Synthetic mesh placement - modality of choice in spontaneous intercostal pleural herniation: a case report

Hernia is defined as protrusion of a viscus or its part from the wall covering it and in some rare cases due to increased intercostal space there is spontaneous herniation of pleura and lung also known as extrathoracic lung hernia. A 48 year gentleman was admitted in our centre for chest wall swelling which has developed spontaneously 1 year back, painless, with cough impulse, further investigations like chest x-ray revealed nothing , subsequently CT thorax showed intercostal pleural hernia. He underwent surgery which diagnosed it as a case of intercostal pleural hernia having defect between 8th and 9th rib. Subsequently primary repair of defect was done with placement of monofilament mesh over it and then approximation of intercostal space was done with monofilament suture placed over 8th and 9th ribs. Post operatively patient had no complications and no recurrence of hernia. Spontaneous pleural herniation is a usually caused by coughing, heavy weight lifting, weakness of thoracic muscles by smoking, obesity etc. Ideal management is to treat the aetiology along with repair of the defect to prevent recurrence. In the present case the hernia developed after a bout of cough due to increased intercostal space between 8th and 9th ribs and also due to obesity leading to weak musculature. Intercostal pleural hernia repair can be achieved by primary repair of defect but it is advisable to use synthetic materials such as knitted monofilament polypropylene (Marlex) mesh to provide addition support to prevent recurrence.

Fractional CO2 Laser Treatment after Transvaginal Polypropilene Mesh for Urinary Incontinence and Pelvic Organ Prolapse Treatment as an Alternative to Improove Mesh Erosion Rates

The support advantages of synthetic mesh in vaginal reconstructive surgery and stress urinary incontinence are significant. However, erosion of the mesh may occur as a complication, Four sessions of fractional CO2 Laser treatment protocol (Mona Lisa Touch Deka M.E.L.A Florence Italy protocol, were performed in the study group to 96 patients, beginning at 30 days, after mesh insertion, important improvement regarding erosion rates was found inside our study group, thanks to the trophic effects of fractional CO2 laser protocol. The use of alternative technologies that provide bio -stimulation of vaginal epithelium by increasing its thickness, and trophic changes that may be related to the very low erosion rate was found in our group of patients

Mesh-related complications and recurrence after ventral mesh rectopexy with synthetic versus biologic mesh: a systematic review and meta-analysis

Background Ventral mesh rectopexy (VMR) is a widely accepted surgical treatment for rectal prolapse. Both synthetic and biologic mesh are used. No consensus exists on the preferred type of mesh material. The aim of this systematic review and meta-analysis was to establish an overview of the current literature on mesh-related complications and recurrence after VMR with synthetic or biologic mesh to aid evidence-based decision making in preferred mesh material. Methods A systematic search of the electronic databases of PubMed, Embase and Cochrane was performed (from inception until September 2020). Studies evaluating patients who underwent VMR with synthetic or biologic mesh were eligible. The MINORS score was used for quality assessment. Results Thirty-two studies were eligible after qualitative assessment. Eleven studies reported on mesh-related complications including 4001 patients treated with synthetic mesh and 762 treated with biologic mesh. The incidence of mesh-related complications ranged between 0 and 2.4% after synthetic versus 0–0.7% after biologic VMR. Synthetic mesh studies showed a pooled incidence of mesh-related complications of 1.0% (95% CI 0.5–1.7). Data of biologic mesh studies could not be pooled. Twenty-nine studies reported on the risk of recurrence in 2371 synthetic mesh patients and 602 biologic mesh patients. The risk of recurrence varied between 1.1 and 18.8% for synthetic VMR versus 0–15.4% for biologic VMR. Cumulative incidence of recurrence was found to be 6.1% (95% CI 4.3–8.1) and 5.8% (95% CI 2.9–9.6), respectively. The clinical and statistical heterogeneity was high. Conclusions No definitive conclusions on preferred mesh type can be made due to the quality of the included studies with high heterogeneity amongst them.

Concurrent Spigelian and Grynfeltt-Lesshaft Hernias

Only 0.12% to 2% of diagnosed hernias are Spigelian type. Even less frequently encountered—Grynfeltt-Lesshaft hernias—hernias have unknown incidence. A Spigelian hernia is encountered along the Spigelian fascia and Grynfeltt-Lesshaft hernias are bounded by the superior lumbar triangle. These unique hernias can both be intermuscular, given their anatomical borders which allow concealment and preclusion of accurate diagnosis. Here, an 86-year-old male presented with symptoms consistent with small bowel obstruction. On physical exam, a right lower quadrant hernia and right posterior flank mass were appreciated. Computed tomography revealed obstruction secondary to bowel incarceration within Spigelian hernia and additional Grynfeltt-Lesshaft hernia. The patient underwent reduction and repair of Spigelian hernia with synthetic mesh, while repair of asymptomatic hernia was deferred. These unusual hernias are difficult to distinguish, given their negligible occurrence and unreliable exam findings. Clinicians must remain cognizant of their features to aid in diagnosis and mitigate potential sequelae.

P011 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: A CASE-CONTROL SERIES

Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods A prospective clinical trial started in 2016 and designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and a longer operative and anesthesia time. At 30-days, surgical site occurrences were observed in 18 (47.4%) AI vs. 17 (44.7%) CC; surgical site infection occurred in 4 (10.4%) AI vs. 6 (15.8%) CC, and a higher number of procedural interventions were required in the CC group, 15.8% AI vs. 28.9% CC. At 6-months follow-up, no chronic infections or hernia recurrences were observed in both groups. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

O13 BIOLOGIC VERSUS SYNTHETIC MESH IN VENTRAL HERNIA REPAIR: PARTICIPANT-LEVEL ANALYSIS OF TWO RANDOMIZED CONTROLLED TRIALS AT ONE YEAR

Aim Biologic mesh has been increasingly utilized in complex ventral hernia repair despite limited evidence at low risk of bias supporting its growth. We hypothesized biologic mesh when compared to synthetic mesh would have fewer major complications at one year. Material and Methods We performed a participant-level meta-analysis of published randomized controlled trials (RCTs) comparing biologic to synthetic mesh at one year. Primary outcome was major complication (composite of mesh infection, recurrence, reoperation, or death) at one year post-operative. Secondary outcomes included length of index hospital stay, surgical site occurrence, and surgical site infection. Outcomes were assessed using frequentist generalized linear models. Results A total of 252 patients from two RCTs were included, 126 patients randomized to the intervention arm of biologic mesh and 126 patients randomized to the control of synthetic mesh. Median follow-up was 15 (12, 27) months. Major complication occurred in 41 (33%) patients randomized to biologic mesh, and 44 (35%) patients randomized to synthetic mesh, (relative risk [RR] 0.91, 95% confidence interval [CI] 0.54-1.55, p-value 0.740). There were 36 total recurrences, 23 (18%) in the biologic arm, and 13 (10%) in the synthetic arm (RR 1.83, 95% CI 0.84-3.99, p-value 0.130). The remainder of outcomes demonstrated no statistically significant differences. Conclusions The risk of major complication did not differ between biologic versus synthetic mesh. In patients undergoing ventral hernia repair, there was no clinical benefit with biologic mesh as opposed to synthetic mesh at one year post-operative.