical site occurrence requiring intervention (18% SA, 13% P, 14% B p = 0.72), readmission (12% SA, 14% P, 12% B, p = 0.90), or reoperation (8% SA, 2% P, 4% B, p = 0.14) at 30days. In patients with 1-year follow-up, there was no difference in recurrence among groups (20% SA, 26% P, 24% B p = 0.90). Based on our findings, SA has comparable outcomes to other types of mesh, particularly when an optimal retro-rectus repair is performed.

OC-094 LESSONS LEARNT FROM DEVELOPING AN ABDOMINAL WALL RECONSTRUCTION (AWR) MULTIDISCIPLINARY TEAM (MDT) IN A COMPREHENSIVE HERNIA CENTRE

Abstract We present our experience of developing a successful AWR MDT in a Tertiary Referral Centre, which aimed to optimise the management of complex AWR patients. The weekly AWR MDT was established in August 2020. Cases are discussed with a hollistic approach. A comprehensive individualised plan is agreed regarding appropriateness of surgery, pre-operative risk factors requiring optimisation and operative specific decisions. 151 patients have been discussed to date (118 incisional hernias, 33 primary). In 65% of patients, at least one risk factor for adverse surgical outcomes was identified that required pre-optimisation, most commonly the need for weight loss (93%), glycemic control (22%), & smoking cessation (22%). 50 patients have been operated on to date. Retrorectus repair was the most commonly used technique (86%). Adjuvant techniques such as peritoneal flaps were suggested in 36% of patients. 23 patients are currently on waiting list for surgery, 45 remain in their prehabilitation period. 20 patients did not undergo surgery after combined patient and MDT decision. 8 patients await further investigation and 5 patients have been transferred to other centres due to specialist input requirement. MDT management of abdominal wall hernias remains poorly established in most regions. Our experience highlights how vital it is. We have proven that it is feasible to run MDTs and that it has improved pre-operative planning and focus on modifiable risk factors in our centre. We would encourage other centres to establish this for complex cases, so that the most appropriate decisions can be made for this surgically challenging group.

Anatomical causes for why retrorectus repair requires component separation at smaller hernia width than other repairs

Anatomical causes for why retrorectus repair requires component separation at smaller hernia width than other repairs

Prospective cohort study on mesh shrinkage measured with MRI after robot-assisted minimal invasive retrorectus ventral hernia repair using an iron-oxide-loaded polyvinylidene fluoride mesh

BackgroundMesh-reinforced ventral hernia repair is considered the gold standard treatment for all but the smallest of hernias. Human data on mesh shrinkage in the retrorectus mesh position is lacking. A prospective observational cohort study was performed to measure mesh shrinkage in robot-assisted minimal invasive retrorectus repair of ventral hernias.MethodsA cohort of 20 patients underwent a robot-assisted minimal invasive retrorectus repair of their ventral hernia. Magnetic resonance imaging (MRI) imaging was performed one month and thirteen months after implantation of an iron-oxide-impregnated polyvinylidene fluoride (PVDF) mesh to assess the decrease in mesh surface area. Inter-rater reliability among three radiologists regarding measurement of the mesh dimensions was analyzed. Quality of Life scoring was evaluated.ResultsThe inter-rater reliability between the radiologists reported as the intra-class correlations proved to be excellent for mesh width (ICC 0.95), length (ICC 0.98) and surface area (ICC 0.99). Between MRI measurements at one month and thirteen months postoperatively, there was a significant increase in mesh surface area (+ 12.0 cm2, p = 0.0013) and mesh width (+ 0.8 cm, p < 0.001), while the length of the mesh remained unchanged (−0.1 cm, p = 0.754). Quality of Life Scoring showed a significant improvement in Quality of Life after one month and a further improvement at thirteen months (p < 0.001).ConclusionThere was an excellent inter-rater reliability between three radiologists when measuring width, length, and surface area of an iron-oxide-impregnated PVDF mesh using MRI visualization. Mesh shrinkage was not observed, instead the effective mesh surface area and width of the mesh increased.

OC-014 FAVOURABLE OUTCOMES AFTER RETRO-RECTUS (RIVES-STOPPA) MESH REPAIR AS TREATMENT FOR NON-COMPLEX VENTRAL ABDOMINAL WALL HERNIA, A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Aim Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For noncomplex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard. Level-1 evidence confirming this presumed superiority is lacking. The aim of this study was to assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality. Material &amp; Methods Five databases were searched for studies reporting retro-rectus repair. Randomized and non-randomized studies were included. Outcomes were pooled with random-effects models. Results Ninety-three studies representing 12,440 patients undergoing retro-rectus repair were included. Pooled hernia recurrence was estimated at 3.2% [95% confidence interval (CI): 2.2%–4.2%, n = 11,049] after minimally 12 months and 4.1%, (95%CI: 2.9%–5.5%, n = 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2%–6.4%, n = 4891) and 5.5% (95%CI: 4.4%–6.8%, n = 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair (odds ratios (OR): 0.27, 95%CI: 0.15–0.51, P &amp;lt; 0.001) and equal recurrence rates compared to intraperitoneal onlay mesh (IPOM) repair (OR: 0.92, 95%CI: 0.75–1.12, p = 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03–3.14, p = 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%) and SSI (1.5%), albeit based on non-randomized studies. Conclusions Retro-rectus repair results in excellent outcomes, superior or similar to other techniques for all outcomes except SSI. The latter occurred less after IPOM repair, which is usually laparoscopic.

P-076 PROSPECTIVE COHORT STUDY ON MESH SHRINKAGE MEASURED WITH MRI AFTER ROBOT ASSISTED MINIMAL INVASIVE RETRORECTUS VENTRAL HERNIA REPAIR USING AN IRON OXIDE LOADED PVDF MESH

Abstract Aim Mesh-reinforced ventral hernia repair is considered the gold standard treatment for all but the smallest of hernias. Human data on mesh shrinkage in the retrorectus mesh position is lacking. A prospective observational cohort study was performed to measure mesh shrinkage in robot assisted minimal invasive retrorectus repair of ventral hernias. Methods A cohort of 20 patients underwent a robot assisted minimal invasive retrorectus repair of their ventral hernia. Magnetic resonance imaging (MRI) imaging was performed one month and thirteen months after implantation of an iron-oxide-impregnated polyvinylidene fluoride (PVDF) mesh to assess the decrease in mesh surface area. Inter-rater reliability among three radiologists regarding measurement of the mesh dimensions was analyzed. Quality of Life scoring was evaluated. Results The inter-rater reliability between the radiologists reported as the intra-class correlations proved to be excellent for mesh width (ICC 0.95), length (ICC 0.98) and surface area (ICC 0.99). Between MRI measurements at one month and thirteen months postoperatively, there was a significant increase in mesh surface area (+12.0 cm2, p=0.0013) and mesh width (+0.8 cm, p&amp;lt;0.001), while the length of the mesh remained unchanged (-0.1 cm, p=0.754). Quality of Life Scoring showed a significant improvement in Quality of Life after one month and a further improvement at thirteen months (p&amp;lt;0.001). Conclusion There was an excellent inter-rater reliability between three radiologists when measuring width, length and surface area of an iron-oxide-impregnated PVDF mesh using MRI visualization. Mesh shrinkage was not observed, instead the effective mesh surface area and width of the mesh increased.

P-032 FASCIOTENS: FIRST CASE IN THE HOSPITAL OF MéRIDA

Abstract Aim Anterior abdominal wall incisional hernias are a problem present in approximately 11–20% of patients undergoing laparotomy. Incisional hernias with loss of right of abode are associated with many physical, physiological and psychological problems. In order to surgically repair these incisional hernias with loss of right of abode, we need to perform a prehabilitation of the incisional hernias. Effective prehabilitation is required in order to close the aponeurotic defect without tension and to return the hernial contents to the abdominal cavity. Material and methods A 59-year-old female patient with a history of open cholecystectomy and incisional hernia repaired on three occasions, presenting with multisaccular midline incisional hernia (M1-M4 W3) containing colon and greater omentum. Results After application of botulinum toxin and Fasciotens, it is possible to perform Rives-Stoppa retrorectus repair, being able to reduce the hernial content without tension and without increasing intra-abdominal pressure. Conclusions Prehabilitation in complex abdominal wall surgery is essential to repair large aponeurotic defects without tension. In addition, the application of Fasciotens after administration of botulinum toxin allows closure of the aponeurotic defect using standard abdominal wall closure techniques.

SURGICAL OUTCOME OF MODIFIED LAPAROSCOPIC RETRORECTUS APPROACH FOR UPPER MIDLINE VENTRAL AND UMBILICAL HERNIAS

Background: The incidence of ventral hernias such as umbilical, epigastric and midline incisional hernias has increased over the years. Many surgical modalities of treatment have been evolved for better management and outcome of hernia repair. Igor Belyansky performed the rst successful endoscopic Rives Stoppa procedure (eTEP). The current Laparoscopic retrorectus repair needs more than three ports, and it also requires USG marking of the retrorectus space. Crossing over to the opposite retrorectus space will be difcult for beginners. This study standardises the easy and ergonomically better Laparoscopic Retrorectus approach for umbilical and upper midline hernias using three ports in the suprapubic area. Aim And Objectives: To study the feasibility and effectiveness of the Modied Laparoscopic Retrorectus approach. Material And Methods: This prospective study involved 18 patients admitted to tertiary health center, with umbilical hernia, epigastic hernia and upper midline ventral hernia. We performed the analysis after taking institutional ethical committee approval and informed consent from patients. A qualied surgeon performed laparoscopic retrorectus hernioplasty (e -TEP) with modication in port placement. An observational analysis was done on the feasibility and outcome of the modied approach. SPSS version 20. was used to perform the statistical analysis. Unpaired t-test, Pearson's correlation coefcient was applied. Results: A total of 18 patients were included in the study, with a mean age of 48.78 years. The hernia was predominantly seen in the female gender, overweight or obese patients. The mean duration of the procedure with the modied approach was 160minutes. The patients' numeric rating scale of pain on postoperative day 1 and day 2 was mild in 66.6% of patients. We noted seroma formation in two patients, which was signicantly associated with the duration of surgery (p =0.0069). Most of the patients were discharged on postoperative day 5. Follow up of patients up to 1 year had no history of recurrence or chronic pain. Conclusion: The standard of care for ventral hernia repair is the laparoscopic e – TEP approach. This study's modication of port placement showed better cosmetic results with reduced risk of chronic pain and low recurrence rate. The prolene mesh used during this procedure is very economical, making laparoscopic hernia surgery affordable for low socio–economic populations in developing countries.

Favorable Outcomes After Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Noncomplex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-analysis.

To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For noncomplex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. Ninety-three studies representing 12,440 patients undergoing retro-rectus repair were included. Pooled hernia recurrence was estimated at 3.2% [95% confidence interval (CI): 2.2%-4.2%, n = 11,049] after minimally 12months and 4.1%, (95%CI: 2.9%-5.5%, n = 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2%-6.4%, n = 4891) and 5.5% (95%CI: 4.4%-6.8%, n = 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair [odds ratios (OR): 0.27, 95%CI: 0.15-0.51, P < 0.001] and equal recurrence rates compared to intraperitoneal onlay mesh (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, P = 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03 -3.14, P = 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7%-2.3%, n = 849) and SSI (1.5%, 95%CI: 0.8%-2.8%, n = 982), albeit based on non-randomized studies. Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except SSI. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.

P160 ENDOSCOPIC ANTERIOR COMPONENT SEPARATION OR OPEN TRANSVERSUS ABDOMINUS RELEASE ARE NOT ASSOCIATED WITH INCREASED WOUND MORBIDITY FOLLOWING INCISIONAL HERNIA REPAIR

Abstract Aim Traditional anterior component separation during incisional hernia repair is associated with a high rate of postoperative wound morbidity. Because extensive subcutaneous dissection is avoided by endoscopic anterior component separation (eACS) or open transversus abdominis release (TAR), we hypothesized that these techniques did not increase the incidence of surgical site occurrence compared to incisional hernia repair without component separation. Material and Methods This was a retrospective cohort study of patients undergoing open, retro-rectus incisional hernia repair. Component separation during retro-rectus repair was performed using eACS or TAR. The primary outcome was 30-day incidence of postoperative surgical site occurrence. Secondary outcomes included length of stay, 30-day readmission, 30-day reoperation rate and 3-year recurrence rate. Results A total of 322 patients underwent retro-rectus repair, 168 (52%) of whom received either eACS or TAR. Addition of eACS or TAR was neither associated with surgical site occurrence, (odds ratio: 0.82, confidence interval: 0.40-1.68, P = 0.596) nor with hernia recurrence (hazard ratio 0.80, CI 0.27-2.40, P = 0.693). There was no significant difference between the groups regarding the frequencies of 30 day-readmission or 30-day reoperation. Conclusions The addition of eACS or TAR to a retro-rectus incisional hernia repair was not associated with increased wound morbidity or hernia recurrence.

P140 OBSERVATIONAL STUDY WITH ONE YEAR FOLLOW-UP ON ROBOTIC ASSISTED RETRO-RECTUS VENTRAL HERNIA REPAIR (RTARUP) WITH A SELF-FIXATING MESH

AimLaparoscopic retro-rectus ventral hernia repair avoids the need for intra-peritoneal mesh placement and penetrating mesh fixation. The robotic platform facilitates the execution of this technique.Material and MethodsFrom a prospective consecutive single center database all patients that underwent a robotic assisted trans-abdominal retro-rectus ventral hernia repair (rTARUP) via lateral single docking using a self-fixating mesh (ProGrip) were identified.ResultsBetween September 2016 and December 2019, 203 patients were included. There were 89 (44%) umbilical hernias, 34 (17%) epigastric hernias and 80 (39%) incisional midline hernias. Patients had a mean BMI of 29 kg/m2. The mean hernia diameter was 3.2 cm and mainly located in zone M2-M3-M4 of the EHS classification. The mean operative time was 85 min (SD: 33 min) and all except one were clean operations. The self-fixating mesh was mostly 15 cm wide with a variable length between 15 and 30 cm. No intra-operative complications or conversions to open surgery. Intra-hospital complications were seen in 12 patients (6%) and one patient needed a reoperation for bleeding. The operation was performed in day care in 37% of patients and hospital stay was less than 24 hours in 80%. There were 6 readmissions within 30 days of surgery (3%). At 12 months clinical follow-up 3 patients were documented with a recurrence and 2 underwent an laparoscopic intra-peritoneal hernia repair. Due to COVID-19 restrictions a clinical follow-up was only possible in 73 % of patients and needs updating.ConclusionsThis case series reports favorable early clinical outcome of an innovative retro-rectus repair using the robotic platform.

P068 ROBOTIC REPAIR OF VENTRAL AND INCISIONAL HERNIAS: A STUDY ON 118 PATIENTS OPERATED BY RV-TAPP AND R-RIVES

Abstract Aim The purpose of this study is to compare the results of robotic ventral TAPP and robotic retrorectus repair for ventral and incisional hernias. Material and Methods The results of 118 consecutive rv-TAPP (88) and r-Rives (30) surgeries are presented. The study was approved by the ethics committee (Ref. No. 2019-02046). Primary ventral hernias were treated mainly by rv-TAPP approach, incisional hernias by r-Rives Technique. Patients were followed up six weeks postoperatively. Results In every third patient, an additional finding at the linea alba was found. Patients in the r-Rives group were significantly older (p = 0.001). Hernia gaps were significantly larger and meshes were significantly larger in the r-Rives group (p &amp;lt; 0.001). The ratio of mesh area to hernia gap area was comparable in both groups (p = 0.142). OR time was significantly shorter for rv-TAPP (82min) than r-Rives (109min). Hospital stay was shorter in the rv-TAPP group than in the r-Rives group (1.5 vs. 2.7 days, respectively) (p &amp;lt; 0.001). There was a significant clustering of type II seromas in the r-Rives group (p &amp;lt; 0.001), however, the total number of seromas was comparable. Conclusions rv-TAPP and r-Rives have the advantages of minimally invasive procedures (low complication rate) and most of the advantages of open procedures (morphological reconstruction). Both techniques allow consistent extraperitonealization of meshes. Umbilical and epigastric hernias (&amp;lt;4cm) are treated as rv-TAPP; incisional hernias, large hernia gaps (4-7cm), as well as in case of planned suturing of the linea alba, the r-Rives is indicated. Concomitant hernia gaps of the linea alba are also treated. Both procedures have few complications and are suitable for residents training.

Acute Kidney Injury After Large Ventral Hernia Repair Requiring Transversus Abdominis Release.

Acute kidney injury (AKI) is a known postoperative complication of open ventral hernia repair contributing to increased costs, hospital length of stay, and mortality. The aim of this study was to identify whether the muscle injury that occurs in a posterior separation of components via transversus abdominis release (TAR) contributes to a higher incidence of postoperative AKI. A retrospective cohort study of patients who underwent open retrorectus ventral hernia repair with and without TAR at a single institution between 2012 and 2019 was performed. Patients who underwent a separation of components via either unilateral or bilateral transversus abdominis release were compared to those who did not undergo TAR as part of their hernia repair (non-TAR). The outcome of interest was the development of postoperative AKI. Acute kidney injury was defined as an increase in creatinine of greater than 50% of the preoperative baseline. Univariate and multivariate analyses were performed to determine the influence of TAR on the development of AKI. There were 523 patients who met inclusion criteria, of which 159 (30.4%) had a TAR as part of their retrorectus hernia repair. No differences were found in preoperative characteristics between the TAR and non-TAR group including age, gender, history of kidney disease, or history of diabetes. By contrast, the TAR group had significantly greater median estimated blood loss (100mL vs 75mL, P < .01), mean positive intraoperative fluid balance (2255mL vs 1887mL, P < .01), and operative duration (321min vs 269min, P < .001). The rate of AKI in the TAR group was 11% (n = 18) vs 6% (n = 23, P = .0503) in the non-TAR group. On multivariate analysis controlling for patient characteristics and intraoperative factors, TAR was the only factor with a significantly increased odds of AKI (OR 1.97, 95% CI 0.994-3.905, P = .0521). In patients with large ventral hernias requiring retrorectus repair, performing a TAR is associated with a nearly 2-fold increase in the development of postoperative AKI. These findings suggest that these patients should be optimized perioperatively with emphasis on fluid resuscitation, limiting nephrotoxic medications and monitoring urine output.

A Novel Minimally Invasive Retro Rectus Repair of Ventral Hernia

Background Ventral hernia repair is one of the common general surgical procedures. A novel eTEP technique has been developed where in a mesh is placed in retro muscular plane through minimally invasive approach. There is scarcity of data on its effectiveness as compared to conventional Laparoscopic IPOM hernioplasty. Aims and Objectives We aim to introduce our innovative Kumar-Subhash’s modified 3 port eTEP technique for ventral hernia repair and compare its clinical effectiveness with conventional IPOM repair. Methods A prospective comparative study was undertaken at Devagiri Hospital, Bangalore, India from January 2017 to December 2019. 30 patients were included in the study (12 in eTEP group and 18 in IPOM group) based on predefined inclusion and exclusion criteria. Patients were followed up to 30 days post-operatively. The outcomes were compared with respect to postoperative pain, length of hospital stay and early postoperative complications. Results Baseline characteristics and presenting complaints were comparable for both the groups. The mean pain score on POD 1 in eTEP group was 3, and 1 on POD 7 as compared to 7 and 3 in IPOM group on POD1 and 7 respectively, which was statistically significant. Patients in eTEP group had a shorter length of hospital stay (LOS). None of the patients had any complications related to the novel technique. Conclusions Kumar-Subhash’s modified 3 port eTEP technique is a novel and easy approach for laparoscopic repair of ventral hernia with significantly less post-operative pain and LOS with an additional cosmetic advantage for patients.

Incisional Hernia Incidence, Repair Techniques, and Outcomes Based on 1600 Consecutive Patients Receiving Abdominally Based Autologous Breast Reconstruction.

As the number of postmastectomy patients who receive abdominally based autologous breast reconstruction (ABABR) increases, the frequency of unique paramedian incisional hernias (IHs) at the donor site is increasing as well. We assessed incidence, repair techniques, and outcomes to determine the optimal treatment for this morbid condition. A total of 1600 consecutive patients who underwent ABABR at the University of Pennsylvania between January 1, 2009, and August 31, 2016, were retrospectively identified. Preoperative and operative information was collected for these patients. Incisional hernia incidence was determined by flap type and donor site closure technique. Repair techniques and postoperative outcomes for all patients receiving IH repair (IHR) after ABABR at our institution were also determined. Univariate and multivariate analyses were conducted. The incidence of IH after ABABR in our health system was 3.6% (n = 61). Fifteen additional patients were referred from outside hospitals for a total of 76 patients who received IHR. At the time of IHR, mesh was used in 79% (n = 60) of cases (13 biologic and 47 synthetic), with synthetics having significantly lower recurrent IH incidence (10.6% vs 38.5%, P = 0.017) when compared with biologics. Mesh position did not have any statistically significant effect on outcomes; however, sublay mesh position had zero adverse outcomes. Mesh should be used in all cases when possible. Although retrorectus repair with mesh is optimal, this plane is often nonexistent or too scarred in after ABABR. Thus, intraperitoneal underlay mesh with primary fascial closure or primary closure with onlay mesh placement should then be considered.

Comparison of Hernia Recurrence and Seroma Formation in Cancer Patients Undergoing Incisional Hernia Repair with Transfascial Sutures vs. Fibrin Glue for Mesh Fixation

Background: Open ventral incisional hernia repairs with mesh reduce hernia recurrence rates to less than 10%. The Rives-Stoppa retrorectus hernia repair technique is becoming the standard of care for mesh repair of complex incisional hernias. In these hernia repairs, mesh has traditionally been fixated with transfascial sutures, but fibrin glue has been used as an alternative to reduce pain and may also reduce operative time and the risk of seroma formation. The primary objective of this study was to compare the rates of hernia recurrence and seroma formation in cancer patients who underwent Rives-Stoppa incisional hernia repair using transfascial sutures vs. fibrin glue for mesh fixation. Methods: We conducted a retrospective review of a prospectively maintained database of cancer patients at our free-standing cancer institution who underwent Rives-Stoppa ventral incisional hernia repair performed at our institution. Fisher’s exact test was used to assess differences in hernia recurrence and seroma formation rates between patients who underwent mesh fixation with transfascial sutures vs. fibrin glue. Using a neutral prior probability distribution, a Bayesian analysis was performed to evaluate the posterior probability of seroma formation requiring intervention and hernia recurrence after retrorectus repair with fibrin glue fixation. Log-rank test was used to assess the difference in overall survival between the two groups. Results: Forty-one patients (22 in the transfascial suture group and 19 in the fibrin glue group) were included in the analysis. The patient demographics were similar in both groups. There was no statistically significant difference in seroma formation requiring drainage by interventional radiology (IR) between the fibrin glue and the transfascial suture groups (5.3% vs. 9.1%; P=1.00). The odds of having a hernia recurrence was 4 times higher in the transfascial suture group than in the fibrin glue fixation group, but this was not statistically significant (18.2% vs 5.3%, p=0.35). The Bayesian analysis showed a 90% probability that the hernia recurrence rate would be higher in the transfascial suture than in the fibrin glue fixation group. Conclusion: Using fibrin glue instead of transfascial sutures may reduce hernia recurrences and seroma formation in cancer patients undergoing ventral incisional hernia repairs with retro rectus mesh. The high probability of reducing the odds of hernia recurrence with fibrin glue fixation warrants a prospective randomized, multi-institutional clinical trial.

A short-term preliminary evaluation of ventral hernia repair using a new prosthetic mesh

BACKGROUND: Syneco® (W.L. Gore and Associates, Flagstaff, AZ) is a new permanent synthetic mesh made of a combination of an absorbable synthetic component and a permanent synthetic component that can be used intraperitoneally or within the abdominal wall layers. Currently, there are little data on outcomes related to this mesh product. AIMS AND OBJECTIVES: The purpose of this project is to review our medical center’s outcomes using Synecor® mesh in ventral hernia repair. MATERIALS AND METHODS: We retrospectively reviewed all patients at our single medical center undergoing ventral hernia repair using Synecor® mesh included in the Americas Hernia Society Quality Collaborative (AHSQC) database from April 2016 through September 2019. Demographic, perioperative, and short-term outcomes (surgical site infection [SSI], surgical site occurrence [SSO], surgical site occurrence requiring procedural intervention [SSOPI]) were reviewed, and descriptive statistics were calculated. RESULTS: Forty-eight patients who underwent ventral hernia repairs using Synecor® mesh met study inclusion criteria. The average age of our patient population was 59 years (range: 29-78) with 50% female and 85% Caucasian. Ninety-six percent of cases were classed as clean cases. Comorbidities were present in 73% of patients. Open repairs were completed in 56% of cases and included retrorectus repair in 67% and transversus abdominis muscle release (TAR) in 30% of open cases. Repairs were laparoscopic in 27% of cases and robotic in 17%, with 85% having closure of the defect during repair. At 30 days follow-up, the rate of SSI was 8%, SSO 17%, and SSOPI 13%. There was an overall complication rate of 29%, a hernia recurrence rate of 4%, and an average follow-up of 97 days (range: 0 days to 1 year). CONCLUSION: Synecor® mesh is a new synthetic mesh that can be used for ventral hernia repair in an open, laparoscopic, or robotic approach. Short-term, preliminary results appear favorable; however, more study is needed to fully evaluate this new mesh prosthetic.

A Novel Technique of Minimally Invasive Retro-Rectus Repair of Ventral Hernia- Modified eTEP

Poster presented at Forum for Interdisciplinary Research in Medicine, Science &amp; Technology Conference, Moscow 2020&#x0D; Peer reviewed by JS Bamrah, Ananthakrishnan Raghuraman, Soumit Dasgupta &amp; Jyothi Srinivasan

Retrorectus repair of incisional ventral hernia with urinary bladder matrix reinforcement in a long-term porcine model.

Not all biologically derived materials elicit the same host response when used for reinforcement of ventral hernia repairs. This study aimed to evaluate the remodeling characteristics of the abdominal wall following reinforcement with urinary bladder matrix (UBM) in a large animal preclinical model of ventral hernia repair. Midline defects in 36 Yucatan minipigs were reinforced with UBM-derived surgical devices using a classic Rives-Stoppa-Wantz approach, and compared with primary repair controls. After 3 or 8months, the abdominal wall was explanted for histological and mechanical analysis. All UBM-derived surgical devices were completely resorbed within 8months and facilitated deposition of vascularized, biomechanically functional connective tissue in the retrorectus plane, with no evidence of hernia formation.