P141 USE OF POLYPROPYLENE STRIPS FOR REINFORCEMENT OF THE CRUROPLASTY IN LAPAROSCOPIC PARAESOPHAGEAL HERNIA REPAIR: A RETROSPECTIVE COHORT STUDY

Aim Laparoscopic paraesophageal hernia repair is an effective treatment for symptomatic paraesophageal hernias. To reduce recurrence rates, the use of prosthetics for the crural repair has been suggested. Mesh-related complications are rare, but known to be disastrous. To address another form of crural repair, polypropylene strips are suggested. This study aimed to assess peri- and postoperative complications of reinforcement of the cruroplasty with polypropylene strips. Material and Methods From 2013 to 2020, patients with a type II, III or IV primary or recurrent paraesophageal hernia that underwent cruroplasty with polypropylene strips were retrospectively reviewed. Intra- and postoperative complications were graded according to the Clavien-Dindo classification. The incidence of symptomatic recurrent hiatal hernia (CT or endoscopy proven) and hospital stay were assessed. Results One-hundred-and-fifty-eight patients were included. Mean age was 65 years (standard deviation 10.4), 119 patients were female (75.3%). Almost 50% of surgeries took place between 2018 and 2020. Median follow-up was 7 months (interquartile range 17.5). Mean operation time in the primary hernia group was 159 minutes (standard deviation 39.0), and length of stay was 4.4 days. In 3/158 patients (2.0%) intra-operative complications occurred. Two patients developed a grade IV and seven patients a grade III postoperative complication. No mortality was recorded. Twelve recurrences (8.2%) were detected in the primary hernia group, and one (9.1%) in the recurrent hernia group. Conclusions There were no mesh-related complications seen and symptomatic recurrence rate was low, but longer follow up is needed.

Use of Polypropylene Strips for Reinforcement of the Cruroplasty in Laparoscopic Paraesophageal Hernia Repair: A Retrospective Cohort Study

<b><i>Introduction:</i></b> Laparoscopic paraesophageal hernia repair is an effective treatment for symptomatic paraesophageal hernias. To reduce recurrence rates, the use of prosthetics for the crural repair has been suggested. Mesh-related complications are rare but known to be disastrous. To address another form of crural repair, polypropylene strips are suggested. This study aimed to assess peri- and postoperative complications of reinforcement of cruroplasty with polypropylene strips. <b><i>Methods:</i></b> From 2013 to 2020, patients with a primary or recurrent type 2, 3, or 4 paraesophageal hernia that underwent cruroplasty with polypropylene strips were retrospectively reviewed. Intra- and postoperative complications were graded according to the Clavien-Dindo classification. The incidence of symptomatic recurrent hiatal hernia (CT or endoscopy proven) and hospital stay were assessed. <b><i>Results:</i></b> One hundred fifty-eight patients were included. Mean age was 65 years (standard deviation 10.4), and 119 patients were female (75.3%). Almost 50% of surgeries took place between 2018 and 2020. Median follow-up was 7 months (interquartile range 17.5). Mean operation time in the primary hernia group was 159 min (standard deviation 39.0), and length of stay was 4.4 days. In 3/158 patients (2.0%), intraoperative complications occurred. Two patients developed a grade 4 and seven patients a grade 3 postoperative complication. No mortality was recorded. Twelve recurrences (8.2%) were detected in the primary hernia group and one (9.1%) in the recurrent hernia group. <b><i>Conclusion:</i></b> There were no mesh-related complications seen and symptomatic recurrence rate was low, but longer follow-up is needed.

Ventral Primary Hernia with Liver Content

Background. Herniation of the liver through the anterior abdominal wall is an extremely rare phenomenon. Most cases occur within an incisional hernia (mostly upper abdomen surgery or cardiac surgery). Only two reports mentioned liver herniation without previous abdominal incision. Case Presentation. We report the case of a 70-year-old woman presenting an epigastric swelling. Radiological findings showed a liver herniation in a primary ventral hernia. This case is the first to have been described requiring semiurgent hernia repair associated with partial liver resection. Conclusion. This case is, to the best of our knowledge, the first case of primary ventral hernia with liver content necessitating wedge resection of the left liver lobe.

TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR INGUINAL HERNIAS: A FIVE YEARS EXPERIENCE IN A TERTIARY CARE HOSPITAL

Objective To evaluate the efficacy of Transabdominal pre-peritoneal repair in the treatment of inguinal hernias Materials and Methods: This retrospective study was conducted in Surgical A Unit, Khyber Teaching Hospital from January 2015 to December 2019. A total 114 patients were included in the study. All of the patients underwent Laparoscopic Trans-abdominal pre-peritoneal(TAPP) repair. After six months follow up, their outcome variables were analysed. Results: Mean age of the study population was 41±7.8(SD) years(range 21-67 years). 104 patients had unilateral while 10 patients had bilateral hernias. 89(78.07%) patients had primary hernia while 25(21.92%) patients had recurrent hernia. Mean postoperative hospital stay was 1.21±0.3(SD) days. Umbilical port infection was noted in 2(1.75%) patients while no case of deep/ mesh infection was noted. Recurrence was noted in one case only. Chronic groin pain was noted in 5(4.38%) cases. Conclusion: TAPP is a safe and effective treatment modality for the treatment of primary and recurrent inguinal hernias.

Current trends in hernia surgery in NHS England

Background Mesh is recommended for the repair of most hernias when prevention of recurrence is the primary endpoint. However, mesh may be associated with increased complications for the patient. The aim of this study was to quantify the use of mesh for abdominal wall hernia surgery in NHS England in recent years. Materials and methods The NHS Digital Secondary Uses Service database for 2016/17 and 2017/18 was interrogated for numbers of patient undergoing elective primary hernia surgery. Using the specific hernia code inguinal (T201-9), umbilical (T241-9), incisional (T251-9) and other abdominal wall hernia (T271-9), the use of mesh or suture repair was determined. Recurrent and emergency hernia surgery were excluded. All data were provided by NHS RightCare. Results There are almost 100,000 hernia repairs performed annually in NHS England. For every four hernias, three are repaired with mesh. The percentage repaired by mesh varies by hernia type. Mesh repairs in inguinal, umbilical and incisional hernias accounted for 95%, 50% and 82%, respectively. Conclusions Mesh repair for all hernia types is more common than suture repair. However, for umbilical and other abdominal wall hernias, a significant proportion are repaired without the use of mesh.

RESULTS OF USING POLYPROPYLENE MESH BY TOTAL EXTRAPERITONEAL LAPAROSCOPIC FOR INGUINAL HERNIAS REPAIR

Background: Inguinal hernia is a common disease in general surgery, it is treated by total extraperitoneal (TEP) procedure. It is also applicated in the worldwide. Study objectives: The results of use polypropylene mesh by TEP for inguinal hernias. Materials and Method: Prospective study of 93 patients with 102 inguinal hernias hernioplasty by TEP from November 2010 to March 2013 in Hue Central Hospital. Results: The mean age 51.9 ± 19, primary hernia 94.1%, recurrent hernia 5.9%, hematoma 3.2%, seroma 9.5%, wound infection 0%, conversion 6.9%, recurrence rate 1.1%. Conclusions: Hernioplasty by TEP for inguinal hernias are valuable and effective, shorter surgical time, low complications post-operation and low recurrence rate. Keywords: inguinal hernia; TEP