INCISIONAL HERNIA: COMPLICATIONS & QUALITY OF LIFE

Hernia (2015) (SuppI2):S3-S194 ABSTRACTS INCISIONAL HERNIA: COMPLICATIONS & QUALITY OF LIFE © Springer-Verlag 2014 C08:01 NEGATIVE PRESSURE WOUND T...
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Hernia (2015) (SuppI2):S3-S194

ABSTRACTS

INCISIONAL HERNIA: COMPLICATIONS & QUALITY OF LIFE © Springer-Verlag 2014

C08:01 NEGATIVE PRESSURE WOUND THERAPY FOR TREATMENT OF MESH INFECTION AFTER ABDOMINAL SURGERY: LONG-TERM RESULTS AND PATIENT-REPORTED OUTCOME S NobaekI, P Rogmark2, U Petersson2 IDepartment of Surgery, Bornholm Hospital, 3700 Ronne, Bornholm, Denmark, Ronne, DENMARK 2Department of Clinical Sciences, Malmo, Faculty ofMedicine, Lund University, Malmo, SWEDEN Introduction: The purposes of this study were to evaluate wound healing, mesh preservation and patient-reported outcome after negative pressure wound therapy (NPWT) of mesh infection after abdominal surgery. Methods: Medical records of patients treated with NPWT for a mesh infection and age-matched mesh operated controls without an infectious wound complication, were scrutinized in a retrospective study. An abdominal wall complaints questionnaire was used to evaluate patient-reported outcome. Results: Between January 2005 and June 2012, 722 patients were treated with mesh repair of an abdominal wall hernia. Patients with inguinal or femoral hernia repair with mesh were not included. Wound complications occurred after 233/722 (30.3%) mesh operations. Fifty-four patients were treated with NPWT for a mesh infection. No differences were found between the 54 NPWT-treated and the 54 control patients in regard to preoperative patient characteristics. Emergency operation; infected surgical field; surgical techniques other than laparoscopic intraperitoneal onlay mesh repair (lPOM); mesh used for fascial closure after open abdomen treatment; implantation of two meshes; larger mesh size; longer duration of surgery; and not being able to totally cover the mesh with the anterior rectus sheath; were significantly more frequent in the NPWT group. The entire mesh was successfully salvaged in 48 (89%) of the NPWT patients. Six meshes were partly excised. Wounds healed in 47 (87%) patients after median 138 (range 12-1 102) days. Eighty-three per cent in the NPWT group and 74% in the control group answered the questionnaire. There was no difference regarding "pain not easily ignored", but controls were overall more satisfied with the result. Conclusions: When NPWT was used for treatment of an infected mesh, no mesh had to be explanted and wound healing was achieved in the majority of patients, although time to healing was long and numerous procedures were sometimes needed. Patient-reported outcome was better amongst controls.

C08:02 NEGATIVE PRESSURE WOUND THERAPY FOR MESH-SITE INFECTION AFTER INCISIONAL HERNIA REPAIR: A CASE REPORT AND LITERATURE REVIEW S B Hu, P Sun, Z F Song, M Li, X Cheng, B Guo, Y Zhang, C Zhang,

Q CZheng' Union Hospital, Huazhong University ofScience and Technology, Wuhan, CHINA

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Purpose: We reviewed a case of negative pressure wound therapy (NPWT) for mesh-site infection after incisional hernia repair and relevant literature. Methods: This was a 76 years old female patient. She had a history of many times of abdominal operations, 3 of which was incisional hernia repair, including 2 times of mesh implantation. The latest operation was done on October 19, 2013. Four months later, intermittent incisional exudation emerged. But she did not go to hospital until 2 months later. The culture of the exudation was positive for E. coli. After systematic treatment with sensitive antibiotics and local debridement for 3 months, the bacteria infection could not be controlled well. Thus, we applied NPWT. Then the systematic and abdominal symptoms released and white blood cells decreased. Unfortunately, the infection could not be cleaned completely 3 months later and the intestinal fistula appeared. At last, we had to move out the in-lay mesh. But we still applied negative pressure drainage by urinary catheter besides nutritional support. One month later, she healed from infection and fistula. Literature review and conclusions According to the review and our experience, NPWT can make sure drain well, reduce toxin absorption, improve abdominal distention, promote the growth of granulation tissue. If NPWT is applied in early stage of infection, the majority of patients would achieve good results. Even some studies reported that prophylactic use of NPWT can reduce the incidence of postoperative infection after huge belly defect reconstruction. But NPWT can not control the infection completely, and may even induce intestinal injury, especially when applied not so early.

C08:03 FEW SHORT-TERM COMPLICATIONS AFTER ENDOSCOPIC COMPONENT SEPARATION FOR GIANT VENTRAL HERNIA REPAIR K Jensen', K Linde', L Jorgensen' IDigestive Disease Center, Bispebjerg Hospital, Copenhagen, DENMARK Introduction: Giant ventral hernia repair is technically challenging. Moreover, patients undergoing these operations are often highly comorbid and at increased risk of pulmonary and wound-related complications. Endoscopic component separation (ECS) with division of the external oblique aponeurosis is one technique for abdominal wall reconstruction, making it possible to achieve midline closure and restore the linea alba. At our center we have performed ECS combined with open synthetic mesh repair since 2010. The aim of this study was to examine the incidence of early postoperative complications after giant ventral hernia repair using this surgical technique. Methods: All patients who underwent ECS for ventral hernia repair from October 2010 - August 2014 were registered in a prospective database. Additional data was retrieved retrospectively from patient

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S52 charts. Surgical and medical complications within the first 30 days postoperative were registered. Furthermore, readmissions and reoperations were registered. Results: 81 patients were included in the study. The median age was 63 years (range 29-81 years) and the median body mass index of patients was 27.8 kg/m2 (15-42 kg/m2). The median horizontal and vertical defect size was 10.5 cm (5-24 cm) and 16 cm (3-30 cm). ECS was bilateral in 67 (83%) and unilateral in 14 (17%) of the patients. Closure of the posterior rectus sheath was achieved In 72 (90%) of the patients, and restoration of the linea alba was obtained in all patients. Postoperative wound complications developed in 11 (14%) patients including superficial wound dehiscence in 7 (9%) and surgical site infection in 4 (5%) patients. Pneumonia developed in 14 (17%) patients and 2 (3%) patients required assisted ventilation postoperative. The median length of hospital stay was 6 days (2-40 days) and 11 (14%) patients were readmitted to the hospital. 10 (12%) patients underwent additional surgery within the study period, due to wound-related complications (54, bowel obstruction (3), mesh displacement (2) and acalculous cholecystitis (I). Conclusion: Abdominal wall reconstruction for giant ventral hernia assisted by ECS is safe and has low short-term complication rates compared with reported rates after open component separation. Long-term follow-up of hernia recurrence rates and quality of life after this type of repair is required to determine the overall outcome.

C08:04 THE USE OF SEPRAMESH® IN THE INFECTED SURGICAL FIELD: SQUAMOUS CELL CARCINOMA OF THE ANTERIOR ABDOMINAL WALL, CHRONIC MESH INFECTION AND BOWEL RESECTION C Birolini l, J S Miranda l, E M Utiyama l, S Rasslan l IAbdominal Wall and Hernia Surgery, University of sao Paulo, School ofMedicine, sao Paulo, BRAZIL

Introduction: Chronic mesh infection is a devastating complication of the modem hernia repair armamentarium. The degeneration of mesh infection into squamous cell carcinoma of the abdominal wall has been reported, and it is possibly related to the persistence of a long-term inflammatory response. The association of mesh infection, invasive cancer with bowel involvement and destruction of the anterior abdominal wall is unusual and represents a unique technical and tactical challenge. The association of mesh infection and the need for bowel resection are usually considered absolute contra-indications to perform the necessary repair with synthetic mesh.

Methods: In this video, we recorded the single-staged reconstruction of the abdominal wall on a 39 years old white male. He had a fourteen years history of mesh infection following multiple operations and a mesh peritoneostomy after an abdominal gunshot in the year 2000. He presented with an enormous ulcerated tumor of the anterior abdominal wall, along with extrusion of pieces of polypropylene mesh and multiple draining sinuses. Cultures were positive for Morganella morganii. Results: The operation comprised an RO resection of the tumor involving the infected mesh and the right rectus muscle. The work up of the abdominal cavity included an enterectomy, a cholecystectomy, the tactical removal of the appendix and the resection of an enteric fistula between the duodenum and the transverse colon. The midline could not be restored, and an intra-peritoneal bridged repair with Sepramesh® was used to close the abdominal wall. The post-operative was uneventful, except for a minor skin breakdown. He was referred for adjuvant ~ Springer

Hernia (2015) (SuppI2):S3-S194 chemotherapy. He is followed since July 2014, and he has a continent abdominal wall, without signs of mesh infection or tumor recurrence. Conclusion: Sepramesh® enabled a reliable closure of the abdominal wall despite the presence of contamination and active infection.

C08:05 TOPICAL NEGATIVE PRESSURE FOR TREATING INFECTIONS COMPLICATING OPEN INCISIONAL HERNIA REPAIR WITH NON-ABSORBABLE MESH

G Sarrol, U Rivolta l, R GiorgP, B Laterza!, S Pigliafreddo l, M Serbelloni l, F Signorelli!, F Torretta l lAO Legnano - Presidio Abbiategrasso - UO Chir Gen, Abbiategrasso, ITALY

Purpose: Evaluate the efficacy oftopical negative pressure to treat infections complicating open hernia repair with non-absorbable implants. Materials and Methods: From January I, 2013 to October 20,2014, 72 consecutive patients underwent surgery for abdominal post-incisional hernia. Of these 53 were treated by laparoscopy, 19 by laparotomy. Out of 53 procedures performed by laparoscopy were not observed graft infections or wound access. Out of 19 procedures performed by laparotomy 3 (15.8%) were complicated by wound infection. In the three cases we proceeded to application of topical therapy negative pressure to -125 mmHg. None of the patients underwent antibiotic therapy early. Results: The three patients showed complete healing at a distance of 29 days, 64 days and 62 days respectively. Two of the three patients were subjected to systemic antibiotic therapy after wound culture tested positive and according to specific antibiogram for a period not exceeding 12 days. Conclusions: From the small number of our center and according to data of the literature, treatment with topical negative pressure for infections complicating open hernia repair with non-absorbable implants appears the most appropriate and conservative therapeutic choice and it should always be considered, even for prolonged periods, before revision surgery and the partial or total removal of the prosthesis. The laparoscopic technique has a lower incidence of graft infections statistically significant. Macroporous meshes respond better to topical negative pressure in infections complicating open hernia repair with non-absorbable implants and should be used in patients at high risk: recurrences and obese.

C08:06 TREATMENT EXPERIENCES FOR COMPLICATIONS OF ABDOMINAL INCISIONAL HERNIA REPAIR

H Huang l 1 Union Hospital, Fujian Medical University, Fuzhou, CHINA Introduction: To explore the causes and treatment experiences for complications of abdominal incisional hernia repair.

Methods: The clinical data of 120 patients with abdominal incisional hernia who underwent surgical treatment from November 2004 to October 2014 in Fujian Medical University Union Hospital were analyzed retrospectivley. The cause, prevention and treatment of postoperative complications were summarized.

Hernia (2015) (SuppI2):S3-S194 Results: The operation time was 45-420 min, and the average time was (160 ± 25) min. No one was dead during perioperative period. 116 patients (96.6%) were followed up. The follow-up time was 1-120 months, and the average time was (38 ± 12) months. 4 patients lost to follow-up because of the change of the way to contact. 17 patients suffered from postoperative complications (14.1 %), including incision infection in 4 patients (3.3%), intestinal obstruction in 5 patients (4.2%), intestinal fistula in 2 patient (1.6%), seroma in 5 patients (4.2%), abdominal pain in 4 patients (3.3%). Other patients had no discomfort. No recurrence, complications or death occurred. Conclusion: The key point to postoperative complications of abdominal incisional hernia repair is prevention, including the gastrointestinal cleaning and respiratory training before operations, careful separation, correct hemostasis and intraoperative positive anchoring, unobstructed drainage, infection prevention, pressure dressing and to deal with abdominal distension as soon as possible, preventing seroma and incisional infection after operations.

C08:07 QUALITY OF LIFE AND COSMETIC OUTCOME FOLLOWING COMPONENT SEPARATION FOR OPEN VENTRAL HERNIA REPAIR FOR LARGE HERNIAS K De Paep!, F Berrevoet! 1University Hospital Ghent, Ghent, BELGIUM Introduction: Component separation (CS) has become a frequently used alternative to repair large ventral defects when mesh augmentation can not be achieved. However, the impact of transecting the external oblique aponeurosis to facilitate closure of the abdomen on quality of life (QOL) and Body Image has yet to be investigated. The study goal was to investigate QOL and outcomes after open incisional hernia repair (OIHR) using CS for large ventral hernias. Methods: All patients included in this study suffered an incisional hernia and were treated without or with mesh using a retromuscular or intraperitoneal mesh repair. Prospective data for all CSs were reviewed and analysed using SPSS Statistical software. All defects were 100 to 1000 cm2 in size and repaired with mesh. Comorbidities, operi-operative complications and outcomes were analysed. To evaluate QOL pain was evaluated using the VAS scale analysis, the Carolinas Comfort Scale score was used to evaluate Hernia specific QOL outcome, while the European Quality of Life scale was used to evaluate overall improvement after surgery. The validated Body Image Questionnaire was performed in all patients to analyze cosmetic outcomes.

S53 Whereas wound breakdown and seroma formation are high, the overall outcome after intermediate follow-up time is excellent. When bilateral CS is not necessary unilateral CS should be preferred because of improved pain sensation and QOL, although cosmetic results might a little bit inferior in unilaterally treated patients.

C08:08 A LONG-TERM EVALUATION OF PERMACOLTM SURGICAL IMPLANT IN ABDOMINAL WALL REPAIR: INTERIM RESULTS OF THE ENHANCE PROSPECTIVE, MULTI-CENTRE TRIAL P Giordano!, J Schuld2, N ZuegeP, R. D. Pullan\ M Montorsi5, P Delri06, F GossettF, J Lemaitre 8, 0 Van Kerschaver9, 1. R. Danie1s lO , T Ferynll, B Griffiths!2 lBarts Health, Whipps Cross University Hospital, Leytonstone, London, UNITED KINGDOM 2Universitiitsklinikum des Saarlandes, Saarbriicken, GERMANY 3Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, LUXEMBOURG 4Torbay Hospital, Torquay, UNITED KINGDOM 5Dept of Surgery, University of Milan, Istituto Clinico Humanitas, IRCCS, Rozzano, ITALY 6Istituto Nazionale per 10 Studio e la Cura dei Tumori Fondazione Giovanni Pascale, ICRRS, Napoli, ITALY 'University Hospital, Policlinico Umberto I, Roma, ITALY 8H6pital Ambroise Pare, Mons, BELGIUM 9AZ Saint Lucas, Gent, BELGIUM lORoyal Devon and Exeter Hospital, Exeter, UNITED KINGDOM llAz Saint Jan Brugge 12The Newcastle upon Tyne Hospitals, NHS Foundation Trust of the Freeman Hospital, Newcastle upon Tyne, UNITED KINGDOM Introduction: The ENHANCE trial (NCTOI268514) is a prospective, European, multi-centre, non-randomised study aimed to evaluate the long-term outcomes of Permacol™ surgical implant in the repair of complex abdominal wall defects. The results presented here describe an interim analysis of safety and efficacy data collected as part of the ongoing study. Methods: Patients with complex abdominal wall defects were treated with Permacol™ surgical implant. Patients underwent a clinical assessment at 1,6, 12,24, and 36 months post-surgery to monitor for hernia and post-operative complications. The primary endpoint is the proportion of patients requiring reoperation for hernia or hernia recurrence within 36 months post-surgery.

Results: In total 34 patients were treated, 19 females and 15 men with a mean age of56.8 years and a BMI of28.7 ± 5.6. Thirty-two patients had a anterior component separation, of which 13 were unilaterally performed, 17 bilaterally and in 1 patient one side was treated with anterior CS and the other side by posterior CS. One patient got a bilateral posterior CS. Two patients had no mesh used, while a retromuscular mesh repair was done in 20 patients, 1 onlay repair and 11had an intraperitoneal onlay mesh repair. The main postoperative sequellae were seroma (23.5%), superficial (11.7%) and deep (5.8%) wound infections and recurrence (11.7%) after a follow-up ranging from 12-36 months. Mean hospital stay was 12 days. Pain scores as well as QOL-scores after this follow-up were significantly higher in unilaterally treated patients, while regarding the body image questionnaire there was a significantly better score in the bilaterally treated patients.

Results: Patients (N = 115) with a median follow-up of 58.2 weeks (range 0.1-178.1 weeks) are included in this interim analysis. One patient was excluded from the efficacy analysis due to concurrent implantation of another mesh product during the procedure. Follow-up at 1, 6, 12,24, and 36 months has been completed in 106 (93.0%), 93 (81.6%),84 (73.7%), 46 (40.4%), and 11 (9.6%) patients, respectively. VHWG wound classification was Grade 2 in 73 (64.0%) patients and Grade 3 in 32 (28.1 %) patients, and most patients included in the study (92.0%) were treated for incisional hernia. Twelve (10.5%) of the 114 patients exhibited hernia recurrence during the follow-up, and recurrence occurred a median of50.3 weeks (range 0.7-107.0 weeks) post-surgery. One or more adverse events were observed in 76 (66.1 %) patients. The most common adverse events were seroma, wound dehiscence, and wound infection, affecting 13.3%, 14.2%, and 9.7% of patients, respectively, but very few of these events were severe.

Conclusion: All patient undergoing CS with mesh reinforcement had improvement of their QOL both using CCS and EQ-5D evaluation.

Conclusion: Results from this interim analysis with a median follow-up of 58 weeks demonstrate low rates of recurrence and post-operative ~ Springer

S54 complications after the repair of abdominal wall defects using Permacol™ surgical implant.

C08:09 IMPROVING VALUE-BASED OUTCOMES FOR ABDOMINAL WALL RECONSTRUCTION B Ramshaw 1 lAdvanced Hernia Solutions, Daytona Beach, USA Introduction: Patients with complex ventrallincisional hernias often undergo major abdominal wall reconstructions, These operations have a high cost of care and often result in a long hospital stay and high complication rate. Methods: Using the principles of clinical quality improvement (CQI), several attempts at process improvement were implemented in one hernia program over a three year period. For 63 consecutive cases of patients undergoing abdominal wall reconstruction, process improvements attempts included the use of a long-term resorbable synthetic mesh in place of a biologic mesh, the use of the transversus abdominus release approach in place of an open or endoscopic component separation (external oblique release) technique and the use of a pre-operative transversus abdominus plane (TAP) block preoperatively as a part of peri-operative multi-modal pain management strategy. Results: This patient population included 50% of patients with prior wound and/or mesh infections, 24% with active wound and/or mesh infections, 27% of patients with loss of abdominal domain, 54% of patients with recurrent hernias and 20% of patients had intraoperative contamination. Using value defmed as improving quality outcomes measures while decreasing costs, outcomes were determined and measured compared to the results prior to each process improvement attempt. For cost of mesh data, the real costs of mesh for the 63 cases after the use ofiong-term resorbable mesh was implemented was $232,434 compared with $772,200 (net savings of $539,766) if the prior mesh had continued to be used. After the 17th case, the TAR approach for AWR and pre-operative TAP blocks were instituted. The group of patients after these changes were initiated used 64% less IVIIM opioids post-operatively (276.3 vs.99.3 morphine equivalents), 20% les oral opioids post-operatively (55.6 vs. 44.7 morphine equivalents) and had a 34% decrease in average length of stay (6.8 vs. 4.5 days). Conclusions: In this real-world value-based application of CQI, several attempts at process improvement led to decreased costs and improved outcomes for patients who underwent abdominal wall reconstruction for complex ventral/incisional hernias. Value-based CQI could be a tool for improved healthcare value globally.

C08:10 THE CHALLENGE OF TREATING COMPLEX ABDOMINAL WALL DEFECTS: A PROPOSAL FORA MULTIDISCIPLINARY APPROACH E Gialamas 1, A Balaphas 1, MAssalino 1, P MoreJl, W Staszewicz 1 1 University Hospital Geneva-Division o/Visceral Surgery and Transplanation-Department o/Surgery, Geneva, SWITZERLAND Introduction: The Complex Abdominal Wall Defects (CAWD) remain a challenge for every surgeon in terms of choice of appropriate repair technique, patients preparation as well as prevention and treatment of postoperative complications. Some methods and algorithms of CAWD management have been proposed in the literature. However, the evidences for a multidisciplinary approach are missing. We believe

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Hernia (2015) (SuppI2):S3-S194 that the management of this disease starts month before the operating date and encompasses many non-surgical disciplines. The aim of this work is to propose a standardized algorithm for the multidisciplinary management of CAWD, based on our single center experience focused around a single stage repair with a biologic mesh. Methods: A retrospective review of all cases operated in Visceral Surgery and Transplantation Division of University Hospital of Geneva between 2012 and 2014, meeting the criteria for CAWD as proposed by Slater (Slater et al. Hernia. 2014) was performed. Patient's data were stratified by: demographics, medical history, preoperative evaluation, operative indication, operative technique, intra- and postoperative complications and use of special wound therapy (Hyperbaric oxygen therapy, Negative pressure wound therapy). Preoperative and postoperative courses as well as extracted data were considered in a way to create a preliminary management algorithm. Results: A total of 14 patients were included. All patients were firstly evaluated by a hernia surgeon consultant. Following this preliminary consultation, an abdominal CT scan and ancillary radiological and endoscopic investigations (fistulography, coloscopy etc.) were performed. Each case was then discussed on Division board, concerning the adapted surgical approach. This step was followed by an anesthesiologist evaluation and completed with paraclinical examinations when necessary (Cardiac Investigations, pulmonary functions tests etc.). Some patients required a plastic surgeon advisor consultation. Each patient was also screened for undernutrition and was referred to a nutritionist if necessary. In every case, a tension free aponeurotic coverage was achieved and reinforced using the StratticeTM (LifeCell, Bridgewater, NJ, USA) biologic mesh, mostly in intra-abdominal position. In some cases, the reconstruction was completed with Ramirez's compartment separation. Seven patients presented postoperative complications and among them 5 required reoperation but none of them required the mesh explantation. In 3 patients, Negative pressure wound therapy was used and 2 patients underwent simultaneous Hyperbaric oxygen therapy. All patients were followed in our specialized wound treatment and stoma therapy ambulatory unit. After a follow-up period of 12 months, 2 patients presented a recurrence of their hernia and only 1 needed reoperation. A management algorithm was created which has for cornerstone paraclinical examinations and preoperative evaluation. Conclusion: The objectives of treatment of CAWD are multiples: restore durable abdominal wall integrity and function, regain quality of life, prevent complications and recurrence and provide a good aesthetic result. The use of a biologic mesh allows a single stage repair, even if additional minor interventions are required for subsequent wound healing and the secondary abdominal wall closure. Treating CAWD requires a systematic approach with a multidisciplinary team composed of hernia and plastic surgeons, anesthesiologists, infectiology specialist, wound nurses and nutritionists. The preliminary algorithm of management of CAWD we proposed deserves further prospective validation.

C08:11 ARE THERE ANY DIFFERENCES IN OUTCOME OF INCISIONAL HERNIA REPAIR BY PRE PERITONEAL (SUBLAY) MESH IMPLANTATION DEPENDING ON THE PLACE OF THE PREVIOUS LAPAROTOMY? P Bojovic 1, V Cijan, M Scepanovic, R Duraki, Z Bokun, M Brankovic lClinical Hospital Center Zvezdara, Belgrade, SERBIA

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Conclusion: Preperitoneal (sublay) mesh implantation resulted in an effective herniorrhaphy with low peri operative morbidity and postoperative complications in patients with incisional hernias and were not depending on the place of the previous laparotomy.

Results: Forty-nine patients, 22 males and 27 females, had mean age, BMI, and ASA of 55.8, 31.7, and 2.6. Major symptoms were pain and movement limitations. Patient received either lightweight monofilament polyester mesh (n = 29) or lightweight monofilament polypropylene (n = 20) mesh. Mean area of defect, mesh and skin flaps were 448 cm2, 868 cm2 and 696 cm2 • 62.2% of patients underwent panniculectomies, 31 PR and 11 TA component separations. Average operative time was 239.7 minutes. Median blood loss and hospital stay were 150 ml and 5.0 days. Median follow-up was 234 days. Twenty-one patients had 20 wound-related and 17 non-wound related complications. Most resolved with conservative measures and only 2 required operative intervention, a wound washout and a flap debridement for necrosis. Our patients were largely categorized as Grade 2 or 3 according to the Ventral Hernia Working Group classification with few Grade 3 patients having a history of wound infections. Wound complications did not correlate with mesh type (p = 2.6, OR 0.7 to 10.9), panniculectomy (p = 0.7; 95% CI 0.03 to 6.16), PR (p = 3.3; 95% CI 0.86 to 16.66) or TA (p = 0.5; 95% CI 0.07 to 2.27) component separations. CCS score analysis found significant improvements in pain (65%, p < 0.01) and movement limitations (74%, p < 0.01) after surgery. Overall, 84% of patients had resolution of significant pain and movement limitation after surgery with only 12% relating mesh sensati on post surgery.

C08:12 OPERATIVE AND QUALITY OF LIFE ASSESSMENT POST ABDOMINAL WALL RECONSTRUCTION WITH NONABSORBABLE MESH FOR VENTRAL AND INCISIONAL HERNIAS

Conclusion: Our study found AWR with synthetic mesh to be both safe and effective as assessed by operative and quality oflife outcomes. Complete elimination of pain symptoms and movement limitations were seen in 84% of patients after surgery. Quality of life assessment provides an important added vantage point to evaluate outcomes and should be a standard part of post-operative evaluation after AWR for ventral/incisional hernias.

Introduction: Incisional hernia is the frequent and common postoperative complication following abdominal surgery and represent a formidable challenge. The aim of this study was to determine the safety and efficacy of open preperitoneal mesh repair of incisional hernias depending on the place of the previous laparotomy. Methods: Retrospective study of patients undergoing an open preperitoneal mesh repair of incisional hernias at a district teaching hospital. Results: From January 2004 to January 20 II, all patients who underwent surgical repair of incisional hernias on the different place of the previous laparotomy were recorded. The original operations were bowel related, gynaecological, hepatopancreaticobiliary and aortic aneurysm repair. All patients who underwent repair of incisional hernia with the Rives-Stoppa technique were operated by using polypropylene macroporus flat mesh different size (Herniamesh®, s.r.1.ltaly). Data regarding demographics, co-morbidity, complications and hospitalisation were recorded. Patient satisfaction following the operation was also assessed (short-follow up - I year).

H ZahirP, U Sibia l, I Gilberti, 0 Ghaneml,AParkI, I Belyanskyl lAnne Arundel Medical Center, Department o/Surgery, Annapolis, USA

Introduction: Complex ventrallincisional hernia repairs with non-absorbable mesh and abdominal wall reconstruction (AWR) are often reserved for those with large defects, recurrent disease or risk factors for failure after repair. Use of mesh has significantly reduced recurrence rates. Furthermore, more emphasis is being placed on quality of life impact after such repairs. We report operative and quality of life outcomes following AWR with preperitoneal wide synthetic mesh placement for ventrallincisional hernias. Methods: We conducted a retrospective review of all patients who underwent open abdominal wall reconstruction for incisionallventral hernias at Anne Arundel Medical Center from January 2012 to August of 20 14. Abdominal wall reconstruction involved elevation of subcutaneous flaps, wide preperitoneal space development and mesh insertion, component separations, selective panniculectomy and closure over drains. Non-absorbable mesh types used were lightweight monofilament polyester mesh (Parietex TCM, Covidien) or polypropolene monofilament mesh (Atrium Prolite, Maquete Getinge Group). Operative outcomes were measured according to wound-related and non-wound-related complications. Wound complications were seroma, hematoma, superficial infection, deep infection/abscess, skin necrosis, flap necrosis, and mesh infection. Non-wound complications were prolonged ileus, acute renal failure, urinary tract infection, deep venous thrombosis, pulmonary embolus, myocardial infarction, and congestive heart failure. Quality of life changes were quantified using the Carolinas Comfort Scale (CCS), pre and post surgery. Mean and median values were calculated for comparison. The Student's t test was used to determine significance. A p-value < 0.05 was statistically significant.

C08:13 A PROSPECTIVE NON-RANDOMIZED CONTROLLED TRIAL FOR HYBRID AND LAPAROSCOPIC INCISIONAL HERNIA REPAIR X Deng, B Wu, J Kang, Y B Fan l lShanghai Sixth People Hospital, Shanghai Jiaotong University, Shanghai, CHINA

Introduction: The purpose ofthis study was to evaluate the safety and efficacy of new hybrid technique, laparoscopic combined with open mini-incision, for complex incisional hernia. Methods: Between April 2009 and April 2011, 40 patients with incisional hernias underwent either laparoscopic or hybrid repair with IPOM mesh at our institution. Results: The hybrid and laparoscopic groups were comparable in age, sex, American Society of Anesthesiologists score, body mass index, indication for surgery, hernia size, operative duration, pain score, length of hospital stay, and complications. The hybrid group had a significantly shorter operative time than the laparoscopic group, while mean pain score and length of hospital stay were not significantly different between groups. Furthermore, there was significantly less recurrence and bulging in the hybrid group than in the laparoscopic group during the postoperative follow-up period. Conclusions: Hybrid hernia repair appears to be feasible and safe for patients with difficult incision hernias and to result in less recurrence and bulging compared with laparoscopic repair.

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C08:14 INITIATIVE VOLUME REDUCTION SURGERY PERFORMED IN HUGE VENTRAL INCISIONAL HERNIA X F Han, J Chen [, Y M Shen, S Yang, F Q Chen 1Department of Hernia and Abdominal Wall Surgery, Beijing Chao- Yang Hospital, Capital Medical University, Beijing, CHINA

Objective: To discuss our experience in repair of huge ventral incisional hernia with Initiative Volume Reduction Surgery (IVRS). Methods From January 2011 to January 2013, we performed IVRS in 26 cases of huge abdominal incisional hernia with acellular tissue matrix (ACTM) grafts which had the ability to withstand infection. Results The procedure was completed in all the 26 cases, with a mean operation time of

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Hernia (2015) (SuppI2):S3-S194 (121.3 ± 17.9) min, range from 95-160 min. The mean intraoperative blood loss was (65.3 ± 28.4) ml, range 30-200 m!. About 150-350 cm intestine was resected in these patients, a mean of(212.6 ± 38.3) cm. The Intra-abdominal Pressure (lAP) during the first week after surgery was monitored, with mean of(7.8 ± 2.1) mmHg, range from 5.2-10.7 mmHg. After the operation, the patients was discharged from our hospital in 9 to 20 days with a mean of(14.2 ± 3.3) days. Two of the patients had postoperative wound infection without anastomotic leak or abdominal organ injuries. We followed up all the patients for (28.1 ± 5.2) months (range 18-42months). A case of recurrence was observed. Conclusions IVRS is safe and effective for huge ventral incisional hernia associated with loss of abdominal domain. It can reduce postoperative intra-abdominal pressure (IAH), and to avoid the occurrence of abdominal compartment syndrome (ACS), which finally can reduce the rate of postoperative complications and recurrence rate.