301 IS IT WORTH USING MESH FOR THE TREATMENT OF GIANT HIATAL HERNIA? A SYSTEMATIC REVIEW AND META-ANALYSIS.

The use of mesh associated with cruroplasty is still controversial in giant hernias, due to possible complications of the prosthesis reported in the literature, such as infection, chest migration, shrinkage, esophageal and aortic erosion, stenosis and obstruction. This systematic review and meta-analysis aimed to compare the use or not of mesh as a reinforcement in the laparoscopic repair of giant hernias and to determine which technique has the best results in recurrence and complication rates. Methods A search was conducted using databases and included prospective and randomized studies. The studies should include patients with giant hernias who have undergone laparoscopic treatment comparatively analyzed between cruroplasty and suture associated with prosthetic reinforcement. Results Of the 768 articles analyzed, 8 were selected for systematic review, and 7 were included in the meta-analysis. The meta-analysis showed no statistically significant differences in favor of any of the intervention methods (mesh versus suture cruroplasty) for the different outcomes evaluated: recurrence (RD -0.06, CI [−0.13,0.01], I2 22%, p 0.27); postoperative complications (RD 0.04, CI [−0.01,0.9], I2 5%, p 0.30); deaths (RD -0.01, CI [−0.04, 0.02], I2 0%, p 74); intraoperative complications (RD -0.03, CI [−0.07, 0.1]); reoperation (RD -0.04, CI [− 0.10, 0.02], p 0.14). Conclusion There is no evidence supporting that routine mesh reinforcement in laparoscopic repair of giant hernias decreases recurrence and other complications. Systematic review registration number at PROSPERO: CRD42019147468.

External Prosthetic Reinforcement of the Pulmonary Autograft

Background Neo-aortic root dilatation accounts for the majority of reoperations needed after the Ross procedure with implantation of the pulmonary autograft as complete root replacement. This study evaluates early results of external prosthetic reinforcement of the autograft. Methods From July 2015 to October 2017, 16 adolescent and adult patients received a Ross procedure at our department by this technique. A congenital-dysplastic valve was present in 13 patients, including 9 patients with a bicuspid aortic valve. Clinical and echocardiographic follow-up is complete with a mean duration of 19.7 ± 5.8 months. Results The mean age at operation was 27.1 ± 16.1 years. Mean aortic cross-clamping time was 102 ± 39 minutes. No bleeding complication occurred. The median stay on the intensive care unit was 2 days. In-hospital mortality was 0%. All patients were discharged with no or trivial aortic regurgitation. In one patient both the autograft and homograft were replaced because of endocarditis 3 months after the primary operation, leading to 93.8% freedom from reoperation at 2 years. There were no late deaths during the study period. The latest echocardiography confirmed absence of aortic regurgitation grade >I in all patients. Neo-aortic root diameters remained stable during follow-up. Conclusion The presented modification of the Ross procedure does not prolong ischemia time, and can be performed with a low operative morbidity and mortality and an excellent early valve function.

A prospective and retrospective study of Stoppa procedure (giant prosthetic reinforcement of visceral sac) for recurrent, complex and bilateral inguinal hernias

Background: Managing complex inguinal hernia is always a challenge for surgeons. When recurrent or complex hernia is present it is mandatory to adopt an alternative and different approach for the repair of inguinal hernia to avoid any further complication and recurrence. Primary aim of this study is to assess the usefulness of Stoppa procedure in current situation for treatment of bilateral, complex and recurrent hernias.Methods: A prospective and retrospective study of Stoppa procedure (giant prosthetic reinforcement of visceral sac [GPRVS]) for recurrent, complex and bilateral inguinal hernias was conducted in Department of General Surgery Hamidia Hospital from January 2016 to October 2017 , 30 patients with 27 bilateral and 3 unilateral hernias making total 57 hernial sites including five recurrent hernias (after Lichtenstein repair) were operated by GPRVS for bilateral, recurrent and complex inguinal hernias, were included in study.Results: Four complications were seen. One patient developed seroma which resolved spontaneously, one patient developed superficial wound infection. One patient developed right testicular pain which was relieved after medication. One patient developed pain in groin and right thigh which was present preoperatively also but increased after surgery and was relieved on medication. Risk for recurrence present in 18 patients. No recurrence was observed.Conclusions: Because of the excellent results, ease of the procedure and low complication rate, GPRVS is an effective and good option for bilateral, complex and recurrent inguinal hernias.

ANALYSIS OF EARLY POST-OPERATIONAL COMPLICATIONS IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERY FOR HIATAL HERNIA

In order to identify the advantages of the original modification of Nissen fundoplication techniques and identify the safest mash material for prosthetic reinforcement of hiatal closure, was made analysis of early postoperative complications in 121 patients with hiatal hernia.The formation of the non tension fundoplication reduces the level of early postoperative complications. The usage of biological prosthesis has the advantage in comparison with synthetic ones. In general, the usage of mashes significantly increases the severity of the complaints of patients after the intervention, but most of them are within 3-14 days of the postoperative period.