Flat patch mesh versus three-dimensional mesh (plug) for open umbilical or epigastric hernia repair. A retrospective study.

INTRODUCTION: Hernia repair using prosthetic mesh materials has become the preferred method of repair, as the recurrence rates are much lower than with conventional repair techniques. The aim of this retrospective study was to compare open small- and medium-sized abdominal wall hernia repair with flat patch mesh versus three-dimensional mesh (plug) in terms of recurrence and complication rates. METHODS: The medical records of 300 patients who underwent abdominal wall hernia repair using flat patch mesh versus three-dimensional mesh between January 2010 to December 2015 were reviewed. All patients were followed up after 1 month, 3 month and 1 year. The rate of recurrence, and short-term postoperative complications such as incidence of Surgical Site Infections (SSIs), hematoma and seroma were evaluated. RESULTS: Short-term follow-up data were available for all patients. The first group was composed of 150 patients that were treated with a flat polypropylene mesh (68% presened umbilical hernia and 32% presented epigastric hernia). The second group was composed of 150 patients that were treated with a three-dimensional polypropylene mesh (60% presented umbilical hernia and 40% presented epigastric hernia). The majority of postoperative (1-month) complications were wound related, representing superficial SSI or seroma. Our results showed a statistically significant reduction of SSIs [3 (2%) vs 13 (8.6%); p = 0.038] and seroma [2 (1.3%) vs 12 (8%); p = 0.030] in the group of patients treated with plugs compared to flat-mesh group. There was no statistically significant difference in hernia recurrences. DISCUSSION: Usage three-dimensional mesh for open small- and medium-sized umbilical or epigastric hernia repair represents a feasible and safe technique that significantly lowers the incidence of complications such as SSIs and seroma. Furthermore, compared to flat patch mesh, plugs displayed non-inferiority in terms recurrence. Further, well-designed clinical trials could be realized to investigate possible applications of plugs in treatment of small- and medium-sized umbilical and epigastric hernias. KEY WORDS: Mesh, Umbilical Hernia.

Laparoscopic prosthetic repair of laparocele. A comparison of techniques and a review of the literature.

Incisional hernia, or post-laparotomy hernia, is a defect in the abdominal wall, which can produce mechanical and systemic changes in both respiratory and splanchnic circulation. This pathology has an important impact on Health and Society, with an incidence ranging from 2% to 20%, stimulating the improvement or development of surgical techniques, to reduce discomfort and complications, e.g. imprisonment, strangulation and recurrences. The growing availability of prostheses, with greater resistance and lower risk of visceral adhesions, has improved the result and reduced relapses. Over the past 15 years, further improvements have been achieved, thanks to the greater use of laparoscopy, decreasing relapses and complications and improving patient comfort. In this regard, the Ventralight Echo PS prosthesis, introduced for the first time in 2013 and routinely used by our team, have shown encouraging results. In this work, a retrospective study aims to compare in different aspects two groups of patients, suffering from defects on the abdominal wall and undergoing reconstructive surgery with laparoscopic technique. It has been used simple prostheses for the first, whereas the Echo PS~ Positioning System with Ventralight - ST Mesh or Composix - L/P Mesh for the second group. In our experience, we conclude that the use of prostheses, such as the Ventralight Echo PS, in the treatment of incisional hernias, regardless of the location of the defect, is a valid and safe alternative to the use of non-self-expandable prostheses. KEY WORDS: Incisional Hernia, Hernia Repair, Laparoscopic Technique.

Neuropathic inguinal pain: neurectomy associated with open prosthetic hernioplasty for the prevention of post-operative pain.

INTRODUCTION: Inguinal hernia is one of the most common surgical diseases in the world. Today, this disease is treated by surgical technique only. Among the late complications after surgery, the most frequent is the appearance of chronic post-operative pain after surgical treatment. The incidence of this complication is about 28% of patients undergoing hernioplasty suffering a varying degree of chronic pain, severe enough to interfere with normal daily activities. OBJECTIVES: In this study we evaluated the onset of the neuropathic pain as a complication of inguinal prosthetic hernioplasty surgery. METHODS: This is a prospective observational study run between September 2019 and August 2020. All patients, during the first visit conducted in an outpatient clinic, were recruited in a specific database. Subsequently, surgery was planned in election on one day surgery, patients were administered a specific questionnaire aiming at the identification of any pain and its exact location. The Inguinal Pain Questionnarie (IPQ) was used. During the surgical procedure the selective neurectomy of the 3 nerves has been documented, the entire population of patients has undergone a standardized surgical treatment. At the end of surgery, a follow-up was carried out administering two questionnaires (IPQ Short Form Modified and the IPQ Short Form Paresthesia Modified) concerning the possible chronic post-operative pain and the eventual paresthesia. The questionnaires were administered at first, third and sixth month from the date of surgery. RESULTS: A total of 266 patients were screened from September 2019 to October 2020. Fiftyseven male patients were included in the study with a confirmed diagnosis of primary inguinal hernia. Clinical data, baseline characteristics and outcomes are described. Preoperatively, at the time of IPQ administration, 1.8% of patients had a pain score of 6, 10% of 5, 21% of 4, 31% of 3, 28% with a score of 2 and 7% of patients with a score of 1. In all cases the ileoinguinals and ileohypogastric nerves found were subjected to neurectomy, in 19% of cases also the genitofemoral nerve was subjected to surgical resection. At the end of the follow-up, the first questionnaire (IPQ Short Form Modified) results did show that, among the total of patients who had an open prosthetic hernioplasty with extensive nerves resection in the inguinal canal, 84% of them indicated a pain score equal to 0 (no pain) after 6 months of treatment and only 1.7% indicated a score equal to 4. Analyzing the second questionnaire on paresthesia (IPQ Short Form Paresthesia Modified), 79% of patients indicated a score equal to 0 by describing no paresthesia and no changes in sensitivity; 15.7% score 1; 3.5% score 2; 1.7% score 3. CONCLUSIONS: Based on our experience and according to the modern literature, we would advise prophylactic total neurectomy of the inguinal canal nerves during prosthetic inguinal hernioplasty. KEY WORDS: Abdominal Surgery, Chronic pain, Inguinal hernioplasty, Neurectomy, Paresthesia.

Grynfeltt-Lesshaft hernia Personal experience of nine cases and a review of the literature.

Grynfeltt's lumbar hernia, from the author who first described it in 1866, is the rarest among all hernias of the abdominal wall and it represents, according to the most recent literature, only 2% of all hernias. Of these, about 20% are congenital, secondary mainly to defects of embryonic development, while 80% are acquired defects. Surgeries, penetrating wounds, and infections are risk factors for the development of secondary and therefore iatrogenic lumbar hernias. In the literature, there is a predominance of the left Grynfeltt hernia while a bilateral presentation is exceptional. Our recent observation of a massive Grynfeltt hernia brought us to perform a revision of the literature and of our case studies. Based on our personal experience, with the most recent literature, we believe that in the case of Grynfeltt's lumbar hernias, the laparotomy approach with the use of prosthetic materials is the most appropriate, thus making the procedure fast, easy, and safe, compared to the treatment of all other wall defects that often require a laparoscopic approach. To confirm this, it is perceived that the open technique is currently more widespread; in fact, a small lumbotomy is easy to perform, fast, and can also be performed under loco-regional or epidural anaesthesia. KEY WORDS: Lumbar hernioplasty, Grynfeltt hernia, Hernia repair.