(P 363) A NEW SURGICAL TECHNIQUE FOR THE RECONSTRUCTION OF INGUINAL 'NEOLIGAMENT' AFTER SOFT TISSUE SARCOMA RESECTION

Objective: Soft Tissue Sarcomas (STS) involving the groin region require demolitive surgery, often including en-bloc resection of the inguinal ligament. This can lead to the development of inguinal-femoral hernias, necessitating re-operation. This study presents a new surgical technique for the reconstruction of an inguinal “neoligament” and investigates surgical complications within 90 days.

Methods: We included all consecutive patients with STS who underwent groin region surgical demolition and inguinal “neoligament” reconstruction using a "cigarette-rolled" mesh between 2020 and 2024 at IRCCS Humanitas Research Hospital (Rozzano, MI). The inguinal “neoligament” was reconstructed with a non-absorbable rolled polypropylene mesh, fixed to the anterior superior iliac spine and the pubic symphysis with interrupted, synthetic, non-absorbable stitches. The procedure could include loco-regional pedicled muscular flaps and/or additional meshes to cover the remaining wall defect. Fasciocutaneous flaps were used to cover the soft tissue and skin defect.

Results: We included eight patients. Detailed patient demographics, surgical details, and outcomes are summarized in Table 1. In all patients, the reconstruction of the neoligament was performed using our new technique. Pedicled muscular flaps and/or additional meshes were used as needed based on the final assessment post-resection (e.g., Figure 1, patient number seven reconstructed with neoligament plus one pedicle muscular flap plus two additional meshes). Seven patients were males (87.5%) and one was female (12.5%). Histologically, there were seven liposarcomas (LPS, 87.5%) of the spermatic cord (6/7 – 85.7% de-differentiated LPS, 1/7 – 14.3% well-differentiated LPS), and one pelvic leiomyosarcoma (12.5%). Out of the entire cohort, three (37.5%) were primary sarcomas, two (25.0%) were residual after incomplete surgery performed in another center, and three (37.5%) were recurrences. Two patients (25.0%) received preoperative chemotherapy, and one patient (12.5%) received preoperative radio-chemotherapy. Three patients (37.5%) received postoperative treatment.
The mean tumor size was 84.9 mm (range 13-130 mm), the mean operative time was 247.8 minutes (range 172-355 minutes), and the mean length of stay was 6.5 days (range 2-13 days). Analyzing surgical complications at 90 days, we found three wound dehiscence and one wound infection, all with a Clavien-Dindo Score of 2. No patient developed a hernia during follow-up.

Conclusion: To our knowledge, this is the first paper describing a series of surgical cases with inguinal “neoligament” reconstruction using a "cigarette-rolled" synthetic mesh and non-absorbable stitches. The described surgical technique can be considered an additional option for the surgeon’s armamentarium when reconstructing the groin region, with particular attention to preventing herniation of intra-abdominal organs. This technique appears to be safe, feasible, and reproducible. However, the patient cohort in this study is small, and further studies are needed to evaluate its effectiveness compared to other reconstructive techniques.