O37 CONCOMITANT INTESTINAL RESECTION DOES NOT NEGATIVELY INFLUENCE LONG TERM OUTCOMES FOLLOWING COMPLEX ABDOMINAL WALL RECONSTRUCTION

Aim Simultaneous intestinal resection increases infective risks following abdominal wall reconstruction. We investigated the frequency of those risks and its impact on long-term outcomes. Material and Methods Analysis of prospectively accrued data from patients undergoing AWR by a single surgeon (01/01/2014–31/12/2020). Comparison between AWR with (IR-AWR) and without (AWR) concomitant intestinal resection. Clinical review was undertaken 6 monthly for 24 months with ongoing telephone follow-up thereafter. Results 101 repairs were performed within the study period (46 AWR,55 IR-AWR). IR-AWR patients underwent 129 gastrointestinal procedures including 30 gastrointestinal fistula,33 small bowel,19 colonic and 2 gastric resections. Both groups were similar in terms of smoking status, diabetes, but obesity (BMI>30) was more prevalent in AWR(23/46(50%)vs.16/55(29%); p=0.03). Hernia defects were the same for both groups; AWR median area (range) 511cm2(47–2171 cm2) and IR+AWR 471cm2(50–2827cm2) (p = 0.7). Post-operative wound infection was more frequent following IR-AWR (20/55(36%) (Superficial incisional=13,deep incisional=6, cavity=1) vs. 6/46(13%)(N = 5,0,1 respectively);Odds ratio(OR)=3.8 (95% CI1.4-10.6); p=0.01). Patients undergoing IR-AWR were also more likely to experience ileus necessitating short-term postoperative parenteral nutrition (OR 3.3(1–10.8); p=0.05) and Clavien Dindo>2 complications (OR4.4 (1.2–16.7); p=0.03). Within IR-AWR cohort there was a single anastomotic complication requiring re-laparotomy and one mesh infection treated with antibiotics. Median follow-up= 25.2 months(range 1.2–88.8). 14 patients died during follow-up (AWR 7/46(15%), IR-AWR 7/55(13%); p=0.7). 5 were lost to follow-up (3AWR, 2 IR-AWR). 12(26%) AWR and 8(15%) IR-AWR reported either persistent or delayed onset chronic abdominal wall pain post repair(P = 0.14). Recurrent hernias occurred in 7/46(15%) AWR compared with 10/55(18%)IR-AWR(p = 0.5). Conclusions Despite more frequent short-term complications in IR-AWR patient outcomes are comparable at 2 years.

CHRONIC NON-CANCER ABDOMINAL WALL PAIN AMELIORATION VIA PHENOL NEUROLYSIS BY TRANVERSUS ABDOMINIS PLANE APPROACH: A CASE REPORT

Abdominal pain is common and has multiple etiologies. We present a case of chronic abdominal wall pain that was treated with phenol neurolysis via a tranversus abdominis plane (TAP). To date, only 4 case reports utilizing TAP neurolysis have been reported and all were performed in the context of malignancy-related pain. The TAP block has become an integral component of the regional anesthesiologist’s perioperative anesthesia and analgesia arsenal. In summary, chemical denervation of the anterior abdominal wall is feasible and efficacious in palliating chronic non-cancer pain via a TAP block technique. Key words: TAP, transversus abdominal plane, phenol, abdominal wall pain, neurolytic, noncancer pain