Using Prophylactic Prolene Mesh to Reduce the Incidence of Incisional Hernia at the Site of Stoma Closure

Background Incisional hernias at stoma sites are not an infrequent problem, occurring in up to 30% of cases and it also varied in a range of studies from 0-48%. Objectives This is a prospective study to detect the feasibility of application of prolene mesh at the site of stoma closure in reducing the rate of post stomal incisional. INTRODUCTION Abdominal wall hernias are common and are a significant cause of morbidity. Stomas are commonly constructed following colorectal surgery to protect distal anastomosis or when sepsis prevents primary anastomosis. There is a risk of a wide range of morbidity following both stoma formation and stoma reversal (Chow et al., 2009). Incisional hernias at stoma sites are not an infrequent problem, occurring in up to 30% of cases and it also varied in a range of studies from 0-48% (Tilney et al., 2008). They occur over time and are generally under-reported, which may be due to the elderly nature of the population, the significant co-morbidities or early discharge from follow-up (Cingi et al., 2006). One in three patients may develop a hernia after stoma closure, and around half of hernias that are detected require repair.Risk of hernia is greater after colostomy closure than after ileostomy closure(Bhangu et al., 2012). A meta-analysis published in 2012 investigated the incidence of incisional hernia following closure of stoma, The overall mean incisional hernia rate following stoma closures was 7.4%. The authors reported a lower risk of hernia following reversal of ileostomy when compared to respectively (Bhangu et al., 2012). A further systematic review found a similar incidence for stoma site incisional hernias to be 8.3% (0–33.9%) (Nguyen et al., 2014). Two factors should be noted with regard to the incidence of stoma site hernia. Firstly, that the long-term risk is not known and secondly, that clinical examination alone is shown to have a lower detection rate of incisional hernia post stoma closure when compared to clinical imaging (Bhangu et al., 2012; Cingi et al., 2006). Therefore, studies focusing on only clinical examination may be underestimating the prevalence, as radiological detected herniae may become symptomatic over time and may be missed in studies with a short follow-up period. AIM OF THE WORK This is a prospective study to detect the feasibility of application of prolene mesh at the site of stoma closure in reducing the rate of post stomal incisional.

SP7.2.7 Consenting practice in open inguinal hernia mesh repair and compliance with the British Hernia Society Standards

Aims Inguinal hernia repairs (IHRs) are one of the most frequently performed procedures worldwide with approximately 100,000 taking place in the UK each year. This study analyses open IHR consent practice against British Hernia Society standards, in particular, whether the term ‘mesh’ and significant postoperative complications were stated on consent forms. We also identified whether adequate post operative advice was given upon discharge in order to prevent recurrence. Methods This was a retrospective audit of all patients above 18 years old, who underwent open IHR 1 January - 31st December 2019. A total of 94 patients were included. Results Although in all cases a prolene mesh was inserted, 8.5% of patients received no mention of mesh in either the clinic letter or consent form. Postoperative readmission was 5.3% at one week, and 8.5% at one month. Reasons for readmission included pain (1%), haematoma (2%), and wound dehiscence (1%). In over 90% of consent forms, non-specific complications (bleeding, infection) were documented. However, common IHR postoperative complications, such as chronic pain (not mentioned in 15%), were not mentioned in consent forms. Only 38% of patients received written postoperative advice. Conclusion Adherence to consenting standards benefits both patients and doctors. Our study highlights that further intervention is required to ensure surgeons are consenting patients adequately, as well as providing sufficient postoperative advice. We advise use of pre-filled forms and patient information leaflets, both in line with GMC guidance, to improve the quality of service offered.

Evaluation of Double Mesh Modification of Chevrel’s Technique in Management of Midline Incisional Hernia

Background: Chevrel’s technique provides tensionfree repair of midline incisional hernia, but wide skin and subcutaneous dissection increases rate of complications. Here, we evaluate the double mesh modification of Chevrel’s technique in midline incisional hernia repair. Methods: 22 patients with midline incisional hernia underwent double mesh modification of Chevrel’s technique. After excision of hernial sac with minimal dissection of the skin and subcutaneous tissue, the anterior rectus sheath is incised on both sides to create medial flaps that are sutured toeach other. Both recti abdominis muscles were dissected off the posterior rectus sheath, opening the retrorectus space. Prolene mesh was fixed in the retrorectus space with prolene sutures, and tailored to cover the bare area of anterior surface of both recti muscles and fixed to the lateral flaps of the anterior rectus sheath with interrupted prolene sutures. Results: We observed no recurrences, no skin necrosis, two cases of seroma, one case of superficial wound infection and one case of temporarychronic pain. Conclusion: Double mesh modification of Chevrel technique is an efficient method for treatment of midline incisional hernia, with minimal surgical site occurrences. Keywords: Chevrel technique, Double mesh technique, Midline incisional hernia

Improvement of results of surgical treatment of giant hernias of inguinofemoral region by choice of method of hernioplasty (clinical case)

Aim. Description of a clinical case pf patient K., 71 years old, as an illustration of the possibility to improve treatment of giant hernias in the inguinofemoral region. The patient was hospitalized with the diagnosis: bilateral giant irreducible inguinoscrotal hernia. The specificity of this case was implementation of the operation of hernioectomy from preperitoneal access with prosthetics of the posterior surface of the anterior abdominal wall with polypropylene (prolene) mesh on both sides. In a month after discharge from hospital the condition remained satisfactory, postoperative scar was normotrophic, testicles painless to palpation with a small amount of fluid in the dartos, skin of scrotum contracted. Conclusion. Hernioectomy from preperitoneal access with prosthetics of the posterior surface of the anterior abdominal wall with polypropylene (prolene) mesh in patients with giant, irreducible and recurrent hernias possesses a number of peculiarities in comparison with traditional methods, since it permits: 1) to fix endoprosthesis to permanent anatomical structures with simultaneous repair of all the defects of the transverse fascia; 2) to operate outside the zone of scar tissue in recurrent hernias; 3) to perform an adequate revision of the organs of the hernial sack in irreducible hernias; 4) to perform operations on patients with distinct comorbid pathology and contraindications to general anesthesia.

Endoscopic holmium laser fragmentation and retrieval of migrated intravesical prolene mesh

A 52-year-old man presented with lower urinary tract symptoms and intermittent haematuria for the last 6 months. He had undergone totally extraperitoneal right inguinal hernia repair a decade ago. The ultrasonography and an X-ray of the pelvis suggested a large radio-opaque shadow in the bladder. However, CT revealed an encrusted intravesical extension of the migrated mesh along the right anterolateral wall. The entire intravesical part of the migrated mesh with encrustations was successfully retrieved by endourological approach using holmium laser. The patient symptomatically improved and at follow-up, cystoscopy showed a complete re-epithelisation of the bladder mucosa. The intravesical extension of migrated mesh is a rare but challenging complication following mesh hernioplasty and can be successfully managed with a complete endoscopic approach.

Comparison between the composite heavy weight prolene mesh versus the prolene soft mesh for the reduction in post-operative pain in patients undergoing lichensteins mesh repair for inguinal hernias

Background: Globally, inguinal hernia is the most common type of hernia, comprising of approximately 75% of all abdominal wall hernias.Aim of the study was to compare the heavyweight composite polypropylene mesh versus the prolene soft mesh for the reduction of post-operative pain in patients undergoing lichensteins mesh repair for inguinal hernia.Methods: This study was conducted in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum attached to KLE University’s J.N.M.C Belgaum.Results: Male preponderance was seen with 96.67% of patients in group SP and all (100%) patients in group RP were males. The mean age in group SP was 51.93±18.73 years compared to 49.50±14.03 years in group RP (p=0.571). The mean duration of the disease was 12.67±9.85 months in group SP whereas in group RP it was 15.10±8.98 months (p=0.321). The mean pulse rate in group SP and RP (79.60±5.64 vs 82.37±5.46 /min; p=0.059), systolic blood pressure (120.33±9.99 vs 124.33±11.94 mmHg; p=0.165) and diastolic blood pressure (73.73±6.76 vs 75.80±8.59 mmHg; p=0.305) were comparable. Right position was noted in 56.67% of patients in group SP compared to 50% of patients in group RP (p=0.673).Conclusions: Prolene soft mesh (lightweight macro-porous polypropylene mesh) significantly reduced the post-operative pain in patients undergoing lichensteins mesh repair for inguinal hernia as compared to heavyweight composite polypropylene mesh.