The primary lumbar hernia with multiple defects: a rare case

Lumbar hernia is a rare entity of abdominal wall hernia. Due to varied presentation it poses a challenge in diagnosis and management to attending surgeon. The requirement of preoperative imaging and clinical examination has indispensable role in the diagnosis and surgical (open or laparoscopic) approach is the only treatment option. We are presenting a case of 44 year old male, diagnosed as lumbar hernia with multiple defects and successfully managed by laparoscopic mesh hernioplasty. The primary lumbar hernia is a rare entity that a surgeon may encounter once in his lifetime making it an interesting surgical challenge. The adequate knowledge of preoperative imaging and anatomy are indispensable. With advances in minimally invasive surgery, it can be applied to patients with lumbar hernia and management requires a more tailored approach. This condition can be managed by laparoscopic approach successfully.

FACTORES DE RIESGO ASOCIADOS A RECIDIVA EN PACIENTES CON ANTECEDENTE DE PLASTIA DE HERNIA INCISIONAL EN CENTRO MEDICO NAVAL

Incisional hernia repairisone of themostfrequentsurgicalprocedures in General Surgerydue to thehighprevalence of thispathology Thesurgicaltechniqueinvolvesthe use ornot of prostheticmesh, depending onthesurgeon, however, anothercommonproblemistherecurrence of the hernia after a plasty, due to multiplefactorsthatwerestudied in thisresearch, beingnecessary to haveknownthefollow-up of thesepatients in theirpostoperativeperiod and whatcommoncharacteristicstheypresentedthatconditionedthepatients to presentthesepostoperativecomplications and evensurgicalreoperations. Itiswidelydemonstratedthattherecurrence of incisional hernia plastyis a conditionthat can be prevented, knowingtheconditioningriskfactors. Itisimperative to knowtheway in whichpatientshavebeenapproached, theirfollow-up and theirtherapy, determine whichriskfactorswererelevantaccording to thepathology to be studied and thusproposeanalternativesolution, thusreducingmorbidity and mortality. In ourpatients, thesurgicalreoperationsthatnotonlyaffectthequality of life of thepatientsbutalsothegreaterconsumption of material and economicresources in theInstitution. Objective: to determine themostfrequentriskfactorsassociatedwithrecurrence in patientswith a history of incisional hernia plasty at the Naval Medical Center. Material And Methods: 48 electronic records of patientswith a history of abdominal wall hernia plastywereanalyzed. Descriptive and inferentialanalysiswascarriedout in order to associateriskfactorswithrecurrence of incisional hernia. Results: No statisticallysignificantresultswerefoundfortheassociation of obesity, surgicalsiteinfection and smoking withrecurrence of incisional hernia. However, in oursampleobesitywaspresent in 54% of thepatients and 25% overweight. Conclusions: In Naval Medical Center, therate of patientswithincisional hernia plastyislimited, however, overweight andobesityis a characteristicthatourpopulationpresents in common and thatclearly determines multiplecomplications, such as recurrence in this case, requiring a narrowapproach to thiscondition.

P059 QUALITY OF LIFE IN COMPLEX ABDOMINAL WALL HERNIA PATIENTS

Aim determine themes reported as important to Quality of Life (QoL) in Complex Abdominal Wall Hernia (CAWH) patients Material and Methods 15 purposively sampled CAWH patients were interviewed using topic guides (8 men and 7 women aged between 36 to 85 years [median = 65 years] covering all VHWG grades). All verbatim transcripts were coded and analysed using NVIVO12 software and Interpretative Phenomenological Analysis (IPA) until thematic saturation. Results 3 overarching groupings and 5 superordinate themes were identified. Each superordinate theme is associated with several subordinate themes: Conclusions This is the first phenomenological qualitative study in CAWH patients. The themes presented are interrelated and should shape our understanding of QoL in CAWH. Current QoL tools do not incorporate all aspects identified by this study. Further research is needed in order to generate a standardised CAWH QoL instrument which incorporates bio-psycho-emotional-social processes important to patients as identified by patients.

OV18 ENDOSCOPIC RETRO-MUSCULAR REPAIR OF PARASTOMAL HERNIA - A TANTALIZING NEW TECHNIQUE

Development of retro muscular space with transversus abdominis release has reached maturity in endoscopic surgery. Next-level reconstruction is adaptation to parastomal hernia repair alone or in conjunction with another abdominal wall hernia repair. We aim to present this extraperitoneal modified mesh technique based on the Sugarbaker principle with video demonstration and share clinical data and results from twenty-four patients operated with this technique within two years from the spring of 2019 to the spring of 2021. 77% patients had para-colostomy hernia and 41% of the patients had accessory repairs for midline or opposite flank hernia. 18% had prophylactic mesh at index operation, 27% were recurrent parastomal hernia and ostomies were formed median 32 months prior to parastomal hernia repair. 72% of the patients were operated robotically and 28% laparoscopically. Median follow up at time for presentation will be 17 months.

O34 AUTOLOGOUS FENESTRATED CUTIS GRAFTS FOR VENTRAL HERNIA REPAIR IN PATIENTS WITH OBESITY

Aim Traditional approaches to ventral hernia repair involve implantation of synthetic mesh (SM), primary suture (PS) repair, and the use of biologic prostheses (BP). A body mass index (BMI) > 30 increases recurrence rates and complications for such repairs. We have begun to use Autologous Fenestrated Cutis Grafts (CG) as an alternative hernia repair. We investigated the impact of obesity on the recurrence and complication rates of CG compared to traditional repairs. Material and Methods A five-surgeon, retrospective study included all ventral/incisional, epigastric and umbilical hernia repairs (SM, PS, and BP from 2015-2020; CG repairs from 2018-2020). Patients with a BMI ≥ 30 were stratified according to surgical approach. Outcomes included recurrence and complication rates. Descriptive statistics for demographics and outcomes were compared and logistic regression performed with p < 0.05 considered significant. Results A total of 301 hernia repairs were performed (173 CGs, 54 SM, 59 PS, 15 BS). The groups had similar recurrence rates. A significant difference in complications rates did exist (37% CGs, 48.1% SMs, 15.3% PS, 66.7% BP, p < 0.001). Logistic regression revealed PS had fewer total complications than all other repairs. Compared to SM, CG had fewer seromas. Compared to BP, CG had fewer wound infections, systemic infections, renal complications, and additional procedures. Conclusions CG for abdominal wall hernia repair in patients with BMI ≥ 30 is an acceptable hernia repair in obese patients with similar recurrence rates and an acceptable complication profile compared to traditional repairs.