Underwent Mesh Repair Research Articles

Treatment of chronic mini-thoracotomy wound pain and lung herniation with intercostal cryoablation and surgical mesh repair: a case report

BackgroundThe incidence of minimally invasive heart surgery via mini-thoracotomy (MT; right anterior thoracotomy) is on the rise, accompanied by an increase in post-MT intercostal nerve neuralgia and the risk of lung herniation through the incision site. While various methods have been proposed to address these issues, none have been commonly effective. In this case report, we attempted to simultaneously address these problems by performing intercostal cryoablation (IC) and mesh repair.Case presentationA 43-year-old male was referred to our hospital for chronic post-thoracotomy neuralgia following heart surgery via MT, involving patch closure of an atrial septal defect and tricuspid annuloplasty. He presented with intercostal nerve neuralgia and lung herniation accompanied by severe pain. Despite medication and lidocaine injections, there was no relief. Consequently, he underwent surgical treatment with IC for chronic MT wound pain and simultaneously underwent mesh repair for a lung hernia. He was discharged from hospital free of complications. Subsequently, he no longer required further pain medication and experienced a favorable recovery.ConclusionOur findings suggest that concurrent IC and mesh repair can effectively relieve chronic post-MT intercostal nerve neuralgia and severe lung herniation pain in patients who underwent MT surgery, leading to a decrease in opioid medication usage.

Application of bridging mesh repair in giant ventral incisional hernia.

Achieving ideal abdominal wall reconstruction in giant ventral incisional hernia has been a challenging for surgeons. This study aimed to verify the safety and efficacy of bridging repair by comparing it with primary fascial closure (PFC) repair in the treatment of giant ventral incisional hernia. We retrospectively analyzed the clinical data of 92 patients with giant ventral incisional hernia who underwent mesh repair at our medical institution from January 1, 2014 to December 31, 2020. Patients were divided into 2 groups: the bridging repair group with 40 patients in whom repair was completed using the bridging technique and the PFC group with 52 patients in whom primary fascial closure was achieved and all patients underwent mesh reinforcement during the operation. The main outcome measures were recurrence rate and morbidity, especially intra-abdominal hypertension (IAH). Follow-up time of both groups lasted at least 24months after surgery. After a median of 46months and 65months of follow-up, respectively, in the two groups, bridging repair did not increase the long-term recurrence rate (2.56%) in the larger defect area group compared to the PFC group (1.96%). There were no significant differences in perioperative morbidity, IAH, incidence of postoperative chronic pain, and sensory impairment of the abdominal wall between both groups. The application of bridging surgery in the treatment of complex giant ventral incisional hernias is safe and effective and does not significantly increase the postoperative recurrence rate.

Clinical and Radiological Evaluation of Onlay Mesh Abdominoplasty in Obese Multiparous Patients with Moderate-to-Severe Rectus Diastasis.

Women with multiple pregnancies often experience abdominal protrusion and/or a lax abdominal wall. Various open surgical techniques have been developed to address rectus diastasis in abdominoplasty, ranging from suture plication to mesh reinforcement. This study aims to compare the clinical and radiological changes between traditional abdominal plication and the addition of non-absorbable mesh for rectus muscle (RM) diastasis repair in terms of function, postoperative outcome, and recurrence. This prospective retrospective study involved 63 women who underwent cosmetic tummy tuck surgery and met certain eligibility criteria. Patients with only mild diastasis recti, midline hernia, contraindications for major surgery, recent smoking history, or refusal of mesh augmentation were excluded. Clinical examination for abdominal protrusion or bulging and CT imaging was performed to check for recurrence of diastasis recti. The study included 33 patients who underwent mesh repair and 30 who underwent traditional abdominal plication. Follow-up was conducted after 1year using CT and a questionnaire to assess various factors compared to preoperative measurements, with overall satisfaction rated on a 10-point Likert scale. There was no significant difference in demographic data between the two groups. Patients who underwent mesh repair had a slightly longer hospital stay and drain duration. The average waist circumference decreased in both groups without any statistically significant difference. Objective CT showed significant reductions in both groups in inter-rectus distance, RM width and circumference, and intra-abdominal circumference compared to preoperative values. All patients expressed satisfaction with scar quality and umbilicus aesthetics, and no recurrence was detected either clinically or radiologically during the follow-up period. Comprehensive preoperative assessment and imaging techniques like ultrasound and CT scans allow surgeons to detect postpartum changes in the abdominal wall. Mesh reinforcement may be indicated for diastasis above 4 cm in obese multiparous females. Thorough preoperative evaluation permits customized surgical plans to optimally restore abdominal wall anatomy and function. 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 at www.springer.com/00266 .

Robotic Enhanced-View Totally Extraperitoneal vs Intraperitoneal Onlay Mesh Evaluation: 1-Year Exploratory Outcomes of the REVEAL Randomized Clinical Trial.

Patients with small to medium-sized ventral hernias randomized to robotic enhanced-view totally extraperitoneal (eTEP) or robotic intraperitoneal onlay mesh (rIPOM) previously demonstrated comparable 30-day patient-reported outcomes. Here we report 1-year exploratory outcomes for this multi-center, patient-blinded randomized clinical trial. Patients with midline ventral hernias ≤7cm wide undergoing mesh repair were randomized to robotic eTEP or rIPOM. Planned exploratory 1-year outcomes include pain intensity (Patient-Reported Outcomes Measurement Information System [PROMIS 3a]), hernia-specific quality of life (HerQLes), pragmatic hernia recurrence, and reoperation. One hundred randomized patients (51 eTEP, 49 rIPOM) reached a median 12 months follow-up [interquartile range 11-13] with 7% lost. Following regression analysis adjusting for baseline scores, there was no difference in postoperative pain intensity at 1-year for eTEP compared to rIPOM (OR 2.1, 95% CI 0.85-5.1, p=0.11). HerQLes scores were on average 15 points lower (i.e. less improved) at 1 year following eTEP repairs compared to rIPOM, a difference maintained after regression analysis (OR 0.31, 95% CI 0.15-0.67, p=0.003). Pragmatic hernia recurrence was 12.2% (6 of 49) for eTEP and 15.9% (7 of 44) for rIPOM (p = 0.834). Two eTEP and one rIPOM patients required reoperations related to their index repair in the first year (p=0.82). Exploratory analyses showed similar outcomes at 1 year in regards to pain, hernia recurrence, and reoperation. Abdominal wall quality of life at 1 year appears to favor rIPOM, and the possibility that an eTEP dissection is less advantageous in that regard should be the subject of future investigation.

Management and outcomes of obturator hernias: a systematic review and meta-analysis.

Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair. PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups. Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient's clinical status, comorbidities, and degree of intraoperative contamination.

Open Inguinal Hernia Repair: Incidence of Mesh Infection

Introduction: Wound and mesh infections after inguinal hernia repair are very severe complications. Today it is an established fact to repair hernias with meshes in various ways to prevent or delay the recurrence of hernia, but knowledge regarding the incidence of mesh infection is rare. The aim of the study was to assess the incidence of mesh infection in Open Inguinal Hernia Repair. Methods: This retrospective study was conducted at the Department of Surgery, Sylhet M.A.G Osmani Medical College, Sylhet, Bangladesh during the period from January 2020 to December 2021. The study included 400 patients who underwent mesh repair for inguinal hernia repair during the 2 years period. Among the total 400 patients, 24 were diagnosed with mesh related infections. Mesh related infections influenced by type of mesh use; surgical techniques and underlying comorbidity were all recorded. Both medical and surgical management required for mesh infection were also recorded. Use of antimicrobial included coverage of staphylococcus. Laparoscopic hernia repair cases were excluded from the study. Result: The study found 24 mesh related infection in a total of 400 patients who underwent open inguinal hernia repair. The overall mesh related infection rate was 3%. The infection was established at a variable delay after mesh insertion, with 40% delayed onset after procedure and 60% diagnosed during the first post-operative month. Infection was cured in 6 patients after mesh removal. Conclusion: Mesh removal appears to be one of the appropriate treatments for this rare and serious complication. The most common pathogen was Staphylococcus aureus and E. Coli. The possibility of a mesh related infection remains active weeks or even years after initial hernia repair. If mesh infection develops it should be treated vigorously and mesh should be excised early if necessary.

Comparison of mesh repair and suture repair for the treatment of incarcerated femoral hernia: a retrospective, single-center study.

Femoral hernias often present with incarceration or strangulation that requires emergency surgery. However, recommendations vary regarding optimal approaches for incarcerated femoral hernia. The aim of this study is to compare clinical efficacy between mesh repair and suture repair for the treatment of incarcerated femoral hernia. Retrospective, single-center analysis of the clinical data from 48 patients with incarcerated femoral hernia, including 16 patients who underwent mesh repair (mesh repair group) and 32 patients who underwent traditional suture repair (suture repair group). The mean age, body mass index, incarceration duration, hernia sac size, operation duration, and the rates of postoperative incision infection, recurrence, chronic pain, and mortality were not significantly different between the suture repair and mesh repair groups (P > 0.05 for all). In contrast, the female/male ratio; the rates of bowel obstruction, coexisting diseases, and nighttime operation; and the American Society of Anesthesiologists grade were higher and the rate of prophylactic antibiotic use and the mean cost of hospitalization were lower in the suture repair group than in the mesh repair group (P < 0.05 for all). The surgical approach should be chosen based on the patient's condition. Mesh repair for the emergency treatment of incarcerated femoral hernia is safe and effective, whereas suture repair is suitable for elderly patients, those with more coexisting diseases, and those with limited life expectancy.

Suture or Mesh Repair of the Smallest Umbilical Hernias: A Nationwide Database Study.

Mesh is recommended for umbilical hernias with defects > 1cm to reduce recurrence. For umbilical hernias with defect width ≤ 1cm, the literature is sparse. The aim of this nationwide cohort study was to assess outcomes after suture and mesh repair of umbilical hernias with defect width ≤ 1cm and to evaluate outcomes after onlay mesh repair specifically. By merging data from the Danish Hernia Database and the National Patients Registry from 2007 to 2018, patients undergoing elective open repair of an umbilical hernia with defect width ≤ 1cm were identified. Available data included details about comorbidity, surgical technique, 90-day readmission, 90-day reoperation and operation for recurrence. A total of 7849 patients were included, of whom 25.7% (2013/7849) underwent mesh repair. Reoperation for recurrence was significantly decreased after mesh repair 3.1% (95% C.I. 2.1-4.1) compared with suture repair 6.7% (95% C.I. 6.0-7.4), P < 0.001. Readmission and reoperation rates were significantly higher for mesh repair 7.9% (159/2013) and 2.6% (52/2013) than for suture repair 6.5% (381/5836) and 1.5% (89/5836), P = 0.036 and P = 0.002, respectively. Onlay mesh repairs had the lowest risk of recurrence 2.0% (95% C.I. 0.6-3.5), and readmission [7.9% (65/826)] and reoperation [3.9% (32/826)] rates within 90 days were comparable to suture repairs [6.5% (381/5836)] and [3.3% (192/5836)], P = 0.149 and P = 0.382, respectively. Even for the smallest umbilical hernias, mesh repair significantly decreased the recurrence rate. Onlay mesh repair was associated with lowest risk of recurrence without increasing early complications.

Outcome and complications of Ventralex mesh repair in umbilical hernia

In recent time, various techniques have been applied for the hernia repair surgery. Considering the possibility of the recurrence rates up to 40%, umbilical and umbilical port hernias have been repaired without mesh for a long time. The repair of these hernias by the Ventralex hernia patch may decrease recurrent hernia rates. The aim of this study was to evaluate the outcome and complications of mesh repair in umbilical hernia by the Ventralex hernia patch. A total of 36 patients were studied retrospectively who underwent mesh repair surgery by the Ventralex hernia patch between April 2017 and October 2019 at Anower Khan Modern Medical College &amp; Hospital, Care Medical College &amp; Hospital and LABAID Specialized Hospital. They have also been evaluated for instant post-operative complications, recurrence rate &amp; pain. Short-term clinical outcomes were assessed during post-operative follow up at first and sixth week. One year long-term outcomes were assessed over telephone. In this study, there were 28 female and 8 male patients with the range of age from 24-68 years (Mean 41.5 ±8.36) having 27 umbilical hernias and 9 umbilical port hernias. No major short-term complications were found but early minor complications were found in 5 patients (13.89%). No pain or mild pain was reported in 31 patients after one week’s post-operative follow up. 34 patients reported being very satisfied with their repairs. In this study we found that the Ventralex hernia patch is an effective and easier technique for mesh repair in umbilical and umbilical port hernias. This technique can also save the operative time with less post-operative complications and better outcomes. BSMMU J 2021; 14(3): 79-84

CLINICAL STUDY AND MANAGEMENT OF INCISIONAL HERNIA WITH MESH REPAIR

Objective: To assess the magnitude of this problem, various factors leading to development of this condition and the different modalities of treatment practiced in our set up. Background: Incisional hernia is the one true iatrogenic hernia ianAird denes incisional hernia as a diffuse extrusion of peritoneum and abdominal contents through a weak scar of an operation or accidental wound.Incisional hernia usually starts early after surgery, as a result of failure of the lines of closure of the abdominal wall following laparotomy. Material and methods: The study was carried out a prospective study of 60 consecutive patients who underwent mesh repair for symptomatic incisional hernia in the period between October 2019 and April 2021 in G.R. Medical College and Jaya Arogya Hospital, Gwalior. Results: In our study, out of 60 patients of incisional hernia predominant in females and compared to males mainly between 41-50 years of age predominantly 65% presented with complaint of swelling in abdomen. Etiological factor in our study which lead to hernia is wound infection followed by wound dehiscence and maximum incidence seen after gynaecological procedures and lower midline incision. Incisional hernia predominant in general anesthesia who had previously operated. Incisional hernia is predominantly observed in our study who had previously operated open surgery comparatively laparoscopy procedures. Conclusion: Conscientious aseptic technique and careful closure of the abdominal wound is necessary for preventing incisional hernia. Conventional preoperative preparation of the patients with high risk is an important factor in preventing recurrence of incisional hernia. The postoperative complications can be decreased by the utilization of suction drains in mesh repair.

O31 SUTURE OR MESH REPAIR FOR THE SMALLEST UMBILICAL HERNIAS: A NATIONWIDE DATABASE STUDY

Abstract Aim High level evidence recommends the use of mesh for umbilical hernias with defects &amp;gt;1 cm to reduce recurrence rates without increasing the risk of postoperative complications. For umbilical hernias with defect width ≤1 cm, the literature is sparse. The aim of the study was to assess outcomes after suture and mesh repair of umbilical hernias with defect width &amp;lt;1 cm on a nationwide basis, and to evaluate outcomes after onlay mesh repair specifically. Material and Methods By merging data from the Danish Hernia Database and the National Patients Registry from January 2007 until December 2018, patients receiving elective repair of an umbilical hernia with defect width ≤1 cm were identified. Available data included details about comorbidity, surgical technique, 90-days readmission, 90-days reoperation and reoperation for recurrence. Results A total of 7,849 patients were included, of whom 25.7% (2,013/7,849) underwent mesh repair. The cumulative 5-year incidence of reoperation for recurrence was significantly decreased after mesh repair 3.1% (95% C.I. 2.1-4.1) compared with suture repair 6.7% (95% C.I. 6.0-7.4), P &amp;lt; 0.001. Onlay mesh repairs had the lowest cumulative risk of recurrence at 5 years 2.0% (95% C.I. 0.6-3.5). For onlay mesh repairs, readmission 7.9%, (65/826)) and reoperation (3.9% (32/826)) rates within 90-days were comparable to suture repairs (6.5% (381/5,836) and 3.3% (192/5,836), P = 0.149 and P = 0.382, respectively. Conclusions Even for the smallest umbilical hernias, mesh repair significantly decreased the recurrence rate. Onlay mesh repair was associated with the lowest risk of recurrence without increasing early complications.

Herniation of ureter: a rare cause of hydroureteronephrosis

BackgroundOmentum and bowel loops are commonly seen in inguinal hernia. An unusual case of extraperitoneal herniation of ureter was detected in hernial sac with other contents, on computed tomography (CT) urography.Case presentationA 54-year-old male presented with inguinal hernia, with no previous history of surgery or trauma. Pre-operative screening showed a unilateral hydroureteronephrosis involving the pelvicalyceal system and entire ureter. No calculus was visualized in the ureter on ultrasound. On non-contrast CT (NCCT) followed by CT urography, the ureter was seen descending into the hernia sac causing hydroureteronephrosis. The patient subsequently underwent mesh repair surgery of the inguinal hernia with meticulous reduction of the herniated contents including the ureter, resulting in complete resolution of the hydroureteronephrosis.ConclusionAn isolated extraperitoneal inguinal herniation of the ureter without concomitant urinary bladder involvement is extremely rare, especially with no prior history of trauma or surgery, as seen in our case. The case also exemplifies the role of pre-operative imaging as a protocol in cases of inguinal hernia to prevent per-operative complications.

Women with advanced pelvic organ prolapse and levator ani muscle avulsion would significantly benefit from mesh repair surgery.

Mesh repair surgery for pelvic organ prolapse (POP) has been suspended in some countries owing to concerns about its associated complications. However, mesh repair has been shown to reduce the risk of prolapse recurrence after surgery. In view of this controversy, our aim was to assess the incidence of subjective and objective recurrence of POP following mesh repair surgery vs native-tissue repair in women with Stage-III or Stage-IV POP. This was a prospective observational study of women who presented with Stage-III or Stage-IV POP and received primary prolapse surgery between 2013 and 2018. Transperineal ultrasound was performed before the operation and volumes were analyzed offline to assess the presence of levator ani muscle (LAM) avulsion. All women were counseled on either mesh repair or native-tissue reconstruction. The mesh-repair group was followed up for up to 5 years and the native-tissue-repair group for up to 2 years after the operation. Prolapse symptoms and POP quantification (POP-Q) staging were assessed at follow-up. Subjective recurrence of POP was defined as symptoms of prolapse (vaginal bulge sensation or dragging sensation) reported by the patient. Objective recurrence was defined as POP-Q ≥ Stage II. The subjective and objective recurrences of prolapse were compared between women with and those without mesh use. Multivariate regression analysis was used to identify risk factors for the recurrence of POP. A total of 154 Chinese women with Stage-III or Stage-IV prolapse were recruited. Of these, 104 (67.5%) underwent mesh repair (transabdominal in 57 women and transvaginal in 47 women) and 50 (32.5%) had native-tissue repair surgery. Ninety-five (61.7%) women had LAM avulsion. Both the subjective POP recurrence rate (4.8% vs 20.0%; P = 0.003) and the objective recurrence rate (20.2% vs 46.0%; P = 0.001) were significantly lower in the mesh-repair group than in the native-tissue-repair group. On multivariate logistic regression analysis, mesh repair was associated significantly with a reduced risk of subjective recurrence (odds ratio (OR), 0.20 (95% CI, 0.07-0.63)) and of objective recurrence (OR, 0.16 (95% CI, 0.07-0.55)) of prolapse. On subgroup analysis of women with LAM avulsion, mesh repair significantly reduced the risk of subjective recurrence (OR, 0.24 (95% CI, 0.07-0.87)) and objective recurrence (OR, 0.23 (95% CI, 0.09-0.57)) of POP. The incidence of mesh-related complications was low, and mesh exposure could be treated conservatively or by minor surgery. Mesh repair surgery, compared with native-tissue repair, was associated with a 5-fold reduction in the risk of subjective recurrence and a 6-fold reduction in the risk of objective recurrence of prolapse in women with Stage-III or Stage-IV POP. In women with concomitant LAM avulsion, mesh repair surgery was associated with a 4-fold reduction in both objective and subjective recurrence of POP. The rate of mesh-related complications was low, and mesh exposure could be treated conservatively or by minor surgery. The benefit of mesh surgery for these high-risk women appears to outweigh the risks of mesh complications, and it could be a treatment option for this group of women. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

COMPARATIVE CLINICAL STUDY OF NON-MESH VERSUS MESH REPAIR IN PRIMARY INGUINAL HERNIA

Background: The inguinal regions are one of the natural weak areas in the abdominal wall and are the most common site of herniation. Inguinal hernia repair is one of the most frequently performed operations. Amis: The aim of this study is to compare open mesh and non-mesh suture repair of primary inguinal hernias with respect to clinical outcome which include postoperative pain, complications, time of return to work and recurrence. Matierial and methods: This prospective study of 102 cases of primary inguinal hernia repair was carried out at M.G.M. Medical College &amp; L.S.K. Hospital, Kishanganj with the aim of comparing open mesh and non-mesh suture repair with respect to clinical outcome which included postoperative pain, complications time of return to work and recurrence. Result: In our study there were no specific criteria for allocation of the method of repair and of 102 patients 52 patients randomly underwent non-mesh repair and 50 patients underwent mesh repair. Conclusion: The use of prosthetic mesh allows tension-free repair of inguinal hernia and in theory better results. Our study proves the superiority of this method over non-mesh repair in the long term with regard to hernia recurrence; in addition, there were less complications and postoperative pain.

THE EFFECTIVENESS OF MESH REINFORCEMENT DURING LAPAROSCOPIC HIATAL HERNIA REPAIR

Purpose . To analyze short-term and long-term results of surgical treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease. Materials and methods . A retrospective analysis of short-term and long-term results of treatment of 98 patients for the period 2009–2016, who underwented surgical treatment of hiatal hernia with a hernia defect size 5 or more cm was performed. The first group included 69 patients underwent suture repair of hernia defect. The second group underwent mesh repair - 29 patients. Results . Intraoperative complications - 7 (10.1%) versus 2 (6.9%), postoperative complications - 6 (8.7%) versus 3 (10.4%), the duration of surgery - 141 ± 21.1 min versus 179 ± 28.4, duration of hospital stay - 6.7 ± 1.6 days versus 6.9 ± 1.8, postoperative dysphagia - 11 (15.9%) versus 6 (20.7%) were not noted. In 5 years after surgery, reccurence in the suture group were noted in 14 (20.3%) patients, in the mesh group - in 4 (13.8%) patients. The total GERD–HRQL questionnaire score was 6.4 ± 1.8 points in the suture repair group and 5.9 ± 2.1 points in the mesh group. 9 (13%) patients in the suture repair group and 5 (17.2%) in the mesh group evaluated their condition as unsatisfactorily. Conclusion . The analysis of long-term results in 5 years after the surgery showed the absence of benefit after using mesh reinforcement during laparoscopic repair of large hiatal hernias compared to usual suture cruroraphy both in recurrence rate and in assessing the quality of life.

Primary lumbar hernia: a rarely encountered ventral hernia

Ventral hernia is a fascial defect located on the abdominal wall. Primary ventral hernias are named as umbilical, epigastric, spigelian and lumbar hernias. A lumbar hernia is a parietal wall defect that may occur anywhere in the lumbar region between the 12th rib and the iliac crest. A 47-year-old female, came with complaints of mass in left lower abdomen since 2 months. On clinical examination a defect of 8 × 8 cm was felt in the left lumbar region with positive cough impulse. CECT abdomen and pelvis was done to confirm lumbar hernia. Patient underwent mesh repair for the same. Lumbar and flank hernias are uncommon and are a challenge to treat for any general surgeon. Surgery is considered gold standard either an open mesh repair or laparoscopically.

Mesh Repair in Crohn's Disease: A Case-Matched Multicenter Study in 234 Patients.

There are no specific guidelines for ventral hernia management in Crohn's disease (CD) patients. We aimed to assess the risk of septic morbidity after mesh repair in CD. This was a retrospective multicentre study comparing CD and non-CD patients undergoing mesh repair for ventral hernia (primary or incisional hernia). Controls were matched 1:1 for the presence of a stoma, history of surgical sepsis, hernia size and Ventral Hernia Working Group (VHWG) score. All demographic, pre-, intra- and postoperative data were retrieved, including long-term data. We included 234 patients, with 114 CD patients. Both groups had comparable VHWG scores (p = 0.12), hernia sizes (p = 0.11), ASA scores ≥ 3 (p = 0.70), body mass index values (p = 0.14), presence of stoma (CD 21.9% vs. controls 15%, p = 0.16), history of sepsis (14% vs. 6.7%, p = 0.23), rates of malnutrition (4.4% vs. 1.7%, p = 0.46), rates of incisional hernia (93% vs. 95%, p = 0.68) and concomitant procedures (18.4% vs. 11.7%, p = 0.12). CD patients carried a higher risk of postoperative septic morbidity (18.4% vs. 5%, p = 0.001), entero-prosthetic fistula (7% vs. 0, p < 0.01) and mesh withdrawals (5.3% vs. 0, p = 0.011). Ventral hernia recurrence rates were similar (14% vs. 8.3%, p = 0.15). In the univariate analysis, the risk factors for septic morbidity were CD (p = 0.001), malnutrition (p = 0.004), use of biological mesh (p < 0.0001) and concomitant procedure (p = 0.004). The mesh position, the means used for mesh fixation as well as the presence of a stoma were not identified as risk factors. CD seems to be a risk factor for septic morbidity after mesh repair.

Primary uncomplicated midline ventral hernias: factors that influence and guide the surgical approach.

Considering recently published high-level evidence on the management of primary midline ventral hernias, we set out to review current practices and reevaluate the literature surrounding this topic. The Americas Hernia Society Quality Collaborative (AHSQC) was used to abstract all uncomplicated primary midline ventral hernias. The primary outcomes of interest were surgical approaches, including the use of mesh, the type and position of mesh, and the use of minimally invasive surgery (MIS). A total of 7030 met inclusion criteria; mean age of 52 ± 14, 71% male, with a median hernia width of 2 [1, 2]. A total 69% underwent mesh repair, while 31% underwent suture repair. The most commonly used mesh was permanent synthetic (98%), placed in either the intraperitoneal (46%) or preperitoneal (42%) spaces. The majority of repairs were performed through an open approach (72%). When mesh was used through an open approach (58%), the majority were patches (70%) placed in the preperitoneal space (50%). Through an MIS approach (95%), the majority were flat meshes (53%) placed in the intraperitoneal space (58%). Recent high-level literature recommends the use of mesh repair (flat mesh) in all patients with hernia width ≥ 1cm. This evidence is limited to the use of flat mesh through an open approach. While AHSQC surgeons do offer mesh repair in the majority of cases, this is most commonly using a mesh patch, and is selective towards larger hernias and obese patients. Further research is required to evaluate the safety of mesh patches, and a mesh repair should be offered to a young non-obese healthy patient, as they benefit similarly from the use of mesh.

Self-Retaining Freedom Proflor vs. Lichtenstein Mesh Repair for the Reduction of Postoperative Pain in Inguinal Hernia: A 1-Year Randomized Controlled Study

Introduction: Lichtenstein tension-free mesh repair (LMR), surgical procedure for inguinal hernia, associated with postoperative pain. The study was aimed to compare self-retaining Freedom ProFlor versus LMR for the reduction of postoperative pain in inguinal hernia.Methodology: A total of 60 patients with inguinal hernia undergoing mesh repair were randomized into two groups of 30 each: group A (Freedom ProFlor mesh repair) and group B (LMR). Demographic data and clinical findings of all the patients including duration of pain, lump size, cough impulse, and the position of hernia were noted. Recorded findings such as postoperative pain and operative time were subjected to statistical analysis.Results: Most (31) of the patients had a hernia on the right side. The operative time was significantly less in group A when compared to group B (P &lt; 0.05). Significantly lower pain scores were observed in group A than in group B (P &lt; 0.05). The mean postoperative pain was significantly lower in group A compared with group B during the fifth follow-up visit (0.2 ± 0.41 vs. 1.07 ± 1.28; P &lt; 0.0001). Conclusion: The Freedom ProFlor mesh repair was better than the LMR regarding postoperative pain. Moreover, the dose of the analgesic needed in the Freedom ProFlor mesh repair group was less and for a shorter time when compared to the LMR group. However, further long-term studies are required for documenting hernia recurrences.

Laparoscopy Versus Open Incarcerated Inguinal Hernia Repair in Octogenarians: Single-Center Experience With World Review.

The clinical study is aiming to discuss the therapeutic benefit of laparoscopic hernia (LH) repair with comparing conventional open hernia (OH) repair in incarcerated hernia in octogenarians. The clinical data of 29 octogenarian incarcerated hernia patients who underwent hernia repair from November 2013 to March 2017 were retrospectively analyzed. The variables analyzed include baseline, operation characteristics, and clinical outcomes. The patients were divided into LH and OH according to the surgical approach and their clinical parameters were compared. Descriptive statistics were calculated, and outcomes were compared using the Fisher exact test and the student t test, a P≤0.05 was considered significant. Of reported 18 octogenarian patients, 7 patients underwent LH, whereas the remaining 11 patients underwent OH. The median age of the patients was 86 (81 to 97). All patients in LH group and 3 patients in OH group underwent nonmesh repair. In total, 8 patients in OH group underwent mesh repair. Simultaneous intestinal resection was needed in 4 patients (2 in LH, 2 in OH) due to the necrotic bowel. No mortality was observed in all subjects. The results showed significantly shorter operation time (50±5 vs. 110±3 min; P=0.000), hospital stay (6±1 vs. 12±3 d; P=0.04). There were no noteworthy postoperative complications and during the follow-up period, no patient experienced recurrent hernia in both groups. LH nonmesh repair has not increased the morbidity and mortality but showed shorter hospital stay and fast recovery and no recurrence in octogenarian incarcerated hernia patients. Therefore, LH in octogenarian incarcerated hernia patients might be preferred approach in sophisticated hands with acceptable outcomes.