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Introduction. PG is a rare neutrophilic skin disorder with a variable clinical presentation, and diagnosis is often delayed. PPG typically presents as a necrotic ulcerative lesion with surrounding erythema and is often mistaken for a surgical site infection. Delayed diagnosis can lead to extensive morbidity and a prolonged healing time. Case Report. A 75-year-old male presented to the emergency department 2 weeks following laparoscopic appendectomy for acute appendicitis. He had fever and a suspected surgical site infection. Antibiotic treatment was initiated, and debridement was performed. Eventually, the diagnosis of PPG was made. Immunosuppressive therapy combined with NPWT was initiated. Complete wound healing was achieved 2 months after admission. Conclusions. Surgeons should have a high index of suspicion of underlying skin disorders when presumed postoperative wound infections do not respond to aggressive antibiotic and surgical treatment. Early multidisciplinary consultation should be considered. In the case of PPG, the authors of the present report advise early initiation of systemic immunosuppressive therapy combined with atraumatic wound care. NPWT should be considered as appropriate. Surgical debridement may be indicated in the setting of extensive necrosis or uncontrollable superinfection.

Introduction Information on the long-term performance of biosynthetic meshes is scarce. This study analyses the performance of biosynthetic mesh (Phasix™) over 24 months. Methods A prospective, international European multi-center trial is described. Adult patients with a Ventral Hernia Working Group (VHWG) grade 3 incisional hernia larger than 10 cm2, scheduled for elective repair, were included. Biosynthetic mesh was placed in sublay position. Short-term outcomes included 3-month surgical site occurrences (SSO), and long-term outcomes comprised hernia recurrence, reoperation, and quality of life assessments until 24 months. Results Eighty-four patients were treated with biosynthetic mesh. Twenty-two patients (26.2%) developed 34 SSOs, of which 32 occurred within 3 months (primary endpoint). Eight patients (11.0%) developed a hernia recurrence. In 13 patients (15.5%), 14 reoperations took place, of which 6 were performed for hernia recurrence (42.9%), 3 for mesh infection (21.4%), and in 7 of which the mesh was explanted (50%). Compared to baseline, quality of life outcomes showed no significant difference after 24 months. Despite theoretical resorption, 10.7% of patients reported presence of mesh sensation in daily life 24 months after surgery. Conclusion After 2 years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Results of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations. Trial registration Registered on clinicaltrials.gov (NCT02720042), March 25, 2016.

Introduction: Patient satisfaction after inguinal hernia surgery is currently underappreciated and not as well studied as other patient-reported outcome measures (PROMs) on this topic. This study aims to review the literature and summarize available data. Materials and Methods: A literature review was conducted using Medline with focus on patient-reported satisfaction after elective, inguinal hernia surgery in adults. All inguinal hernia repair techniques were considered. Small sample sizes and short follow-up periods were excluded. The methodology and results of the remaining articles were reviewed. Due to heterogeneity of reporting between articles, only a descriptive analysis was performed. Results: The available data from patient-reported outcome measures regarding satisfaction yields considerable heterogeneity and lacks validation. We found that 53% of all included studies used an asymmetrical response questionnaire. Although there is an overwhelming positive patient satisfaction, wide ranges of satisfaction were seen (78–100% more than averagely satisfied, compared to 0–15% less than averagely satisfied). The number of patients not willing to undergo inguinal hernia repair again ranges from 1–16%. Conclusion: Our study demonstrates that patient-reported satisfaction after inguinal hernia surgery is not uniformly surveyed and remains unvalidated. Further research on patient-reported satisfaction would benefit from the reported raw data of a standardised, validated, and symmetrical five-point Likert or 11-point NRS scale on regular intervals pre- and postoperatively.

Introduction: The incidence of incisional hernias (IHs) after open repair of an abdominal aortic aneurysm (AAA) is high. Several randomized controlled trials have reported favorable results with the use of prophylactic mesh to prevent IHs, without increasing complications. In this analysis, we report on the results of the 60-month follow-up of the PRIMAAT trial. Methods: In a prospective, multicenter, open-label, randomized design, patients were randomized between prophylactic retrorectus mesh reinforcement (mesh group), and primary closure of their midline laparotomy after open AAA repair (no-mesh group). This article reports on the results of clinical follow-up after 60 months. If performed, ultrasonography or computed tomography were used for the diagnosis of IHs. Results: Of the 120 randomized patients, 114 were included in the intention-to-treat analysis. Thirty-three patients in the no-mesh group (33/58-56.9%) and 34 patients in the mesh group (34/56-60.7%) were evaluated after 5 years. In each treatment arm, 10 patients died between the 24-month and 60-month follow-up. The cumulative incidence of IHs in the no-mesh group was 32.9% after 24 months and 49.2% after 60 months. No IHs were diagnosed in the mesh group. In the no-mesh group, 21.7% (5/23) underwent reoperation within 5 years due to an IH. Conclusions: Prophylactic retrorectus mesh reinforcement after midline laparotomy for the treatment of AAAs safely and effectively decreases the rate of IHs. The cumulative incidence of IHs after open AAA repair, when no mesh is used, continues to increase during the first 5 years after surgery, which leads to a substantial rate of hernia repairs.

Purpose: Abdominal wall hernia repair in contaminated cases remains a therapeutic challenge due to the high risk of post-operative surgical site occurrences (SSO). Slowly resorbable synthetic (biosynthetic) meshes have recently been introduced and may offer unique advantages when challenged with bacterial colonization during abdominal wall reconstruction. Methods: A multicenter single-arm retrospective observational cohort study examined all consecutive patients in whom a poly-4-hydroxybutyrate mesh (Phasix™ or Phasix™ ST; Becton Dickinson, Franklin Lakes, NJ, USA) was used for the repair of an inguinal or ventral/incisional hernia, or to replace an infected synthetic mesh. Patient records were analyzed according to the level of contamination, using the classification score of the Centers for Disease Control and Prevention (CDC). The primary objective was to evaluate short-term postoperative morbidity by assessing SSOs and the need for reoperation or even mesh excision. Results: A total of 47 patients were included. The median age was 68 years (30-87), the male/female ratio was 26/21, and the median BMI was 26.5 kg/m2 (16.4-46.8). There were 17 clean cases, 17 clean-contaminated, 6 contaminated and 7 dirty. Median follow-up time was 48 days. An SSO was seen in 4 clean (23.5%), 7 clean-contaminated (41.2%), 2 contaminated (33.3%) and 5 dirty cases (71.4%). A surgical site occurrence requiring procedural intervention (SSOPI) was seen in 2 clean (11.8%), 3 clean-contaminated (17.6%), 1 contaminated (16.7%) and 2 dirty cases (28.6%). Hernia recurrence was seen in 1 clean (5.9%), 2 clean-contaminated (11.8%) and 3 dirty cases (42.9%). Mesh excision had to be performed in only one case in the contaminated group. Conclusion: The Phasix™ mesh shows promising short-term results when used in contaminated hernia-related surgery. Even in contaminated or dirty conditions, with or without infection of the mesh, resection of the mesh only had to be performed once and patients could be managed either conservatively or by relatively minor reoperations. However, further research is needed to fully evaluate the safety and efficacy of these meshes.

Introduction and importance An infection of an abdominal wall prosthesis can be a real disaster for the patient. A conservative treatment might be an option if biological or slowly resorbable synthetic meshes were used. However, adequate research of their use in contaminated and dirty wounds lacks. Case presentation Herein we report the case of a 69-year-old patient with a heavily infected poly-4-hydroxybutyrate mesh that was successfully treated conservatively. Clinical discussion Despite promising results of poly-4-hydroxybutyrate meshes, their use remains controversial and studies in contaminated wounds are scarce. Conclusion Our case report shows the potential benefits of a poly-4-hydroxybutyrate mesh in a very high-risk patient with active infection., Highlights • Mesh infection is a dreaded complication after hernia repair. • Some mesh infections can be treated conservatively. • Poly-4-hydroxybutyrate has favorable biological and mechanical characteristics. • In contaminated wounds, poly-4-hydroxybutyrate meshes seem superior to conventional synthetic meshes.

Background: Accurate staging of patients with gastric cancer is necessary for selection of the most appropriate and personalized therapy. Computed Tomography (CT) is currently used as primary staging tool, being widely available with a relatively high accuracy for the detection of parenchymal metastases, but with low sensitivity for the detection of peritoneal metastases. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) has a very high spatial and contrast resolution, suggesting a higher diagnostic performance in the detection of small peritoneal lesions. The aim of this study was to retrospectively evaluate the added value of whole-body diffusion-weighted MRI (WB-DWI/MRI) to CT for detection of peritoneal carcinomatosis (PC) and distant metastases in the preoperative staging of gastric cancer.Methods: This retrospective study included thirty-two patients with a suspicion of gastric cancer/recurrence, who underwent WB-DWI/MRI at 1.5 Tesla, in addition to CT of thorax and abdomen. Images were evaluated by two experienced abdominal radiologists in consensus. Histopathology, laparoscopy and/or 1-year follow-up were used as reference standard.Results: For overall tumor detection (n=32), CT sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was 83.3%, 100%, 100% and 82.4% respectively. For WB-DWI/MRI these values were 100%, 92.9%, 94.7% and 100%, respectively. For staging (n=18) malignant lymph nodes and metastases, CT had a sensitivity, specificity/ PPV/ NPV of 50%/ 100%/ 100%/ 71.4%, and 15.4%/ 100%/ 100%/ 31.3% respectively. For WB-DWI/MRI, all values were 100%, for both malignant lymph nodes and metastases. WB-DWI/MRI was significantly better than CT in detecting tumor infiltration of the mesenteric root, serosal involvement of the small bowel and peritoneal metastases for which WB-DWI/MRI was correct in 100% of these cases, CT 0%.Conclusions: WB-DWI/MRI is highly accurate for diagnosis, staging and follow-up of patients with suspected gastric cancer. These results need to be confirmed in larger studies.

BACKGROUND: Resorbable biomaterials have been developed to reduce the amount of foreign material remaining in the body after hernia repair over the long-term. However, on the short-term, these resorbable materials should render acceptable results with regard to complications, infections, and reoperations to be considered for repair. Additionally, the rate of resorption should not be any faster than collagen deposition and maturation; leading to early hernia recurrence. Therefore, the objective of this study was to collect data on the short-term performance of a new resorbable biosynthetic mesh (Phasix™) in patients requiring Ventral Hernia Working Group (VHWG) Grade 3 midline incisional hernia repair. MATERIALS AND METHODS: A prospective, multi-center, single-arm trial was conducted at surgical departments in 15 hospitals across Europe. Patients aged ≥18, scheduled to undergo elective Ventral Hernia Working Group Grade 3 hernia repair of a hernia larger than 10 cm2 were included. Hernia repair was performed with Phasix™ Mesh in sublay position when achievable. The primary outcome was the rate of surgical site occurrence (SSO), including infections, that required intervention until 3 months after repair. RESULTS: In total, 84 patients were treated with Phasix™ Mesh. Twenty-two patients (26.2%) developed 32 surgical site occurrences. These included 11 surgical site infections, 9 wound dehiscences, 7 seromas, 2 hematomas, 2 skin necroses, and 1 fistula. No significant differences in surgical site occurrence development were found between groups repaired with or without component separation technique, and between clean-contaminated or contaminated wound sites. At three months, there were no hernia recurrences. CONCLUSION: Phasix™ Mesh demonstrated acceptable postoperative surgical site occurrence rates in patients with a Ventral Hernia Working Group Grade 3 hernia. Longer follow-up is needed to evaluate the recurrence rate and the effects on quality of life. This study is ongoing through 24 months of follow-up. ispartof: INTERNATIONAL JOURNAL OF SURGERY vol:83 pages:31-36 ispartof: location:United States status: published

Objective and importance: Candida auris is a relatively new yeast species and an emerging opportunistic pathogen. It was first reported in 2009 in East Asia, as a difficult-to-identify Candida spec...

Objective: Patients with stage III and high-risk stage II colorectal cancer (CRC) are advised to initiate adjuvant treatment as soon as feasible and certainly before 8 to 12 weeks after resection of the tumor. A protective ileostomy is often constructed during surgery to protect a primary anastomosis “at risk”, especially in rectal cancer surgery. However, up to 17% of patients with a stoma suffer from high output, a major complication that can prevent adjuvant treatment implementation or completion. To avoid delay or cancellation of adjuvant therapy after CRC resection, effective strategies must be implemented to successfully treat and/or prevent high-output stoma (HOS). Methods: We report two clinical case reports clearly demonstrating the impact and management of HOS in this setting. A review of the available literature and ongoing clinical studies is provided. Results: The clinical cases describe patients with advanced stage CRC and focus on the different strategies for HOS management, presenting their outcome and how each strategy affects the implementation of adjuvant treatment. The patient population with the highest risk of developing HOS is described, along with the rationale for using somatostatin analogs, such as lanreotide, to treat and prevent high output. Conclusion: In patients with CRC and protective ileostomies after primary resection, HOS could be treated with somatostatin analogs in combination with dietary recommendations and Saint Mark's solution. The role of this therapeutic approach as a preventive strategy in patients at high risk of developing HOS, deserves further exploration in a prospective randomized clinical trial.

This retrospective study reveals the results of our approach to the treatment of complex ventral hernias. A single-center, single-surgeon retrospective chart review on 68 consecutive patients who underwent abdominal wall reconstruction for incisional herniation on the midline between January 2012 and December 2016 is presented. The Bonheiden technique is based on anterior component separation in combination with preperitoneal retromuscular mesh reinforcement of the midline. Data of 68 consecutive cases of incisional midline abdominal wall defects treated electively with the mesh reinforced anterior component separation technique were analyzed. Demographics, patient characteristics, and hernia properties were evaluated. Postoperative complications included 28% of wound infections/dehiscence, 25% seromas, and 7% hematomas. No recurrences have been seen. We conclude this technique to be safe and reliable for large midline defects in patients suffering with several comorbidities.

BACKGROUND: This study assessed clinical outcomes, including safety and recurrence, from the two-year follow-up of patients who underwent open ventral primary hernia repair with the use of the Parietex™ Composite Ventral Patch (PCO-VP).METHODS: A prospective single-arm, multicenter study of 126 patients undergoing open ventral hernia repair for umbilical and epigastric hernias with the PCO-VP was performed.RESULTS: One hundred twenty-six subjects (110 with umbilical hernia and 16 with epigastric hernia) with a mean hernia diameter of 1.8 cm (0.4-4.0) were treated with PCO-VP. One hundred subjects completed the two-year study. Cumulative hernia recurrence was 3.0% (3/101; 95%CI: 0.0-6.3%) within 24 months. Median Numeric Rating Scale pain scores improved from 2 [0-10] at baseline to 0 [0-3] at 1 month (P CONCLUSIONS: The use of PCO-VP to repair primary umbilical and epigastric defects yielded a low recurrence rate, low postoperative and chronic pain, and high satisfaction ratings, confirming that PCO-VP is effective for small ventral hernia repair in the two-year term after implantation.TRIAL REGISTRATION: The study was registered publically at clinicaltrials.gov ( NCT01848184 registered May 7, 2013).

Background:The incidence of incisional hernias after abdominal aortic aneurysm repair is high. Prophylactic mesh-augmented reinforcement during laparotomy closure has been proposed in patients at high risk of incisional hernia.Methods:A multicenter randomized trial was conducted on patients undergoing elective abdominal aortic aneurysm repair through a midline laparotomy (Clinical.Trials.gov: NCT00757133). In the study group, retromuscular mesh-augmented reinforcement was performed with a large-pore polypropylene mesh (Ultrapro, width 7.5cm). The primary endpoint was the incidence of incisional hernias at 2-year follow-up.Results:Between February 2009 and January 2013, 120 patients were recruited at 8 Belgian centers. Patients' characteristics at baseline were similar between groups. Operative and postoperative characteristics showed no difference in morbidity or mortality. The cumulative incidence of incisional hernias at 2-year follow-up after conventional closure was 28% (95% confidence interval [CI], 17%-41%) versus 0% (95% CI, 0%-6%) after mesh-augmented reinforcement (P < 0.0001; Fisher exact test). The estimated freedom of incisional hernia curves (Kaplan-Meier estimate) were significantly different across study arms ((2) = 19.5, P < 0.0001; Mantel-Cox test). No adverse effect related to mesh-augmented reinforcement was observed, apart from an increased mean time to close the abdominal wall for mesh-augmented reinforcement compared with the control group: 46 minutes (SD, 18.6) versus 30 minutes (SD, 18.5), respectively (P < 0.001; Mann-Whitney U test).Conclusions:Prophylactic retromuscular mesh-augmented reinforcement of a midline laparotomy in patients with abdominal aortic aneurysm is safe and effectively prevents the development of incisional hernia during 2 years, with an additional mean operative time of 16 minutes.

BACKGROUND & AIMS: Vitamin D deficiency is common in Crohn's disease (CD). High-dose vitamin D had anti-inflammatory effects in preclinical studies and trials of patients with CD. We performed a randomized trial to determine whether high-dose vitamin D prevents postoperative recurrence of CD after ileocolonic resection. METHODS: Patients with CD after ileocolonic resection with ileocolonic anastomosis were assigned randomly to groups given weekly 25,000 IU oral vitamin D (n = 72) or placebo (n = 71) for 26 weeks, at 17 hospitals in The Netherlands and Belgium, from February 2014 through June 2017. Patients were assessed at baseline and at weeks 2, 6, 12, and 26 for laboratory and clinical parameters, and underwent ileocolonoscopy at 26 weeks. The primary end point was endoscopic recurrence (modified Rutgeerts score, ≥i2b, as assessed by blinded readers) at 26 weeks. Secondary end points included clinical recurrence (Crohn's disease activity index, ≥220), quality of life (measured by the 36-Item Short Form Health Survey, Inflammatory Bowel Disease Questionnaire, and EuroQol, a 5-dimension questionnaire), and outcomes associated with the baseline serum concentration of vitamin D. RESULTS: In the vitamin D group, serum levels of 25-hydroxy vitamin D increased from a median of 42 nmol/L at baseline to 81 nmol/L at week 26 (P < .00001), whereas levels did not change significantly in the placebo group and remained unchanged at 43 nmol/L. In the intention-to-treat analysis, the proportion of patients with endoscopic recurrence at 26 weeks did not differ significantly between the vitamin D vs the placebo group (58% vs 66%; P = .37). The cumulative rate of clinical recurrence did not differ significantly between the groups (18.1% in the vitamin D group vs 18.3% in the placebo group; P = .91). Quality of life improved slightly over time in both groups, but did not differ significantly between groups (P = .07). There were few adverse events in either group. CONCLUSIONS: High-dose vitamin D, compared with placebo, did not reduce the incidence of postoperative endoscopic or clinical recurrence of CD in patients who underwent ileocolonic resection with ileocolonic anastomosis. ClinicalTrials.gov no: NCT02010762. ispartof: CLINICAL GASTROENTEROLOGY AND HEPATOLOGY vol:19 issue:8 pages:1573-+ ispartof: location:United States status: published

BACKGROUND: Incisional heia is a frequent complication of midline laparotomy. The use of mesh in hernia repair has been reported to lead to fewer recurrences compared to primary repair. However, in Ventral Hernia Working Group (VHWG) Grade 3 hernia patients, whose hernia is potentially contaminated, synthetic mesh is prone to infection. There is a strong preference for resorbable biological mesh in contaminated fields, since it is more able to resist infection, and because it is fully resorbed, the chance of a foreign body reaction is reduced. However, when not crosslinked, biological resorbable mesh products tend to degrade too quickly to facilitate native cellular ingrowth. Phasix™ Mesh is a biosynthetic mesh with both the biocompatibility and resorbability of a biological mesh and the mechanical strength of a synthetic mesh. This multi-center single-arm study aims to collect data on safety and performance of Phasix™ Mesh in Grade 3 hernia patients. METHODS: A total of 85 VHWG Grade 3 hernia patients will be treated with Phasix™ Mesh in 15 sites across Europe. The primary outcome is Surgical Site Occurrence (SSO) including hematoma, seroma, infection, dehiscence and fistula formation (requiring intervention) through 3 months. Secondary outcomes include recurrence, infection and quality of life related outcomes after 24 months. Follow-up visits will be at drain removal (if drains were not placed, then on discharge or staple removal instead) and in the 1st, 3rd, 6th, 12th, 18th and 24th month after surgery. CONCLUSION: Based on evidence from this clinical study Depending on the results this clinical study will yield, Phasix™ Mesh may become a preferred treatment option in VHWG Grade 3 patients. TRIAL REGISTRATION: The trial was registered on March 25, 2016 on clinicaltrials.gov: NCT02720042 . ispartof: BMC SURGERY vol:18 issue:1 ispartof: location:England status: published

Background : A variety of anti-adhesive composite mesh products have become available to use inside the peritoneal cavity. However, reimbursement of these meshes by the Belgian Governemental Health Agency (RIZIV/INAMI) can only be obtained after conducting a prospective study with at least one year of clinical follow-up. This Belgian multicentric cohort study evaluated the experience with the use of Proceed(R)-mesh in laparoscopic ventral hernia repair. Patients and methods : During a 25 month period 210 adult patients underwent a laparoscopic primary or incisional hernia repair using an intra-abdominal placement of Proceed(R)-mesh. According to RIZIV/INAMI criteria recurrence rate after 1 year was the primary objective, while postoperative morbidity, including seroma formation, wound and mesh infections, quality of life and recurrences after 2 years were evaluated as secondary endpoints (NCT00572962). Results : In total 97 primary ventral and 103 incisional hernias were repaired, of which 28 (13%) were recurrent. There were no conversions to open repair, no enterotomies, no mesh infections and no mortality. One year cumulative follow-up showed 10 recurrences (n = 192, 5.2%) and chronic discomfort or pain in 4.7% of the patients. Quality of life could not be analyzed due to incomplete data set. Conclusions : More than 5 years after introduction of this mesh to the market, this prospective multicentric study documents a favorable experience with the Proceed mesh in laparoscopic ventral hernia repair. However, it remains to be discussed whether reimbursement of these meshes in Belgium should be limited to the current strict criteria and therefore can only be obtained after at least 3-4 years of clinical data gathering and necessary follow-up.

Frederik Berrevoet,1 Carl Doerhoff,2 Filip Muysoms,3 Steven Hopson,4 Marco Gallinella Muzi,5 Simon Nienhuijs,6 Eric Kullman,7 Tim Tollens,8 Mark R Schwartz,9 Karl LeBlanc,10 Vic Velanovich,11 Lars Nannestad Jørgensen12 1Department of General and Hepatopancreaticobiliary Surgery, Ghent University Hospital, Ghent, Belgium; 2General Surgery, Surgicare of Missouri, Jefferson City, MO, USA; 3Department of Surgery, AZ Maria Middelares Ghent, Ghent, Belgium; 4Bon Secours Hernia Center, Mary Immaculate Hospital, Newport News, VA, USA; 5University Hospital Tor Vergata, Rome, Italy; 6Catharina Hospital, Eindhoven, the Netherlands; 7Medicinskt Centrum Linköping, Linköping, Sweden; 8Imelda Hospital-General Surgery Imelda Hospital, Bonheiden, Belgium; 9Monmouth Medical Center, Long Branch, NJ, 10Our Lady of Lakes Regional Medical Center, Baton Rouge, LA, 11Tampa General Hospital, University of South Florida, Tampa, FL, USA; 12Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark Purpose: This study assessed the recurrence rate and other safety and efficacy parameters following ventral hernia repair with a polyester composite prosthesis (Parietex™ Composite Ventral Patch [PCO-VP]).Patients and methods: A single-arm, multicenter prospective study of 126 patients undergoing open ventral hernia repair with the PCO-VP was performed. Patient outcomes were assessed at discharge and at 10days, 1, 6, 12, and 24months postoperative.Results: All patients had hernioplasty for umbilical (n = 110, 87.3%) or epigastric hernia (n = 16, 12.7%). Mean hernia diameter was 1.8 ± 0.8cm. Mean operative time was 36.2 ±15.6minutes, with a mean mesh positioning time of 8.1 ± 3.4minutes. Surgeons reported satisfaction with mesh ease of use in 95% of surgeries. The cumulative hernia recurrence rate at 1year was 2.8% (3/106). Numeric Rating Scale (NRS) pain scores showed improvement from 2.1 ± 2.0 at preoperative baseline to 0.5 ± 0.7 at 1month postoperative (P < 0.001), and this low pain level was maintained at 12months postsurgery (P < 0.001). The mean global Carolina’s Comfort Scale® (CCS) score improved postoperatively from 3.8 ± 6.2 at 1month to 1.6 ± 3.5 at 6months (P < 0.001). One patient was unsatisfied with the procedure.Conclusion: This 1-year interim analysis using PCO-VP for primary umbilical and epigastric defects shows promising results in terms of mesh ease of use, postoperative pain, and patient satisfaction. Recurrence rate is low, but, as laparoscopic evaluation shows a need for patch repositioning in some cases, an accurate surgical technique remains of utmost importance. Keywords: intraperitoneal mesh, epigastric hernia, umbilical hernia, pain

Following our previous study about a lightweight self-adhering mesh (Adhesix®, Cousin Biotech, Wervicq-Sud, France; distributed by Davol Inc., subsidiary of C.R. Bard, Inc.), we report the long-term results with the use of this mesh in patients treated for a primary, unilateral inguinal hernia without any other hernias. Prospectively collected data of 100 patients between February 2011 and February 2014 were analyzed. The mean follow-up time was 2.7 years (range 1-4), and mean length of hospital stay was 0.6 days (range 0.5-1). At the time of the last follow-up visit, two patients (2%) had a recurrent inguinal hernia. Compared to preoperative values, patients reported a significant reduction in their pain sensation (visual analogue scale, VAS) after one month (4.61 vs. 1.32; P0.001). A difference in VAS scores remained significant at the last follow-up visit (1.31 vs. 0.28; P0.001). Patients reported high quality of life scores. Only one patient (1%) developed a clinically significant seroma that required an evacuating puncture. Two patients (2%) had superficial wound infections. Neither mesh infections nor mortalities occurred. This study, with a long follow-up, confirms our previous results: use of the Adhesix® mesh is safe, feasible, and efficient in laparoscopic hernia repair.

The Ultrapro® Advanced™ mesh (Ethicon, Sommerville, NJ) is a new mesh design, using the best characteristics from the previous platform, while adding new, advanced features. Our centre, Imelda Hospital, Bonheiden, Belgium, was chosen as one of the first clinical testing sites. The aim of this study was to present our preliminary data on complication rate and patient satisfaction.From October 1, 2015 until January 31, 2016, we treated 57 patients, implementing 67 Ultrapro® Advanced™ meshes. One patient was excluded due to postoperative cerebral haemorrhage with aphasia. Only patients with more than one-month follow-up were included for further analysis, resulting in a population of 41 patients with 51 meshes. Of them, 35 were male and only 6 were female, with an average age of 61.4 years and an average BMI of 25.9. The indications were uni- and bilateral laparoscopic inguinal hernia repair (n = 23 and 10 respectively), open inguinal hernia repair (n = 3), and open incisional hernia repair (n = 5). Quality of life was measured preoperatively and at four weeks postoperatively, using the hernia specific Carolina Comfort Scale (CCS) questionnaire.The primary endpoint was complication rate. Only two patients (4.8%) mentioned a mild scrotal hematoma and two patients (4.8%) demonstrated a seroma. There were no superficial wound infections nor early recurrent hernias. Our secondary endpoint was quality of life, measured by the CCS questionnaire, which differentiates between a symptomatic and an asymptomatic group. A total of 13 patients were asymptomatic, whilst 28 patients reported some sort of discomfort, ranging from mild (n = 25) to moderate and/or daily symptoms (n = 3). No patients were disabled by their symptoms.The Ultrapro® Advanced™ is a sequel of the classic Ultrapro® mesh with similar characteristics: it is a "lightweight", macroporous, partially absorbable mesh built out of thin filaments, while maintaining sufficient strength. Its improvement is due to incorporation of evidence-based characteristics such as an increased mesh elasticity. Furthermore, the surgical manipulation is improved thanks to the increased mesh memory. Our prospective cohort study shows good initial and short-term results after implementation of the Ultrapro® Advanced™. However, further prospective research is mandatory on the long-term outcomes.

Suturing is an essential surgical technique, because there is no resection without the need for reconstruction. Therefore, every surgeon should master a set of suturing techniques so he can adapt his approach to the specificity of the situation. The development of laparoscopic surgery poses a new challenge as not all open techniques are amendable for laparoscopic use. We would like to propose a modified fisherman's knot, which has been optimised in our center for laparoscopic use. The technique can be used with every monofilament non-braided wire. The needle is placed through the tissue to be sutured and both wires are externalised through the trocar. First, a simple knot is placed by crossing the left over the right wire. Next, the left is turned around the right wire four times proximal to the starting knot and crossed to the left wire where an additional two turns are made moving away from the trocar. The knot is closed gently, making sure not to lock the knot. Then the instrument of Drouard is used to gently glide the knot over the right wire back through the trocar into the abdomen. After making sure that adequate pressure has been delivered to the knot, to firmly close the tissue, the wire must be cut at a length of at least 3 mm. A new wire should be used for every knot and in this manner several knots can be delivered to make sure the tissue is adequately closed. In our center, no known complications due to loosening or failure of these knots have occurred since we incorporated this knotting technique into our daily practice more than 20 years ago.

Laparoscopic ventral hernia repair (LVHR) is a common procedure in abdominal surgery. Use of mesh has become the gold standard in the last decade because of significantly fewer recurrences. Subsequently, the attention shifted to reduce mesh related complications in the short- and long-term as well as to facilitate its handling and positioning. In continuation of our previous study, we conducted a final analysis about the use of the Ventralight™ ST hernia patch (Davol Inc, Subsidary of C. R. Bard, Inc. Warwick, RI).Prospectively collected data of 61 consecutive patients (men/women: 44/17) from July 2011 to October 2013 were analysed in this final study. Patients were evaluated clinically at four time points in total. At the final clinical check- up, 97% of the total study population was reassessed. The primary outcome parameter was recurrence. Secondary outcome parameters were described in terms of mesh related complications, pain scores, and quality of life.Mean follow-up time was 23 months (range 16-44). Mean length of hospital stay was four days (range 2-17). There were no operative complications. Two patients (both80 years old) died more than one year after the procedure because of a cardiovascular event. One morbidly obese patient (2%) treated for a recurrent incisional hernia showed a second recurrence at the last follow-up visit. A clinical significant seroma was observed in two patients (3%) one month postoperatively. At last follow-up, two patients (3%) reported persistent mild discomfort at one specific spot. There was a significant reduction in the visual analogue scale (VAS) scores at the last follow-up visit compared to preoperative scores (3.01 vs. 0.27; P0.01). Quality of life measurements using the SF-36 questionnaire showed good results.This final analysis of long-term follow-up results on the use of the Ventralight™ ST hernia patch in laparoscopic ventral hernia repair confirms our preliminary findings of the previous two reports. Use of the Ventralight™ ST hernia patch is associated with good short- and long-term outcomes and can be considered as safe and feasible in LVHR.

The purpose of this study was to show the short- and long-term results of a lightweight self-adhering mesh, Adhesix®. Between February 2011 and April 2013, we prospectively collected data of 100 consecutive patients who underwent incisional or inguinal hernia repair. Mean follow-up time was 23 months (range 7-33 months). Mean length of hospital stay was 1.7 days (range 0.5-16 days). No recurrences occurred. Pain was significantly reduced after 1 month (4.1 vs 1.6; 95% confidence interval [CI] 1.9-3.1; P0.0001) as well as at the last follow-up visit (1.6 vs 0.48; 95% CI 0.6-1.7; P0.0001). SF 36 scaled scores, as an indicator of quality of life, were good with 86, 84, 86, 84, 83, 88, 92, 87. Only 2 patients developed clinically significant seromas. No clinically significant hematomas were observed. Neither mesh nor wound infections occurred. Four patients developed urinary retention immediately postoperative, while 2 were hospitalized 2 weeks after discharge because of pneumonia. Two patients died because of unrelated causes. Based on these results, use of the Adhesix mesh seems to be safe, feasible, and efficient in hernia repair.

Primary ventral and even small incisional hernias have historically been repaired by primary closure; however, data proves that use of mesh can significantly reduce hernia recurrence. Here we report clinical outcomes at one year using the International Hernia Mesh Registry following the use of a three-dimensional tissue-separating mesh device (Proceed Ventral Patch™, Ethicon, Somerville, NJ). This ongoing prospective multi-center registry collects preoperative, perioperative, and postoperative outcome data including adverse events at 1, 6, 12, and 24 months. Patient-reported outcomes are collected including a hernia-specific questionnaire. A total of 234 patients (72.1% male, 27.9% female) from 13 sites in the United States and Europe were enrolled. Mean age and BMI were 52.2 (SD 15.0) and 29.2 kg/m² (SD 5.2), respectively. Hernia types: umbilical 67.1%, epigastric 11.5%, small incisional including trocar 21.3%. Preoperatively 46.9% and 38.3% of patients reported symptomatic pain and movement scores, respectively. At 1 year, these were significantly reduced to 8.9% and 5.0%, respectively (p0.001). At 12 months hernia recurrence was 3.0% (95% CI, 1.2% to 6.1%), seroma (2.1%), infection (2.1%) with other events being less than 1%. These results indicate repair using this device led to significant improvement in pain and movement limitations and were associated with low complication and recurrence rates.

The purpose of the current prospective study was to confirm the results of our previous study on the use of the Ventralight™ ST mesh. In this study we also evaluated a pre-attached positioning system. Between July 2011 and October 2013 prospectively collected data of 61 consecutive patients who underwent a laparoscopic ventral hernia repair were analyzed. Short- and long-term outcomes were described. A total of 61 patients were treated in this period (men/women ratio 44/17). Overall median follow-up was 7 months (range 2-29). There were 30 patients with a follow-up of at least 12 months. Mean hernia diameter was 6 x 5 cm (craniocaudal x laterolateral) (range 1.5 x 1.5 to 20 x 15 cm). Overall mean length of hospital stay was 4.4 days. Postoperative visual analog scale (VAS) at last follow-up was significantly lower than the preoperative VAS (3.01 vs 0.68; P = 0.011) There were no intraoperative complications. In the whole group, only 6 patients (10%) showed minor complications. Four patients had mild discomfort, another 2 patients developed a clinically significant seroma. The complication rate in the subgroup with a follow-up of at least 1 year was 13%. No recurrences were observed. This study confirms our preliminary findings on the use of this mesh. The optional positioning system offers a significantly more quick and proper mesh positioning.

The aim of the current prospective study was to show the results of a new type of medium-weight monofilament polypropylene mesh covered with a hydrogel barrier on the visceral side. Between July 2011 and April 2013 prospectively collected data on 30 consecutive patients who underwent abdominal wall hernia repair using a medium-weight mesh covered with carboxymethylcellulose-sodiumhyaluronate coating (Ventralight™ ST mesh, Davol Inc, Subsidary of C. R. Bard, Inc. Warwick, RI) were analyzed. Out of these patients, those who had a follow-up of at least 12 months were selected. Short- and long-term outcomes were described. Meanwhile, registration continues up to completion of a series with 100 included patients. A total of 17 patients were selected (men/women ratio 11/6). Median follow-up was 12 months (range 12-21). Mean hernia diameter was 7 cm x 5 cm (craniocaudal x laterolateral) (range 1.5 x 1.5 to 20 x 15). Mean length of hospital stay was 6.1 days. Postoperative Visual Analogue Scale (VAS) at last follow-up was significantly lower than the preoperative VAS (P = 0.017) There were no intraoperative complications. Four patients (23%) developed minor complications. Two patients had mild discomfort, another two patients developed a seroma. No recurrences were observed. This intermediate study shows good results using a biofilm coated mesh and confirm the positive results obtained in the Sasse clinical trial.

The ideal mesh suited for intraperitoneal placement should address both requirements of tissue separation on the visceral surface and tissue integration on the parietal surface. Meshes with bioresorbable coatings have recently been demonstrated to be successful. In this article, the results are shown of a study with a new type of tissue-separating lightweight mesh with a bioresorbable coating (Physiomesh; Ethicon, Somerville, NJ) in laparoscopic ventral hernia repair. In this single-center retrospective analysis, 88 patients (50 men, 38 women) undergoing hernia surgery between November 16, 2010 and August 10, 2012 at the Imelda Hospital Bonheiden were included. Patients were asked to score their pre- and postoperative pain (1 month after surgery) on a visual analogue scale (VAS), as well as the chronic postoperative pain (pain at more than 6 months after surgery). The time period after which patients were pain free and after which they could return to work was also noted. Our results demonstrate that Physiomesh is a good alternative to the existing meshes leading to significant pain reduction, early return to work, acceptable complications, and low recurrence and reintervention rates.

Lighter-weight, large pore meshes with absorbable layers are designed for intra-abdominal placement in laparoscopic ventral hernia repair. This retrospective review of 86 patients who underwent ventral hernia repair with PROCEED™ Surgical Mesh (Ethicon, Inc., Somerville, NJ) represents an evaluation of a cohort of patients implanted with this mesh. All patients implanted with PROCEED Mesh for ventral hernia repair between October 2006 and December 2007 were contacted and asked to participate in an evaluation of their hernia repair. Patients were evaluated for pain, recurrence of their hernia and other potential complications. Eight patients underwent open repair; all others were performed laparoscopically. One patient continued to have pain at 1 year. Twelve developed seromas early on and 5 required drainage by a single puncture each. None persisted. There were 4 recurrences with none in patients with a Body Mass Index 3 32. One case of abdominal wall cellulitis responded to antibiotics. There were no wound infections, mesh infections, bowel obstructions or enteric fistulas. This study demonstrates the utility of a lighter-weight, large pore, partially absorbable mesh for intraperitoneal use in laparoscopic ventral hernia repair and indicates this mesh is strong enough for use in obese patients.

In 1998, Gilbert introduced the Prolene Hernia System (PHS), a bilayer polypropylene mesh device composed of an onlay patch, a connector, and an underlay patch. The overall concept of its design was to include the best features of all currently available techniques while eliminating their undesirable features. This device is now available in a lightweight version, the Ultrapro® Hernia System (UHS; JohnsonJohnson, Somerville, NJ). We present the Bonheiden experience. From 2006 until 2009, we used 890 UHS devices in 712 patients. All patients were requested to join a prospective analysis with follow-up at one week and one month. Follow-ups at one and two years were organized using a telephone questionnaire. We were able to monitor 668 UHS implants in 526 patients. Bilateral primary hernias were repaired simultaneously in 142 patients and 6 hernias were a recurrence of a previous nonmesh repair. There were 472 men and 54 women in our cohort, with an average age of 57.5 years and average BMI of 24.79. No recurrences have occurred to date. Superficial wound infection presented in 3 patients. They were treated with antibiotics and no mesh needed to be removed. Seromas are much more common after this bilayer technique and are not considered a true complication. Whereas ecchymosis is very common, large hematomas were seen in 5 patients. One patient presented with a DVT of the iliac vein. She was treated with anticoagulation for three months, stockings, and early mobilization. The Ultrapro Hernia System is a good alternative to other preperitoneal hernia repairs, feasible in a day hospital under locoregional or general anesthesia. It has a very low recurrence rate but carries a more extensive dissection. We think the price paid for this extensive dissection is more than acceptable and is comparable to the Lichtenstein experience.

The aim of this retrospective study was to determine the long-term recurrence and complication rates following small abdominal wall hernia repair with the Ventralex hernia patch. The study also aimed to identify risk factors for hernia recurrence in patients undergoing such repair and to examine the relationship between quality of life and hernia recurrence.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 prevention of long-term complications and improvements in the quality of life should also be considered as important features of successful repair. The Ventralex patch is a bilayer prosthesis, designed for retromuscular or intraperitoneal placement. Currently, seven studies have evaluated the device for small ventral hernia repair, and all have shown low short- and long-term recurrence rates.The medical records of 176 patients who underwent abdominal wall hernia repair using the Ventralex patch between May 2004 and February 2009 were reviewed. All patients were followed up after 1 month and later in 2010. The rate of recurrence, immediate postoperative and long-term complications, and quality of life were evaluated.Long-term follow-up data were available for 135 patients. The mean follow-up was 49 months (range 13-70 months). There were 12 hernia recurrences (8.9%) during this time. Postoperative (1-month) complications included seroma (4%), superficial surgical site infections (3%), and an abscess (1.5%). At the mean long-term follow-up, complications included infection (1.5%) and subobstruction (1.5%). The only risk factor for hernia recurrence was female gender (unadjusted odds ratio 0.19, 95% confidence interval [CI] 0.05-0.72, P = 0.02). Patients with hernia recurrence reported significantly lower quality of life scores than patients without recurrence.The Ventralex hernia patch offers a simple and quick means of repairing small abdominal wall hernias. A relatively high recurrence rate was observed in this study. Reviewing the available literature, a critical appraisal is needed, attention should be paid to follow the correct implantation technique, proper deployment technology should be used, and a lightweight version would be welcome.

Surgical treatment of umbilical and small ventral hernias ranges from a simple suture repair to the placement of large intra-abdominal or retromuscular meshes. Several articles report a lower incidence of recurrence after mesh repair, whether this is positioned onlay, retromuscular, or intraperitoneally. Often, a simple suture repair fails in the longterm, whereas a laparoscopic or retromomuscular approach seems too extensive for these rather small hernias. In between those two treatment options exists a go-between repair that carries the idea of posterior repair without being so aggressive in its approach. In this study, the authors examined a new device called the Proceed Ventral Patch (PVP) (Ethicon, Inc., Sommerville, NJ, USA). It is a self-expanding, partially absorbable, flexible laminate mesh device that allows an easy, quick and minimal invasive, tension-free, and standardized approach to umbilical hernia treatment. No data nor publication exist on this new device. Reported herein is our early and first experience with this novel technique.

A classification for primary and incisional abdominal wall hernias is needed to allow comparison of publications and future studies on these hernias. It is important to know whether the populations described in different studies are comparable., Comparative Study, Consensus Development Conference, Journal Article, Review, SCOPUS: ar.j, info:eu-repo/semantics/published

A case of an intrapericardial tumor diagnosed in utero at 26 weeks of gestation is presented. The prenatal echocardiographic follow-up of an incipient hydrops fetalis determined the management and the emergency surgical treatment. Histologically, the tumor appeared to be a benign teratoma, grade I. In the postoperative period an unexpected mediastinal tumor was found and removed later. This tumor also appeared to be a benign teratoma, grade 0. Both teratomas were independent and therefore primary.