O39 ASSOCIATION OF DIFFERENT MESH AND MESH FIXATION COMBINATIONS WITH REOPERATION RISK AFTER LAPAROSCOPIC GROIN HERNIA SURGERY. A SWEDISH HERNIA REGISTRY STUDY OF 25,190 TEP AND TAPP REPAIRS

Aim The HerniaSurge guidelines concerning mesh and fixation options in laparoscopic totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. We hypothesized that the value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The present registry-based nationwide cohort study compared different mesh/fixation combinations regarding relative risks for reoperation after TEP and TAPP. Material and Methods All TEP and TAPP with standard polypropylene (StdPPM) or lightweight (LWM) flat meshes, combined with either tacks, fibrin glue, or no fixation, registered in the Swedish Hernia Registry 2005-2017 were included. Endpoint was reoperation due to recurrence as of December 31, 2018. Multivariable Cox regression rendered relative risk differences between the exposures, expressed as hazard ratios (HR) with 95% confidence intervals (CI). Results Of 25 190 repairs, 924 (3.7%) were later reoperated for recurrence. The lowest, mutually equivalent, reoperation risks were associated with StdPPM without fixation (HR 1), StdPPM with metal tacks (HR 0.8, CI 0.4-1.4), StdPPM with fibrin glue (HR 1.1, CI 0.7-1.6), and LWM with fibrin glue (HR 1.2, CI 0.97-1.6). LWM correlated otherwise with increased risk, whether without fixation (HR 2.0, CI 1.6-2.6), or affixed with metal (HR 1.7, CI 1.1-2.7), or absorbable tacks (HR 2.4, CI 1.8-3.1). Conclusions With StdPPM, fixation seems not to improve outcomes, despite being costlier. Thus, for this mesh category, we recommend non-fixation. With LWM, we recommend fibrin glue fixation, which was the only LWM alternative on par with non-affixed StdPPM.

Post-operative Pain Outcomes of Laparoscopic Ventral Hernia Repair (LVHR): An eight-year experience

Objective:To evaluate post-operative pain, recovery time and standard of living in patients undergoing LVHR in detail. Study design and Setting: This prospective cohort study was conducted at a tertiary care hospital of Karachi, Pakistan,after getting approval from the “National Medical Centre EthicalReview Board”, from January 2011 to December 2019, Methodology: Total n= 577 patients undergoing standard LVHR procedure (defect closed with non-absorbable monofilamentsuture, reinforced with intra-abdominal dual layer mesh, anchored with non-absorbable tacks & sutures). Patient demographics,perioperative & postoperative findings and post-operative pain analysis were investigated and presented as descriptivestatistics. Follow-up was carried out at 1stweek, 2ndweek, 3rdmonthly, 6 monthly and 12 monthly post-operative appointments. Results: During the study period of nine years (January 2011 to December 2019), 577 patients (primary ventral hernia n=232, recurrent ventral hernian=188 patients, incisional hernian=157) underwent LVHR. Mean post-operative hospitalstay was 1.53 ± 1.8 days. Mean post-operative pain assessment onvisual analog scale (VAS) after surgery (0-3days) wasreported to be 38.5±29 by 65 patients out of 577 (11.26%), which significantly decreased at the end of 1st week to 27.9 ± 25.6. Only 3 patients (0.51%) reported chronic pain during the span of 3-6 months. Conclusion: LVHR was associated with considerably less post-operative pain, shorter hospital stay and reduced time of convalescence. It is demonstrated that LVHR to be a safe and superior approach for the repair ventral hernias

Large Drill Holes Are Still Present in the Long Term After Arthroscopic Bankart Repair With Absorbable Tacks: An 18-Year Randomized Prospective Study

Background: Studies have demonstrated the development of an osseous reaction at the drill sites of anchors after arthroscopic shoulder surgery. Purpose: To investigate the drill-hole size at 18 years after arthroscopic Bankart repair using either fast polygluconate acid (PGA) or slow polylevolactic acid (PLLA) absorbable tacks and to compare the functional outcomes and development of osteoarthritis. Study design: Randomized controlled trial; Level of evidence, 2. Methods: 40 patients with unidirectional anterior shoulder instability, treated with arthroscopic Bankart repair, were randomized into the PGA group (n = 20) or the PLLA group (n = 20). Plain radiographs of both shoulders, as well as computed tomography (CT) images of the operated shoulder, were used to evaluate the drill-hole size, volume, and degenerative changes. Functional outcomes were assessed by use of the Rowe score, Constant score, and Western Ontario Shoulder Instability (WOSI) index. Results: Of the 40 patients, 32 patients returned for the follow-up (15 PGA and 17 PLLA). No significant differences were found in the population characteristics between the study groups. The mean follow-up time was 18 years for both groups. No significant differences were seen in range of motion, strength in abduction, or Constant, Rowe, and WOSI scores between the groups. Recurrence rate was 33% in the PGA group and 6% in the PLLA group during the follow-up period ( P = .07). The drill-hole appearance on plain radiographs (invisible/hardly visible/visible/cystic) was 11/2/2/0 and 6/5/5/1 for the PGA and PLLA groups, respectively ( P = .036). The mean ± SD drill-hole volume as estimated on CT images was 89 ± 94 and 184 ± 158 mm3 in the PGA and PLLA groups, respectively ( P = .051). Degenerative changes (normal/minor/moderate/severe) on plain radiographs were 7/4/4/0 and 3/8/5/1 for the PGA and PLLA groups, respectively ( P = .21), and on CT images were 5/7/3/0 and 2/6/6/3 for the PGA and PLLA groups, respectively ( P = .030). Conclusion: This long-term follow-up study demonstrated that the PLLA group had significantly more visible drill holes than the PGA group on plain radiographs. However, this difference was not evident on CT imaging, with both groups having several visible cystic drill holes and a substantial drill-hole volume defect. No significant differences were found between the study groups in terms of clinical outcomes.

Mesh Fixation in Laparoscopic Inguinal Hernia Repair: Absorbable vs. Non-Absorbable Tacks

Background: Laparoscopic inguinal hernia repair is an accepted technique for the treatment of primary inguinal hernias. There are several ways of mesh fixation including absorbable, non-absorbable staplers and even human fibrin glue. Little evidence is found when looking for a difference in recurrence rates between the first two.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

Laparoscopic ventral hernia mesh repair without the use of transfascial sutures: our experience

Background: Repair of the abdominal wall defects can be quite challenging even for most experienced surgeon under best of conditions. In the laparoscopic method there have been many modifications with regard to the type of mesh and methods of fixation. The aim of this study was to identify immediate post-operative pain and the long-term outcomes of laparoscopic ventral hernia mesh repair without the use of transfascial sutures to fix the mesh.Methods: A total of hundred (n=100) patients underwent Laparoscopic Ventral Hernia Mesh Repair by our surgical unit between January 2011 and December 2015. All patients underwent standardized Laparoscopic mesh repair with light weight composite meshes and without the use of transfascial sutures. Only absorbable tackers were used to anchor the mesh. Analgesics stopped after 24 hours or given only on demand. Mesh fixation time, post-operative pain score (visual analogue score), and follow up for pain and recurrence (at 6 months, 12 months and 24 months) were recorded and analyzed.Results: Out of 100 patients (42 men and 58 women), the mean age was 48 years and BMI of the patients was 20-35. Types of hernias operated were 63 para umbilical hernias, 32 incisional and 5 recurrent hernias. The median defect size was 5 cm (Range 3-8 cm) and the mesh sizes used were15 x 15 cm circular (87) and 15 x 20 rectangular (13). The median mesh fixation time with only absorbable tackers was 15 mins (range 15-20 mins). Visual analog scale for pain (VAS) was of median 1 (Range 0-2) at 24 hours. Five patients required analgesics for 48 hours. No patients complained of pain at follow ups (1 month, 6 months, 12 months and 24 months). Mean hospital stay post operatively was 2-3 days. Only one patient had recurrence of hernia within 6 monthsConclusions: Laparoscopic Ventral Hernia Mesh Repair without the use of transfascial sutures is an easy and feasible approach. The use of only absorbable tacks to fix the mesh is time saving and gives less post-operative pain. However, randomized controlled trials are required to compare transfascial sutures with absorbable tacks for fixing the mesh in separate cases to reach a standardized method.