Outcome of children on the UK national prioritised paediatric registration tier

P69 Table 1Demographic and transplant data for all 14 prioritised patientsPatient/Sex Centre Age at registration (yrs) Primary liver disease Registered prior to Prioritisation Indication of Prioritization LT Waiting time on prioritised tier/Time on list prior to prioritisation 1/M 1 0 CDG Yes Acute decompensation with presence of encephalopathy Yes/LLS 5/27 2/M 2 1 Cryptogenic Cirrhosis Yes CLD with nodular lesions s/o HCC Yes/LLS 16/48 3/F 1 15 AILD Yes Chronic rejection Yes/whole liver 3/4 4/M 2 0 Biliary Atresia Yes PTLD/HAT/Sepsis Yes/LLS 14/71 5/F 2 4 IFALD No Coagulopathy with active bleeding/Renal impairment Yes/LLS 15/820 6/F 2 0 Biliary Atresia Yes Acute decompensation due to portal hypertension Yes/LLS 37/405 7/M 2 10 NSC Yes Decompensated chronic liver disease/Renal impairment Yes/reduced R lobe 4/7 8/M 3 8 PFIC3 Yes Acute decompensation of Chronic liver disease Yes/LLS 6/51 9/F 1 0 Other (Hepatoblastoma) Intestinal Tx prioritized Acute decompensation of Chronic liver disease Yes/LLS 11/ 10/F 2 0 Biliary atresia Yes Decompensated Chronic Liver Disease with Severe Coagulopathy Yes/LLS 10/120 11/M 1 0 Biliary atresia (Hepatoblastoma) Yes Acute decompensation of Chronic liver disease Yes/LLS 9/4 12/F 3 0 Biliary atresia Yes Acute decompensation of Chronic liver disease Yes/LLS 12/323 13/F 1 17 Hepatic Artery thrombosis Yes Hepatic Artery thrombosis Yes/whole liver 2/ 14/F 2 0 Biliary atresia Yes Acute decompensation of Chronic liver disease Suspended 12/65 PFIC3;Progressive Familial Intrahepatic Cholestasis type 3, LT;Liver transplantation, HCC;Hepatocellular Carcinoma NSC;Neonatal Sclerosing Cholangitis, CDG;Congenital Disorder of Glycosylation, AILD;Autoimmune Liver Disease, IFALD;Intestinal Failure Associated Liver Disease,PTLD;Center 1-Kings;Center2-Birmingham;Center3-Leeds.ConclusionThe national paediatric prioritization tier, introduced during the COVID19 pandemic, has been a pivotal initiative for the UK paediatric LT program, showcasing national collaboration. All patients underwent a LT successfully within a short time from prioritization with 100% patient and graft survival. The intention is to maintain this prioritized paediatric tier beyond the pandemic.

An innovative way of working within the Covid 19 Pandemic trialling the use of the Eldon Blood Typing Kit for ABO and Rh blood grouping within the Living Donor Liver Transplant Program at Leeds Teaching Hospitals

IntroductionThe pandemic Covid-19 normalised remote working and we addressed what this meant for our living donors. Within the liver donor liver transplant (LDLT) team one of the major challenges was gaining access to getting donors blood groups which is required as the initial stage of assessment to see if they are a compatible blood group to proceed with their intended recipient. To enable our service evaluated the ‘Eldon Home Blood Typing Kit’ for ABO and Rh blood grouping.The aim of this study was to evaluate the accuracy and reliability of the Eldon Home blood typing kit 1n comparison with the standard laboratory method.MethodThe Eldon Home Kit 2511 is a rapid user friendly self-test kit to determine the blood group inside the ABO and RhD blood group systems. The blood kits were evaluated by 30 living donors to determine their accuracy. Blood grouping was conducted as per the instructions in the company manual.ResultsThe Eldon Home blood typing kit correctly identified the blood group of all 30 potential donors in comparison with the gold-standard hospital laboratory slide and tube method. No disparity was observed. The living donors described that the cards were easy to use and gave reliable results within one minute thus providing a convenient and reliable way of remotely obtaining the donor’s blood group required to assess their suitability as a living donor for their intended recipient within the pandemic.ConclusionThe Eldon Home Blood Typing Kit provides a rapid method for potential living donors that is both accurate and acceptable to prospective donors. Whilst this service development was initiated during the Covid-19 pandemic it will continue to be used in increase efficiency in living donor assessment process and to reduce unnecessary travel.

Liver cirrhosis and palliative medicine: the potential impact of COVID-19 on patient care and how progress can be sustained

OP27 Figure 1The authors propose a model, summarised in Figure 1, to integrate palliative and supportive care alongside and within standard hepatology care for patients with end stage liver disease who are ineligible for transplant, in an era where remote and distant review requires innovation to provide care in the right place and at the right time, to safeguard the previous progress made.

The story of transjugular intrahepatic portosystemic shunt (TIPSS) at the Royal Free Hospital, 2021–2022: indications and outcomes of 84 procedures

Transjugular intrahepatic portosystemic shunt (TIPSS) is an effective treatment for decompression of portal hypertension and is most commonly indicated in patients with chronic liver disease (CLD) or portal vein thrombosis (PVT). It is a technically challenging intervention. CLD patients are often frail with comorbidities conferring increased procedural risk. We tell the story of one year of procedures at the Royal Free Hospital (RFH), one of the major centres for TIPSS in Europe.A retrospective electronic casenote review was carried out for all patients who underwent TIPSS procedure at the RFH between April 2021 and April 2022. The outcomes of interest were success rate, complications and survival including those who went on to transplantation. A successful procedure was defined as a correctly placed stent with no procedural complications and symptom resolution. Eighty-four (84) patients underwent TIPSS during the 12-month period. Of these, 3 were abandoned: 2 because portal hypertension was absent on direct measurement and 1 due to anatomical infeasibility. Of the 81 completed, the most common indication was diuretic-intolerant ascites (n=32), followed by variceal bleeding (n=27), PVT (n=14), and other indications (n=8). The clinical success rates post-TIPSS for each indication are as follows. For diuretic intolerant ascites, 53.1% (17/32) of patients no longer require large volume paracentesis (LVP), 28.1% (9/21) require LVP at a reduced frequency, 6.3% (2/32) have been transplanted and 1 patient continues to have LVP at the same rate. For variceal bleeding, 85.2% (23/27) of patients have had no further episodes of bleeding. For PVT, 85.7% (12/14) of TIPSS remain patent with no patient requiring surgical intervention. No procedural complications were reported. Overall survival post-TIPSS is 87.7% (71/81) with procedure-related mortality accounting for no deaths. 8 patients who received TIPSS went on to be listed for liver transplant, of those 3 successfully received a graft, 4 remain listed and 1 has died while listed.A high number of TIPSS procedures were performed. The majority were successful with favourable clinical outcomes. Major challenges faced by the service during this time included staff shortages, bed capacity, transfer logistics and the wider impacts of the COVID-19 pandemic. This service depends on the collective expertise and close working of multiple specialties including hepatology, interventional radiology, intensive care and anaesthetics along with logistical and operational support. In an environment where all of these healthcare professionals work together to support the provision of TIPSS, patients can benefit from positive outcomes.

NCEPOD – alcohol related liver disease care: ‘measuring the units’ 10 years on

The 2013 NCEPOD report ‘Measuring the Units’ reviewed the care of patients who died with alcohol-related liver disease (ArLD) in 2011. It highlighted that the care of patients who died of ArLD was less than good in more than 50% of cases reviewed. Given the ongoing concerns about the variation in outcomes of patients with ArLD, a Survey of the care of patients admitted to hospital with ArLD was commissioned by NCEPOD.All Acute Trusts in England, Wales and Northern Ireland were sent the Survey, which required completion based on Trust data and Lead Gastroenterologist/Hepatologist input. The questions covered numbers of admissions and mortality, alcohol screening and withdrawal management, the presence and constitution of an Alcohol Care Team (ACT), triage of decompensated ArLD patients to Gastroenterology/Hepatology and use of the BSG/BASL chronic liver disease care bundle, as well as escalation of care. In view of the impact of COVID-19, the Survey was sent round to Acute Trusts in January 2021 interrogating information from 2019.ResultsNCEPOD received responses from 145 Acute Trusts including District General Hospitals, regional Liver Units as well as Liver Transplant Units. This included 20,876 ArLD admissions and 2481 deaths in hospital, constituting 11.9% of admissions), with a wide variation in the numbers of reported admissions and deaths between Trusts. The use of symptom-triggered alcohol withdrawal scale (CIWA-Ar) was only 9.9% in the original report, but was employed on specific wards in 88.2% of Trusts in this Survey. The presence of a multidisciplinary ACT increased from 23.2% of Trusts in 2011 to 51.9%, although only 20% of Trusts responding had a Consultant Lead with dedicated sessions. 78% of Trusts stated that they triage patients with decompensated cirrhosis to a Gastroenterologist/Hepatologist and 70% of responding Trusts stated that they used BSG/BASL decompensated chronic liver disease care bundle. The responding clinician reported that it was subjectively more difficult to get patients with decompensated ArLD rather than other forms of cirrhosis into Critical Care in 28.3% of Trusts. Only 23% of ArLD patients who died had coded evidence of palliative care input.ConclusionsThis Survey compares specific aspects of care in patients with ArLD between 2011 and 2019 and indicates that there have been noteworthy improvements in certain areas of care provision, but also points to where attention is required in order to achieve consistent, high-quality care for this patient group, who have a high in-patient mortality.

Impact of COVID-19 pandemic on collection of allogeneic hematopoietic stem cells

Introduction: COVID-19 pandemic brought challenges in the organization of hematopoietic stem cell (HSC) transplantation. Availability of HSCs was decreased due to donor infection and transport limitations. Accordingly, a series of measures was introduced to ensure the protection of patients and donors and availability of transplants during the pandemic. The goal of this study was to show the impact of COVID-19 pandemic on the collection of allogeneic HSCs in University Hospital Centre (UHC) Zagreb. Methods: We conducted a retrospective analysis for the period from March 1, 2020, to June 30, 2021. The data were collected from hospital computer database and meeting reports of the HSC Transplantation Committee of UHC Zagreb. Results: In the reported period peripheral blood stem cells (PBSC) were preferred, except when bone marrow (BM) transplantation was strongly indicated. Allogeneic HSC grafts were cryopreserved before conditioning to ensure availability on the day of transplantation. Thirteen patients were excluded from the program due to COVID-19 infection. HSCs were collected from related and unrelated donors from the Croatian HSC Donor Registry and World Marrow Donor Assocciation for the total of 135 patients. All 17 (12.5%) harvested BM grafts were transplanted. Sixteen patients were transplanted with PBSC instead of BM. Out of the collected PBSC 94.1% were transplanted but in 17 patients transplantations were delayed due to COVID-19 infection of the donor and/or the patient. Of the total 118 PBSC transplants 100 (84.7%) were cryopreserved in 540 cryo bags. Seven (5.9%) cryopreserved grafts have not been infused because of the progression of the main disease (5), COVID-19 infection of the patient (1) and poor product viability (1). Conclusion: COVID-19 pandemic adversely impacted HSC collection and transplantation with many organizational and logistical challenges. Cryopreservation of allogeneic grafts enabled efficient management of the transplantation programs but was accompanied with the risk of not infusing some grafts, which exposed donors to unnecessary risks and increased the cost of treatment. © 2022 Hrvatski Lijecnicki Zbor. All rights reserved.

Tinospora cordifolia induced liver injury during covid-19 pandemic

IDDF2022-ABS-0185 Table 1Clinical characteristics of patients with Giloy-induced liver injuryCharacteristics Number of patients (Total-16 patients) Gender Male 7 (43.75%) Female 9 (56.25%) Age (mean ± SD) 48.3±14 years Presentation type Acute hepatitis 6 (37.5%) ACLF 10 (62.5%) Mean duration for symptom onset after consumption of giloy 84.3±35 days Mean BMI 23.23±3 kg/m2 Comorbidities Type 2 diabetes 9 (56.25%) Interstitial lung disease (on inhalational steroids) 2 (12.5%) Hypertension 1 (6.25%) None 5 (31.25%) NAFLD 2 (6.25%) Symptoms Jaundice 16 (100%) Ascites 8 (50%) Fatigue 12 (75%) Pruritus 4 (25%) Liver function tests Peak total bilirubin (Mean ± SD) 17 ± 9.4 mg/dl Peak ALT (mean ± SD) 365± 219 U/L Peak AST (mean ± SD) 558 ± 475 U/L Peak ALP (mean ± SD) 186 ± 114 U/L Peak serum IgG (mean ± SD) 2400 ± 1213 mg/dl Peak INR (mean ± SD) 2.63 ± 1.05 AIH serology ANA 1(6.25%) ASMA - Anti LKM1 - AMA - Seronegative (biopsy proven) - Liver biopsy 10 (62.5) Drug induced liver injury 5 (31.25%) Features of AIH 5 (31.25%) Treatment N-Acetyl Cysteine infusion+Ademetionine 3 (18.75%) Steroids 10 (62.5%) Plasma Exchange 3 (18.75%) Outcome Alive 16 (100%) One listed for liver transplant Mean duration for recovery 37 ± 16 days IDDF2022-ABS-0185 Figure 1ConclusionsGiloy, a commonly used immunity booster, can produce drug-induced liver injury, which often mimics autoimmune hepatitis and responds to steroids.

Response to COVID-Vaccination and Infection in Islet Transplant Recipients

Background: Since response to COVID-vaccine among transplant recipients remains diminished comparing to general population, we decided to assess effect of COVID-specifically among islet transplant patients. Methods: Response to COVID-infection and vaccine was assessed in a cohort of 20 islet transplant recipients: N=13 after islet transplant alone (ITx) , N=7 with islet after kidney (IAK) or pancreas after islet transplantation (PAI) . The median age was 48 years (25-62) . Maintenance immunosuppression included tacrolimus and an antimetabolite in addition to 5mg of Prednisone in IAK and PAI recipients. Nine patients received booster. Results: Seven patients (38%) chose not to be vaccinated and 4 (57%) of them remained COVID-free with no SARS-CV-2 Spike total antibody (Spike ab) present in their blood. The other three patients (43%) developed only mild symptoms of infection with a high level of Spike ab (>2,500 U/ml) afterwards. In contrast, all remaining 13 patients (62%) , who were vaccinated while on immunosuppression for a median of 7 years (0.5-16) , remained COVID-free (p=0.11, Fischer) . The level of Spike ab in response to vaccine varied: undetected- (N=4) , in range 1-100U/ml (N=6) , around 400U/ml (N=2) , and above 2,500U/ml (N=1) . Presence of 5mg of Prednisone did not affect the outcomes. Booster was administered in patients and increased the level of Spike ab above 100U/ml in all of them, in 7 (78%) to over 2,500 U/ml. One patient responded neither to vaccine nor to booster. There were no SAEs related to the vaccination or booster. Islet graft function remained stable in all but one patient after initial vaccination or COVID-19. Conclusion: Nearly half of unvaccinated islet transplant recipients developed Covid-19, however, all of them presented only with mild symptoms. In contrast, none of vaccinated transplant patients developed COVID-infection with 69% rate of seroconversion. Booster increased level of the Spike ab in those patients who responded to the original vaccination.

This Week in the Journal

In a phase 3 trial, the antibody–drug conjugate trastuzumab deruxtecan resulted in longer progression-free and overall survival than the physician’s choice of chemotherapy among patients with HER2-low breast cancer. see Original Article, N Engl J Med 2022;387:9-20 Previous Infection and Vaccination in Covid-19 A study in Qatar assessed the effectiveness of previous infection, vaccination, and both against symptomatic SARS-CoV-2 caused by omicron BA.1 and BA.2 and against severe, critical, or fatal Covid-19. see Original Article, N Engl J Med 2022;387:21-34 Brief Report: Porcine-to-Human Cardiac Transplantation In this report, a porcine-to-human heart transplantation is described. Most patients with low-risk pulmonary embolism can be treated with oral anticoagulants. see Clinical Practice Audio, N Engl J Med 2022;387:45-57 The Vaccine-Hesitant Moment The proliferation of vaccine misinformation and its use for political purposes are placing a large number of people at risk in the Covid-19 pandemic and allowing the pandemic to continue. see Review Article, N Engl J Med 2022;387:58-65 Monkeypox Genital Lesions A 31-year-old man presented with a painless genital rash. The midscapular pain was worse at night and lessened with exercise. see Clinical Problem-Solving, N Engl J Med 2022;387:67-73 Genetic Modification in Xenotransplantation In a recent case of xenotransplantation, now described in the Journal, a porcine heart was transplanted into a human patient, an advance made possible through genetic alterations in the animal donor. see Editorial, N Engl J Med 2022;387:79-82 Tympanostomy Tubes for Recurrent Otitis Media This interactive feature about recurrent acute otitis media in a young child offers a case vignette accompanied by two essays, one supporting insertion of tympanostomy tubes and the other supporting conservative medical management. see Clinical Decisions, N Engl J Med 2022;387:83-85 Physicians Spreading Misinformation on Social Media In light of widespread falsehoods about Covid-19 and its treatment and prevention, the American Board of Internal Medicine has informed doctors that disseminating misinformation is grounds for disciplinary sanctions. see Perspective, N Engl J Med 2022;387:1-3 Institutionalizing Misinformation A new bill, the Dietary Supplement Listing Act of 2022, would create the impression of reform in the supplement industry while leaving the current lax regulatory framework largely untouched. see Perspective, N Engl J Med 2022;387:3-5 The Portal What does it mean for a physician who has long maintained her privileged back channels to finally acquiesce to entering her own electronic medical record — and interacting with her doctors — through the patient portal? see Perspective, N Engl J Med 2022;387:5-7 A Call for Antiracist Action The neo-Nazi march on Brigham and Women’s Hospital and attacks on health equity interventions are stark reminders of the obligation of physicians to denounce White supremacism and reaffirm race-conscious antiracism efforts. see Perspective, N Engl J Med 2022;387:e1 Decreased Neutralization of Omicron Subvariants In a small study involving 54 participants, omicron subvariants BA.2.12.1, BA.4, and BA.5 of SARS-CoV-2 were more likely to escape neutralizing antibodies induced by both vaccination and previous infection than were the prior omicron subvariants BA.1 and BA.2. see Correspondence, N Engl J Med 2022;387:86-88 VITT Recurrence after Covid-19 or Vaccine In 69 patients with vaccine-induced immune thrombotic thrombocytopenia caused by anti–PF4 antibodies, subsequent Covid-19 infection or receipt of an mRNA-based vaccine did not induce VITT recurrence. see Correspondence, N Engl J Med 2022;387:88-90

High Dose Post-Transplantation Cyclophosphamide to Induce Delayed Immune Tolerance After Reconstructive Transplantation

Developing novel treatment concepts to minimize/avoid immunosuppression by induction of immune tolerance represents the prime task in the field of transplantation. Immunosuppression-free allograft survival has been achieved in several small and large animal models as well as in humans in living-related combined kidney and donor bone marrow transplantation via transient or stable mixed hematopoietic chimerism. This is a concept of particular interest in VCA, as component grafts may inherently contain vascularized donor bone marrow and thus a vital bone marrow niche home to donor-derived hematopoietic progenitor cells. However, as living-related transplantation is ethically precluded in VCA, reconstructive transplantation is limited to cadaveric donors and thus extensive pre-transplant preconditioning is not feasible. Recently, we were able to demonstrate immune tolerance in mice using a peri-transplant induction regimen based on high-dose post-transplantation cyclophosphamide treatment (PT/Cy). In the underlying novel approach, we aim to apply the PT/Cy treatment protocol after the use of conventional immunosuppression to induced a state of delayed tolerance in an attempt to bypass limitation of cadaveric donor settings in VCA.

Real-World Experience of Cryopreserved Allogeneic Hematopoietic Grafts during the COVID-19 Pandemic: A Single-Center Report.

In response to the widespread COVID-19 pandemic, cryopreservation of allogeneic donor apheresis products was implemented to mitigate the challenges of donor availability and product transport. Although logistically beneficial, the impact of cryopreservation on clinical outcomes and graft composition remains unclear. In this study, we compared outcomes and graft composition with cryopreserved versus fresh allografts in the setting of allogeneic hematopoietic cell transplantation (allo-HCT). We retrospectively analyzed the clinical outcomes of 30 consecutive patients who received cryopreserved allografts between March and August 2020 and 60 consecutive patients who received fresh allografts before the COVID-19 pandemic. Primary endpoints were hematopoietic engraftment and graft failure (GF), and secondary outcomes were overall survival (OS), relapse-free survival (RFS) and nonrelapse mortality (NRM). In addition, extended immunophenotype analysis was performed on cryopreserved and prospectively collected fresh apheresis samples. Compared with recipients of fresh allografts, both neutrophil and platelet recovery were delayed in recipients of cryopreserved reduced-intensity conditioning (RIC) allo-HCT, with a median time to engraftment of 24 days versus 18 days (P = .01) for neutrophils and 27 days versus 18 days (P = .069) for platelets. We observed primary GF in 4 of 30 patients in the cryopreserved cohort (13.3%) versus only 1 of 60 patients (1.7 %) in the fresh cohort (P = .03). Cryopreserved RIC allo-HCT was associated with significantly lower median total, myeloid, and T cell donor chimerism at 1 month. OS and RFS were inferior for cryopreserved graft recipients (hazard ratio [HR], 2.16; 95% confidence interval [CI], 1.00 to 4.67) and HR, 1.90; 95% CI, 0.95 to 3.79, respectively. Using an extended immunophenotype analysis, we compared 14 samples from the cryopreserved cohort to 6 prospectively collected fresh apheresis donor samples. These analyses showed both a decrease in total cell viability and a significantly reduced absolute number of natural killer cells (CD3-CD56+) in the cryopreserved apheresis samples. In this single-institution study, we found delayed engraftment and a trend toward clinical inferiority of cryopreserved allografts compared with fresh allografts. Further evaluation of the use of cryopreserved allografts and their impact on clinical and laboratory outcomes is warranted.

COVID-19 outcome in kidney allograft recipients, a report of a referral center

Introduction. The pandemic of SARS Cov-19 (COVID-19) has affected millions of individuals and resulted in 3 percent mortality worldwide. Kidney allograft recipients are at increased risk of mortality and morbidity in COVID-19, due to their immunosuppressed and cardiovascular conditions. Methods. This study evaluated the outcome of renal allograft recipients with COVID-19 in a single referral center. Seven thousands, seven hundred and forty one patients with COVID-19 admitted in Firoozgar Hospital from March 2019 to September 2021. Among them 59 were kidney allograft recipients with the age range of 18-76. We reported our outcome as the mortality during hospital stay. Acute kidney injury and severity score were defined based on KDIGO and WHO classification, respectively. Our Therapeutic management included low dose CNI and antimetabolites withdrawal. The selection of steroid dose was related to severity score. Critical and severe patients received methylprednisolone pulse for three consecutive days. Results. Fifty nine renal allograft recipients were included in this study, 38 (64.5%) were male and 21(35.6%) were female. The most frequent comorbidities were diabetes mellitus (52.5%) and hypertension (30%). The mortality rate was 22% (13 out of 59). Forty six (78%) patients were discharged from the hospital with good condition. According to defined WHO classification severity score, 15 (25.4%) had mild, 14 (23.7%) moderate, 17 (28.8%) severe, and 13 (22%) were in a critical situation on admission. Acute kidney injury developed in 13.6% of patients. Univariate analysis showed that Severity score, age, transplant duration, CRP and lymph/neutrophil ratio, LDH, and need for intubation were the major predictive risk factors of mortality (P < 0.05). Conclusion. The mortality rate in hospitalized kidney allograft recipients was 1.5 to 3 fold higher than general population. Those with acute kidney injury need long term follow up for the detection of permanent sequel. As the COVID-19 infection in renal allograft recipients considerably increases the risk of morbidity and mortality, these patients should be monitored closely to prevent poor outcomes.

The use of polypropylene mesh in inguinal hernia surgery: A retrospective study.

Previously, inguinal hernia surgery was based exclusively on repairing the abdominal wall defects using the patient's own tissues, which were put in contact with and tensioned to recalibrate the natural orifices. At present, inguinal hernia surgery is based almost solely on mounting an allograft, which has the role of strengthening the weakened groin region that allowed the herniation. This modern method of operation on inguinal hernia can be performed in a classic or laparoscopic manner. The mesh is made of polypropylene, which is a polymer of cyclic hydrocarbons. The aim of the present study was to evaluate the effectiveness, biocompatibility, as well as the immediate and long-term complications in textile allografts used in open surgery of inguinal hernia repair. Another aim was to demonstrate once again the superiority of low-weight meshes with large pores by decreasing the number of complications caused by the synthetic material used, but also by a decrease in the tension on the tissues to which it was fixed. The present study included 255 cases submitted to inguinal hernia surgery. Only 1.5% required immediate reintervention before discharge to evacuate hematoma. The short duration of hospitalization, the quality-price ratio, the good postoperative results, as well as the rapid socio-professional reintegration, render the use of polypropylene mesh in inguinal hernia surgery very attractive for patients.