Welcome to the AHS 2020 ePoster Session. Please scroll down to view all of the submitted posters or press Control-F to search. To view the poster and its abstract, click on the poster image. Many posters also have a brief audio introduction which can be played by going to the bottom of the poster screen.
P018: STOPPA HERNIORRHAPHY FOR COMPLEX GROIN HERNIAS: MODERN SERIES OF A CLASSIC TECHNIQUE
Colin G DeLong, MD; Alexander T Liu, MD; Vamsi V Alli, MD; Eric M Pauli, MD; Penn State Milton S. Hershey Medical Center
Introduction: Modern, minimally invasive techniques for groin hernia repair have proven advantages for both primary and recurrent hernias; however, these methods have intrinsic limitations for the management of highly complex hernias. Factors contributing to such complexity include multiple prior mesh repairs or significant scrotal involvement with loss of domain. This series examines the use of an open Stoppa preperitoneal mesh repair for complex inguinal hernias in modern surgical practice.
Methods: An IRB-approved retrospective medical record review was conducted to identify patients who underwent a Stoppa groin hernia repair from 2014-2020. All cases were performed at an academic tertiary care referral center by one of two board-certified general surgeons with additional training in abdominal wall reconstruction.
Results: Ten patients were identified with the following profile: mean age 55.0 ± 20 years, 10 (100%) male, 5 (50%) prior/current smokers, mean ASA Class 2.5 ± 1, and mean BMI 33.9 ± 4. Eight (80%) patients had recurrent hernias, with a mean of 2.5 ± 2 prior repairs, and 6 (60%) patients had prior mesh in place. Eight (80%) had bilateral hernias and 6 (60%) had scrotal involvement. Prior to hernia repair, patients underwent procedures including Botox injection (10%), scrotal debridement (10%), hydrocele drainage (10%), orchiectomy (10%), and nephrostomy tube placement (10%). Mean operative time was 431 ± 171 minutes and TAP blocks or epidurals were used in 9 (90%) cases. Bilateral release of the posterior rectus sheath was performed in 8 (80%) cases, bilateral transversus abdominis release (TAR) performed in 5 (50%) cases, and unilateral TAR was performed in 1 (10%) case. Concurrent procedures included orchiectomy (30%), vasectomy (20%), scrotoplasty (20%), and bladder mobilization (20%). Mean length of stay was 6.8 ± 5 days. Three (30%) patients had surgical site occurrences, not requiring intervention. Two (20%) patients had significant medical complications related to underlying disease and 1 (10%) mortality occurred on post-operative day 11 from myocardial infarction and subsequent cardiac failure. No recurrences have been noted, with mean follow-up of 671 ± 620 days.
Conclusion: The Stoppa approach offers a technically sound operation for patients with complex groin hernias, providing low rates of recurrence and surgical site occurrences. The procedure is appropriate for complex inguinal hernias including those requiring concurrent urologic procedures. Given the prolonged operative duration and significant medical comorbidities in this population, careful attention must be paid to patient selection and optimization.
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