Seroma Rate Research Articles

Comparing Complications of Biologic and Synthetic Mesh in Breast Reconstruction: A Systematic Review and Network Meta-Analysis

Background In breast reconstruction, synthetic meshes are frequently used to replace acellular dermal matrix (ADM), since ADM is expensive and often leads to complications. However, there is limited evidence that compares the types of substitutes. This study aimed to compare complications between materials via a network meta-analysis. Methods We systematically reviewed studies reporting any type of complication from 2010 to 2021. The primary outcomes were the proportion of infection, seroma, major complications, or contracture. We classified the intervention into four categories: ADM, absorbable mesh, nonabsorbable mesh, and nothing used. We then performed a network meta-analysis between these categories and estimated the odds ratio with random-effect models. Results Of 603 searched studies through the PubMed, MEDLINE, and Embase databases, following their review by two independent reviewers, 61 studies were included for full-text reading, of which 17 studies were finally included. There was a low risk of bias in the included studies, but only an indirect comparison between absorbable and non-absorbable mesh was possible. Infection was more frequent in ADM but not in the two synthetic mesh groups, namely the absorbable or nonabsorbable types, compared with the nonmesh group. The proportion of seroma in the synthetic mesh group was lower (odds ratio was 0.2 for the absorbable and 0.1 for the nonabsorbable mesh group) than in the ADM group. Proportions of major complications and contractures did not significantly differ between groups. Conclusion Compared with ADM, synthetic meshes have low infection and seroma rates. However, more studies concerning aesthetic outcomes and direct comparisons are needed.

Facilitating drain free mastectomies (+/- axillary clearance): does thrombin spray reduce post-operative seroma rate?

Introduction: Seromas are collections of serous fluid in dead space between skin flaps; a common complication post mastectomy, affecting post-operative recovery and can delay adjuvant therapy. Methods exist to prevent seromas; drains, quilting sutures or sealant sprays such as thrombin. Thrombin spray promotes haemostasis and skin flap adherence, reducing dead space. This study aims to determine if thrombin spray reduces seroma formation post mastectomy.

The Usage of Intravenous Tranexamic Acid in Reduction Mammaplasty Safely Reduces Hematoma Rates.

Bleeding complications are not uncommon after breast reduction surgery, and recently, tranexamic acid (TXA) as an antifibrinolytic agent has been used in various surgical specialties as a way to minimizes such adverse outcomes. We elected to evaluate the effectiveness of intravenous (IV) intraoperative TXA in reduction mammoplasty patients. This is a retrospective chart review of clinical charts of all patients who received reduction mammoplasty by a single surgeon at Emory University Hospital or its affiliated Aesthetic Center from January 1, 2020, to March 1, 2022. Seventy-four consecutive breast reduction patients received 1-g IV TXA intraoperatively compared with 117 consecutive controls. The outcome of interest included 30-day postoperative bleeding complications. There was no significant difference in age ( P = 0.92), body mass index ( P = 0.98), percentage of smokers ( P = 0.56), operating time ( P = 0.87), estimated blood loss ( P = 0.90), or weight removed ( P = 0.98) between patients in each arm. There were 19 bleeding events (16.2%) in the non-TXA arm compared with 1 bleeding event (1.4%) in the TXA arm ( P = 0.0143). Of the 19, 6 (5.1%) were major events, and 13 were minor events (11.1%); the only bleeding event in the TXA arm was minor. Number needed to treat all bleeding events with use of TXA was 7, and the number needed to treat minor hematomas was 11. There was no significant difference in the rate of seroma, wound healing complications, infection, or nipple necrosis between the 2 arms ( P > 0.05). The use of IV TXA is a safe and effective way to reduce hematoma rates in patients receiving reduction mammoplasty.

Comparative study of intact specimen extraction in laparoscopic nephrectomy by Pfannenstiel incision

ObjectivesThe aim of our study is to demonstrate that the Pfannenstiel incision is a reliable option in terms of postoperative complications compared to other types of incisions usually performed for kidney extraction after laparoscopic nephrectomy. Materials and methodsRetrospective and comparative study of 256 patients who underwent laparoscopic nephrectomy or nephroureterectomy. Patients were divided into two groups: specimen extraction by Pfannenstiel incision (group 1) and specimen extraction by way of other incisions (group 2). Incisional hernia, surgical site infection, pain score, seroma, haematoma/bleeding, wound dehiscence and muscle paralysis were analyzed in each patient. ResultsPatients in Pfannenstiel group presented a rate of wound complications of 11.72% vs. 27.34% with other incisions, p=0.002, it was significantly inferior the rate of wound dehiscence (5.5% vs. 12.5%, p=0.047) and seroma (3.1% vs. 7.8%, p=0.022). Using multivariate logistic regression, Pfannenstiel incision was a significant protective predictor factor for wound complications (OR=0.34, p=0.005). ConclusionsThe Pfannenstiel incision allowed the extraction of bigger kidney masses with less incidence of dehiscence, seroma and in general wound complications. The hospital stay was lower in Pfannenstiel extraction group. These results present this incision as a reliable and safe option in the decision of which incision to select.

The effects of prolonged intraoperative hypothermia on patient outcomes in immediate implant-based breast reconstruction

The importance of thermoregulation in surgical procedures has become a recent focus for anesthesiologists and surgeons to improve patient outcomes. In breast surgery, maintenance of normothermia has been shown to reduce surgical-site infections. However, there is a paucity of information evaluating the relationship between intraoperative core body temperatures and reconstructive surgical outcomes. A retrospective review of patients who underwent immediate breast reconstruction following mastectomy from 2015 to 2020 was performed. Patients were classified into a majority normothermic (NT) group if patients spent greater than half of the operative time ≥36°C or a majority hypothermic (HT) group if patients spent greater than or equal to half of the operative time <36°C. Patient demographics, comorbidities, surgical techniques, and postoperative complications were recorded. Complications were classified according to the Clavien-Dindo Classification. Univariate and multivariate statistics were used to assess significant relationships. A total of 329 patients met inclusion criteria, of which 174 were in the NT group and 155 were in the HT group, yielding 302 and 264 total breasts, respectively. There was no significant difference in rates of infection (p=1.0), seroma (p=0.27), hematoma (p=0.61), or wound dehiscence (p=1.0). However, patients in the HT group had significantly more overall ischemic complications (p=0.009) and, specifically, grade IIIb ischemic complications (p=0.04). After controlling for tobacco use, body mass index, mastectomy pattern, radiation, operating surgeon, and mastectomy weight, multivariate analysis showed increased ischemic complications in the HT group (p=0.04). Prolonged intraoperative hypothermia can increase the risk for the development of ischemic wounds such as tissue necrosis or eschar formation that require operative intervention. This presents reconstructive complications that increase both patient and health system burdens that could be addressed through the maintenance of normothermia. Further studies using real-time flap temperature would provide more accurate insight into the relationship between temperature and implant-based breast reconstruction.

Desarda Non-mesh Technique Versus Lichtenstein Technique for the Treatment of Primary Inguinal Hernias: A Systematic Review and Meta-Analysis.

The aim of the current systematic review was to compare the Desarda technique with the Lichtenstein technique for the repair of inguinal hernias. A systematic literature search for randomized controlled trials(RCTs) was conducted comparing the Desarda technique and the Lichtenstein technique using electronic databases. The primary outcomeevaluated was hernia recurrence and the secondary outcomes evaluated were post-operative complications,time to return to normal activity and operative time in minutes. Five RCTs were included in this meta-analysis, which included a total of 536 patients. There were 310 patients in the Desarda group and 226 patients in the Lichtenstein group. There was no statistically significant difference in terms of hernia recurrence between the two groups (p=0.74). Post-operative complications were significantly more in the Lichtenstein group. There was a lower rate of post-operative seroma following the Desarda technique as compared to Lichtenstein repair (p=0.02). Both Desarda and Lichtenstein had low rates of recurrence following surgery and had acceptable rates of post-operative complications with lower rates noted in the Desarda group.

Comparing Outcomes of Robotically Assisted Latissimus Dorsi Harvest to the Traditional Open Approach in Breast Reconstruction.

We read with interest the article entitled “Comparing Outcomes of Robotically Assisted Latissimus Dorsi Harvest to the Traditional Open Approach in Breast Reconstruction,” published in the December of 2020 issue by Winocour et al.1 The study demonstrates that the postoperative seroma rate is higher in robotically assisted latissimus dorsi harvest than in the traditional open approach (16% versus 0%; P = 0.034).1 Seroma is reported to be the most common complication at the latissimus dorsi (LD) flap donor site. The reported incidence ranges from 21% to more than 79%.2 Several factors contribute to formation of the seroma: the thermal injury of electrocautery to the tissue, the disruption of lymphatic vessels and capillaries, the release of inflammatory mediators, and the creation of dead space. Various methods have been described to reduce the dead space, such as closed suction drainage, quilting of the skin flaps, application of adhesive tissue glues, infiltration of steroids or sclerosing agents, and reduction of the use of electrocautery.3 In our experience, seroma is a disabling postoperative sequela that increases the risk of wound infection, dehiscence, and skin flap necrosis, thereby compromising the success of reconstruction. In the traditional open approach, harvest of the LD muscle inevitably comprises the lesion of thoracic lymphatic vessels, which contributes in a fundamental way to the supply of the seroma. For this reason, we perform a reverse lymphatic mapping of dorsal region with Patent Blue solution.4 At the start of surgery, we inject intradermally and subcutaneously five bumps of 0.2 mL of blue dye 2.5% (Bleu Patent V 2.5%, 2 mL; Monico SPA, Venezia/Mestre, Italy) into five locations on the lower dorsal region. Referring to Suami’s study,5 we thought to mark the lymphosome that may have been damaged during flap preparation, injecting in five places on the umbilical line every 4 cm, from the incision to the midline (Fig. 1). At the end, when the LD flap is harvested, we proceed to close the interrupted lymphatic vessels, colored by Patent Blue dye (Fig. 2). Quilting sutures and fibrin glue (Evicel; Omrix Biopharmaceutical, Ltd., Tel Hashomer Ramat Gan, Israel) are used to close the dead space. We use two drains in suction, and we ask the patient not to move the arm for 2 weeks. With this approach, patients have been evidenced a lower incidence of seroma. We consider acceptable the modest increase in operating time in exchange for the shorter hospitalization times and reduced drainage times. In no case was there an adverse reaction to the Patent Blue dye. It is our opinion that higher seroma rates could be due not only to the use of electric endothermy and radiation therapy, but also to the difficulty of performing a careful coagulation of lymphatic vessels that are hardly visible if not colored. The use of Patent Blue dye for lymphatic reverse mapping for ligation of damaged lymphatic vessels has proven to be an effective, economical, and reproducible practice. Prospective studies and more case studies are needed to confirm this hypothesis.Fig. 1.: Intraoperative view of the five injections of Patent Blue dye at the level of the dorsal region.Fig. 2.: Damaged lymphatic vessels previously marked with Patent Blue dye.DISCLOSURE The authors have no financial interests to disclose. No funding was received for this communication. Roberta Albanese, MDNicola Zingaretti, MDGlenda Giorgia Caputo, MDEmanuele Rampino Cordaro, MDPier Camillo Parodi, MDClinic of Plastic and Reconstructive SurgeryDepartment of Medical Area (DAME)Academic Hospital of UdineUniversity of Udine

Perioperative Hormone Management in Gender-Affirming Mastectomy: Is Stopping Testosterone before Top Surgery Really Necessary?

Gender-affirming mastectomy, or "top surgery," has become one of the most frequently performed procedures for transgender and nonbinary patients. However, management of perioperative testosterone therapy remains controversial. Despite a lack of supporting evidence, many surgeons require cessation of testosterone before top surgery. This is the first study to compare complication rates in patients undergoing gender-affirming mastectomy with and without discontinuation of perioperative testosterone. This retrospective review included patients undergoing top surgery by the senior author between 2017 and 2020. Reflecting a change in the senior author's practice, before May of 2019, all patients were required to discontinue testosterone before surgery; all patients treated after this point continued their testosterone regimens throughout the perioperative period. Patients were stratified according to testosterone regimen and perioperative hormone management, with demographic characteristics and postoperative outcomes compared among groups. A total of 490 patients undergoing gender-affirming mastectomy during the study period were included. Testosterone was held perioperatively in 175 patients and continued in 211 patients; 104 patients never received testosterone therapy. Demographic characteristics were similar among groups and there was no difference in rates of hematoma (2.9% versus 2.8% versus 2.9%, respectively; P = 0.99), seroma (1.1% versus 0% versus 1%, respectively; P = 0.31), venous thromboembolism (0% versus 0.5% versus 0%, respectively; P = 0.99), or overall complications (6.9% versus 4.3% versus 5.8%, respectively; P = 0.54). Our results demonstrate no difference in postoperative complication rates among groups. Whereas further investigation is warranted, our data suggest that routine cessation of testosterone in the perioperative period is not necessary for patients undergoing gender-affirming mastectomy. Therapeutic, III.

Global Prevalence and Preferences of Progressive Tension Suture Usage in Abdominoplasties.

Abdominoplasty is one of the most popular esthetic procedures. Seroma is the most frequent postoperative complication. Two decades of literature have described benefits of quilting sutures/progressive tension sutures (PTS) in reducing seroma rates and other complications in abdominoplasties. Despite this, PTS have not been universally adopted by plastic surgeons (ISAPS international survey on aesthetic/cosmetic procedures performed in 2020, 2021) Furthermore, PTS techniques and preferences vary widely. The aim of this study is to determine the prevalence of PTS use, reasons for reluctance to utilize them, and variety of techniques utilized by plastic surgeons performing abdominoplasties internationally. A 13-question survey was emailed via ISAPS to 3842 plastic surgeons internationally. Responses were collected and analyzed. Of the 272 respondents, the majority, 58%, currently use PTS. 46% were introduced to PTS during training. Only PTS training exposure was found to significantly correlate with current usage. Only 22% of North American trainees were exposed to PTS compared to 40-62% of trainees from other geographies. Of respondents who utilize PTS, most, 74%, combine them with drains. The majority use interrupted sutures, 65%, while 19% utilize a running suture, and the remaining 16% combine interrupted and running sutures. Of respondents who do not currently utilize PTS, the most common reason stated is that the surgeon's technique works well without them, 73%, which was significantly correlated with years in practice. Globally, most plastic surgeons currently utilize PTS (typically with drains) with training exposure being a significant predictor. There are still areas to address reluctance to implement them and use them without drains. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Robotic vs Open Lateral Hernia Repair: A Multicenter Propensity Score–Matched Analysis of 30-day Outcomes

INTRODUCTION: Lateral ventral hernia repair (LVHR) is a challenging surgical dilemma due to location, different anatomical considerations, and low volume of cases. Our study aims to compare and assess early 30-day outcomes between open LVHR (oLVHR) and robotic-assisted LVHR (rLVHR) approach. METHODS: A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was performed to include all adult patients who underwent elective LVHR based on European Hernia Society classification. A 1:1 propensity score match (PSM) analysis was conducted for balanced groups. Univariate analysis was performed to compare the 2 groups (oLVHR and rLVHR) across preoperative, intraoperative, and postoperative timeframes. RESULTS: ACHQC database identified 2,569 LVHR patients. A PSM analysis stratified 665 patients to each oLVHR and rLVHR group. Median length of stay is higher in the oLVHR 3 days (interquartile range [IQR] 1 to 5) vs rLVHR 1 day (IQR 0 to 2; p < 0.001). The surgical site infection rate was higher in the oLVHR 3% vs 1% (p = 0.006). Surgical site occurrence (SSO) such as wound cellulitis was also found at a higher rate in the oLVHR 21% vs the rLVHR 0% (p < 0.001). Seroma rate was higher in the rLVHR (6.5% vs 5.6%, p < 0.001). oLVHR had 18% postoperative complication compared with rLVHR 12% (p < 0.001). There was no difference in quality-of-life measures (HerQLes and PROMIS pain 3a surveys) between groups at 30 days and 1 year. CONCLUSION: Robotic-assisted LVHR is safe with decreased length of stay and SSO compared with the conventional open approach. However, it does carry a higher seroma rate with no clinical significance.

Impact of negative pressure wound drainage compared with natural wound drainage after thyroid tumour surgery: A meta-analysis.

We conducted a meta-analysis to compare the effectiveness of negative pressure wound drainage to that of spontaneous wound drainage after thyroid tumour surgery. A thorough analysis of the literature up to July 2022 revealed that, of the 1234 patients who used surgery for thyroid tumours, 615 used negative pressure wound drainage and 619 used natural wound drainage. To measure the influence of negative pressure wound drainage in comparison to natural wound drainage following thyroid tumour surgery, mean difference (MD) and odds ratio (OR) with 95% confidence intervals (CIs) were measured using the contentious and dichotomous approaches with a random or fixed-effect model. Subjects who used negative pressure wound drainage had significantly higher averages for drained material (OR, 12.52; 95% CI, 6.78-18.26, P= 0.001), shorter drain placement times (MD, -1.06; 95% CI, 1.57 to -0.55, P= .001), lower rates of infection at the surgical site (OR, 0.17; 95% CI, 0.05-0.60, P= .006), higher rates of wound healing (OR, 5.91; 95% CI, 1.56-22.34, P= .009), and lower rate of wound seroma (OR, 0.21; 95% CI, 0.10-0.42, P< .001) in subjects after thyroid tumour surgery in comparison to subjects who used natural wound drainage after thyroid tumour surgery. Those who used negative pressure wound drainage had significantly higher averages of drained material, shorter drain placement times, lower rates of wound infection at the surgical site, higher rates of wound healing, and lower rates of wound seroma. Care must be used when analysing the results because of the small sample size of 7 of the 13 studies included in the meta-analysis and the lack of studies in several comparisons.

Botulinum Toxin Use for Abdominal Wall Reconstruction

INTRODUCTION: Preoperative botulinum toxin (BTX) injection may assist in fascial closure of large incisional hernia repair. We examine outcomes of incisional hernia patients who receive BTX injections before abdominal wall reconstruction (AWR). METHODS: A retrospective cohort study of patients from 2019–2021 who underwent BTX abdominal wall injections and interval AWR was conducted. A matched cohort who underwent IH repair without BTX treatment was selected for comparable defect size and BMI. Clinical and demographic data were extracted from charts. RESULTS: Twenty patients received BTX injections, and 30 comparable patients did not. There was no difference in average age (58.6 and 61.4 years, p = 0.514), BMI (32.9kg/m2 and 32.4kg/m2, p = 0.813), or defect size (663.9 cm2 and 608.43 cm2, p = 0.513). Primary outcome of fascial closure was achieved in every patient in the BTX group (20 of 20) vs 86.7% (26 of 30) in the non-BTX group (p = 0.089). The BTX group had a lower rate of component separation (65.0% of the BTX group vs 93.3%, p = 0.01). The BTX group had higher rates of seroma (p = 0.03) and longer surgery time, 4:07 vs 3:58 (p < 0.01). The postoperative period had one dehiscence (non BTX group). There was no difference in incidence of surgical site infection, abscess, delayed healing, respiratory failure, pulmonary embolism, acute kidney injury, or length of stay. CONCLUSION: Patients receiving botulinum toxin injections into their abdominal wall musculature achieved greater rates of closure with good outcomes. We conclude that botulinum toxin injection for large incisional hernias is an effective method for relaxation of abdominal wall muscle and closure of large abdominal wall.

P-003 LATERAL ABDOMINAL HERNIAS: A REGISTRY-BASED MULTIVARIATE ANALYSIS OF SURGICAL TECHNIQUES AND OUTCOME

Abstract Aim Data on lateral incisional hernia (LAH) repair is scarce. The operative therapy is challenging due to complex anatomy and bulging due to previous nerve lesions. Data concerning medial hernias are not necessarily transferable. Therefore, this study evaluates the status-quo of LAH repair, compares different strategies, and identifies risk factors for complications and adverse outcomes. Materials and Methods The German Herniamed registry was screened for LAH. Data from patients operated on between 01–05–2009 and 05–31–2020, resulting in 6,306 cases. Data analysis focused on patient-specific, surgery-related factors, complications, and outcome. In addition, a logistic regression analysis of multiple variables was conducted. Results Laparoscopic IPOM (27.9%) and open sublay (38.1%) were the most common surgical procedures. Intraoperative complications were more common in laparoscopic IPOM compared to open sublay (1.8% vs. 0.9%; p&amp;lt;0.001), whereas seroma rate was lower (1.8% vs. 3.4%; p&amp;lt;0.001). Open sublay showed a lower risk for intraoperative complications compared to laparoscopic IPOM (OR 0.298 [0.158–0.564]; p&amp;lt;0.001) in the regression analysis. Risk factors for recurrence were large defect size, open onlay/IPOM, and BMI. Conclusion LAH repair is especially challenging due to its anatomical complexity, rareness, and weak management evidence. This study adds registry-based data with the largest number of cases yet published. Due to the complexity and the flimsy evidence of treatment options, lateral incisional hernias should be treated in specialized hernia centers. In addition, further evaluation of repair techniques is needed, and particular focus should be put on a proper localization classification and defect size (both according to EHS).

OC-019 MESH-RTL PROJECT FOR PREVENTION OF WOUND ABDOMINAL DEHISCENCE: NON-INFERIORITY CLINICAL TRIAL TO COMPARE TWO APONEUROTIC CLOSURE TECHNIQUES IN MIDLINE LAPAROTOMY IN PATIENTS WITH ELEVATED RISK

Abstract Aim Abdominal wound dehiscence (AWD) has an incidence of 2–4%, which can increase to 20% in specific risk groups. The aim of this study is to report the results of the use of the reinforced tension line (RTL) technique compared with the use of onlay mesh closure (OM) in the prevention of AWD in high-risk patients undergoing laparotomy. Material and Methods Non-inferiority open randomized controlled clinical trial. Included were patients older than 18 years who underwent midline laparotomy, emergency or scheduled, who were considered high risk. The patients were randomized 1:1 to the RTL technique or to OM. The objective was to report the incidence of AWD and the complications associated with the closure method. Intention-to-treat analyses were performed. Results A total of 239 patients were randomized; 118 patients from the RTL group and 121 patients from the OM group. The global incidence of AWD was 8.8% (21 patients). We did not find a statistically significant difference between the two groups, RTL group (13/118, 11%) and OM group (8/121, 6.6%) (p=0.259, OR 0.6, 95% CI 0.25–1.39). The groups were similar in the rates of surgical site infection, hematoma, seroma, and postoperative pain during follow-up. Conclusions The RTL and OM techniques are useful in the prevention of AWD in high-risk midline laparotomy patients, the advantage of RTL is that it can be used in patients with a contaminated, or dirty abdomen and its cost does not go beyond a couple of sutures.

Analysis of 'enhanced-view totally extra-peritoneal' (eTEP) approach for ventral hernia: Early results.

Laparoscopic ventral hernia repair is undergoing a paradigm shift with the introduction of numerous new techniques to improve the outcomes. Enhanced-view totally extra-peritoneal (eTEP) is a novel approach for the repair of ventral herniae introduced by Belyansky et al. The key innovation lies in placing the mesh in a large retrorectus-pre-peritoneal space contrary to the widely practiced intra-peritoneal placement. This approach can be easily coupled with a component separation in the form of transversus abdominis release (TAR) for large herniae. We conducted a midterm analysis of 'eTEP' approach to ventral hernia at a high-volume tertiary care centre and present our results of over 3 years of employing this technique. A retrospective study of 150 cases of ventral hernia repaired using eTEP approach from January 2018 to February 2021 at a tertiary care centre by a team of three surgeons. The procedures were performed by a single team of three members headed by the first author. Out of total 150 cases, incisional hernia occurred in 73 cases (48.7%), primary hernia occurred in 48 cases (32%) and recurrent hernia in 29 cases (19.3%). Although the majority of incisional (87.7%) and recurrent (79.3%) ventral hernias occurred in female, the incidence of primary ventral hernia was equal at 24 cases in both genders. The majority of the cases (80.7%) underwent eTEP RS procedure, and the rest were W3 hernias, which were managed by including a component separation in the form of eTEP TAR. The operating time for eTEP TAR (222.24 min ± 32.56) compared to eTEP RS (124.33 ± 23.68) was significantly longer. The mean length of stay was significantly shorter for primary hernias (3.75 days ± 1.62) compared to recurrent (5.21 days ± 2.51) and incisional hernias (4.36 days ± 2.19) (F = 4.376) (P = 0.014). The peri-operative period was uneventful in majority of the cases. We experienced a seroma rate of 5.8% in our series. At follow-up of 1 year, 3.3% of patients complained of discomfort/bulge in the upper abdomen. There were no other surgical site occurrences (SSO) in the form infection, posterior rectus sheath disruption and skin necrosis. We observed no recurrences till date with a minimum follow-up of 1 year. eTEP approach to ventral hernia is a promising abdominal wall reconstruction technique. It is safe and offers good functional outcomes with restoration of abdominal wall dynamics. It is a reproducible and safe technique for tackling various types of ventral hernia. It is specifically useful in managing unusual lateral hernias, incisional and recurrent hernias with ease.

Comparison of Outcomes Following Prepectoral and Subpectoral Implants for Breast Reconstruction: Systematic Review and Meta-Analysis.

Simple SummaryBreast cancer is a growing problem in modern society and is one of the most prevalent cancers among women. Oncologic breast surgery has become an effective therapeutic modality but is often accompanied by major physical and moral impacts on patients. Implant-based reconstruction helps to restore quality of life and aims at providing an optimal esthetic recovery, although the question of implant placement has been too poorly assessed in the past years. In this meta-analysis, we collected and analyzed existing evidence on postoperative outcomes following prepectoral and subpectoral breast reconstruction and allowed us to provide one of the largest pools of patients on this topic. We observed globally higher pain scores following subpectoral implants; however, the rates of postoperative complications remained comparable in a pooled analysis. The risks and benefits of each procedure should be discussed with the patient prior to surgery, and decision making should be guided by surgical expertise.(1) Background: Implant-based breast reconstruction following mastectomy helps to restore quality of life while aiming at providing optimal cosmetic outcomes. Both prepectoral (PP) and subpectoral (SP) breast implants are widely used to fulfill these objectives. It is, however, unclear which approach offers stronger postoperative benefits. (2) Methods: We performed a systematic review of the literature through PubMed, Cochrane Library, and ResearchGate, following the PRISMA guidelines. Quantitative analysis for postoperative pain as the primary outcome was conducted. Secondary outcomes included patient satisfaction and postoperative complications such as seroma, implant loss, skin necrosis, wound infection, and hematoma. (3) Results: Nine articles involving 1119 patients were retrieved. Our results suggested increased postoperative pain after SP implants and significantly higher rates of seroma following PP implants (p < 0.05). Patient satisfaction was found to be similar between the two groups; however, the heterogeneity of measurement tools did not allow us to pool these results. The rates of implant loss, skin necrosis, wound infection, and hematoma showed no significant differences between the two cohorts. (4) Conclusion: Our data suggest that both implant placements are safe and effective methods for breast reconstruction following mastectomy. However, homogeneity in outcome measurements would allow one to provide stronger statistical results.

EP-581 Prophylactic onlay mesh at emergency laparotomy: Promising early outcomes with long-acting synthetic resorbable mesh

Abstract Background Careful surgical strategy is paramount in balancing the prevention of fascial dehiscence, incisional hernia (IH) and fear of additional mesh-related wound complications post-laparotomy. This study aims to review early outcomes of patients undergoing an emergency laparotomy with prophylactic long-acting resorbable synthetic TIGR® mesh, used to reduce early fascial dehiscence and potential subsequent IH. Methods A retrospective, ethically approved review of 24 consecutive patients undergoing prophylactic TIGR® mesh placement during emergency laparotomies by a single surgeon between January 2017 and June 2021 at a University Hospital. A standardised approach included onlay positioning of the mesh, small-bite fascial closure, and a wound bundle. We recorded patient demographics, operative indications, findings, degree of peritonitis, postoperative complications, and mortality. Results The study included 24 patients; 16/24 (66.6%) were female and mean age was 66.5 (range 31–86); 14/24 patients were ASA grade III or greater; 4/24 patients (16.6%) developed six complications and 3/6 occurred in a single patient. Complications included subphrenic abscess, seroma, intrabdominal hematoma, enterocutaneous fistula leading to deep wound infection and small bowel perforation. Five (20.8%) patients died in hospital; central venous catheter sepsis (n=1), fungal septicaemia (n=1) and multiorgan failure (n=3). Surgical site infection and seroma rates were low, occurring in 2/24 patients (4% each). Conclusions This small study has identified that prophylactic onlay mesh in patients undergoing an emergency laparotomy is not associated with significant wound infection or seroma when used with an active wound bundle. The wider use of TIGR® to prevent fascial dehiscence and potential long-term IH prevention should be considered.

EP-69 The use of IFAbond© tissue adhesive to reduce seroma rates and improve breast reconstruction outcomes

Abstract Introduction Tissue adhesives have had uses in surgery for over 45 years. Evidence for use in haemostasis and cavity closure is growing. Seromas are a common (up to 85% incidence) but potentially serious complication in implant-based breast reconstruction (IBBR). If infected can cause implant loss and reconstruction failure. Tissue adhesives may reduce seroma rates. Aims and Methods Our study considered whether IFAbond© significantly reduces seroma formation following IBBR and as a pilot to evaluate the optimum use and application of IFAbond©. 7 consecutive patients undergoing pre-pectoral IBBR were recruited to the control arm (standard closure) and a further 7 patients undergoing pre-pectoral IBBR were recruited to the intervention arm (standard closure including IFAbond©). Qualitative assessment of seroma formation and IBBR objective early outcomes were assessed at 1 week, 2 weeks and 30 days. Results Cohorts were comparable for demographics, mastectomy weight and implant size. No wound infection, healing concerns or implant loss at thirty days in either cohort. No patients developed clinically significant seroma (requiring drainage) in either arm. 4 of 7 control arm patients developed clinically noticeable seroma at 30 days compared to none in the intervention arm. Conclusions IFAbond© is safe and easily applied during IBBR adding little time to closure. This study suggests that IFAbond© can reduce clinically evident seroma formation in IBBR compared to standard closure. This pilot will inform a larger study to explore the statistical significance of this intervention and with longer term follow-up whether this correlates to lower rates of implant loss/failure.

Comparison of outcomes of ventral hernia repair using different meshes: a systematic review and network meta-analysis.

We conducted a network meta-analysis to evaluate potential differences in patient outcomes when different meshes, especially biological meshes, were used for ventral hernia repair. PubMed, Embase, Cochrane Library, and Clinical Trials.gov databases were searched for studies comparing biological meshes with biological or synthetic meshes for ventral hernia repair. The outcomes were hernia recurrence rate, surgical site infection, and seroma. We performed a two-step network meta-analysis to investigate the outcomes of several biological meshes: non-cross-linked human acellular dermal matrix (NCHADM), non-cross-linked porcine ADM (NCPADM), non-cross-linked bovine ADM (NCBADM), cross-linked porcine ADM (CPADM), and porcine small intestinal submucosa (PSIS). From 6304 publications, 23 studies involving 2603 patients were finally included. We found no differences between meshes in recurrence at 1-year follow-up and in surgical site infection rate. NCBADM was associated with the lowest recurrence rate and the lowest surgical site infection rate. NCHADM implantation was associated with the lowest rate of seroma. PSIS was associated with a higher risk of seroma than NCHADM (pooled risk ratio 3.89, 95% confidence interval 1.13-13.39) and NCPADM (RR 3.42, 95% CI 1.29-9.06). Our network meta-analysis found no differences in recurrence rate or surgical site infection among different biological meshes. The incidence of postoperative seroma was higher with PSIS than with acellular dermal matrices. We observed large heterogeneity in the studies of ventral hernia repair using biological meshes, and, therefore, well-designed randomized clinical trials are needed.

Prophylactic onlay mesh at emergency laparotomy: promising early outcomes with long-acting synthetic resorbable mesh.

BackgroundCareful surgical strategy is paramount in balancing the prevention of fascial dehiscence, incisional hernia (IH) and fear of additional mesh‐related wound complications post‐laparotomy. This study aims to review early outcomes of patients undergoing an emergency laparotomy with prophylactic TIGR® mesh, used to reduce early fascial dehiscence and potential subsequent IH.MethodA retrospective, ethically approved review of 24 consecutive patients undergoing prophylactic TIGR® mesh placement during emergency laparotomies by a single surgeon between January 2017 and June 2021 at a University Hospital. A standardized approach included onlay positioning of the mesh, small‐bite fascial closure, and a wound bundle. We recorded patient demographics, operative indications, findings, degree of peritonitis, postoperative complications, and mortality.ResultThe study included 24 patients; 16/24 (66.6%) were female and median age was 72.5 (range 31–86); 14/24 patients were ASA grade III or greater; 4/24 patients (16.6%) developed six complications and 3/6 occurred in a single patient. Complications included subphrenic abscess, seroma, intrabdominal hematoma, enterocutaneous fistula leading to deep wound infection and small bowel perforation. Five (20.8%) patients died in hospital; central venous catheter sepsis (n = 1), fungal septicaemia (n = 1) and multiorgan failure (n = 3). Surgical site infection and seroma rates were low, occurring in 2/24 patients (4% each).ConclusionThis study has identified that prophylactic onlay mesh in patients undergoing an emergency laparotomy is not associated with significant wound infection or seroma when used with an active wound bundle. The wider use of TIGR® to prevent fascial dehiscence and potential long‐term IH prevention should be considered.