Y Viswanath, Mr, Kevin Etherson, Mr, Dariush Kamali, Anil Reddy, Mr. James Cook University Hospital
Introduction
Recent advances in hernia surgery are focussed towards tension free atraumatic fixation and self-adherence of the mesh. We report a single surgeon’s experience with the Adhesix ® self adherent mesh in comparison to a variety of other mechanically self-adherent & sutured meshes during 2014.
Methods
A prospective consecutive cohort database of single surgeon experience of abdominal wall mesh hernia repair during 2014. Data was extracted for any patient fulfilling the inclusion criteria: Presence of an inguinal or abdominal wall hernia clinically or on ultrasound imaging, and undergoing a mesh repair (laparoscopic- TAPP or open) during 2014. Exclusion criteria: absence of peritoneal sac at time of surgery, or repair without a mesh.
Results
66 patients (60 male, 6 female) with a median age of 53 years [SD 15] underwent 77 hernia mesh repair procedures during 2014. 58 were for inguinal hernia repairs and 19 for abdominal wall hernia repairs. 39 patients (36M, 3F, median age 54 [SD 14.8]) had repair with an Adhesix® mesh (Group A). The remaining 27 patients (24M, 3F, median age 50 [SD 14.7]) had repair with 6 different varieties of mesh for either open abdominal wall hernia or Laparoscopic incisional or inguinal hernia repairs. The Adhesix® group A, consisted of 44 hernia repairs; 3 primary trans-abdominal pre-peritoneal (TAPP) inguinal repairs, 38 open primary inguinal repairs, 1 primary laparoscopic ventral repair, and 2 primary open ventral repairs. Group B, consisted of 33 hernia repairs; 11 primary TAPP, 2 recurrent TAPP repairs, 4 primary open inguinal repairs, 16 other abdominal wall hernia repairs. Anaesthetic recovery time was 38 minutes [SD 15.6] in the Adhesix® group A and 38 minutes [SD 10.0] in group B (P=0.88). Duration before discharge was also similar at 8 hours versus 7 hours respectively (P=0.68). The overall incidence of short-term adverse events were similar at 8 (21%) in the Adhesix® group A, and 6 (22%) in group B. There was a significantly reduced incidence of severe post-operative pain in the Adhesix® group A (0%) versus group B (11%) [ P =0.03]. There have been no short-term recurrences in either group to date.
Conclusions
The study demonstrates that a tension free atraumatic fixation self-adhering mesh such as Adhesix®, appears to have a similar safety profile to a variety of other meshes with assosciated advantage in reduction of severe post-operative pain. Longer-term prospectively assessed outcomes of hernia recurrence rates & safety profiles with these new self-adhesive meshes are required