P061 ANALYSIS OF THE IMPACT DERIVED FROM MORBIDITY IN THE INCISIONAL HERNIA SURGERY

Aim To analyse the repercussion derived from the morbidity that appeared after the repair of incisional hernias. Material and Methods Descriptive, retrospective and longitudinal study based on a prospective database of all incisional hernia operated patients of a university-level hospital in the period between 2013 and 2019. Anthropometric parameters, classification of the hernia according to the European Hernia Society guides and characteristics of the intervention performed were registered. Complications observed until the end of the follow-up and the final evolution are analysed. Results The sample is composed by 244 patients with a mean follow-up of 11 months. In 50% of the surgeries anterior separation of components was performed. In 240 patients, the mesh was placed in the following positions: 68.5% onlay, 13.5% retromuscular, 13% preperitoneal, 3.6% intraperitoneal and 1.3% inlay. During the first postoperative month, 63 patients (25.8%) presented some type of complication: seroma (47.6%), surgical wound infection (20.6%) and dehiscence (17.5%). 31 complications (49.2%) were classified as Clavien-Dindo III or greater severity. In 60% of patients with seroma the mesh was placed onlay. Of the 30 patients with seroma, 9 recurred over a mean of 16 months of follow-up (30%). Conclusions In our sample, the main cause of postoperative seroma is onlay placement of the mesh, and this complication may cause recurrence. We consider that it’s important to register our results to obtain a correct analysis and to prevent morbidity in the future.

O21 EVALUATION OF THE TREATMENT OF PARASTOMAL HERNIA IN THE NETHERLANDS: A NATIONAL SURVEY

Aim The incidence of a parastomal hernia (PSH) is approximately 40% two years after stoma construction and can even increase to 50% after a longer period. The European Hernia Society (EHS) published a guideline showing that the evidence for treatment of a PSH is of low quality. Due to the lack of evidence, a survey was conducted to provide insight into the Dutch approach. Material and Methods A survey was sent to 104 surgeons in the Netherlands representing their surgical department. The survey was developed by three hernia surgeons and a physiotherapist specialized in abdominal wall pathology. Results The survey was completed by 103 surgeons (99%) from 75 hospitals. 75% of the respondents perform a laparoscopic Sugarbaker for the treatment of PSH after colostomy, ileostomy or Bricker deviation. Most respondents (75%) replied that they never use a prophylactic mesh to prevent for the occurrence of PSH, although more than half of them do wish to introduce this. Conclusions Authors believe that the implementation of minimally invasive surgery and the systematic review performed by Hansson et al. in 2012, shifted the treatment strategy for PSH towards the use of a laparoscopic Sugarbaker. Nevertheless, little is known about the results of this treatment. Although there is a high level of evidence for the use of prophylactic mesh placement in reducing the incidence of PSH development, this has not been implemented in daily practice for colorectal and/or hernia surgeons. Authors aim for registration of PSH repair to evaluate the outcomes in terms of recurrence, pain and quality of life.

BARBED SUTURE FOR LAPAROTOMY CLOUSURE IN URGENCY PROCEDURES. RETROSPECTIVE ANALYSIS

INTRODUCTION Urgency surgeries are often performed in a stressful setting, out of hours and with critical patient involved. In this context, laparotomy closure can sometimes be deficient. Suture recommended by European Hernia Society is slowly absorbable monofilament continuous suture with a “small bites” technique. Barbed sutures appear as an alternative to conventional suture, frequently used in laparoscopic procedures due to its’ intrinsic maintenance of traction. The aim of this study is to describe the results in terms of short and mid-term rate of incisional hernia after urgency midline laparotomy, according to the suture utilized. MATERIAL AND METHODS A single-center retrospective cohort study was performed including patients with urgency midline laparotomy during 2018. Group A was represented by patients with slowly absorbable monofilament continuous suture. Group B included patients with barbed suture laparotomy closure. Main variables were hernia rates one month and one year after surgery, diagnosed by physical exploration and/or imaging. RESULTS A total of 68 of patients (36 on group A; 32 Group B) were included. On Group A, 13.9% (5) patients presented incisional hernia on the month follow-up, whereas none did on Group B. After a year, Group A only had 1 new case, but 12.5% of patients did herniate on group B; with no significantly relation with obesity neither underlying neoplasm. CONCLUSIONS Midline laparotomy closure must be performed within quality standards, as “small bites” technique with the ratio at least 4/1. Barbed suture appears as a promising closure option, especially in emergency procedures, but needs further study.

Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry

Purpose Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. Methods A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719). Results Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46%), abdominal compartment syndrome (20.5%), burst abdomen (11.3%), abdominal trauma (9%), and other conditions (13.2%). The overall definitive fascial closure rate was 57.5% in the intention-to-treat analysis and 71% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC. Conclusion The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure.

ФАКТОР ІНТРАБДОМІНАЛЬНОЇ ГІПЕРТЕНЗІЇ ПРИ ГЕРНІОПЛАСТИЦІ ВЕНТРАЛЬНИХ ГРИЖ

Обґрунтування. Сучасні методики реконструкції черевної стінки, що ґрунтуються на розрізах апоневрозів прямих і косих м'язів живота в поєднанні з використанням поліпропіленових ендопротезів дозволяють значно збільшувати залишковий обсяг черевної порожнини, але повністю не знімають питання необхідності контролю рівня внутрішньочеревного тиску. Матеріали. Проведено аналіз результатів лікування 35 хворих з післяопераційними вентральними грижами (ПВГ). Жінок було 22(62,9%), чоловіків -13(37,1%), середній вік становив 57,8±6,4 роки. Розміри грижових воріт за класифікацією European Hernia Society (2009) відповідали W2 8(22,9%), W3 -у 17(48,6%), W4- у 10(28,5%) пацієнтів. Результати. Всім виконана комбінована герніопластика з використанням місцевих тканин і сітчастих поліпропіленових ендопротезів з фіксацію onlay. Перед зшиванням країв грижового дефекту з метою профілактики абдомінального компартмент-синдрому визначався внутрішньочеревний тиск (ВТ) за Kron I.L. et al.,1984. Зшивання вважали допустимим при значенні ВТ не більше 150 мм вод. ст., що було можливим у 12 хворих (W2-W3). У 15 пацієнтів (W3-W4) при ВТ вище зазначеного рівня проводилося додаткове розсічення переднього листка піхви прямих м'язів живота. Рівень ВТ після операції не залежав від його вихідного рівня і виду операції і коливався в межах 132,5-129,5±5,1-6,2 мм вод.ст. З метою контролю ранового процесу проведено УЗД післяопераційної рани. Відмічалася гіпоехогенна смужка між зшитими апоневротичними листками, яка при не ускладненому перебігу набувала гіперехогенності, що свідчило про активний процес утворення рубцевої тканини і зменшення інфільтративних процесів в рані. Висновки. Дослідження показало, що інтраопераційний контроль ВТ при герніопластиці ПВГ знижає ризик розвитку абдомінального компартмент-синдрому.

The application of single-port laparoscopic percutaneous internal ring suture for the management of indirect inguinal hernia in female adults

As most of the female inguinal hernias are of indirect type, we conducted this retrospective study to evaluate whether the single port laparoscopic percutaneous internal ring suture is feasible for the management of indirect inguinal hernia in female adults. From April 2016 to August 2019, there were 31 female adults who were diagnosed with inguinal hernias and received laparoscopic inspection at our surgical department. One patient who was finally diagnosed as an encysted hydrocele was excluded from the statistic study. All the 30 cases were of indirect type with a total of 35 single port laparoscopic percutaneous internal ring sutures performed. The median age was 38 years (range 20–88 years). The number and percentage of patients with right, left and bilateral hernias were 17 (56%), 11 (37%) and 2 (7%) respectively. Three contralateral patent processi vaginalium and 1 occult femoral hernia were found during operation. The percentages of the respective classifications according to the European Hernia Society system for the 35 PIRSs were L1: 40%, L2: 49%, and L3: 11%. The average operation time was 18 min for unilateral and 30 min for bilateral hernias. There were 1 recurrence and 1 chronic postoperative inguinal pain. Both had their symptoms and signs resolved after reoperation. The mean follow-up period was 13.6 months. We concluded that the single-port laparoscopic percutaneous internal ring suture is feasible for the management of indirect inguinal hernia in female adults.