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Background: Long-term resorbable mesh represents a promising technology for ventral and incisional hernia repair (VIHR). This study evaluates poly-4-hydroxybutyrate mesh (P4HB; Phasix Mesh) among comorbid patients with CDC class I wounds., Study Design: This prospective, multi-institutional study evaluated P4HB VIHR in comorbid patients with CDC class I wounds. Primary outcomes included hernia recurrence and surgical site infection. Secondary outcomes included pain, device-related adverse events, quality of life, reoperation, procedure time, and length of stay. Evaluations were scheduled at 1, 3, 6, 12, 18, 24, 30, 36, and 60 months. A time-to-event analysis (Kaplan-Meier) was performed for primary outcomes; secondary outcomes were reported as descriptive statistics., Results: A total of 121 patients (46 male, 75 female) 54.7 ± 12.0 years old with a BMI of 32.2 ± 4.5 kg/m 2 underwent VIHR with P4HB Mesh (mean ± SD). Fifty-four patients (44.6%) completed the 60-month follow-up. Primary outcomes (Kaplan-Meier estimates at 60 months) included recurrence (22.0 ± 4.5%; 95% CI 11.7% to 29.4%) and surgical site infection (10.1 ± 2.8%; 95% CI 3.3 to 14.0). Secondary outcomes included seroma requiring intervention (n = 9), procedure time (167.9 ± 82.5 minutes), length of stay (5.3 ± 5.3 days), reoperation (18 of 121, 14.9%), visual analogue scale-pain (change from baseline -3.16 ± 3.35 cm at 60 months; n = 52), and Carolinas Comfort Total Score (change from baseline -24.3 ± 21.4 at 60 months; n = 52)., Conclusions: Five-year outcomes after VIHR with P4HB mesh were associated with infrequent complications and durable hernia repair outcomes. This study provides a framework for anticipated long-term hernia repair outcomes when using P4HB mesh., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Surgeons.)

Background: This study represents a prospective, multicenter, open-label study to assess the safety, performance, and outcomes of poly-4-hydroxybutyrate (P4HB, Phasix™) mesh for primary ventral, primary incisional, or multiply-recurrent hernia in subjects at risk for complications. This study reports 3-year clinical outcomes., Materials and Methods: P4HB mesh was implanted in 121 patients via retrorectus or onlay technique. Physical exam and/or quality of life surveys were completed at 1, 3, 6,12, 18, 24, and 36 months, with 5-year (60-month) follow-up ongoing., Results: A total of n = 121 patients were implanted with P4HB mesh (n = 75 (62%) female) with a mean age of 54.7 ± 12.0 years and mean BMI of 32.2 ± 4.5 kg/m 2 (±standard deviation). Comorbidities included: obesity (78.5%), active smokers (23.1%), COPD (28.1%), diabetes mellitus (33.1%), immunosuppression (8.3%), coronary artery disease (21.5%), chronic corticosteroid use (5.0%), hypo-albuminemia (2.5%), advanced age (5.0%), and renal insufficiency (0.8%). Hernias were repaired via retrorectus (n = 45, 37.2% with myofascial release (MR) or n = 43, 35.5% without MR), onlay (n = 8, 6.6% with MR or n = 24, 19.8% without MR), or not reported (n = 1, 0.8%). 82 patients (67.8%) completed 36-month follow-up. 17 patients (17.9% ± 0.4%) experienced hernia recurrence at 3 years, with n = 9 in the retrorectus group and n = 8 in the onlay group. SSI (n = 11) occurred in 9.3% ± 0.03% of patients., Conclusions: Long-term outcomes following ventral hernia repair with P4HB mesh demonstrate low recurrence rates at 3-year (36-month) postoperative time frame with no patients developing late mesh complications or requiring mesh removal. 5-year (60-month) follow-up is ongoing., Competing Interests: Dr. Roth reports a grant and consulting fees from C.R. Bard, Inc./Davol/Becton Dickinson (BD) during the conduct of this study. Dr. Roth also reports consulting fees (Johnson & Johnson) and stock (Miromatrix) outside of the current work. Dr. Anthone has no conflicts of interest to disclose related to this study. Dr. Anthone reports consulting fees and speaker honoraria (Becton Dickinson (BD)) outside of the current work. Dr. Selzer reports a grant from C.R. Bard, Inc./Davol/Becton Dickinson (BD) during the conduct of the study. Dr. Selzer also reports consulting fees (Cook Biotech, Inc.) outside of the current work. Dr. Poulose has no conflicts of interest to disclose related to the current study. Dr. Poulose reports salary support (Americas Hernia Society Quality Collaborative) and research support (Becton Dickinson (BD) and Advanced Medical Solutions) outside of the current work. Dr. Pierce has no conflicts of interest to disclose related to the current study. Dr. Pierce reports research support (Intuitive Surgical Solutions) outside of the current work and his spouse is a salaried employee of a medical device company (CareFusion) that falls under the overall umbrella of the parent company, Becton Dickinson (BD). Drs. Dunn, Bittner, Linn, Romanelli, and Sandler report a grant from C.R. Bard, Inc./Davol/Becton Dickinson (BD) during the conduct of the study but have nothing to disclose outside of the current work. Dr. Hope reports consulting fees and research support from C.R. Bard, Inc./Davol/Becton Dickinson (BD) during the conduct of the study. Dr. Hope also reports consulting fees, honoraria, and research support (Intuitive, W.L. Gore, and Medtronic) outside of the current work. Dr. Martindale has no conflicts of interest to disclose related to the current study. Dr. Martindale reports consulting fees (Allergan, C.R. Bard, Inc./Davol/Becton Dickinson (BD), and Nestle) and employment (OHSU) outside of the current work. Dr. Goldblatt reports a grant from C.R. Bard, Inc./Davol/Becton Dickinson (BD) during the conduct of the study. Dr. Goldblatt also reports consulting fees (W.L. Gore, Medtronic, and Allergan) and a grant (Medtronic) outside of the current work. Dr. Earle has no conflicts of interest to disclose related to the current study. Dr. Earle reports consulting fees (Becton Dickinson (BD) and Medtronic) and ownership stake/advisory board (Via Surgical) outside of the current work. Dr. Mancini has no conflicts of interest to disclose related to the current study. Dr. Mancini reports consulting fees (Stryker Endoscopy) and speakers’ fees (Gore Medical and Medtronic) outside of the current work. Dr. Greenberg reports a grant from C.R. Bard, Inc./Davol/Becton Dickinson (BD) during the conduct of the study. Dr. Greenberg also reports grants (Becton Dickinson (BD) and Medtronic), as well as course registration, travel, and lodging (Intuitive) outside of the current work. Dr. Parra-Davila has no conflicts of interest to disclose related to the current study. Dr. Parra-Davila reports consulting fees (C.R. Bard, Inc./Davol/Becton Dickinson (BD), Intuitive, Auris, Johnson & Johnson, and Titan), board membership (C.R. Bard, Inc./Davol/Becton Dickinson (BD)), and proctoring (Intuitive) outside of the current work. Dr. Deeken reports consulting fees from C.R. Bard, Inc./Davol/Becton Dickinson (BD) during the conduct of the study. Dr. Deeken also reports consulting fees from C.R. Bard, Inc./Davol/Becton Dickinson (BD), Surgical Innovation Associates, Americas Hernia Society Quality Collaborative, Colorado Therapeutics, TelaBio, and Aran Biomedical outside the submitted work, as well as grants from Ethicon, Inc. and TelaBio to support a book chapter outside the submitted work. In addition, Dr. Deeken is the owner of Covalent Bio, LLC and holds the following issued patents: 2009293001, 2334257, 2,334,257UK, 602009046407.8, 2,334,257FR, 16/043,849 and 2,737,542. Dr. Verbarg reports consulting fees from C.R. Bard, Inc./Davol/Becton Dickinson (BD) during the conduct of the study. Dr. Verbarg has no other conflict of interest to disclose outside of the current work. Drs. Salluzzo and Voeller have no conflicts of interest to disclose relative to the current study or any other work., (© 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Omental infarction is a rare phenomenon that can be idiopathic or secondary to a surgical intervention. Greater omentum division has been advocated to decrease tension at the gastro-jejunal anastomosis during laparoscopic Roux-en-Y gastric bypass (RYGB). We report a case of omental infraction complicated by liquefied infected necrosis presenting 3 weeks after antecolic antegastric RYGB. The patient underwent laparotomy and subtotal omentectomy with a protracted hospital course due to intra-abdominal abscesses, acute kidney injury and small bowel obstruction that were successfully managed non-operatively. We reviewed the available literature on omental infarction after RYGB, focusing on associated symptoms, possible etiology, timing of presentation, management and propose an alternative technique without omental division., (Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2020.)

Background: Utilization of robotic-assisted inguinal hernia repair (IHR) has increased in recent years, but randomized or prospective studies comparing outcomes and cost of laparoscopic and Robotic-IHR are still lacking. With conflicting results from only five retrospective series available in the literature comparing the two approaches, the question remains whether current robotic technology provides any added benefits to treat inguinal hernias. We aimed to compare perioperative outcomes and costs of Robotic-IHR versus laparoscopic totally extraperitoneal IHR (Laparoscopic-IHR)., Methods: Retrospective analysis of consecutive patients who underwent Robotic-IHR or Laparoscopic-IHR at a dedicated MIS unit in the USA from February 2015 to June 2017. Demographics, anthropometrics, the proportion of bilateral and recurrent hernias, operative details, cost, length of stay, 30-day readmissions and reoperations, and rates and severity of complications were compared., Results: 183 patients had surgery: 45 (24.6%) Robotic-IHR and 138 (75.4%) Laparoscopic-IHR. There were no differences between groups in age, gender, BMI, ASA class, the proportion of bilateral hernias and recurrent hernias, and length of stay. Operative time (Robotic-IHR: 116 ± 36 min, vs. Laparoscopic-IHR: 95±44 min, p < 0.01), reoperations (Robotic-IHR: 6.7%, vs. Laparoscopic-IHR: 0%, p = 0.01), and readmissions rates were greater for Robotic-IHR. While the overall perioperative complication rate was similar in between groups (Robotic-IHR: 28.9% vs. Laparoscopic-IHR: 18.1%, p = 0.14), Robotic-IHR was associated with a significantly greater proportion of grades III and IV complications (Robotic-IHR: 6.7% vs. Laparoscopic-IHR: 0%, p = 0.01). Total hospital cost was significantly higher for the Robotic-IHRs ($9993 vs. $5994, p < 0.01). The added cost associated with the robotic device itself was $3106 per case and the total cost of disposable supplies was comparable between the 2 groups., Conclusions: In the setting in which it was studied, the outcomes of Laparoscopic-IHR were significantly superior to the Robotic-IHR, at lower hospital costs. Laparoscopic-IHR remains the preferred minimally invasive surgical approach to treat inguinal hernias.