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USE OF A REINFORCED BIOLOGIC MESH IN A MINIMALLY INVASIVE TECHNIQUE FOR VENTRAL HERNIA REPAIR
C Banaschak, P Szotek
St. Vincent Hospital

Background
Surgical treatment of ventral hernias continues to be complex. Different mesh types and minimally invasive techniques have been introduced to combat surgical site infection and recurrence. The goal of this study is to describe and evaluate the use of a biologic mesh reinforced with permanent suture in ventral hernia repair using the minimally invasive single incision retrorectus (SIRR) or single incision preperitoneal (SIPP) techniques. Primary outcomes studied include recurrence, surgical site occurrence, and surgical site infection.

Methods
This study utilized a retrospective review from a single surgeon using a SIRR or SIPP technique for repair of ventral hernia between 2018-2020. Both techniques utilize a small incision (3cm), through which a wound protector (Alexis XS or S) or Gelport mini, for laparoscopic or robotic assistance, can be placed. The subcutaneous tissues are dissected laterally to define and reduce the ventral hernia. Once reduced, the preperitoneal space or retrorectus space is developed. In many cases, the endo-GIA stapler can be utilized to plicate the linea alba anteriorly and create a neo-posterior sheath posteriorly. A variant of a reinforced biologic mesh was utilized in all cases. Follow-up was conducted through a HIPAA compliant application (Klara), in which, complications are self-reported by text messaging or phone call directly with the operative surgeon.

Results
From 2018-2020, 29 cases using either the SIRR or SIPP technique for a ventral hernia were identified. A majority of cases were open (n=25), and 4 cases were completed with robotic assistance. All cases utilized a variant of Ovitex reinforced biologic mesh. All but two cases were over 1 year out at time of review. There were no reported cases of recurrence. There was 1 reported surgical site occurrence (3.4%). This was a post-operative hematoma identified in a patient on chronic anticoagulation. There was also 1 death occurring on post-operative day 6. Exact cause of death is unknown, but does not appear to be directly related to the procedure.

Conclusion
In conclusion, the use of a reinforced biologic mesh during the minimally invasive SIRR or SIPP procedure for ventral hernia appears to be an effective and safe option.


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