Open IPOMs for medium/large incisional ventral hernia repairs in the French Hernia Registry: factors associated with their use and mesh-related outcomes.

PURPOSE: The use of open intra-peritoneal onlay mesh repairs (O-IPOMs) for treating medium/large incisional ventral hernias has come into question due to the development of minimally invasive and sublay procedures. This study aimed to identify factors that are associated with the use of O-IPOMs in France. METHODS: We analysed prospectively collected data from the French Hernia Registry on incisional ventral hernia repairs (IVHR) for hernias ≥ 4 cm in width. RESULTS: We obtained data for 2261 IVHR (from 11/09/2011 to 30/03/2020): 733 O-IPOMs and 1,528 other techniques. We found that the O-IPOMs were performed on patients with more patient-related risk factors compared with the other techniques. Specifically, there was a higher proportion of patients with ASA III/IV (40.47% vs. 28.02%; p < 0.00001) and at least one patient-related risk factor (66.17% vs. 58.51%; p = 0.0005). Of the 733 O-IPOMs, 195 used Ventrio ST™ (VST), the most commonly used mesh for such IPOMs in our database; the other 538 O-IPOMs used other meshes (OM). The VST subgroup had a higher proportion of patients with ASA III/IV (52.58% vs. 36.07%; p < 0.0001) and on anticoagulants (26.04% vs. 18.41%; p = 0.0229) compared with the OM subgroup; they also had a lower recurrence rate after 2 years (5.83% vs. 15.41%; p = 0.008). However, large (≥ 10 cm) or lateral defects were more common in the OM subgroup, and their mesh/defect area ratio was lower. CONCLUSION: O-IPOMs were performed on patients with more comorbidities and/or complex incisional hernias compared with other techniques.

PerFix™ plug versus 4DDOME(®) implants for inguinal hernia repair: prospective multicentric randomised controlled trial.

INTRODUCTION: Anterior mesh placement is the standard of care for hernia repair. The use of partially absorbable meshes may limit post-operative pain without altering the durability of the repair. We designed a prospective randomised study, which aims to compare the PerFix™ plug to the 4DDOME(®), a partially absorbable mesh. MATERIALS AND METHODS: Inguinal hernia patients were prospectively and randomly included in the study. Hernia repair was performed using either the PerFix™ plug (Davol) or the 4DDOME(®) implant (Cousin Biotech). Operative evaluation included type and duration of anaesthesia, characteristics of the incision, post-operative hospital stay and pain evaluated through a visual analogue scale (VAS) at day 1, day 8, month 1, month 6, and year 1. Return to personal or professional activity was evaluated. Quality of life was measured by a SF36 questionnaire at 1, 6, and 12 months' follow-up. RESULTS: Ninety-five patients were prospectively enrolled and randomised to one type of prosthetic repair. The two groups of patients did not differ in terms of clinical characteristics, type of hernia, and intra-operative course. When comparing PerFix™ plug to 4DDOME(®) groups, the post-operative course was similar: pain (VAS 3.42 (SD 1.83) vs. 3.82 (SD 2.0), p = 0.69); in-hospital stay (2.12 (SD 1.36) vs. 2.25 (SD 1.62), p = 0.67); and return to personal (9.39 days (SD 8.15) vs. 9.48 days (SD 11.68), p = 0.96) and professional activity (25.71 days (SD 17.47) vs. 22.82 days (SD 18.10), p = 0.62). Post-operative pain and discomfort assessed by the SF36 questionnaire at day 8, months 1, 6, and 12 were similar, but significantly lower after 4DDOME(®) repair at 3 months for "pain" (p = 0.021) and at 6 months for "health" criteria (p = 0.028). CONCLUSION: This clinical study demonstrated similar short-term results. The 4DDOME(®) was associated with less pain and discomfort after 3 and 6 months. The combination of the dome shape and the double component mesh including an absorbable part meet the conflicting demands of early strength with a long-term low-weight material to minimise shrinkage and fibrosis. This design represents a potential advance in anterior tension-free hernia repair with mesh.

Duodenocaval fistula: a life-threatening condition of various origins.

We report on two cases of duodenocaval fistula. The first patient, a 73-year-old man, had sepsis and occult digestive bleeding. We diagnosed a fistula that resulted from a right nephrectomy and subsequent radiotherapy for a urothelial tumor 20 months earlier. The second patient, a 60-year-old woman, complained of right abdominal pain. A duodenocaval fistula that was caused by duodenal perforation by a migrating caval filter placed 10 years earlier was revealed by means of endoscopy. Both patients had a successful operation to treat the condition. An extensive review of the literature disclosed 35 other cases and identified two factors of good prognosis: duodenocaval fistulas caused by migrating caval filters and early surgery.