P065 LONG TERM OUTCOMES AFTER LAPAROSCOPIC REPAIR OF VENTRAL HERNIAS LOCATED ON THE ABDOMINAL BORDERS

Aim To assess the long-term outcomes after laparoscopic repair (LR) of ventral hernias located on the abdominal borders. Material and methods Out of our prospectively collected LR database, all cases of ventral hernias were reviewed. Defects located near the abdominal borders were identified (M1, M5, L1 and L4 according to the EHS classification). All patients received intraperitoneal implantation of an e-PTFE mesh. The primary aim of this study was to assess long-term outcomes. Results Out of 175 LR, 105 (60%) had a M1 component, 61 (35%) an M5, 24 (14%) an L1 and 5 (3%) an L4. The median defect width was 9 cm (range 2.5 - 30), the median length 13 (range 2 - 30), with a median defect area of 92 cm2 (range 5 - 471). Two (1%) cases required conversion to open approach. After a median follow up of 55 months, there were 7 recurrences: 4/105 in M1 patients, 1/61 M5 patients, 1/24 L1 patients and 1/4 L4 patients. 41 patients (23%) experienced chronic seroma, while 24 (14%) had chronic pain. 6 patients (3%) required a reoperation with mesh removal. At univariate analysis, only previous hernia repair was associated with recurrence; COPD, hypertension and M5 defect were associated with seroma development; seroma development and chronic pain were mutually associated. Conclusions Laparoscopic repair for ventral hernias is safe and feasible, with good long term outcomes.

Chest wall and diaphragm reconstruction; a technique not well established in literature

Introduction: The treatment for most primary chest wall tumors is wide excision. After radical chest wall resection, skeletal reconstruction, when appropriate to preserve the reconstruction, is the essential element for successful management. Case presentation: We describe a case of a 27-year-old male patient who had chest wall and diaphragm reconstruction for a recurrent chest wall tumor, using a single patch of Polytetrafluoroethylene (PTFE) mesh with diaphragm implanted into the middle of the mesh. There were no operative complications. The patient received post-operative radiotherapy with good functional and cosmetic results. Conclusion: We present a novel and safe technique resulting in stable results after full-thickness multi-rib chest wall resections involving the diaphragm.

Which mesh should be used to repair abdominal wall defect in peritonitis? An experimental study

Background: In this study, following the Bogota bag closure of abdominal wall defects created in a rat peritonitis model, the short-term efficacy of polypropylene (PP) mesh (Prolene®, Ethicon), PP Mesh+Seprafilm®, polytetrafluoroethylene (PTFE) mesh [Infinit® Mesh (Gore)] and expanded PTFE (ePTFE) [Dualmesh®plus(Gore)] in the permanent repair of the defects was investigated.Methods: 64 rats were used. The rats were randomized into four groups, each consisting of 16 subjects: PP mesh (Group 1), PP mesh+Seprafilm (Group 2), PTFE mesh (Group 3), and ePTFE mesh (Group 4). Laparotomy was performed and abdominal wall defects were created. Contamination of the peritoneal cavity was induced, and closure was undertaken using a Bogota bag. After three days, the Bogota bag was removed, and materials were placed. At the end of the follow-up period, the rats were sacrificed. Mortality, grade of adhesion, surgical site infection (SSI), and tensile strength were evaluated.Results: Mortality was calculated as 6.3%, 50%, 25%, and 0% for Groups 1, 2, 3, and 4, respectively (p=0.002). Adhesion was observed at a rate of 61.1% in Group 1 and 38.9% in Group 2 (p=0.621). There was no adhesion in Groups 3 and 4 (p=0.001). The rate of SSI was 68.8% in Group 1, %75% in Group 2, and 100% in Groups 3 and 4 (p=0.022). Tensile strength was 2196±193.6 g/cm in Group 1 and 1906±142.1 g/cm in Group 2 (p=0.258).Conclusions: We argue that PP mesh is a suitable prosthesis for the permanent repair of contaminated abdominal wall defects despite the increased adhesion risk.

Erfolgreiche biokompatible Therapie von Zwerchfelldefekten im Rattenmodell

ZusammenfassungDie Behandlung größerer angeborener Zwerchfellhernien (CDH) stellt eine anspruchsvolle Aufgabe in der Kinderchirurgie dar. In der Regel wird heute Gore-Tex® zur Therapie von CDH eingesetzt, dies birgt jedoch das Risiko von Rezidiven, Infektionen und anderen Komplikationen. Ziel unserer Studie war es, zu analysieren, inwieweit sich Lyoplant® – ein azelluläres, avaskuläres biokompatibles Kollagen-Mesh – für CDH im Rattenmodell eignet. Material und Methoden Nach Intubationsnarkose und Beatmung erfolgte eine mediane Laparotomie bei jungen Wistar-Furth-Ratten mit einem Körpergewicht von 155 – 205 g. Anschließend wurde ein 1,0 × 1,0 cm großes Muskelsegment des linken Zwerchfells reseziert und der Defekt durch Implantation eines PTFE-Netzes (Gore-Tex; n = 5) oder eines Lyoplant-Netzes (n = 6) verschlossen. Zu Kontrollzwecken (Sham-Gruppe) wurde bei 2 Tieren der Defekt mittels einer Direktnaht verschlossen. Postoperativ erfolgte eine Röntgenthoraxaufnahme zur Beurteilung des Zwerchfells. Danach wurden die Tiere über 12 Wochen täglich visitiert. Nach diesem Zeitraum wurde das Abdomen der Tiere wieder geöffnet, das linke Zwerchfell auf Verwachsungen hin untersucht und anschließend für die histologische und immunhistologische Untersuchung explantiert. Ergebnisse Alle operierten Wistar-Furth-Ratten zeigten nach dem Eingriff eine physiologische Körpergewichtsentwicklung. Während des o. g. Zeitraumes konnte kein Rezidiv der CDH radiologisch oder klinisch gefunden werden: Bei allen Tiere (PTFE- vs. Lyoplant- vs. Sham-Gruppe) zeigten sich starke Adhäsionen des linken Leberlappens zum implantierten Material. Im Gegensatz zum PTFE-Mesh konnte in der Lyoplant-Gruppe ein stetiger Gewebsumbau (Remodeling) sowie eine kontinuierliche Neovaskularisierung gefunden werden. Schlussfolgerung Unsere Ergebnisse zeigen, dass Lyoplant zur biokompatiblen Therapie von CDH im Rattenmodell erfolgreich eingesetzt werden kann.

Infection of PTFE mesh 15 years following pedicled TRAM flap breast reconstruction: mechanism and aetiology

The pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedure is still widely used for breast reconstruction. The repair of the flap harvest site in the transverse rectus abdominis muscle and sheath is often assisted by the use of prosthetic meshes. This decreases the risk of abdominal wall weakness and herniation but, being a foreign body, it also carries the risk of infection. In this report, we describe the case of a 63-year-old patient who, whilst receiving chemotherapy for metastatic breast cancer, presented with an infected polytetrafluoroethylene mesh 15 years after pedicled TRAM flap immediate breast reconstruction. This necessitated mesh removal to treat the infection. Following a thorough review of the English literature, this is the longest recorded presentation of an abdominal prosthetic mesh infection. The mechanism and aetiology of such a late complication are discussed.