P049 SAFETY AND EFFICACY OF ABSORBABLE AND NON-ABSORBABLE FIXATION SYSTEMS FOR INTRAPERITONEAL MESH FIXATION: AN EXPERIMENTAL STUDY IN SWINE

Aim Choice of the best fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of this study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation. Material and Methods Fourteen Landrace swine were utilized and the experiment included two stages. Initially, four pieces of polypropylene mesh with hydrogel barrier coating1 were fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. Each mesh was anchored with a different tack device between titanium2, steel3 or absorbable (4,5) fasteners. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy. The primary endpoint was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks. Results Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Steel tacks had higher peel strength when compared to titanium and absorbable fasteners. No significant differences were noted regarding the secondary endpoints. Conclusions Steel fasteners provided higher peel strength that the other devices in this swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.

P135 ESTABLISHMENT OF MINIMALLY INVASIVE VENTRAL HERNIA REPAIR WITH EXTRAPERITONEAL MESH PLACEMENT AS A STANDARD APPROACH OF VENTRAL HERNIA REPAIR USING THE ROBOTIC PLATFORM

Aim Several meta-analyses indicated, that extraperitoneal mesh placement in the retromuscular or preperitoneal space shows advantages over intraperitoneal mesh placement. Previous surgical interventions which included extraperitoneal mesh placement were usually performed using open surgery. For several years now, our hospital has pursued to treat ventral hernias using a minimally invasive approach with extraperitoneal mesh placement. A Da Vinci X system has been available since the beginning of 2019. The aim of this analysis is to show the process of changing the operative procedure in ventral hernia repair over the period from 2016 to 2020. Material and Methods All hernia operations from 2016-2020 were evaluated using our hospitals information system. Every surgical intervention which included ventral hernia repair with the indication for mesh implantation was taken into the analysis. Results In 2016, the proportion of minimally invasive procedures was 36.67%. In all of these cases an intraperitoneal mesh was implanted in the abdominal cavity (laparoscopic IPOM operation). Open surgery was performed in 63.33%, out of which we implanted an intraperitoneal mesh in 23.68%, a retromuscular mesh in 73.68% and an onlay mesh in 2.63% of the cases. In 2020, the proportion of minimally invasive operations was already 87.5%, of which 83.33% were performed robotically assisted and 16.67% laparoscopically. In 94.29% of the minimally invasive operated patients an extraperitoneal mesh implantation was carried out, among which 75.76% were placed in the retromuscular and 24.24% in the preperitoneal position. Conclusions The majority of elective operations on ventral hernias can be performed in a minimally invasive technique with retromuscular mesh placement, using the robot.

P031 OPEN VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: A NATIONWIDE DATABASE STUDY

Aim Although laparoscopic repair of incisional hernias decreases the incidence of wound complications as compared with open repair, there has been a rising concern related to intraperitoneal mesh placement. The aim of this study was to examine outcomes after open or laparoscopic elective incisional hernia mesh repair on a nationwide basis. Material and Methods A merge of data between the Danish Hernia Database and the National Patient Registry provided data on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence from 2007-2018. Results A total of 3,090 (57.5%) and 2,288 (42.5%) patients were operated by laparoscopic and open approach, respectively. The defect was closed in 27.9% (865/3,090) of the laparoscopic cases. The median follow-up time was 4.0 (1.8-6.8) years. Rates of readmission (16.2%, 502/3,090) and re-operation for complication (7.0%, 216/3,090) were significantly lower for laparoscopic compared to open repairs (19.3%, 442/2,288, P = 0.003 and 12.5%, 288/2,288, P < 0.001). Re-operation for bowel obstruction or bowel resection was twice as high after laparoscopic repair (0.6%, 20/3,090) compared with open repair (0.3%, 6/2,288, P = 0.044). Patients were significantly less prone to undergo repair of recurrence following laparoscopic compared with open repair of defect widths 2-6 cm (P = 0.002). Conclusions Laparoscopic intraperitoneal mesh repair for incisional hernia should still be considered for fascial defects between 2 and 6 cm, because of decreased incidences of early complications and repair of hernia recurrence compared with open repair.

EP.TU.933Late enterocutaneous fistula formation after evisceration repair using intraperitoneal mesh

Introduction Intraperitoneal meshes pose a potential risk of complications, either due to the material itself or the method of fixation. Enteric fistulas are a rare but serious complication following the repair of an abdominal wall reconstruction using an intraperitoneal prosthesis. Case report We present a 59-year-old male patient, who underwent surgery 5 years previously for urothelial carcinoma with radical cystoprostatectomy and a Bricker-type urinary diversion, without subsequent radiotherapy. He presented an evisceration in the postoperative period treated with an inlay placement of an intraperitoneal mesh, without fascial closure. During these five years the wound did not present any complications, and spontaneous intestinal drainage began through the laparotomy. The physical exploration showed a 2cm hole in the abdominal infraumbilical midline, a wall defect of 20x20cm contained by mesh, no parastomal hernia, BMI 31.2 kg/m2. Thoraco-abdominal CT studies were completed that ruled out other pathologies, nasal culture and optimization were performed with parenteral nutrition and glycosylated hemoglobin control to achieve values below 6. The reconstruction of the abdominal wall was done with posterior component separation with transversus abdominis release, double mesh placement a BioA and PVDF mesh, with a final bridge measuring 8x5cm. The postoperative period was prolonged by an ileus, with an admission period of two weeks. Discussion Intraperitoneal meshes, some of which are no longer commercially available, represent a potential risk of complication. As long as we can optimize the patient for surgery, we will improve the results. Retromuscular repair with large mesh and PVDF material gives us good results.

Effectiveness of hybrid intraperitoneal mesh repair for paracolostomy hernia

Due to advances in medical science, the frequency of surgical interventions that once ended in end-stoma formation has decreased significantly. An ostomy is a life-saving surgery performed when there are no other options. Unfortunately, the number of patients with life-threatening conditions requiring colostomy or ileostomy is growing. A stoma in itself is a cause of social alienation; stoma-associated complications reduce the quality of life and debilitate the patient. The aim of this study was to assess the effectiveness of hybrid intraperitoneal mesh repair of paracolostomy hernia using a modified EUROQOL 5D-5L questionnaire. Sixty patients with paracolostomy hernias included in the study were divided in 2 groups (30 persons per group). The experimental group (10 (33%) men and 20 (67%) women) and the control group (11 (37%) men and 19 (63%) women) were comparable in terms of sex (р = 0.787) and age (66.5 (62.2; 72.0) years vs. 65.0 (61.25; 71.75) years, respectively; р = 0.246). Patients included in the control group underwent a classic Sugarbaker procedure; the experimental group underwent hybrid intraperitoneal mesh repair. The quality of life of the patients was evaluated before surgery and then 1 and 2 years after surgery using a modified EUROQOL 5D-5L questionnaire. Hybrid intraperitoneal mesh repair proved to be effective in the early and late postoperative periods. Based on the significant improvement of the patients’ quality of life after hybrid intraperitoneal mesh repair, we conclude that this technique is an effective surgical treatment for paracolostomy hernias.

Comparison between Dual Layer Intraperitoneal Mesh and Single Layer Mesh for Laparoscopic Ventral and Incisional Hernia Repair

BACKGROUND A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a variety of forms. The abdomen, specifically the groin, is most frequently involved. Incisional hernias and other ventral hernias are common surgical problems. A prosthetic mesh should always be used in ventral hernia repair (VHR). Now, the polypropylene mesh (PPM) has become the prosthetic mesh of choice in the repair of hernias, including inguinal hernia. Newer meshes are introduced, claiming lesser complication rate, but are invariably costlier than Polypropylene mesh (PPM) by 15 – 20 times. In this study we wanted to evaluate the outcomes of intraperitoneal monofilament and dual layer meshes in laparoscopic incisional and ventral hernia repair. METHODS This is a prospective observational study, with a minimum 30 cases for each type of mesh used. All those patients who had undergone ventral and incisional hernia laparoscopic repair at SRM General Hospital, Chennai between June 2018 and 2021 were included in the study. Data was entered in Microsoft excel for analysis, done by using SPSS software version 23. RESULTS Out of 86 hernias which were repaired laparoscopically, PPM was used in 34 (40 %) and composite meshes in 52 (60 %) cases. Out of 52 composite meshes, 11 cases (21.2 %) turned out with complications whereas out of 34 PPMs (11.8 %), 4 cases turned out with complications. CONCLUSIONS With the composite mesh, complications of intraperitoneal PPM (adhesions, inflammation, intestinal fistulisation, sinus formation, seroma and recurrence) may also occur. The difference between the meshes in the occurrence of these complications is not statistically important. KEY WORDS Hernia, Mesh, Surgery, Intraperitoneal Mesh, Laparoscopic Hernia Repair