Introduction: Hernia repair has been an ever evolving field of surgery. Newer modalities of treatment are being developed, with mesh repair becoming the cornerstone of management of hernia. As mesh related complications have increased in the last decade, there has been an evolution in the type of meshes being used. The aim of our study was to compare light weight mesh and heavy weight mesh in Lichtenstein tension free open inguinal repair. Methodology: A prospective study of 100 patients undergoing open inguinal mesh repair in Victoria Hospital, Bangalore, was conducted from August 2016 to March 2018. 50 patients received heavy weight mesh (HWM) and the rest 50, light weight mesh (LWM), after randomization. They were evaluated on post-operative day 7 for examination of wound, post-operative pain and with USG for seroma formation. Patients were reviewed again after 1 st and 6 th month for chronic pain and recurrence. Results: Out of the 100 patients, 52 required 2 days of hospital stay out of which 61.5% were with HWM. At 1 week, all the patients had seroma formation (USG) but clinically significant seroma formation seen in 25 patients. Of this, 10 patients belong to LWM and 15 patients to HWM group. At 6 months, 13 patients had chronic pain and 10 belonged to HWM group. No recurrences reported. Conclusions: LMW and HMW for inguinal hernia repair had similar outcomes with a non-significant trend favouring LWM in terms of decreased seroma formation and lesser incidence of chronic pain at the end of 6 months. However, these results would be required to be validated in larger studies.
BACKGROUND: The VHWG recommend synthetic mesh in Grade I, biologic mesh in Grade III and Grade IV. The use of synthetic mesh in Grade II comrbid patient is matter of consideration and debate. Our aim was to examine the outcome of synthetic mesh repair in open incisional ventral hernia repair in patients with comorbidities. METHODS: Retrospective review of all open, grade II VHR performed by single surgeon over 5 years was evaluated. RESULTS: Seventysix patients with grade II ventral hernia underwent open hernia repair with synthetic mesh during the study period. There were 40 males and 36 females in our study with mean age of 53 years (range 30-85). Comorbidities associated with these patients included obesity in 43 (56%), smoking in 25 (32%), COPD in 19 (25%), diabetes milletus in 32 (42%), and immunosuppression in 2 (2.6%). Surgical site occurrence as defined by VHWG was identified in 12 (16%) patients which included 8 (10%) surgical site infection (SSIs), 3 (4%) seroma and 1 (1%) wound dehiscence. One patient developed recurrence during the follow-up period. CONCLUSION: Synthetic macroporous mesh can be used in co morbid patients with no long term complications with recurrence of less than 1.3%. although surgical site occurrence in this cohort of patients is high (16%), they can be managed conservatively with antibiotics.
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