OC-087 PAIN AND INFLAMMATORY SIGNALLING IN TACKOMESH TRIAL PARTICIPANTS FOLLOWING ELECTIVE LAPAROSCOPIC INCISIONAL HERNIA REPAIR WITH INTRAPERITONEAL ONLAY MESH (IPOM) AND SPIRAL-TACK MESH FIXATION

Background

The aim of this study was to investigate for links between reported pain and inflammation within a sub-cohort of patients undergoing the IPOM plus repair through the measurement of serum/plasma levels of established inflammatory biomarkers in trial participants across 1-year follow up.

Methods

22 patients (12 Protack™ and 10 Reliatack™) within the TACKoMesh randomised controlled trial underwent serial blood sampling as part of their follow up. A panel of pro- and anti-inflammatory biomarkers were assayed using Luminex multiplex assays and ELISAs. Circulating biomarker concentrations were described and compared in the context of clinical and patient reported outcome data that was obtained within the trial.

Results

An increase in the serum concentration of pro- (IL-6 and CRP) and anti- (IL-10) inflammatory biomarkers was seen following IPOM plus repair. Serum IL-6 and CRP were significantly raised compared to baseline at post-operative Days 1, 6 and 30 (p < 0.05). Markers of onward signalling (Cortisol and TNF-alpha) and tissue repair (PDGF-AA and VEGF) showed a trend towards an elevation at similar timepoints (notably at post-op Day 6) but were not significantly different from baseline levels. There were no observed correlations between inflammatory signal and reported pain, treatment allocation within the trial, burden of implanted prosthetic material, or hernia recurrence.

Discussion

This study demonstrates the novel finding of a pro-inflammatory signal at post-operative Day 30 following the IPOM plus repair.

OC-088 CAN PROCOLLAGEN I AND PROCOLLAGEN III SERVE AS PREDICTIVE BIOMARKERS FOR INCISIONAL HERNIA RECURRENCE?

Background

The aim of this study was to determine the temporal evolution of extracellular matrix (ECM) remodelling and collagen biomarkers and their influence on incisional hernia recurrence after the IPOM plus repair.

Methods

A sub-cohort of patients (n=25) undergoing laparoscopic incisional hernia repair within the TACKoMesh randomised controlled trial were bled at serial timepoints up to 1-year following surgery. Serum/plasma concentration of biomarkers (Procollagen I, Procollagen III, Fibronectin, TGF-beta, MMP-2, MMP-9, TIMP-1, and TIMP-2) were quantified using ELISA and Luminex multiplex techniques. Data were described and compared between groups that developed and remained free from recurrence using R statistical software.

Results

Procollagen I was reduced relative to baseline on post-op Day 1 but increased at Days 6 and 30 (p<0.05). Procollagen III showed an elevation at Day 30. Lower levels of Procollagen I were detected at Day 0, Day 1 and Day 6 (p<0.05) and higher levels of Procollagen III at Day 0, Day 1, Day 6 and Day 30 (p<0.05) in patients with a recurrence.

Fibronectin was reduced at Day 1 and 6 (p<0.05) whilst TGF-β was increased at Day 30 (p<0.05). MMP-2 and its inhibitor TIMP-2 were reduced at post-operative Day 1 (p<0.05). MMP-9 was persistently higher than baseline (p<0.05) at all timepoints. TIMP-1 was elevated at post-op Days 6 and 30. No differences were found in the circulating concentrations of these biomarkers to predict a recurrence.

Conclusion

In patients that developed incisional hernia recurrence, low levels of Procollagen I and high levels of Procollagen III were detected.

OC-086 COMPARISON OF MESH-FIXATION TECHNIQUES IN LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA, RELIATACK™ V PROTACK™ (TACKOMESH) NCT 03434301

Background

A study examining post-op pain, comparing permanent versus absorbable tack fixation devices, Protack™ versus Reliatack™, in IPOM plus repair.

Methods

TACKoMesh is a single-centre double-blind RCT conducted from 2017–2020 with 1-year follow up. Patients were randomised to either Protack™ (titanium tacks) or Reliatack™ (an articulating-arm with dissolvable tacks). Primary outcome was reported pain on activity at Day30. Secondary outcomes include recurrence and quality of life measures (SF-36 & Carolina Comfort Score).

Results

67 patients randomised: 36 with Protack™, 27 with Reliatack™, with 4 conversions. No significant difference in reported pain ‘on activity’ (post-operative Day 1, 6, 30 and 365). There was significantly reduced pain ‘at rest’ on Day1 with Reliatack™ (Protack™ 6 [4 to 9] vs Reliatack™ 4 [3 to 5], p = 0.020) and reduced pain at all other points with Reliatack™.

Operation (p = 0.001) & mesh-fixation (p = 0.001) times were longer, with more knots (p = 0.001) & tacks (p = 0.001) used with Reliatack™.

Entire cohort hernia recurrence, seroma formation, SSI & Clavien-Dindo Grade III-V complication were 8/63 (12.7%), 33/63 (52.4%), 7/63 (11.1%), and 12/63 (19.1%) respectively. There were no significant differences in these outcomes between the treatment groups. CCS showed improvement from post-op Day30 to 365. SF36 showed a reduction in baseline scores at post-op Day30.

Conclusion

There is no difference in reported pain ‘on activity’ following elective IPOM plus hernia repair when choosing either Protack™ or Reliatack™. There is a trend towards improved post-op pain ‘at rest’ with Reliatack™.

Systemic biomarkers currently implicated in the formation of abdominal wall hernia: A systematic review of the literature

BACKGROUND

Surgery to the abdominal wall is ubiquitous worldwide and hernia treatment is challenging and expensive, posing a critical need to tailor treatment to individual patient risk-factors. In this systematic review, we consider specific systemic factors with potential as biomarkers of hernia formation.

METHODS

A healthcare database-assisted search, following PRISMA guidelines, identified journal articles for inclusion and analysis.

RESULTS

14 biomarker studies were selected, comparing hernia patients and hernia-free controls, focusing on markers of extracellular matrix (ECM) remodelling and collagen turnover. Matrix metalloproteinase-2 was increased in patients with inguinal hernia. Markers of type IV collagen synthesis were increased in patients with abdominal wall hernia; while markers of fibrillar collagen synthesis were reduced. Additional other ECM signalling proteins differ significantly within published studies.

CONCLUSION

We identify a lack of high-quality evidence of systemic biomarkers in tailoring treatment strategies relative to patient-specific risks, but recognise the potential held within biomarker-based diagnostic studies to improve management of hernia pathogeneses.

Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: A randomized, multicenter, double-blind trial

PURPOSE

To determine whether an antibiotic flush solution containing vancomycin, heparin, and ciprofloxacin (VHC) can prevent the majority of line infections.

PATIENTS AND METHODS

A prospective double-blind study was performed comparing VHC to vancomycin and heparin (VH) to heparin alone in 126 pediatric oncology patients.

RESULTS

The 153 assessable lines resulted in 36,944 line days studied. There were 58 blood stream infections (43 gram-positive, 14 gram-negative, and one fungal). Forty were defined as line infections (31 heparin, three VH, six VHC). The time to develop a line infection was significantly increased using either antibiotic flush (VH, P =.011; VHC, P =.036). The rate of total line infections (VH, P =.004; VHC, P =.005), gram-positive line infections (VH, P =. 028; VHC, P =.022), and gram-negative line infections (VH, P =.006; VHC, P =.003) was significantly reduced by either VH or VHC. Sixty-two (41%) of the lines developed 119 occlusion episodes (heparin, 3.99 per 1,000 line days; VHC, 1.75 per 1,000 line days; P =.0005). Neither antibiotic could be detected after flushing, and no adverse events were detected, including increased incidence of vancomycin-resistant Enterococcus colonization or disease.

CONCLUSION

The use of either VH or VHC flush solution significantly decreased the complications associated with the use of tunneled central venous lines in immunocompromised children and would save significant health care resources.

Intrahippocampal injection of pertussis toxin blocks adenosine suppression of synaptic responses

Adenosine exerts prominent inhibitory effects on synaptic transmission via a presynaptic action. Using the hippocampal slice preparation, we have found in electrophysiological experiments that this action of adenosine is blocked by intrahippocampal injections of pertussis toxin. In biochemical studies, we have confirmed that this treatment affects the GTP-binding proteins, Gi and Go, in this preparation. These results indicate that both pre- and postsynaptic actions of adenosine involve pertussis toxin-sensitive GTP-binding proteins.

Coordinating center follow-up in the Veterans Administration Cooperative Study of Coronary Artery Bypass Surgery

In the VA Cooperative Study of Coronary Artery Bypass Surgery, follow-up by the participating investigators was completed in 1984 and annual centralized follow-up by the coordinating center for an additional 5 years was initiated in 1985. Follow-up was restricted to key outcomes that could be reliably obtained in most patients-survival, severity of angina, myocardial infarction and bypass surgery. Ninety-five percent of patients consented to annual follow-up by telephone or mail. At the first annual follow-up, 95% of all survivors were contacted; 95% were also contacted at the second follow-up. In the initial follow-up, survival status was known in all patients and severity of angina was recorded in 93% of survivors; all bypass operations and all but one infarct identified were documented by a discharge summary. Our results indicate that coordinating center follow-up was effective in a long-term study of a chronic disease and depended on the willingness of patients to participate, the experience of the interviewers, and the ability of the coordinating center to contact patients and retrieve outcome data. This report describes the methods used for the centralized follow-up of the surviving patients and summarizes the initial follow-up results. The limitations and advantages of this approach are also discussed.