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P056: ADHESIVE MESH FIXATION OUTCOMES IN OPEN LATERAL HERNIA REPAIRS WITH WIDE MESH OVERLAP
David J Morrell, MD; Eric M Pauli, MD; Penn State Health Milton S. Hershey Medical Center
Introduction: Transfascial suture mesh fixation (TSMF) in lateral (“flank”) hernia repairs is traditionally described as mandatory to reduce recurrence risk. Non-TSMF via the application of fibrin sealant alone has increasingly been described in the literature for ventral incisional hernia repairs utilizing sublay mesh placement. However, data regarding adhesive mesh fixation (AMF) in lateral hernia repairs remains limited.
Objectives: To compare outcomes of open lateral hernia repairs in a series of patients with TSMF or AMF.
Methods: Data prospectively collected between 2014 to 2020 was retrospectively analyzed. Patients with lateral hernias involving the European Hernia Society Classification lateral zones (L1-4) and undergoing open sublay (preperitoneal/retromuscular) mesh repair were included. Patients with midline hernia components in addition to the lateral hernia, with parastomal hernias, or with minimally invasive repairs were excluded. Patient demographics, comorbidities, hernia characteristics, operative details, 30-day outcomes, and long-term hernia recurrence were recorded. The groups were compared using Fisher’s exact and Mann-Whitney U tests.
Results: Nineteen patients met inclusion criteria (8 TSMF, 11 AMF). Most procedures were performed in the lateral decubitus position (5 TSMF vs 8 AMF, p=1.00). The remaining patients underwent repair in the supine position. No differences were noted in patient demographics, comorbidities, or hernia characteristics. There was no difference in mean hernia area (34.8±20.2cm2 TSMF vs 60.4±76.4cm2 AMF, p=0.7411) or mean implanted mesh area (535.1±407.1cm2 TSMF vs 390.6±256.1cm2 AMF, p=0.4067) between groups. All implanted mesh was polypropylene. An average of 4.2±1.3 transfascial sutures were used for mesh fixation in the TSMF group. One patient with TSMF also had mesh fixation with 10 mL of fibrin sealant. In patients with AMF, an average of 13.1±5.8 mL fibrin sealant was used. Suture closure of the fascial defect was achieved in all patients. No differences were noted in 30-day outcomes (readmission, reoperation, surgical site infection, surgical site occurrence, complications). Length of stay was shorter in the AMF group (4.3±1.2 days TSMF vs 2.4±1.9 days AMF, p=0.0377). No hernia recurrences were observed in either group (mean follow-up 22.0±21.0 months TMSF vs 9.1±9.2months AMF, p=0.1863).
Conclusion: The use of AMF alone in lateral (“flank”) hernia repairs appears safe and effective. TSMF may not be necessary in this hernia population when wide mesh overlap and defect closure are achieved. Further study with larger cohorts is necessary before widespread elimination of TSMF in lateral hernias should be considered.
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