Strength of SIFCON- Ferrocement One-Way Ribbed Slabs Contain Steel Fibers

Slurry infiltrated fiber concrete” composites (SIFCON) are a novel type of concrete with improved strength, ductility, and crack resistance. In this study, infiltrating fibers (SIFCON) were used to reinforce of specimens of ferrocement one way ribbed slabs. The laboratory work consists of cast and testing of eight specimens with dimensions of 750 mm in length, 500 mm in width and 50 mm in depth. These samples have the same wire mesh reinforcement and the same shape as the ferrocement slabs. Two reference ferrocement slab without ribs contains SIFCON and six ferrocement slabs with ribs contains SIFCON. The variables were the volumetric ratio of fibers in the ribs, which were (2, 4 and 6)% and type of steel fiber (hook-end and hybrid fiber). Hybrid fibers contain two type of steel fiber (hook-end and micro steel fiber) with equal ratio. All samples were tested under line load up to failure with mid deflections for each test with simple supported. The results of the test showed that the presence of steel fibers in the ferrocement ribs, for both types of steel fibers, improves the resistance to the final loads and the ability to reduce deflection and increases the ductility and stiffness significantly.

Management of the Crura During Laparoscopic Sleeve Gastrectomy

Despite the increasing number of bariatric procedures being performed, the optimal strategy for managing the crura during laparoscopic sleeve gastrectomy (LSG) remains controversial. Options include no closure, primary suture closure, and suture closure with mesh reinforcement. We sought to investigate outcomes associated with each technique and determine if any approach proved to be superior. Methods This is a retrospective cohort study that evaluated patients undergoing LSG performed by a single surgeon in a 7-year period. Data were collected via chart review. The primary endpoint was hiatal hernia presence at 5 years post-operatively. Secondary endpoints included post-procedural complications (nausea, vomiting, dysphagia, or reflux) at 30 days post-operatively. Results A total of 361 patients were included in the analysis: 154 without crural closure, 164 primary crural closure, and 43 primary crural closure with mesh reinforcement. Rates of hiatal hernia occurrence at 5 years were 9.7% (no closure), 14.0% (primary closure), and 16.3% (closure with mesh reinforcement), respectively, and did not differ significantly among the 3 cohorts (P = .37). Overall rates of 30-day complications were 11.5%, 21.5%, and 28.6%, respectively ( P = .015). Conclusion Rates of hiatal hernia after sleeve gastrectomy do not differ, regardless of management of the crura. In addition, and perhaps more significantly, avoidance of crural closure was associated with fewer 30-day complications. In fact, the highest rate of 30-day complications was seen in the group that received closure with mesh reinforcement. These data suggest that crural closure during LSG should be avoided. Further prospective study of these findings is warranted.

O26 INFECTIOUS COMPLICATION IN RELATION TO THE PROPHYLACTIC MESH POSITION: THE PRIMA TRIAL REVISITED

Aim Prophylactic mesh reinforcement has proven to reduce the incidence of incisional hernia (IH). Fear of infectious complications may withhold the widespread implementation of prophylactic mesh reinforcement, particularly in the onlay position. Material and Methods Patients scheduled for elective midline surgery were randomly assigned to a suture closure group, onlay mesh group, or sublay mesh group. The incidence, treatment, and outcomes of patients with infectious complications were assessed through examining the adverse event forms. Data were collected prospectively for 2 years after the index procedure. Results Overall, infectious complications occurred in 14/107 (13.3%) patients in the suture group and in 52/373 (13.9%) patients with prophylactic mesh reinforcement (p = 0.821). Infectious complications occurred in 17.6% of the onlay group and 10.3% of the sublay group (p = 0.042). Excluding anastomotic leakage as a cause, these incidences were 16% (onlay) and 9.7% (sublay), p = 0.073. The mesh could remain in-situ in 40/52 (77%) patients with an infectious complication. The 2-year IH incidence after onlay mesh reinforcement was 10 in 33 (30.3%) with infectious complications and 15 in 140 (9.7%) without infectious complications (p = 0.003). This difference was not statistically significant for the sublay group. Conclusions Prophylactic mesh placement was not associated with increased incidence, severity, or need for invasive treatment of infectious complications compared with suture closure. Patients with onlay mesh reinforcement and an infectious complication had a significantly higher risk of developing an incisional hernia, compared with those in the sublay group.

O32 TREATMENT OF FASCIAL DEHISCENCE IS IMPROVED BY MESH REINFORCEMENT

Aim In 2014 fascial dehiscence (FD) was treated with re-suturing the fascia as the only measure in half of the cases at our institution, with discouraging re-rupture and incisional hernia (IH) rates. A changing path away from fascia closure (FC) by re-suturing solely towards reinforcement of the closed fascia is now evaluated. Material and Methods Retrospective chart review of consecutive patients operated for FD 2016-2020. Available CT scans were scrutinized for IH. Results 58 patients (14 women) with a mean age of 71 years and a mean BMI of 27.3 were treated with: FC by re-suturing as the only measure (n = 1, 1.7%); FC preceded by a reinforced tension line (RTL) suture (n = 9, 15.5%); FC and on-lay mesh reinforcement (n = 23, 39.7%); retromuscular mesh closure (n = 10, 17.2%); open abdomen treatment with retromuscular mesh reconstruction (n = 1, 1.7%); and, open abdomen treatment with vacuum assisted wound closure and permanent on-lay mesh-mediated fascial traction (VAWCPOM) (n = 14, 24.1%). One patient in the RTL-group suffered a re-rupture (1.7%). The in-hospital mortality was 5%. Wound healing problems were seen in 29 (51.9%) patients. IH was evaluable in 49 patients with a total incidence of 22.4% at mean follow-up of 21 months. The hernia incidence for mesh reinforced or reconstructed patients was 17.5% compared to 44.4% in re-sutured or RTL patients. Conclusions FD treatment with mesh reinforced FC prevented re-rupture and resulted in a lower rate of IH. Additional standardization and refining the mesh techniques may further improve results.

A new reinforcement method for the conservation of fragile, double-sided, printed paper cultural relics

Paper cultural relics such as double-sided printed newspapers and periodicals represent modern cultural heritage. Severe damage such as embrittlement, decay, and dreg generally occur to paper; hence, it urgently needs conservation and restoration. Therefore, herein, a new reinforcement method for the fragile double-sided printed paper cultural relics is proposed with cotton mesh and adhesive PVA217 as reinforcement materials. Using a computer measured and controlled folding endurance tester, a pendulum tensile strength tester, pH meter, pulp viscosimeter, and other instruments, the physical properties of newspaper samples before and after aging were evaluated. In addition, the mechanical properties, chromatic aberration and surface morphology of simulated samples before and after the cotton mesh reinforcement and Japanese washi paper reinforcement were assessed. The experimental results indicate that this new reinforcement method could effectively improve the physical strength, chromatic aberration and durability of the simulated samples. Widespread applications of this cotton mesh reinforcement method for the reinforcement and protection of the red revolutionary cultural relics such as double-sided printed newspaper and periodicals during the Republic of China era are foreseeable.

The Outcome of the Combined Procedure of Abdominoplasty and Repair of Umbilical Hernia

Background Umbilical hernias (UH) are common in patients seeking abdominal contouring surgery and the question of simultaneous abdominoplasty and UH repair is raised. This presents, however, a risk to the umbilicus vascularization with possible umbilical necrosis. As a result, the umbilicus maintains its only blood supply from the underlying fascial attachments via the umbilical stalk. Abdominoplasty in the setting of a hernia repair can improve patients satisfaction, particularly appearance, hygiene, self-confidence and decrease the incidence of recurrence. Objective To assess the outcome of the combined procedure of abdominoplasty and repair of umbilical hernia. Patients and Methods This study Included 26 patients (18 females and 8 males) who were selected from those who presented to the department of general surgery at EL Demerdash University Hospital and Nasr city insurance hospital during the period between april2019 and october 2019. All patients had a physical examination of the UH and diastasis. Divided into two groups, each group formed of 13 patients. First group (group A) with patients underwent herniorrphy alone and the other group (group B) with patients underwent hernioplasty with combined abdominoplasty. Results It may be concluded that (1) during an abdominoplasty, midline fascial plication and ventral hernia repair can be performed in defects <3 cm without mesh reinforcement with no increase in hernia recurrence rates, (2) in patients with defects > 3 cm, mesh reinforcement is indicated after suture hernia repair and midline plication,, yields lower recurrence of abdominal deformity and less refashioning procedures with minimal complications. Conclusion Finally, it may help to reduce the incidence of recurrence by enabling removal of a large pannus and the resultant weight on the anterior abdominal wall, though this has not been proven. Also it improves the quality of life and obtains patients satisfaction with this approach.

DETERMINATION OF THE FAILURE MODE AND BEARING CAPACITY OF CONCRETE COLUMNS WITH MESH REINFORCEMENT

Paper deals with the results of experimental test of reinforced concrete columns withmesh reinforcement. Experimental investigations of columns were performed using hydraulic presswith a maximum load level of 480 tones. On the basis of previous theoretical research three series ofexperimental samples which are represented with simply concrete columns (BS-0), concrete columnsin mesh holder (BS-P) and concrete columns in mesh holder with additional reinforcement rings (BSPS)were produced. The height of all samples is 1000mm and the diameter is 450mm. There threeschemes of experimental tests were considered: static loading using press’ plates (I), monocycle (II)and static (III) loading using additional round steel plates. The results of tests were obtained in theform of failure mode and breaking forces for three series of samples. According to the results of testsover the first scheme, it is obtained that the destruction of columns with mesh reinforcement goesmore slowly than concrete columns. The appearance of cracks started at the level of loading equalto 100 tones for BS-0 samples and 200-250 tones – for BS- and BS-PS samples. The level of breakingforces for BS-P samples and for BS-PS samples is 18-26 % and 21-28 % higher than for BS-0 samplesrespectively. After monocycle loading it is obtained that breaking forces for BS-P and BS-PS samplesare 5 % and 23 % higher than BS-0 samples. It is noted that cracking processes for all samplesstarted near the moment of total destruction, so the failure of samples was brittle and sharp.According to the third scheme of loading the difference between breaking forces for BS-0 and BS-Psamples is about 5 %, BS-0 and BS-PS is 7 %. Failure mode for third scheme is similar to secondscheme, but it is also mentioned multistage destruction of columns when after achieving the level ofbreaking force level of loading falls and increases several times. It is recommended to apply loadover whole cross section of column in real structures, because it plays a significant role in increasingof bearing capacity. The results of experimental tests were compared with results of numericalanalysis, which showed qualitative and quantitative coincidence.

337 MESH REINFORCEMENT OF THE HIATOPLASTY. PROTECTING THE ACHILLES' HEEL

Disruption of hiatoplasty is one of the main causes of anti reflux surgeries failure. There are some conditions that are associated with higher risks of disruption, leading to hernia recurrence. Bioabsorbable meshes have a safer profile compared to the permanent ones and we show in this video its use aiming to prevent early and possibly, late recurrence. Methods We present a video about different indications for reinforcement of hiatal closure with bioabsorbable mesh. With the security of bioabsorbable materials and previous experiences with these kind of meshes used in an U configuration, we are suggesting that it can be used as an inverted C over the posterior and anterior sutures placed to close the hiatal defect. The mesh is cut during the surgery to better accommodate as an onlay protection. It can be fixed to the diaphragm in different ways, but we used fibrin glue in this series. Results Sixteen patients were operated with this technique. The long term results are not available at this point, but short term results are very encouraging. We have noticed a slightly higher complaint of dysphagia among these patient compared to what we use to observe in our non-mesh patients, but dilatation was not necessary in any patient. Conclusion The use of bioabsorbable mesh in the hiatus is safe and can be used with more frequently to prevent hiatal recurrences in specific groups of patients. Video https://www.dropbox.com/s/jsblif0pfjcuicu/BIOMESH.mov?dl=0.

A Polymer-Biologic Hybrid Hernia Construct: Review of Data and Early Experiences

Surgical mesh reinforcement of the human abdominal wall has been found to reduce the chance of recurrence in hernia repairs. While traditionally polymer meshes have been used in hernia repair, alternative mesh options have been engineered to prevent the inflammatory foreign body response invoked by polymers. A reinforced tissue matrix (RTM) mesh has been developed by embedding a polymer within a decellularized extracellular matrix. This combination has been attributed to the recruitment of host cells, a pro-healing response, and attenuation of the foreign body response. This has been observed to lead to the regeneration of functional tissue within the repair site that is reinforced by the polymer to offload abdominal pressures over time. This manuscript presents the review of OviTex, an RTM, in several types of hernia repair. The authors have found that the use of RTM in hernia repair is effective in preventing foreign body response, promoting wound healing, and providing reinforcement to lower the risk of hernia recurrence.

Long-term follow-up of prophylactic mesh reinforcement after emergency laparotomy. A retrospective controlled study

Background Prevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies. Methods This study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared. Results From an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62 vs. 43.2%; P = 0.01) and operation due to a revision laparotomy (32.5 vs.13%; P = 0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P = 0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR = 2.47; 95% CI 1.318–4.624; P = 0.05), contaminated surgery (HR = 2.98; 95% CI 1.142–7.8; P = 0.02), surgical site infection (SSI; HR = 3.83; 95% CI 1.86–7.86; P = 0.001), and no use of prophylactic mesh (HR = 5.09; 95% CI 2.1–12.2; P = 0.001). Conclusion Incidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and surgical site infection (SSI) benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate. Trial registration: NCT04578561. www.clinicaltrials.gov