bluuebunny/crossref_metadata_2025 huggingface dataset:
DD-07 INCISIONAL HERNIA FOLLOWING LAPAROSCOPIC COLORECTAL LIVER METASTASIS RESECTION. FIRST COMPARATIVE STUDY
Authors: Hassan A , Elfarouq A , Katheria V , Subar D
Published: October 2022

Aim

Since first laparoscopic liver surgery (LLR) in 1991, no literature to compare Incisional hernia (IH) incidence between LLR and open Resection (OLR). This is the first comparative study

Material and methods

Single centre retrospective review of Colorectal Liver Metastasis resections between 2011 till 2018. The primary end point is developing IH related to liver resection. Incidence of IH was compared between LLR and OLR. Factors including Age, Gender, Diabetes Mellitus, Steroid intake, Pre-op Creatinine and Albumin, Previous Liver resection ASA score were compared between both groups. Subcutaneous and peri-renal fat thickness measured as indicative of fat distribution. Numeric results presented in Mean±SD. SPSS 20 (IBM, Armonk, USA) used for statistical analysis. p ≤ 0.05 was considered statistically significant

Results

247 procedures with follow-up 41 ± 29 Months. IH was observed in 48 case (19.4%). Incidence was 10%, 19% at 1, 3 years respectively (Kaplan-Meier). 87 case (35%) had LLR and 160 (65%) OLR. OLR had lower pre-op Albumin (32±9 Vs 35±8 g/L, p 0.01, Mann-Whitney U), longer hospital stay (10±7 Vs 6±4 days, p 0.00, Mann-Whitney U) and more major liver resections i.e. Resection of 3 or more segments (58% Vs 29% in LLR, p 0.00, Chi2). No difference in IH Incidence in LLR (8%, 19% Vs 10%, 19%) and OLR at 1, 3 years respectively. Similarly, no difference in hernia size (53±37 mm in LLR Vs 50 ± 33 in OLR, p 0.96, Mann-Whitney U)

Conclusion

No difference in IH incidence or size between LLR and OLR.
DD-08 RETAINER II – DEVELOPMENT AND VALIDATION OF A PATIENT REPORTED OUTCOME MEASURE (PROM) FOR INGUINAL HERNIA REPAIR
Authors: Corghan S , Fullard A , Fleming C ,   I S R C
Published: October 2022

Aim

Outcome reporting following inguinal hernia repair is heterogenous. We aim to develop an inguinal hernia repair PROM.

Methods

The evaluation and development of a disease-specific instrument will be performed in accordance with FDA guidelines for developing PROMs in three phases

Item Generation: An systematic review(PROSPERO ID CRD42021271735) and narrative analysis will be undertaken to identify health related quality of life(HrQoL) issues relevant to patients with inguinal hernia, this will be used to identify themes and concepts to help inform the interview guide.

Pre-Testing: A pre-test questionnaire will be developed based on the conceptual framework devised in Phase I and tested with a sample of 20–30 patients to reach consensus regarding the questionnaire format and structure to confirm that instructions and items are clear, understandable, relevant, and applicable. Quantitative assessment of face validity of the measure will be undertaken using the QQ-10 and data fanalysed both quantitatively and qualitatively.

PROM Evaluation: A field test will be undertaken to evaluate the RETAINER II tool for reliability and validity using psychometric techniques from Classical Test Theory. Each patient will complete:

An approximate sample of 50–100 patients will be purposively sampled ensuring representation of all subgroups. Qualitative analysis, using NVIVO 12 for Windows(QSR International Pty Ltd., Australia) will be performed independently. A test-retest will be undertaken. Consenting participants will complete a second questionnaire pack 5–7 days after inital questionnaires (approximately 50 patients).
OC-002 EVALUATION OF GIANT INGUINAL HERNIA REPAIR RESULTS - A RETROSPECTIVE SINGLE INSTITUTION CASE-CONTROL PROPENSITY SCORE MATCHED STUDY
Authors: Demma J A , Shpigelman O , Marom G , Fishman Y , Pikarsky A , Almogy G
Published: October 2022

Background

Giant inguinal hernia (GIH), defined as a hernia descending below the inner-thigh midpoint in upright position, is rare. Case reports describe techniques in which the abdominal cavity is prepared and care is taken to prevent abdominal compartment syndrome (ACS). Our aim was to analyze and review our experience with GIH repair.

Methods

Retrospective single-institution, case-control, study included adults who underwent GIH repair between 2014–2021 at an university referral center. Technique included endo-tracheal intubation, head-down positioning, maximal pre-incision reduction of hernia contents, and repair with mesh. Follow-up was conducted in outpatient clinic. Results were compared to a time-based control group.

Results

During the study period, 58 patients underwent an open GIH repair with mesh without abdominal preparation. Control group included 232 patients who underwent open non-giant inguinal hernia repair (control group). Bowel resection was not necessary in any case. The in-hospital and 30-day complication rates were 17.2% and 68.9% in the GIH group, and 8.2% and 27.2%, in the control group (p=0.04, OR=2.3; and p<0.001, OR=5.9, respectively). Ischemic orchitis was common in the GIH group (65.5%) compared to the control group (13.4%) (p<0.001, OR=12.3). ACS, major complications and mortality were not reported. 90-day complication rates were similar. 2 cases of recurrence (0.9%) were observed in the control group.

Conclusions

Our study suggests that GIH repair is safe and feasible, and there is no need for abdominal cavity preparation. Early complications, mainly ischemic orchitis, are more common than control group, but without long-term implications and with a very low recurrence rate.
OC-005 ENDOSCOPIC SURGICAL SKILL QUALIFICATION SYSTEM IN JAPAN: PROVEN PERFORMANCE IN HERNIA SURGERY
Authors: Ueno N , Eguchi T , Hayakawa T
Published: October 2022

Endoscopic Surgical Skill Qualification System by Japan Society for Endoscopic Surgery is implemented from 2004.

Laparoscopic inguinal hernia repair (TAPP, TEP) is positioned as a low difficulty level operation under general surgery field in this system.

An application qualification to the system demands the list of a specified operative cases, to participate in education seminars, and training of endoscopic surgery over 2 years after the Board Certified.

A specified case quantity is the operative experience of above 5 examples of a high-difficulty level and 45 examples of a low difficulty level operation.

Candidates submit 3 no edited videos of the endoscopic surgery performed for indirect hernia with the orifice above 1.5 cm in a male-sex. Which to examine among 3 videos is decided randomly by the society.

Two hernia-specified referees examine one candidate. When both results don't agree, an extra referee will examine newly and fixes the result.

An evaluation is estimated within 60 points of common standards and 40 points by an hernia. Equal to or more than 70 points in amount become a pass. Acceptance rate in hernia was 16% in 2021.

The Nationwide Survey of Endoscopic Surgery reported recurrence rates of after laparoscopic hernia surgery as 5% in TEP in and 4% in TAPP in 2012–2013, 2.0% and 1.3% in 2018∼2019, what is improved beyond the period.

It's no exaggeration to say that the Qualification System has played a big part.

The Qualification System like no other in the world is to be introduced.
OC-008 TRENDS IN INGUINAL HERNIA REPAIR: A TAILORED APPROACH
Authors: Khanmohammed Z , Fadaee N , Huynh D , Capati I , Towfigh S , Tung R
Published: October 2022

Aim

Inguinal hernias (IH) can be repaired via open, laparoscopic, and robotic approaches, with or without mesh. We aim to understand the changing trends in IH repair that may serve as a guideline toward a tailored approach for hernia repair.

Materials & Methods

All patients undergoing primary IH repair from 2009–2021 by a single surgeon at a specialty hernia center were included. Temporal differences were evaluated using Chi-squared, Fisher's exact test, and logistic linear regression.

Results

Over 12 years, 533 patients underwent primary IH repair. Most were males (59.1%), average age 51.7 years, and average BMI 26.6 kg/m2. IHs were repaired via open (28.3%) or minimally invasive (MIS) approaches (71.7%), either with (93.4%) or without mesh (6.6%).

Trends showed a significant increase in females undergoing IH repair (p<0.001) and increase in MIS approach (p<0.001). There was a significant decrease in open approach (p<0.001) and an overall trend away from mesh-based repairs and toward tissue-based repairs (p<0.001).

Conclusions

We present our hernia specialty center's best practices for IH repair, which is a result of a tailored approach. Our 12-year study shows a significant trend toward the use of MIS approach for IH repair. This is aligned with international consensus guidelines, especially for females. While mesh use remains the standard of care in the US, we show a progressive and significant trend away from the overuse of mesh in IH, especially for females.
OC-012 THE COMBINATION OF THE THREE MODIFICATIONS OF THE COMPONENT SEPARATION TECHNIQUE IN THE MANAGEMENT OF COMPLEX SUBCOSTAL WALL DEFECT
Authors: Zuvela M , Galun D , Bogdanovic A , Loncar Z , Zivanovic M , Zuvela M , Zuvela M
Published: October 2022

Aim

To present a concept combining three modifications of the component separation technique (CST) in one procedure as an original solution for the management of complex subcostal abdominal wall defect.

Material and Methods

Between January 2010 and January 2022, seven patients with complex subcostal hernia defects compromised by infection, radiation, or chemotherapy underwent surgery in which three modifications of CST were combined into one procedure. Major complex subcostal hernia was defined by either width or length of the defect being greater than 10 cm. The following were the stages of the operative technique: (a) the “method of wide myofascial release” at the side of the hernia defect; (b) “openbook variation” of the component separation technique at the opposite side of the hernia defect; (c) a modified component separation technique for closure of midline abdominal wall hernias in the presence of enterostomies; (d) suturing of the myofascial flaps to each other to cover the defect; and (e) repair augmentation with an absorbable mesh in the onlay position.

Results

The median (range) length and width of the complex subcostal hernias were 15 cm (10–19) and 15 cm (8–24), respectively. The overall morbidity rate was 57.1% (wound infection, seroma and skin necrosis). There was no hernia recurrence during the median follow-up time of 19 (range 3–84) months.

Conclusion

The operative technique integrating three modifications of CST in one procedure with onlay absorbable mesh reinforcement is a feasible solution for the management of complex subcostal abdominal wall defect.
OC-013 INDIVIDUAL STRATEGY FOR PATIENTS WITH ABDOMINAL WALL EVENTRATION – DIFFERENT COMPONENTS SEPARATION TECHNIQUE WITH MESH AUGMENTATION
Authors: Zuvela M , Bogdanovic A , Galun D , Palibrk I , Velickovic J , Djukanovic M , Bidzic N , Zivanovic M , Zuvela M , Zuvela M
Published: October 2022

Aim

To present individual approach for patients with abdominal wall eventration using various anterior component separation techniques (aCST) with mesh augmentation.

Materials and Methods

Between January 2008 and April 2022, 194 patients with abdominal wall eventration underwent surgery by single surgeon. Surgical treatment consists: a) enlargement of the abdominal cavity using different aCST (Ramirez CST, modified CST in the presence of enterostomies, “open book” modification CST, “method of wide myofascial release” or combination of these techniques); b) mesh augmentation (sublay or onlay hernioplasty); c) prolonged muscle relaxation and mechanical respiratory support in intensive care unit.

Results

Type of abdominal wall reconstruction: 143 Ramirez CST, 35 modification CST in the presence of enterostomies, 11“open book” CST modification, 5 “method of wide myofascial release”, 159 onlay mesh hernioplasty and 35 sublay mesh hernioplasty. Mean hernia defect size was 255 cm2 (100–750). During the mean follow-up of 31 months, 78 (40%) patients had one or more complications: intraabdominal hypertension 8 (4,1%), seroma 13 (6,7%), hematoma 10 (5,1%), wound/mesh infections 21 (10,8%), skin necrosis 40 (20,6%), pain 3 (1,6%), and recurrence 5 (2,6%). There were 10 (5,1%) postoperative deaths. The cause of dead was significant comorbidity in 8 patients and postoperative compartment syndrome in two.

Conclusion

Eventration disease is a complex surgical problem and its treatment is associated with significant complications. Individual strategy for each patient based on multidisciplinary approach using different component separation techniques with mesh augmentation may improve postoperative results.
OC-017 INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE FOR THE LAPAROSCOPIC TREATMENT OF PRIMARY AND INCISIONAL VENTRAL HERNIA IN DAY SURGERY REGIME
Authors: Bellino R , Giaccone M , Bertot L , Rosati S , Balestra G , Sandrucci S
Published: October 2022

IPOM technique is a well-established technique for the repair of primary and incisional ventral hernia; and outpatient regime is considered a cost-effective strategy without compromising the quality of care. In this retrospective observational study, we evaluated the application of IPOM technique through outpatient setting, with the use of a non-absorbable, transparent, light prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent polypropylene film.

179 consecutive procedures of primary and incisional hernia repair from 2011 to 2022 have been included in this study (149 with the above-mentioned composite meshes and 30 with other meshes, semi-absorbable and non-absorbable). All the procedures were performed through 3 abdominal trocars executing cold adhesiolysis to release the contents of the hernial sac without dissecting the latter. The abdominal wall was then prepared by blunt dissection to create the space for the mesh and to favor a prompt cell colonization. Mesh fixation was achieved using transparietal points and resorbable tackers.

The primary outcomes of the study were the evaluation of any risk factors for conversion from outpatient regime to standard hospitalisation, and the hernia recurrence, in two subgroups: primitive hernias (n=72) and incisional hernias (n=107).

Our clinical experience showed that IPOM technique through outpatient setting is a safe and effective approach. No statistically significant difference in the recurrence rate between the primitive and incisional hernias groups (5.9% vs 5.0%, p=0.80) was found. Moreover, we found a relationship between the rate of unexpected hospitalization and age of the patients, number of defects and hernia dimension.
OC-020 INCISIONAL HERNIA REPAIR WITH MESH REIMAGINED: PILOT STUDY USING ABDOMINOPLASTY AS PERMANENT AUTOLOGOUS BIOLOGICAL REINFORCEMENT IN HERNIA REPAIR
Authors: Tung R , Fadaee N , Rahban R , Towfigh S
Published: October 2022

Aim

EHS consensus recommends mesh implantation for all incisional hernia (IH) repairs, regardless of size. We propose considering abdominoplasty in the algorithm for IH repairs wherein the plicated fascia functions as a permanent autologous biologic onlay repair over the primary repair of the IH.

Materials & Methods

Four patients with midline IHs underwent abdominoplasty. Their IHs were first closed primarily with #2–0 permanent suture. Next, a two-layer anterior plication of the overlying fascia was performed with permanent suture. No mesh was implanted. Patients were followed up post operatively to monitor for hernia recurrence.

Results

All patients were female with average age 51 years. All had at least one midline IH (1cm-1.7cm wide). Three (75%) had recurrent IHs. Three (75%) had diastasis recti. Patients were followed at 1 year, with no (0%) recurrence.

Conclusion

Abdominoplasty may be a safe and effective alternative for IH repair compared to traditional mesh-based repair. In effect, the patient's own plicated fascia functions as a permanent autologous biologic onlay reinforcement to the IH repair. Meanwhile, the plication may reduce tension off the primary defect closure, thus reducing recurrence. Our pilot study in small IHs showed no hernia recurrence one-year postoperatively after abdominoplasty. Thus, abdominoplasty may serve as an alternative surgical option to a subset of patients with IH. We aim to judiciously expand indications for abdominoplasty for IH repair to address wider defects in select candidates. We hope our experience will supplement the current algorithm for IH repairs by providing a non-mesh alternative.
OC-021 HYBRID ROBOTIC SURGERY - USING LAPAROSCOPY TO BETTER ROBOTIC OUTCOMES
Authors: Soni V
Published: October 2022

Aim

To show that Hybrid Robotic Surgery is essential for a successful and a cost effective General Surgery Robotic Surgery Program

Material & Methods

38 Consecutive cases of General Surgery done from October 2021 to June 2022 were studied with respect to usage of Robotic Instruments & Laparoscopic Instruments, the utility of each instrument, Surgical time, costs & patient outcomes.

Results

A Hybrid approach by using Laparoscopic Instruments (Ports and/or Instruments) was necessary in 38/38 patients (100%) for atleast some step & in 32/38 patients for atleast one important surgical step. Robotic Platform was used to perform Hernia Surgery like TAPP (Trans Abdominal Pre-Peritoneal) & IPOM (Intra-peritoneal Onlay Meshplasty) (n=23). Laparoscopic Instruments were used in all the cases 23/23 (100%).

Conclusions

Usage of Laparoscopic Instruments helped reduce the Surgery duration, decrease use of Robotic instruments, help negate the Haptic blind spots proving to be a cost effective & a tool for optimal Robotic utilization. Laparoscopic instrumentation and steps remain an integral part of Robotic Surgery. The findings highlight the need for dual instrument set, both Robotic & Laparoscopic Instruments, in each Robotic Surgery and underscores the importance of adequate Laparoscopy knowledge and skills for a Robotic Surgery Program.
OC-022 MAINTAINING AN ELECTIVE ABDOMINAL WALL RECONSTRUCTION SERVICE DURING THE COVID 19 PANDEMIC
Authors: Dixon S , Benson A , Kalaiselvan R , Kanwar S , Samad A , Pritchard-Jones R , West C , Scott M
Published: October 2022

Aim

Elective surgery services suffered significantly due to the COVID-19 pandemic. The aim of this study was to analyse the impact and outcomes of abdominal wall reconstruction (AWR) performed during the COVID-19 pandemic, assessing safety and sustainability.

Material and Methods

A retrospective review of all patients undergoing AWR in a single NHS trust, multiple surgeons, between 23rd March 2020 and 22rd March 2022, the 2 years following U.K. Government imposed lockdown, was undertaken and compared with the pre-pandemic AWR activity. Procedures were initially undertaken at a cold site and when demonstrated to be safe, main site operating restarted. The primary outcome was 90 day mortality, secondary outcomes of COVID-19 infection within 7 days, length of stay, critical care requirement, and complication rate.

Results

In the study period, 173 patients underwent AWR, compared with 99 cases in a single year preceding lockdown. 90 day mortality rate was zero. No patients returned positive COVID tests to the trust within 7 days of AWR, and no patients were readmitted for COVID related symptoms. Critical care admission was required in 7 patients, 3 of these were planned admissions pre-operatively. The surgical site occurrence rate was 9.8% (17), infection 5.8% (10), seroma 2.3% (4) and haematoma 1.7% (3). There were no recurrences reported, with follow up ranging between 1 and 18 months.

Conclusion

Continuing AWR services during the COVID pandemic is feasible and safe. Peri-operative COVID infection rates are low, critical care requirements minimal, and there is no impact on patient morbidity or mortality.
OC-036 DEVELOPMENT OF NOVEL IMAGE-BASED DEEP LEARNING MODELS (DLMS) TO PREDICT OUTCOMES IN ABDOMINAL WALL RECONSTRUCTION (AWR) WITH IMBALANCED DATA SETS
Authors: Ayuso S , Elhage S , Zhang Y , Salvino M , Aladegbami B , Augenstein V , Colavita P , Heniford B T
Published: October 2022

Aim

The development of DLMs with imbalanced datasets represents a major challenge in the fields of artificial intelligence and surgery. The aim of this study was to develop and compare DLMs that predict mesh infection and pulmonary failure following AWR.

Methods

A prospectively maintained institutional database was used to identify AWR patients with preoperative CT scans. Standardized axial cuts of CT scans were rendered to DLMs. Conventional DLMs (CDLM) were developed two-class training system (i.e., learns negative and positive outcomes). CDLMs were compared to DLMs that were developed using a Generative Adversarial Network Anomaly (GANomaly) framework, which utilizes image augmentation and anomaly detection. The primary outcomes were receiver operating characteristic (ROC) values for predicting mesh infection and pulmonary failure.

Results

CT scans from 510 patients were utilized (10,004 images). Mesh infection and pulmonary failure occurred in 3.7% and 5.6% of patients, respectively. The CDLMs were less effective than GANomaly for predicting mesh infection (ROC 0.61 vs 0.73, p<0.01) and pulmonary failure (ROC 0.59 vs 0.70, p<0.01). Although the CDLMs had higher accuracies/specificities for predicting mesh infection (0.93 vs 0.78, p<0.01/0.96 vs 0.78, p<0.01) and pulmonary failure (0.88 vs 0.68, p<0.01/0.92 vs 0.67, p<0.01), they were substantially compromised by decreased model sensitivity (0.25 vs 0.68, p<0.01/ 0.27 vs 0.73, p<0.01).

Conclusions

Compared to CDLMs, GANomaly DLMs showed improved performance on imbalanced datasets, predominantly by increasing model sensitivity. Understanding patients who are at-risk for postoperative complications can improve risk stratification.
OC-039 WHAT IS THE INFLUENCE OF FEMALE GENDER AND FEMORAL HERNIA ON PERIOPERATIVE OUTCOME IN GROIN HERNIA REPAIR?
Authors: Kundel L , Riediger H , Köckerling F
Published: October 2022

Groin hernias are rare in women compared to men. The proportion of women in the overall collective of operated groin hernias is between 8–12%. The rate of femoral hernias in women is higher than in men. Femoral hernias account for 3% of all primary groin hernias and 18% of all groin hernias in females. Very little is known about the influence of female gender and a femoral hernia on the outcome in groin hernia repair.

For this retrospective analysis of prospectively collected data from the Herniamed Registry 347.054 primary elective unilateral groin hernia repairs were selected. 42.595 (12.3%) procedures have been performed in females. 10.265 (3%) patients had a femoral hernia. A multivariable analysis was undertaken to investigate the influence of confirmatory defined patient- and procedure-related characteristics on the perioperative outcome.

A significantly favorable correlation was found between the total perioperative complication rate and female gender (OR =0.886; 0.844–0.931) p<0.001. Other factors with positive impact on the perioperative outcome are the laparo-endoscopic approach, smaller defects, medial defects and normal weight. A significantly unfavorable relation was identified between the total perioperative complication rate and a femoral hernia (OR =1.172; 1.095–1.254)p<0.001. Other unfavorable influencing factors on the perioperative outcome are higher age, higher ASA score, antithromboric medication, smoking, COPD and corticosteroid medication.

The risk of perioperative complications is lower in female compared to male groin hernia repair, but not in femoral hernias.
OC-045 AMBULATORY HERNIA SURGERY IN PRIMARY CARE
Authors: Kumaran N , Bylapudi S , Kirmani S , Hodgson G L , Tennakoon A , Rao M
Published: October 2022

Background

Approximately 100,000 hernia repairs are performed in the UK annually, the vast majority in hospital usually under general anaesthetic. Due to increased pressure on hospital facilities especially after the COVID-19 pandemic the waiting times for non-emergency surgery for benign conditions has increased. This study outlines the development and feasibility of a dedicated ambulatory primary care hernia service and examines the outcomes achieved between November 2018 and November 2021.

Methods

We prospectively analysed of records of 212 patients who underwent hernia repair in a primary care centre during the above period. Inclusion criteria were a) BMI<35 b) uncomplicated inguinal or umbilical hernia c) non recurrent hernia. The techniques used were Lichtenstein mesh repair for inguinal hernias and a primary sutured repair for ventral hernias. All procedures were performed as day-cases under local anaesthesia without sedation. All patients were telephoned by a healthcare professional a day after their operation. The primary outcomes of the study were length of stay, immediate complications and the secondary outcome was cost effectiveness.

Results

The median length of post-operative stay was 26 minutes. Complications were low and seen only in 5 patients and managed conservatively. The cost of hernia repair in primary care in UK is only £1012 when compared to £1800 in an NHS hospital.

Conclusion

Routine elective abdominal wall hernia repairs can be performed in a primary care setting, safely, with good clinical outcomes and clear economic benefits. However, this depends on the availability of surgeons and adequate funds to establish the service.
OC-046 SURGICAL ASPECTS AND EARLY MORBIDITY OF RECURRENT INGUINAL HERNIAS DURING OPEN REOPERATION
Authors: Spencer Netto F , Mainprize M , Yilbas A , Szasz P
Published: October 2022

Background

Inguinal hernia recurrences (IHR) are relatively common and have higher complexity and complication risk at reoperation when compared with primary inguinal hernias (PIH). This study aims to further characterize the patterns of recurrence and early complications observed by type of hernia repair at the index surgery.

Methods

After REB approval, a review of charts from patients undergoing elective first reoperation for IHR from 2013–2017 was performed. First operations were classified as: childhood repair, laparoscopic repair, open tissue repair, open mesh repair and Shouldice repair. Early complication included hematoma, infection and seroma. Statistical analyses were completed.

Results

A total of 1281 patients underwent 1340 surgeries for IHR in the study period (4.9% of all inguinal hernias operated). There wa an increased proportion of males, direct type hernias and wound infection in IHR group (p<.001) when compared with PIH repairs. During surgical procedure, the length of surgery was longer, scarring of tissues heavier, nerve identification lower in patients with previous open mesh and Shouldice repairs, in comparison to other groups (childhood, laparoscopic and open repair - p<.001).

Conclusion

Recurrent inguinal hernia repairs present higher complexity than PIH repairs and incurr in higher chances of early postoperative complications. The type of PIH repair technique influences surgical difficulties encountered in the open reoperation, with open mesh and Shouldice techniques being associated with higher surgical difficulty. This information may help in surgical planning, according with the anticipated leverl of procedure difficulty.
OC-048 CHRONIC GROIN PAIN. ALGORITHM FOR EVALUATION
Authors: Santilli O , Santilli H , Nardelli N , Scaravonati R
Published: October 2022

Aim

Chronic groin pain is a challenge for surgeons. It is the main symptom in pathologies caused by sports activities (Sportsman's Groin) and is also found as a complication after inguinal hernia repair.

Currently multivariable analysis reports that : younger age (≤40 years), small hernias (EHS I: <1.5 cm), and preoperative pain; are risk factors for the appearance of postoperative chronic pain.

The Manchester Consensus concluded that general surgeons have límited experience on the topic and the difficulty of making randomized trials with high level of evidence

The main objective is to describe a diagnostic algorithm to be used in patients with chronic groin pain and those with small hernia that are going to be repaired.

Material & Methods

A multidisciplinary team had developed an assessment, diagnosis, and treatment algorithm for CGP. The team is composed of surgeons, physiotherapists, orthopedists, and imaging specialists. We implement this algorithm in young patients (16–30) who consult for chronic groin pain, even those with inguinal hernia diagnosis.

Results

A total of 5,737 patients were assessed by the multidisciplinary team from June 2009 to June 2021.

The most frequent clinical entities registered were tendinopathies: iliopsoas-pectineus- related (42.7%) and adductor-related (39.5%).

In those patients with postoperative pain, (45%) reported preoperative pain and (91%) were not related to neuropathies.

Conclusions

The algorithm has proven to be safe and successful. It has been used in patients who consulted with pre and postoperative chronic groin pain, with a high rate of achievement
OC-049 ROBOTIC RE-TAPP: A MINIMALLY INVASIVE ALTERNATIVE FOR THE FAILED POSTERIOR REPAIR
Authors: Amaral P , Dias E , Pivetta L , Carvalho J P , Macret J , Furtado M , Roll S
Published: October 2022

Aim

To describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair.

Material and Methods

patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through may 2022 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence (SSO), surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted.

Results

thirty patients (96,7% male, mean age 56,5 years, mean body mass index 28) had 41 hernias repaired (N=11 bilateral). Average operative time was 165 ± 51.9min (range 90–300). There were three intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Four SSOs occurred (N=3 seromas and N=1 hematoma. After a median 56 months follow-up [IQR 22–77], no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain.

Conclusions

on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be safe, feasible and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.
OC-054 LONG-TERM OUTCOMES OF POSTERIOR COMPONENT SEPARATION WITH TRANSVERSUS ABDOMINIS RELEASE (TAR) IN LARGE AND OTHER COMPLEX VENTRAL HERNIAS: A SINGLE-SURGEON EXPERIENCE
Authors: Chatzimavroudis G , Kotoreni G , Pavlidis T , Gotti K , Papaziogas V
Published: October 2022

Aim

The application of component separation techniques for the repair of large and other complex ventral hernias, has been a landmark in their successful management. The aim of this study is to present our experience with the posterior component separation with transversus abdominis release (TAR) in patients with these very demanding ventral hernias.

Material & Methods

A retrospective analysis of prospectively collected data of all patients who underwent elective ventral hernia repair with TAR technique between January 2016 and May 2021 was performed. Selection of the type of inserted mesh was based on the risk of developing surgical site infection (SSI) and other surgical site occurrences (SSOs). Preoperative, intraoperative, and postoperative data were analyzed.

Results

A total of 167 patients with large and other complex ventral hernias were included in the final analysis. More than 80% of patients had one or more comorbidities. Of all patients, 156 (93.4%) had a history of previous abdominal surgery, 42 (25.1%) had a history of SSI and 11 (6.6%) had active fistulas, of which nine involved previous implanted meshes. Postoperatively, SSOs were presented in 12 patients (7.2%), including three cases of SSI. Neither mesh infection occurred, nor mesh excision required. With a mean follow-up of 3 years, only one recurrence has been observed.

Conclusions

With a wound complication rate of less than 8% and a recurrence rate of less than 1%, our results show that TAR is a reliable, safe and effective technique for the repair of large and other complex ventral hernias.
OC-058 MORTALITY OF THE ELDERLY: ANALYSIS OF DATA FROM THE LAPARASTOMA REGISTRY
Authors: Wöhler A , Schaaf S , Willms A , Schwab R
Published: October 2022

Aim

The therapeutic concept of open abdomen with temporary abdominal wall closure was introduced about 30 years ago. Since that time, various surgical strategies have been tried, continuously developed and established. In May 2015, a laparastoma registry was released in the form of an internet-based online platform.

Methods

Data from the laparastoma registry were analyzed and evaluated. The focus of the study was on the mortality of patients in the age group 75 years and older who underwent laparastoma treatment. Special attention was paid to the previous diseases, risk factors, MPI.

Results

913 patients with open abdomen and subsequent laparastomy treatment were enrolled in the laparastomy registry from 2015 to 2022. 65% of patients were male. 69.6% had secondary diseases. The indications for laparastoma establishment were peritonitis (37.2%, N=340), trauma (9.2%, n=84), abdominal compartment (18.1%, n=165) and others. The overall mortality rate was 28.7%. The mortality rate in the group between 75 and 80 years (n=155) was 36% (OR= 1.445 [CI: 1.002–2.008]; p=0.049). The mortality rate in patients older than 75 years (n=67) was 40.3% (OR 1.680 CI 1.008–2.802; p=0.047).

Conclusion

In the evaluation, three key questions were raised and analyzed by the study: what is the mortality in the elderly patients under laparastoma treatment, what is the mortality in the patients over 75 years old? What are the leading risk factors in the two groups.
OC-059 TEMPORARY ABDOMINAL CLOSURE NEGATIVE THERAPY IMPROVES DEFINITIVE FASCIAL CLOSURE RATES IN PATIENTS WITH OPEN ABDOMEN MANAGEMENT
Authors: Bannon A , Leatherby R , Birtles L , Augustine T , Moinuddin Z , Van Dellen D
Published: October 2022

Aims

Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement of the bowel by a thickened peritoneum due to prolonged peritoneal dialysis exposure. We are an international referral centre, typically managing cases with a planned open abdomen (OAM) and scheduled relook after 24–48 hours. We compare outcomes for those patients whose OAM was with simple packing (betadine-soaked-gauze) with negative pressure therapy providing temporary abdominal closure (TAC).

Methods

A retrospective review of a contemporaneous database of patients who underwent surgery for EPS between 2010–2020 was performed. Primary endpoints were time to definitive closure and closure method (primary fascial closure vs. bridged biologic mesh closure vs. failure to close fascia). Secondary endpoints included comparison of stoma formation, bowel resection, fistulation rate, enterotomy formation, re-operation post closure, and wound infection.

Results

99 patients had OAM (56 static packing; 43 TAC.) Patients with TAC were significantly more likely to undergo primary closure of fascia when compared to those patients managed with static packing, (63% vs 13%, p<0.0001, Chi Sq). The TAC group required fewer theatre episodes (n=2.27 vs. 4.78, p<0.0001, t-test) and time in days to achieve closure (n=2.78 vs n=4.68, p<0.005, Chi Sq), with less failure to close episodes and returns to theatre 30 days post closure.

Conclusion

This study provides definitive evidence of TAC efficacy for fascial closure following OAM. This provides definitive benefit over traditional open abdominal methods. It may provide benefit in definitive open abdominal management in other areas (sepsis and trauma) and requires further study.
OC-063 BASELINE DATA AND NORMAL ANATOMY OF THE ABDOMINAL WALL IN AN OBSERVATIONAL PROSPECTIVE COHORT STUDY OF NULLIPAROUS WOMEN
Authors: Woxnerud K , Sandblom G , Olsson A
Published: October 2022

Aims

The aim of this study was to describe the pre-partum anatomy of the abdominal wall in a cohort of nulliparous women, with the main purpose to use as a reference for management of patients with postpartum abdominal core instability.

Materials & Methods

Seventy consecutive women were examined with ultrasonography measuring inter-recti distance (IRD), anatomical variations of linea semilunaris and the oblique muscles. Waistline was assessed during activated and relaxed abdominal core. Participant characteristics were registered. Questionnaires regarding habitual physical activity (Baecke), low back pain (Oswestry), physical functioning (DRI), urinary incontinence (UDI-6 and IIQ-7) and quality of life (SF-36) were answered.

Results

Response rate was 100%. Mean age was 30.5 years (19–50), mean BMI 23.5 kg/m2 (18.4–37.1). Ultrasonography showed a mean IRD 1.02 mm (0.27–2.35) at the superior border of the umbilicus, 0.93 mm (0.36–2.01) three cm above the umbilicus, 0.21 mm (-0.53–0.98) two cm below the umbilicus; mean thickness of the linea alba 0.28 mm (0.15–0.5); mean distance between the lateral lining of the rectus muscle and the external, internal and transverse oblique muscles of respectively 1.19 (-0.99–2.82), 0.09 mm (-1.37–1.3) and 1.46 mm (-1.36–3.19) at umbilicus level. Responses to the questionnaires showed overall low values on DRI, UDI-6, IIQ-7 and Oswestry; and overall values on Baecke and SF-36 similar to the normative population.

Conclusions

This study provides baseline data on the normal abdominal wall anatomy as well as mean values of activity, physical function, disabilities and quality of life, in a healthy nulliparous female cohort.
OC-064 TISSUE KINDNESS: A COMPARISON OF TISSUE MANIPULATION BETWEEN A NOVEL SUTURING DEVICE FOR STANDARDIZED ABDOMINAL CLOSURE AND MANUAL NEEDLE TECHNIQUE
Authors: Börner G , Lööf E , Edelhamre M , Rogmark P , Montgomery A
Published: October 2022

Aim

Wound healing is influenced by contamination, wound tension, and tissue handling. Suturing includes tweezer compression and medial traction that might compromise the fascia. This study compared forces involved in suturing with a novel suturing device for standardized abdominal closure and curved suture needles of two sizes.

Method

A model to measure suturing-forces was developed. Ten theatre nurses and 25 surgeons were introduced to the novel suturing-device. Participants performed 10×3 needle-pull-throughs using the device and two sizes of conventional suture needles: 36mm Large Needle (LN) and 26mm Small Needle (SN). Tweezer force and medial tissue traction force were recorded. Needle pull-through time, maximum and Area Under Curve forces (AUC) were calculated.

Results

Device training time was 4min 25s. Maximum tweezer-force was 892g (420.4) for the device, 1037g (457.5) for LN and 1097g (491.1) for SN (p<0.001). Maximum traction-force was 62g (57.6) for the device, 61g (45.4) for LN and 54g (50.0) for SN (p=0.117). Tweezer-force AUC was 2422gs (1797.2) for the device, 3442gs (1550.0) for LN and 3221gs (1588.9) for SN (p<0.001). Traction-force AUC was 148gs (239.0) for the device, 174gs (160.8) for LN and 142gs (161.0) for SN (p=0.068). Needle-pull through time was 3.4s (2.15) for the device, 4.4s (2.12) for LN and 3.9s (1.90) for SN (p<0.001)

Conclusion

The suturing device was faster and less traumatic to tissue for tweezer-force. Medial traction forces were similar. The novel suturing device is quick to learn and gentle to the tissue and device seems promising in facilitating fascial closure.
OC-067 HIATAL HERNIA RECURRENCES AFTER LAPAROSCOPIC SURGERY: EXPLORING CONTRIBUTING SURGICAL FACTORS
Authors: Akmaz B , Hameleers A , Boerma E G , Vliegen R F A , Greve J W M , Meesters B , Stoot J H M B
Published: October 2022

Aim

The recurrence rate of hiatus hernia (HH) is high after laparascopic surgery (25–42%). HH repair can be reinforced by means of additional ventral sutures, pledgets or mesh placement. We determined the recurrence rate of HH after surgery and established whether lower long-term recurrence rates can be achieved with reinforcement techniques.

Methods

Patients were included in this retrospective cohort study if they underwent a laparoscopic fundoplication in our hospital between 2012–2019. HH was measured on CT scans and patient files were reviewed.

Results

In total, 307 patients were included, 206 women and 101 men. Pre-operatively, 102 patients were diagnosed with type III HH and 68 patients with type IV HH. The median transverse diameter of the HH was 3.2 cm. 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of ventral sutures in 132 patients, pledgets in 89 patients and mesh in 17 patients. After primary surgery, recurrence of HH was diagnostically confirmed in 64 patients (20.8%). Secondary surgery was performed in 54 patients (17.6%) and tertiary surgery in 5 patients (1.6%). Use of pledgets during primary surgery (OR=0.34, p=0.048) was significantly associated with fewer recurrences, corrected for confounding factors. Use of ventral sutures and mesh were not significantly associated with reduced recurrence rates.

Conclusions

The recurrence rate among HH patients in our hospital was 20.8% with a mean follow-up time of 6 years. In future, the use of pledgets might lead to fewer recurrences after primary laparoscopic repair of HH.
OC-068 THE USE OF VAC IN THE SALVAGE OF INFECTED SYNTHETIC MESHES
Authors: Fouza A , Simeonidou E , Goutziotis I , Petras P , Kambaroudis A
Published: October 2022

Introduction

Mesh-related infections consist a major complication of hernia repair operations that can negatively affect postoperative outcomes. Until recently, surgical removal of the mesh was the only treatment option and it was related to increased morbidity. VAC devices are a proper alternative in treating such infections and can eliminate the need to remove the infected mesh. The negative pressure that is used, removes the exudate and enhances revascularization and granulation of the wound. Such devices promote quicker wound healing, compared to conventional wound dressings.

Aim

The aim of the study is to review current literature and present three relevant cases from our center.

Materials and Methods

During 2020–2021, we encountered three cases of synthetic mesh infection after incisional hernia repair. The patients were treated conservatively, with the application of VAC devices and targeted antimicrobial therapy. All three patients were discharged and continued to visit the hospital as outpatients in order to change the dressings.

Results and conclusions

In all three cases, complete wound healing was achieved and the infection was treated successfully, without removing the mesh. In conclusion, the use of VAC is an alternative therapeutic strategy of low risk that can contribute to the salvage of the infected mesh.
OC-072 SYSTEMATIC REVIEW AND META-ANALYSIS OF PREOPERATIVE ADMINISTRATION OF BOTULINUM TOXIN AS ADJUNCT TO VENTRAL HERNIA REPAIRS
Authors: Dias E , Amaral P , Zucchini G , Pivetta L , Carvalho J P , Macret J , Malheiros C , Roll S
Published: October 2022

Aim

Preoperative application of botulinum toxin (BTX), with or without preoperative progressive pneumoperitoneum (PPP), is an adjunct to complex ventral hernia repairs, causing flaccid paralysis. We aim to evaluate the benefit of BTX in the advancement of the lateral musculature and decrease hernia defect width.

Material & Methods

It was elaborated a systematic review and meta-analysis following PRISMA guidelines and registered at PROSPERO. “Ventral hernia”, “incisional hernia”, “abdominal wall” and “botulinum toxin” were searched. PubMed (Medline), EMBASE (OVID) and LILACS databases research.

Results

Five studies (235 patients) showed tha BTX significantly increases the lateral abdominal wall muscles length (4,07cm) (95%CI (3.65;4.49), p<0,1 I2=47%). Two studies (113 patients) showes that hernia defect width raised 1.24 cm (95%CI (-3.06;5.53), p<0,05, I2=76%) after BTX with or without PPP.

Conclusions

Increase in the volume of the abdominal cavity after BTX and PPP by enlargement of abdominal wall muscles may be related to improve outcomes such as decreasing abdominal compartiment syndrome and surgical site occurrences.

Despite the Increase in the lateral abdominal wall after BTX, the decrease in hernia defect width was not obseved. Insted, meta-analysis showed a tendency of width increasing, taking into account considerable heterogeneity, witch may be related to PPP association.

BTX in complex ventral hernias increases lateral abdominal muscles length and, thus, is suposed to decrease poor surgical outcomes, although the transverse diameter of the defect does not reduced as expected. Futher studies are necessary to evaluate benefits of BTX in complete fascial closure.
OC-073 PATHWAYS OF THE PREPERITONEAL PLANE: FROM THE “FATTY TRIANGLE” IN RIVES TO THE “FATTY TRIDENT” IN EXTENDED RETROMUSCULAR ABDOMINAL WALL RECONSTRUCTION
Authors: Medina Pedrique M , Lopez Monclus J , De Robin Valle De Lersundi A , Blasquez Hernando L , Rial Justo X , Cruz Cidoncha A , Nogueira Sixto M , García-Ureña M Á
Published: October 2022

Aim

Retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence on retromuscular preperitoneal dissections.

Material & Methods

Thirty frozen cadaver torsos were dissected by posterior component separation (PCS). The shape of the preperitoneal fat was identified, and the dimensions and distances were calculated.

Results

Results showed that preperitoneal fat resembles a trident, along the midline under the linea alba, and expands in the epigastrium into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach Retzius´s space. Bogros space communicated the root of the trident laterally with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum uncovered by the preperitoneal trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair.

Conclusion

The concept of preperitoneal fatty trident may be of practical assistance in performing hernia procedures, from the simple ventral hernia repair to more complex preperitoneal ventral repair or PCS techniques. The consistency of this layer allows us to follow three specific pathways to the plane between the peritoneum and muscles to extend the preperitoneal dissection.