OC-074 BILAYERED RETICULAR AND LAMINAR POLYPROPYLENE MESH AS A USEFUL TEMPORARY ABDOMINAL CLOSURE FOR THE MANAGEMENT OF THE OPEN ABDOMEN

Aim

To demonstrate the utility of a bilayered reticular and laminar polypropylene (PLP) mesh as a temporary abdominal closure device for the management of the open abdomen.

Patients And Methods

Prospective multicentric study including consecutive patients with open abdomen of any etiology. A bilayerede PLP mesh is used as temporary abdominal closure. The mesh has a 30×40 cm laminar PLP intraperitoneal layer that is fully deployed covering the viscera, and a 30x 40 cm large pore PLP layer that is trimmed to the size of the defect and sutured to the border of the fascia. Depending on the evolution time and the clinical situation of the patient, successive plicatures of the reticular PLP are performed to reduce the fascial defect. At the end, the mesh is explanted, and a complete fascial closure is attempted.

Results

Eighteen patients were included. Etiologies of the open abdomen were vascular (22%), trauma (28%) and sepsis (50%). There were 72% female patients, mean age of 60 years (range 19–81). Four patients died in the first 72 hours due to complications of their pathology. The other 14 patients survived, with a mean time of open abdomen of 15 days (range 1–43). In all cases a total fascial closure was achieved, with absence of adhesions between the visceral and the parietal peritoneum. No complications related with the mesh took place during the follow up

Conclusion

Temporary abdominal closure with a bilayered reticular and laminar polypropylene mesh is efficient and safe, with a 100% rate of fascial closure

P-136 MANAGEMENT OF DIRTY ABDOMINAL WALL SITUATIONS WITH AN OVINE RUMEN BIOLOGIC MESH WITH POLYPROPYLENE REINFORCEMENT

Aim

To present our initial results of abdominal wall surgery in dirty situations with an ovine rumen (OR) biologic mesh reinforced with polypropylene.

Patients and Methods

Five patients with elective abdominal wall surgery in a dirty setting were included. Two cases were previous PTFE mesh infections after IPOM repairs, one case of enteroatmospheric fistula through a previous posterior component separation repair, one deep tissue infection after a MILOS retromuscular repair and one definitive closure after a 8 weeks open abdomen in a liver transplantation patient. In the five cases cultures showed polymicrobian infections. Both PTFE meshes were removed and substituted by the OR biologic mesh. In the enteroatmospheric fistula patient the exposed mesh was resected together with the fistula take down, and a re-Rives was performed. In the case of the MILOS deep tissue infection after two weeks with an open abdomen and a temporary abdominal closure the definitive closure was performed with the biologic mesh in the retromuscular space. In the definitive closure of the liver transplantation patient the mesh was placed intraperitoneally as prophylaxis.

Results

In four cases there weren´t any surgical sites ocurrences. In the case of the enteroatmospheric fistula the patient presented a partial fascial dehiscence with mesh exposure, managed with a VAC system. With less than a year follow up no hernia recurrence has taken place.

Conclusión

The use of an OR biologic mesh with polypropylene reinforcement seems to be safe in abdominal wall repair in dirty settings, with good results during early follow up.

V-031 VICRYL MESH WITH ATRAUMATIC FIXATION AS A TECHNICAL RESOURCE FOR DIFFICULT POSTERIOR CLOSURE IN E-TEP APPROACH

Aim

To present a technical resource as a possible solution to the posterior defect that does not allow primary closure in the e-TEP approach for ventral hernias, and which may represent an alternative to transverse abdominis release.

Material and Methods

This is a 44-year-old woman with obesity and previous hysterectomy via infraumbilical median laparotomy. She presented with an M3W1 in incisional hernia with a 4 cm defect containing the transverse colon.

Results

After performing a retromuscular dissection according to the Rives-Stoppa technique, it was found that there was a continuous tear in the most cranial area of the posterior layer, which was not corrected with the primary suture.

It was therefore decided to place an absorbable vicryl mesh to cover the defect, fixed atraumatically with cyanoacrylate.

Conclusion

During a minimally invasive ventral hernia repair, closure of the peritoneal sac can be technically complex. This leads to exposure of the retromuscular polypropylene mesh, which would come into contact with the visceral bundle, and possible herniation of intestinal contents through the posterior defect.

In these cases, one of the most proposed option is the release of the transverse abdominal muscle, but it could increase the technical difficulty and surgical time.

As an alternative to this, we propose the placement of an absorbable vicryl mesh, covering the defect, fixed atraumatically with cyanoacrylate. This, as shown in this case, ensures posterior coverage of the mesh and does not hinder subsequent extension of the mesh.

P-127 E-TEP ASSISTED REVERSE-TAR FOR THE TREATMENT OF LARGE LUMBAR INCISIONAL HERNIAS ASSOCIATED TO MIDLINE DEFECTS

Aim

To describe a new hybrid surgical approach of large lumbar incisional hernias (IH) associated to synchronic midline defects.

Material and Methods

Prospective multicentric study including patients with large lumbar hernias (L4W3) associated to midline abdominal wall defects. Surgical intervention starts with a bilateral retrorectus dissection performed through a minimally invasive extraperitoneal endoscopic approach (eTEP). Once this space has been dissected, the lumbar IH is treated with an overextended centrifugal preperitoneal open approach through the previous lumbar incision. Afterwards the dissected spaces are communicated performing a reverse transversus abdominis release (TAR) from lateral to medial. A prosthetic preperitoneal repair is performed with an absorbable and permantent meshes that cover the space dissected.

Results

Five patients were included in the study. All patients had lumbar hernias L4W3 associated to primary or incisional midline hernias M1–5 W1–2. Eighty percent of the patients were women, with a mean age of 62 years. Mean BMI was 32 (range 30–34), with a 60% of diabetic patients, and 80% of recurrent lumbar hernias (between 1 and 3 previous repair attempts). Mean surgical time was 198 minutes (range 160–250). Mean hospital stay was 5 days (range 4–8 days). Two lumbar hematomas which didn't required any interventional procedure took place as the only surgical site occurrences, without any systemic complications. No recurrence has taken place after 5 months mean follow up (range 2–9 months)

Conclusion

Hybrid eTEP and open approach of large lumbar hernias associated with small midline defects seem to be an efficient and safe approach.