Comparison of prolene with parietex composite® mesh in laparoscopic intraperitoneal mesh hernioplasty for paraumbilical hernia.

Objective: To compare the outcomes of prolene macroporous mesh with Parietex Composite® mesh in patients undergoing Laparoscopic hernioplasty for management of Paraumbilical hernia. Study Design: Prospective Comparative study. Setting: Jinnah Hospital Lahore. Period: 1st January 2016 to 1st January 2018. Material & Methods: A total of 100 patients with diagnosis of Paraumbilical hernia, aged >18 years were included. There were two groups. In group A (n=50) prolene macroporous mesh (Covidien) was placed. In group B (n=50) Parietex Composite® mesh (Covidien) was placed. After hernioplasty all patients were followed for a period of 2 years for evaluation of primary procedure and any complications like seroma, hematoma and intestinal obstruction. Results: The mean length of stay was 2.74±2.13 days in group A, versus 2.23±1.25 in group B (p-value 0.15). Seroma formation was seen in 4 (8.0%) patients in group A versus in 02 (4.0%) patients in group B (p-value 0.40). Hematoma formation was seen in 01 (2.0%) patients in group A versus 0.0% patients in group B (p-value 0.10). There was no recurrence and intestinal obstruction in any group in two years follow up. Conclusion: There was no difference in surgical outcome and the complication between two groups of patients undergoing laparoscopic Paraumbilical hernia repair with prolene macroporous and Parietex Composite mesh. Moreover, parietex composite mesh are difficult to insert and much expensive. Therefore, prolene mesh can be safely used in patients undergoing Laparoscopic Paraumbilical hernioplasty.

P072 ARTICULATED LAPAROSCOPIC INSTRUMENTS. BENEFITS ON LAPAROSCOPIC HERNIOPLASTY

Aim To present initial experience using 5 mm articulated laparoscopic instruments in tapp laparoscopic hernioplasty that emulated the benefits attributed to robotic surgery. Material and Methods We report data from the first 42 procedures using 5 mm articulating instruments. A retrospective analysis was performed in patients who underwent tapp laparoscopic hernioplasty using novel articulated graspers, needle holders, and scissors. The surgeons and surgical nurses were trained in the handling and operation of the articulating instruments, before the first surgical procedure. In all cases, articulating instruments were inserted through 5 mm trocars. Data collected included patient demographics, details related to the surgical procedure, postoperative outcomes, and complications. Results Over a period of one month, were repaired 78 inguinal hernias. 36 patients had a bilateral hernia, and the mean age was 45 years (SD 15.1), with a mean BMI of 28.6 (SD 6.1). 32 male and 4 female patients. The mean operative time was 90 min. The articulated head of the clamp allowed traction, dissection, and suture in different directions. In addition, was not detected a significant learning curve due to its intuitive applicability. Surgical complications included two serohematomas. All patients discharge during operation day. The procedures performing without intraoperative complications nor conversion to open surgery occurred. Conclusions The use of an articulated instrument has a promising future. It would meet some benefits of robotics without increasing costs. We need randomized comparative studies for a better conclusion.

Transperitoneal hernioplasty in a patient with severe hemophilia A on preventive treatment with emicizumab

Performance of surgical interventions in patients with severe hemophilia A on emicizumab requires the development of a protocol for the perioperative period management. Objective. To present the first experience of laparoscopic hernioplasty, hemostatic therapy and laboratory monitoring in a patient with severe hemophilia A on emicizumab. A transperitoneal hernioplasty was performed in a 31-year-old patient with severe hemophilia A on emicizumab. The patient received hemostatic therapy with recombinant FVIII for 5 days. Laboratory parameters (detection of FVIII via chromogenic and clotting methods, thromboelastography, determination of aPTT and FVII inhibitor titer) were monitored for 8 days. For a complete postoperative hemostasis, a significantly smaller amount of FVIII concentrate was required due to the lower frequency of administrations compared to similar surgical interventions in patients with severe hemophilia A who did not receive prophylactic therapy with emicizumab. According to thromboelastrography data, not a single episode of hypercoagulation was recorded. Emicizumab monotherapy can maintain adequate hemostasis during surgical procedures associated with a potentially low risk of perioperative bleeding in patients with hemophilia A. In other situations, the use of standard doses of FVIII concentrate concomitantly with emicizumab makes it possible to control hemostasis during postoperative period without the risk of thrombotic complications. The patient has signed a consent to the use of information, including photos, for research purposes and in publications.

COMPARATIVE STUDY BETWEEN OPEN AND LAPAROSCOPIC HERNIOPLASTY IN PARA UMBILICAL HERNIA.

In this modern surgery era, laparoscopic surgery has gained paramount importance due to its minimally invasive technique, decreased hospital stay, and better cosmesis. Hence the emphasis is on reducing hospital stay and postoperative morbidity with matter to cosmesis. Even though 1 laparoscopic repair has become more popular for long-term outcomes, it needs further evaluation . The present study compares the paraumbilical 2,3 hernia repair in adults by an open and laparoscopic method in view of hospital stay, postoperative complications, and return to normal activities

Efficiency assessment of laparoscopic vs open alloplasty for incisional ventral hernias

Materials and methods. During the period from 2009 to 2020 in the clinic of the Department of Surgery and Proctology of the Shupyk National Healthcare University of Ukraine, the surgical treatment of 217 patients with IVH was analysed.The choice of laparoscopic hernioplasty or open allohernioplasty was made taking into account the size of the abdominal wall defect and the width of the rectus diastasis. By intraoperatively conducting a study during a surgery for IVH with an abdominal rectus diastasis involving approximation of the rectus muscles and measurement of IAP, it was found that with an abdominal rectus diastasis measuring up to 5 cm IAP increases to 5.6 ± 1.3 mm Hg and the abdominal wall defect is closed without an undue tension of the supporting tissues.Depending on the method of surgical treatment, patients were divided into 2 groups.In group I, 109 (21.5%) patients with small and medium-sized IVH with a diastasis of up to 5 cm underwent laparoscopic allohernioplasty, in particular, 63 patients underwent laparoscopic preperitoneal alloplasty and 46 underwent laparoscopic retromuscular alloplasty.Conclusions. For small and medium-sized IVH with an abdominal rectus diastasis of up to 5 cm, laparoscopic allohernioplasty with preperitoneal and retromuscular placement of the mesh implant and elimination of the diastasis is optimal. In comparison with open retromuscular allohernioplasty, it contributes to a significant reduction in the incidence of seroma (from 35.2% to 3.7%), postoperative wound suppuration (from 6.5% to 0%), inflammatory infiltrate (from 4.6% to 0%), chronic postoperative pain (from 6.4% to 2.6%), and recurrence of hernia (from 6.4% to 0%).

Hernioplasty with Laparoscopy Mesh Application in Equine with Incisional Hernia

Background: Incisional hernia in the midline can be a consequence of abdominal surgeries, which incidence is around 5.7-18%. Surgical indication occurs in cases of large hernias, and the most common techniques used involve the closing of the musculature in a primary way, with sutures, and the implantation of a mesh on the abdominal wall. Laparoscopic hernioplasty emerged as a less invasive option, showing superiority when compared with open surgical techniques in human medicine, however there are few reports describing this technique in equines. So, the aim of this paper is to report a case of hernioplasty, using laparoscopic mesh, in a horse with midline incisional hernia.Case: A 13-year-old castrated male Brasileiro de Hipismo horse, weighing 415 kg, practitioner of classic equestrian, presented an incisional hernia after 14 days from an exploratory laparotomy surgery realized to treat colic syndrome. After 6 months, the patient was referred to a Veterinary Medicine Teaching Hospital for the correction of the defect in the abdominal wall. During palpation, the animal did not present local pain or other sign of inflammation, and the hernia measured approximately 20 cm in diameter. The animal was submitted to general anesthesia and placed in dorsal decubitus for the hernioplasty surgical procedure. An incision was made in cranial region of the midline, close to the xiphoid to introduce a single port; the abdomen was inflated with CO2 gas (12 mmHg) and the operating table was tilted in order to displace the organs cranially, facilitating the laparoscopic procedure. The abdomen was inspected and the presence of a single adherence could be observed, which was disrupted with endoscopic forceps. The mesh was introduced through the single port incision and anchored to the musculature, using polypropylene 2 following the marking points previously performed on the implant, covering the defect in the abdominal musculature. In the postoperative period, analgesia was instituted with non-steroidal anti-inflammatory drugs, antibiotic therapy with intravenous benzylpenicillin potassium+gentamicin sulfate, and daily dressings. The animal showed pain responsive to the instituted analgesia in the first 24-72 h after surgery. The discharge was established after 18 days of hospitalization with the recommendation of daily dressings and use of compressive bandage until the complete healing of the wound. Postoperative complications resulting from the laparoscopic hernioplasty technique was not observed in this case.The hernia reduction was satisfactory, with a good aesthetic result after five months, when the animal resumed its athletic activities.Discussion: Laparoscopy hernioplasty is poorly described in equine medicine, and there are no reports of this procedure performed in Brazil, however, it is widely used in human medicine with results superior to open hernioplasty techniques. In the present case and in others reported in the literature, the laparoscopic technique proved to be effective in reducing incisional hernias in horses. The animals had good regression of the hernia sac and the aesthetic result was satisfactory, with few post-surgical complications. In studies in which the open hernioplasty technique was used, there was a higher occurrence of complications, in addition to more intense pain resulting from the procedure and later return to athletic activity, demonstrating that the minimally invasive technique by video surgery can be advantageous.

Effectiveness of the concept of fast-trak surgery for simultaneous laparoscopic hernioplastics and cholecistectomy

The aim of the research was to study the feasibility and effectiveness of simultaneous laparoscopic hernioplasty and cholecystectomy in patients with combined abdominal pathology. Material and methods. Simultaneous laparoscopic hernioplasty and cholecystectomy during 2015–2019 performed on 70 patients, including 49 (70 %) women, mean age 57.3 ± 6.5 g. In 37 patients the principles of Fast-track surgery were applied (group I), including thorough examination for diagnostics of combined abdominal pathology and clinically significant general somatic pathology; if necessary a course of therapy for full compensation of general somatic pathology was prescribed; during the operation of epidural prolonged anesthesia; choice in favor of laparoscopic technology; at the end of the operation – irrigation of the subdiaphragmatic space with local anesthetic; postoperatively: early drainage removal; withdrawal from opioids by prescribing parenteral paracetomol; activation of the patient 6-8 hours after surgery; on the day of surgery – use of chewing gum and fluid intake. In 33 patients the standard complex of perioperative management (group II) is applied. The immediate results of surgical interventions have been studied. Results. There were no significant complications during the operation and in the early postoperative period. In the first group, seroma (after open alloplasty) was detected in 2 (5 %) cases, and in the second group, small wound complications were detected in 4 (12 %) cases (p > 0.05 according to the χ2 criterion). The duration of inpatient treatment in patients of group I is 4.4 ± 1.2 months, in group II – 7.0 ± 1.3 days (р < 0.001 by Student’s test). Conclusion. Application of the principles of Fast-track surgery and accelerated recovery at all stages of simultaneous laparoscopic hernioplasty and cholecystectomy (preparation for surgery, during the operation and in the postoperative period) does not increase the number of postoperative complications and decreased duration of inpatient treatment from 7,0 ± 1,3 in patients with traditional postoperative management to 4,4 ± 1,2 days.

Features of laparoscopic hernioplasty of paracolostomy hernias in patients with combined abdominal pathology

Annotation. The aim of the study is to study the technological features and results of simultaneous laparoscopic hernioplasty of paracolostomy hernias in the presence of combined abdominal pathology. We analyzed the results of surgical treatment of 11 patients with paracolostomy hernias who were treated in the surgical department of the Municipal non-commercial enterprise of the Kharkov regional council “Regional Clinical Hospital” from 2016 to 2020, of whom – women – 4 (36%), men – 7 (64%), aged from 42 to 69 years old. Clinical, anamnestical and instrumental data for the prolongation of cancer were not identified in all patients. Out of 11 patients, in addition to paracolostomy hernia, 3 (27%) had inguinal hernias, 8 (73%) had postoperative ventral hernias. 3 (27%) patients with hernias also had cholecystolithiasis. All patients underwent laparoscopic hernioalloplasty of paracolostomy hernia. 3 patients underwent simultaneous TAPP for inguinal hernias, and 1 patient underwent laparoscopic cholecystectomy and TAPP. 6 patients with incisional ventral hernias underwent simultaneous IPOM according to the standard method, and 2 – according to the own method. Of the above, 2 patients suffering from cholecystolithiasis, in addition to hernioalloplasty, underwent laparoscopic cholecystectomy. In 4 (36%) patients, viscerolysis was additionally performed due to the presence of an adhesive process in the abdominal cavity. Simultaneous hernioalloplasty TAPP and IPOM, as well as laparoscopic cholecystectomy, had no significant effect on the development of complications and the duration of hospitalization. The average length of inpatient treatment was 9.2 bed-days. The study proves the expediency of widespread simultaneous surgical interventions for hernias of the anterior abdominal wall, as well as the preference for laparoscopic techniques.