P139 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR FOR SMALL AND MEDIUM PRIMARY UMBILICAL AND MIDLINE HERNIAS

Aim Complications of open mesh repair for primary umbilical and midline hernias (PUMH) may lead to significant re-admissions and follow-up costs. Although laparoscopic intraperitoneal onlay mesh repair reduces infection rates, especially in overweight patients, it’s controversial in these hernias, mainly due to potential adhesions’ formation. Laparoscopic transabdominal preperitoneal technique (lap-TAPP) may address these issues, as it combines advantages of both open and laparoscopic approaches. The aim of this study is to present the initial results of lap-TAPP for PUMH in regard to its feasibility and complication rates. Material and Methods We evaluated 25 consecutive cases of lap-TAPP repair for PUMH. Patients’s characteristics, intraoperative findings, and postoperative complications after 30-days follow-up were analyzed. Results 21 male and 4 female patients were included in analysis (mean BMI 29.8 kg/m2). Surgery time was 82 minutes (55-120). We found 20 umbilical and 11 epigastric linea alba hernias. Mesh size was 144cm2 (120-225); mean hernia defect width was 25mm (10-40). In 9 patients (36%) the peritoneal rents were created which were easily closed with sutures. All patients were discharged on 1 POD with no complications. After 30-days we found no recurrences or bulging, no pain complaints. We found one subcutaneous small hematoma with no need for intervention. Conclusions Laparoscopic TAPP for small and medium PUMH is a safe and feasible technique with low complication rate. However, this method is technically demanding and time consuming while performed with laparoscopic approach as it requires precise and subtle plane dissection, and non-ergonomic closure hernia defect.

P102 FEMORAL NERVE PALSY POST OPEN INGUINAL HERNIA REPAIR - CASE REPORT AND LITERATURE REVIEW

Aim and Introduction “Inguinal hernia repair is one of the most common surgical procedures performed worldwide. Postoperative pain control is very important and recently nerve block has gained popularity as an alternative to opioid use. Transient femoral nerve palsy (TNFP) is a potential complication of ilioinguinal nerve block, but it is extremely rare with only a few cases reported. We discuss a case of TNFP post-left inguinal hernia repair to highlight this rare complication.” Material and Methods “Case Report: A 17-year-old male with clinically and radiologically confirmed left inguinal hernia underwent open mesh repair (Lichtenstein repair). At the end of the procedure, he had ilioinguinal and iliohypogastric nerve block (10ml, 0.5% bupivacaine). In the recovery room, he developed numbness of his anteromedial aspect of his left thigh with weakness of hip flexion and paralysis of quadriceps with an inability to extend his knee. He was reviewed by the anaesthetic team and was admitted overnight. His symptoms resolved spontaneously within 18 hours. He was subsequently discharged and followed up in the surgical OPD 2 weeks, 6 weeks and 6 months later and there were no residual neurological symptoms.” Results and Conclusion “TNFP post open hernia repair is very rare. Mechanisms of femoral nerve injury include suturing, stapling, scar tissue entrapment or direct compression. Careful attention is needed to the technique of local anaesthesia post-operatively (avoid deep infiltration, lowest volume and concentration used, ultrasound use) to avoid potential morbidity if this complication is not recognised.”

Comparison between Laparoscopic and Open Repair of Umbilical and Paraumbilical Hernia: A Randomized Controlled Trial Study

Background: Laparoscopic repair of umbilical and paraumbilical hernia has largely replaced conventional (Open) repair. The purpose of the study was to compare the effectiveness of laparoscopic vs. open repair of umbilical & para umbilical hernia in a tertiary care government hospital. Methods: A total 50 patients of age >18 years diagnosed with umbilical and paraumbilical hernia who underwent laparoscopic and open hernia repair from May2018 to Nov 2020 were enrolled and divided into two groups of 25 patients in each. The patients were followed up in the post-operative period in the wards during daily rounds till the time of discharge; 1 and 6 months after discharge and yearly. Results: The mean age for open group was 44.24±7.68years while the mean age for laparoscopic group was 50.0±11.82years. Operative time was more in laparoscopic repair (81.68±18.37min) as compared to open (55.44±16.54min). Post-operative pain (VAS score) was greatest in the open group in comparison to lap group at 6 hr, 24 hr, day 8 and at 1month. Postoperative overall complication rate (Infection, seroma and recurrence) was 12% in the laparoscopic group and 28% in the open group. Recovery was faster with laparoscopic repair with a mean postoperative hospital stay of 3.28days as compared to 5.88days for open mesh repair. Patients treated with laparoscopic repair were early return to routine activity and work. Conclusion: The laparoscopic approach appears to be safe, effective and acceptable. It is a complex but very efficient method in experienced hands and it offered a significant advantage over open repair.

Outcomes of primary and recurrent inguinal hernia repair with prosthetic mesh in a single region over 15 years

Background Sutured inguinal hernia repairs are now uncommon, with evidence suggesting that those augmented with mesh are associated with a lower recurrence rate. We aimed to explore the suggestion that the established use of mesh does indeed lower the rate of operation for recurrence in a single National Health Service region. Method We collected retrospective Office of Population Censuses and Surveys coded data across one region of all primary and recurrent inguinal hernia repairs over 15 years (2004–2019). Electronic records of recurrent repairs were scrutinised to identify year and type of previous primary repair. Results In total, 7,234 repairs were performed during this time, of which 289 (4%) were for symptomatic recurrence. Operations for primary repair increased year on year (111 in 2004 to 402 in 2019). Frequency of operation for recurrent herniation declined with increasing use of mesh (8.8% in 2004 to 3.5% in 2019). The majority of repairs (73%) for recurrence were by an open approach. As opposed to an open mesh repair, a primary laparoscopic repair was associated with an earlier recurrence. Conclusions Inguinal hernia repairs are increasing in frequency but operations for later symptomatic recurrence following an open primary prosthetic mesh repair are not.

Platelet-Rich Fibrin-Mesh Technique for Inguinal Hernia Repair: Results of a Feasibility Pilot Study

Background: Open mesh repair is one of the most frequently performed general surgery operations worldwide. Unfortunately, the classic technique using stitches to fix the mesh is still associated with a high risk of chronic pain. We propose a new technique that uses autologous Platelet-Rich Fibrin (PRF) to fix the mesh. Methods: PRF is prepared in theatre by centrifugation of the patient’s own blood and immediately applied to fix the mesh. In this feasibility pilot study, five patients were operated upon with the PRF-mesh repair technique. Postoperative pain was evaluated with a visual analogue scale (VAS) up to 6 months after surgery. Time to recovery was also recorded for all patients. VAS in this small group of patients was grossly compared with that in a historical cohort of patients who underwent Lichtenstein repair; due to the small sample size, no statistical comparison was performed. Results: Postoperative pain remained at low levels and no patient experienced chronic pain, recurrence or any other complication within 6 months. All patients returned to their usual activities within 3 days after surgery. The VAS scores confirmed that PRF-mesh repair may be associated with less pain than the Lichtenstein technique. Conclusions: PRF-mesh repair is a safe and effective option in the treatment of inguinal hernias as it couples the safety of physiologically enhanced healing with the efficacy of prompt fixation of the mesh.

Inguinal abscess following Trans-abdominal Preperitoneal Mesh repair for inguinal hernia

Introduction: Laparoscopic hernia surgery is performed by almost every general and laparoscopic surgeon worldwide, Trans-abdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP) being the most frequently performed. Seroma formation leading to deep seated mesh infection with abscess is rare but once it occurs it can be very difficult to treat. The rate of mesh infection after open mesh repair is reported to be between 0.5% - 3%, whereas in laparoscopic repair is less than 0.16%. Seroma formation following TAPP is 3%-8% and following TEP is 0.5-12.2%. Case Report: A 19 years old male presented with groin swelling, fever and weight loss three months after the laparoscopic TAPP surgery for right inguinal hernia. Workup showed he had developed mesh infection with pre-peritoneal abscess which was managed with open drainage of the abscess with removal of the infected mesh. Conclusion: Seroma formation may result in abscess formation. If occurred removal of the mesh with drainage of abscess is often required. The chance of recurrence of hernia following management of infected mesh should always be considered

Comparative study in healing process and complications inpatient undergoing ventral hernia mesh repair with and without the usage of collagen granules

Background: Ventral hernias are the second most common type of hernias accounting for 21 to 35% of all types of hernias. Collagen is defined as an endogenous substance that forms an important structural component in connective tissue. Collagen granules have an advantage with a reduction in inflammatory cells during healing resulting in decreased days of healing. This study is to compare the outcome of a patient with and without collagen granules usage during ventral hernia open mesh repair.Methods: This prospective comparative study was done in 50 cases of ventral hernias admitted to the department of surgery in VMKV Medical College, Salem between periods of March 2018 to October 2019 were chosen for the study. The test group was treated with collagen granules and the control group was collagen granules not been used during ventral hernia mesh repair.Results: Most common surgical approach used in ventral hernia is open mesh repair. The study shows a group of patients where collagen granules are used after mesh fixation has faster wound healing, reduced seroma, and hematoma collection, and reduced hospital stay, reduced infection compared to the group of patients who undergone non-collagen closure. Conclusions: The study shows a group of patients where collagen granules are used after mesh fixation has faster wound healing, reduced seroma, and hematoma collection, and reduced hospital stay, reduced infection compared to the group of patients who underwent non-collagen closure.