P-091 IMPROVEMENT OF RESPIRATORY PHYSIOLOGY AFTER POSTERIOR COMPONENT SEPARATION TAR: A PILOT STUDY

Aim

Patients with incisional hernia with a width greater than 9 centimeters, submitted to Posterior Component Separation Trasversus Abdominis Release, by Department of Emergency and Transplantation Surgery in Varese Hospital, were analyzed to define the modifications in respiratory physiology after surgery.

Material and Methods

Patients that underwent Posterior Component Separation were prospectively analyzed by evaluating: volume of laparocele, volume of abdominal cavity and their ratio. Furthermore Pulmonary Peak pressures and Pulmonary Plateau pressures were measured in three different times: at the induction of the anaesthesia, when the mesh was placed and at the closure of the anterior muscular layer. All patients were submitted to a pre-operative simple spirometry, and re-examinated three months after the surgical procedure with the same procedure to check if modifications in their respiratory function were present.

Results

Primary results of the study will be shown to define how this surgical procedure impacts on the respiratory function of the patients. The expectation is that an improvement of the respiratory physiology happens independently from a pulmonary pressure elevation which is determinated by the re-allocation of the herniated viscera in the abdomen when the anterior muscular fascia is closed.

Conclusions

the aim of this study is to show how, the reconstitution of a functional abdominal wall with an efficient respiratory accessory musculature guaranteed by the laparocele correction with Posterior Component Separation, ensures an improvement of respiratory physiology visible with spirometry, independently from the development of a superior intrathoracic pressure.

P-092 LAPAROSCOPIC TRANS-PERITONEAL HERNIOPLASTY (TAPP) IN EMERGENCY

 

The aim efficacy and technical feasibility of TAPP operation by analyzing patients operated on incarcerated inguino-crural hernia in emergency setting.

Materials and methods

In 1 year, we enrolled 8 urgent incarcerated hernia patients operated using laparoscopic trans-peritoneal approach (TAPP) operated on acutely for inguino-crural incarcerated hernia associated with suspected visceral ischemic damage.

Results

We repaired 6 inguinal incarcerated hernia and 2 cases of crural hernia. Among 6 inguinal hernia, only one was recurrent. In one case the laparoscopic approach permitted to exclude an obstructed Spigelian hernia diagnosed through tomography. In another case, TAPP allowed to diagnose omental incarcerated Spigelian hernia. In 3 cases this approach permitted to diagnose concomitant unknown wall defects. All cases presented signs of small bowel obstruction. The content of the sac in three cases was small bowel, in other three cases it was omentum, and in other two cases it contained lipoma. None of the cases were converted to open technique. The operative average time was 95 min; the average hospital stay was 1.5 days. No chronic pain or recurrences were observed after a mean follow up time of 8 months.

Conclusions

The repair of complicated inguino-crural with TAPP in emergency is not a standard treatment. In our experience the laparoscopic approach allowed a safe reduction of hernia, the observation of the feature of hernia content, the diagnosis and repair of unknown wall defect, and a crural defects and contralateral inguinal hernia.

V-045 SAFENESS OF LIQUIBAND FIX8® IN T.A.P.P. PROCEDURE: ANALYSIS OF COSTS, POST-OPERATIVE COMPLICATIONS AND RECURRENCES

Aims

We tested the use of LiquiBand®FIX8™ versus standard TAPP procedure comparing costs, surgical time, complications, recurrence rate, chronic pain to check the feasibility of the procedure.

Materials and Methods

LiquiBand®FIX8™is a cyanoacrylic adhesive used to fix the mesh during laparoscopic procedures. It consents the avoidance of plastic or metallic fixing materials that can causes post-operative chronic pain or vascular damage

Discussion

We performer 54 TAPP procedures, 48 with standardized tack technique and 6 with LiquiBand®FIX8™. We checked the results after a 6 months follow-up and we found no difference in recurrence rate or chronic pain between the two techniques. Costs and surgical time were inferior in LiquiBand®FIX8™ group.

Conclusions

The use of LiquiBand®FIX8™is a safe and feasible procedure during TAPP to reduce the surgical time, to limit costs and to avoid intraoperative and postoperative complications that can occur with mechanical fixing materials.

OC-027 IS THERE A CORRELATION BETWEEN TYPE OF PROSTHESIS FIXATION IN T.A.P.P. AND AFTER SURGERY RECOVERY? OUR CENTER EXPERIENCE

Aim

A retrospective study was carried out on patients treated for bilateral inguinal hernia with TAPP technique by the department of Urgency Surgery and Transplantation of Varese's hospital in order to investigate the VAS one month after surgery and functional recovery in two groups of patients.

Material and Methods

38 patients treated in the last year were enrolled, dividing them in two groups: those who received a single fixing material (reabsorbable clips) and those with a double fixing material (reabsorbable clips and glue). Primary end point was the post-operative pain using the VAS scale at one month. Secondary end-point was the return to daily activities and work in days. The Mann-Whitney test with p-value set< 0.05 was used.

Results

The single fixing material group shown a 1-month VAS of 0.57 ±1, versus 1.43±4 of the second group (p-value<0.05); with a return of daily activities in 4.92± 8 days, versus 8.06 ± 11 days (p-value<0.05). In addition, analyzing the subpopulation of still active workers (28 of the 38 patient), it was assessed the working back timing. The positioning of only reabsorbable clips, compared with a double fixing material, ensured a faster return to work in 8.2 ±10 days versus 20 ± 30 days (p-value<0.05).

Conclusions

Fixing the prosthetic mesh with resorbable clips alone, could lead to a more rapid resumption of daily and work activities, with less pain one month after surgery.

V-056 LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH GORE SINECOR INTRAPERITONEAL BIOMATERIAL: OUR CENTER EXPERIENCE

Aim

Ventral hernias including incisional ones are very common in our population. Mesh reinforcement options for ventral/incisional hernia repair continue to evolve with advances in polymer science and better understanding of the extracellular matrix. Consensus on the safety and efficacy of these various types of synthetic and biologic mesh has yet to be reached.

Intraperitoneal onlay mesh (IPOM) is the laparoscopic technique most frequently used in our center to treat umbilical and abdominal ventral defects sized 3 cm to 8 cm. Our equipe built an expertise with Gore DualMesh prosthesis (2% recurrence ratio in our center); we used the Gore Sinecor Intraperitoneal Biomaterial for the first time here.

Methods

Symptomatic supraumbilical incisional hernia in a 74 years old man; parietal defect sized 7×8 cm. We performed an Ipom repair procedure using a 20×25 cm Gore Sinecor Intraperitoneal Biomaterial, trimmed to 18×20 cm. Follow-up at one and six months from surgery.

Results

The patient was discharged the day after surgery. He did not complain severe pain in the first week after surgery and he only use Paracetamolo 1g die as antalgic therapy. After seven days he resumed his daily activities.

He did not experience any short-term sieroma nor long-term complication at follow up.

Conclusions

The Gore Sinecor Intraperitoneal Biomaterial, while maintaining a firm peritoneal adhesivity, has a better handling and feels lighter than the Gore DualMesh we routinely use. The transparency makes it possible to visualize the overlying abdominal wall, allowing a safer tacs positioning.

P-090 EMERGENCY INTRAPERITONEAL ONLAY MESH REPAIR OF INCARCERATED VENTRAL E INCISIONAL HERNIA

Aim

Abdominal wall hernia surgery is the frequent surgical operation. Incarceration and strangulation are the complications for patients going to emergency surgery clinics.Laparoscopic approach in emergency is controversial. IPOM treatment permits safe hernia reduction, accurate abdominal exploration,diagnosis and treatment of unknown hernia.

Material and Methods

in one year,we operated 12 urgent ventral hernia patients with IPOM technique. All patientsshowed hemodynamic stability. We evaluated safety of hernia reduction, conversion rate,operative time,hospital stay, and prosthesis infection.

Results

Nine patients underwent surgery for incarcerated incisional hernia, 3 patients for primary incarcerated ventral hernia. We used a laparoscopic approach. In 10 cases,we placed an intraperitoneal mesh. In two cases, we converted to open surgery, because of small bowel injury. It was never necessary to perform Intestinal resection for strangulated hernia.Contents of hernia sacs were omentum (7 patients), large bowel (1 patients), 4 omentum and small bowel (4 patients). Patients presented signs of small bowel obstruction. Average size of the defect was 6cm.Average operative time was 91 min, the mean post-operative hospital stay was 3.5 days. Post-operative complications weren't recorded. There wasn't mortality. During the follow-up none patients had mesh infection or hernia recurrence.

Conclusion

In emergency the Intraperitoneal Onlay Mesh Repair of Incarcerated Ventral and Incisional Hernia allowed safe adesiolysis, bowel reduction. Laparoscopic approach was associated to low post-operative complications even in emergency setting.

P-099 PERSISTENT POST-SURGICAL PAIN AFTER SURGICAL CORRECTION OF VENTRAL HERNIA REPAIR. PRELIMINARY DATA OF AN OBSERVATIONAL STUDY AT VARESE UNIVERSITY HOSPITAL

Aim

Persistent post-surgical pain (PPSP) is one of the most frequent complication after surgery and has important socio-economic consequences.

Materials and methods

We performed an observational analysis of the patients submitted to surgical correction of ventral hernia repair at our University Hospital between 1st February 2021 and 1st January 2022.We registered data about perioperative surgical period. After at least 3 months we proceeded with a phone interview in order to record the incidence of PPSP according to its definition.

Results

We enrolled 61 patients and 26 patients were lost to follow-up. 9 patients (25%) denveloped chronic pain after surgery and 3 cases reported pain that had deteriorated the quality of life (PPSP group).In the PPSP group median age was 53; obesity, COPD, diabetes mellitus, smoking status, were not significant (p > 0,05). Male sex, previous abdominal surgery and open approach showed correlation with PPSP onset. In our cohort demographical and clinical characteristics were not statistically related to PPSP, while the use of locoregional anesthesia could be protective in front of PPSP onset.

Conclusion

At the moment, although there is no shared protocol in the prevention of PPSP, it is possible to implement some interventions to reduce its risk. Our results show that more effective analgesic/anesthetic perioperative measures may help to prevent the adverse consequences of poorly controlled pain, including its transition to PPSP. The main limits of our data is the small cohort analysed and the study protocol without an analysis about immediate postoperative pain and PPSP outbreak.