Abstract


Ventral hernia repair (VHR) fixation techniques with current meshes on the market are prone to failure from intra-abdominal pressure spikes due to coughing or lifting, for example. The T-Line® Hernia Mesh (Deep Blue Medical Advances, Durham, North Carolina) is a new mesh with a novel fixation mechanism to enhance anchoring strength addressing hernia occurrence and recurrence. Used similarly to traditional mesh, the new mesh uses incorporated mesh sutures that are 15 times the surface area of sutures for fixation rather than monofilament sutures, providing ~275% stronger anchoring strength. The increased surface area of the mesh extensions decreases tension on the mesh and tissue and increases the strength of the repair overall. There is also the likelihood that anchoring gains strength over time as the extensions undergo bioincorporation. This novel mesh specifically addresses the most common complication of VHR and has the potential to significantly improve outcomes.

Abstract


Complex abdominal wall defects (CAWDs) are a new surgical entity that require a dedicated and multidisciplinary approach. The spectra of CAWDs and complex abdominal wall reconstruction (CAWR) are poorly defined, and may include any of these elements: large or multiple recurrent hernia, presence of previously placed mesh (open or laparoscopic), loss of abdominal wall domain due to trauma, infection or tumor resection, hernia in the presence of enterocutaneous or enteroatmospheric fistulae (ECF/EAF), hernia in the presence of infected sinus tract, large debilitating parastomal hernia, hernias in the presence of synthetic erosion into the bowel or causing intestinal obstruction, eroded hernias post open abdomen management with skin graft in the presence of intraabdominal catastrophe or massive trauma, and hernias (umbilical or ventral/incisional) in patients with cirrhosis in the presence of massive ascites. The relevance of abdominal wall reconstruction with reinforcement using synthetic or biological mesh has never been as high as it is now. In particular, the use of biological mesh is rising exponentially due to its inherent properties. We previously described a nine-step approach to the management of difficult abdomen with enterocutaneous fistula. In this paper, we update this strategy based on our recent experience with almost 300 patients at our institution who underwent CAWR. Special attention is paid to the management of contaminated fields and the rationale of using biological mesh.

Abstract


Background: Ventral hernia is a common occurrence in patients undergoing solid organ transplant (SOT) and who require complex abdominal wall reconstruction (CAWR). The aim of this study was to analyze the outcomes of CAWR in SOT patients in a tertiary center.
Methods: We performed a prospective cohort study in patients who underwent CAWR with biological mesh at our center from January 2016 to November 2021. As per the study protocol, all patients will be followed for 3 years.
Results: During the study period, we performed CAWR in 38 SOT patients. The mean age (Standard Deviation: SD) was 61 (9.5) years and the majority were males (68%). Mean body mass index (SD) was 30.3 (5.5) kg/m2 and hernia repair was performed electively in 33 patients. The majority (82%) of the hernias were less than class 2 with a median mesh size (interquartile range) of 600 (400-800) cm2. Seventy-nine percent of patients were liver transplant recipients and the mesh was placed sub-lay (retro-rectus) (82%); the most common technique was posterior component separation (82%). Five patients (13.2%) had surgical site infection and 4 (10.5%) had unplanned reoperations. None of the patients died postoperatively and the 30-day readmission rate was 21%. Three patients (7.9%) had recurrence during follow-up and all of them underwent reoperation.
Conclusions: Complex abdominal wall reconstruction (CAWR) using biologic mesh for solid organ transplant patients with ventral hernia is safe and has low recurrence when performed by a dedicated CAWR team.

Abstract


Introduction: Groin hernia repair can relieve pain from conditions other than groin hernias, such as “sports groin.” The aim of this study was to assess the nationwide frequency of surgically treated sports groins and identify conditions found during groin hernia surgery with no hernia present.
Materials and Methods: In this nationwide cohort study, we included patients with no hernia found during groin hernia repair. Patients were identified in the nationwide Danish Hernia Database. Outcomes were assessed from medical and surgical records. Medical history, preoperative examinations, and operative details were extracted.
Results: Data from 259 patients were included. Of these, 152 (58%) were considered to have a sports groin. A weak posterior inguinal wall was identified in 41 sports groins, a wide profound inguinal ring in 10, and no specific anatomic pathology was described in the remaining patients with a sports groin. A lipoma was found in addition to a sports groin in 60 patients. Findings in patients without a sports groin were predominantly lipomas, and less frequent findings were a cyst and hydrocele.
Conclusions: More than half of the patients were assessed to have a sports groin. Frequent findings that co-existed with a sports groin were weak posterior inguinal wall and/or lipoma.