bluuebunny/crossref_metadata_2025 huggingface dataset:
Preliminary experimental assessment of a vertical shell and tube heat exchanger based on phase change materials
Authors: Al Douri J , Pop H , Apostol V , Hmood KS , Al Qaisy S J , Nabbat A , Fadhil N K , Ionita C , Prisecaru T
Published: October 2022

The paper presents an experimental setup developed for phase change materials (PCM) testing inside a vertical shell and tube heat exchanger (VSATHE). The work presented part of a more complex one focusing on designing a PCM heat exchanger that could be used in the defrosting process of commercial and refrigeration systems. The phase change materials (PCM) were commercial paraffin RT54HC, while water was used as heat transfer fluid (HTF). This work was presented The impact of changing the temperature of the inlet water (70 °C, 75 °C, and 80 °C) and the change of flow rate (0.012kg/sec, 0.014kg/sec and 0.016kg/sec) in the solidification and melting of the PCM. The results of the experiments showed that when the inlet hot fluid temperature increases at the same flow rate, the melting time in VSATHE units decreases. At the same time, during the charging process, the increase of flow rate with the difference in inlet temperature has no effect on the total melting time.
Modelling heat transfer in fins using finite difference method
Authors: Tcaciuc G D , Lupu A G , Popescu A
Published: October 2022

In this paper a heat transfer analysis through rectangular fins (extended surfaces) is conducted using the finite difference method. The impact of different fins geometries and aspect ratios on the convective heat transfer coefficient is investigated using finite difference approach. Transient heat conduction through fins is modelled using a time implicit scheme and convection heat transfer coefficient is computed explicitly using an empirical correlation from literature.
Thermal conductivity of Ag-rGO/water hybrid nanofluids: An experimental approach
Authors: Vardaru G A , Huminic G , Huminic A
Published: October 2022

The main purpose of the study is to analyze the effect of temperature and weight concentration on the thermal conductivity of Ag-rGO/water hybrid nanofluids. The thermal conductivity (TC) of Ag-rGO/water hybrid nanofluid was analyzed for three weight concentrations (0.050, 0.075 and 0.1 wt.%) in the temperature range 20-50 °C. Maximum TC was obtained for the Ag-rGO/water hybrid nanofluid at a concentration of 0.1 wt.% and temperature of 50 °C. To describe the variation of TC of Ag-rGO/water hybrid nanofluid with increasing temperature at different weight concentrations, new correlations were developed based on the measurement data.
Land Restitution and Conflict in Cameroon: the case of The Bakweri
Authors: Sunjo Emile , Page Ben
Published: October 2022

Land that was appropriated in the colonial period is only rarely returned to African claimants. Drawing largely on interviews from 2018, this article examines a process of surrendering parcels of state-managed plantation land to Bakweri communities in the South-West Region of Cameroon, which has been operating since 2003. The article not only analyses the national political effects of the scheme, but also engages with debates about interpretive frameworks by contrasting neopatrimonial and political settlements (PS) approaches. The article argues that the original intention of the land restitution scheme may have been to benefit some local communities, but it also reduced effective opposition to the national government by undermining Bakweri institutions and unity. It sustained established national political arrangements by generating significant rents, which are distributed among the government’s supporters in exchange for loyalty. The article argues that this part of the argument would align with the neopatrimonial framing, but that PS address some of the criticisms levelled at neopatrimonialism particularly in relation to the explanations for and limits to clientelism.
Acquired Acrodermatitis enteropathica – an unusual cause of vulva ulceration in a post-operative patient: a case report
Authors: Ekpemandu Ngozi , Attra Tarun , Bailey Daniel , Walsh Sarah
Published: October 2022

Acrodermatitis enteropathica (AE) is a rare disorder which can be congenital or acquired. The main features are peri-orificial dermatitis, gastrointestinal symptom in the form of diarrhoea, acral dermatitis and alopecia, among others. This report aims to highlight that AE is an important differential diagnosis to consider, when managing older patients with mucosal infections or ulcerations. Here, we present the case of a 68-year-old female with end-stage liver disease who presented with a right inter-trochanteric femoral fracture following a fall and was noted, on admission, to have non-healing mucosal ulcers.
The Psychological Impact of Aesthetic Surgery: A Mini-Review
Authors: Jones Hannah Elizabeth , Faulkner Heather R , Losken Albert
Published: October 2022

The purpose of this summary is to outline the available research on the psychological factors associated with aesthetic surgery. Aesthetic procedures such as abdominoplasty, breast augmentation, face lift, and rhinoplasty are shown to have unique preoperative and postoperative psychological factors. Depression and anxiety may occur after aesthetic procedures with an increased incidence in patients with certain depression prone personality traits. The pre-existing psychology of patients is also an important contributing factor to consider when evaluating surgical candidates. Pre-existing mood disorders such as depression and anxiety are shown with higher incidence in individuals pursuing aesthetic procedures and can predispose such individuals to worsening mood symptoms postoperatively. This article aims to equip surgeons with a better understanding of the common psychological factors seen in the field of aesthetic surgery, so patients can be better supported throughout all parts of the surgical process.

Level of Evidence: Therapeutic 5
BJS-04 OUTCOMES OF OPEN VERSUS ROBOTIC-ASSISTED LAPAROSCOPIC POSTERIOR COMPONENT SEPARATION IN COMPLEX ABDOMINAL WALL REPAIR. A RETROSPECTIVE MULTICENTER CASE-CONTROL STUDY
Authors: Dewulf M , Hiekkaranta J , Mäkaräinen E , Saarnio J , Vierstraete M , Ohtonen P , Muysoms F , Rautio T
Published: October 2022

Background

Transversus abdominis release (TAR) is a relatively new surgical technique in the treatment of complex ventral hernias. The aim of this study is to compare outcomes of open (oTAR) versus robotic-assisted (rTAR) posterior component separation by TAR.

Methods

Consecutive patients at two European hernia centers who underwent bilateral TAR were included. A retrospective analysis of a prospectively maintained database and the electronic medical record was performed. Primary endpoint of the study was length of postoperative hospital stay.

Results

Data from 90 rTAR and 79 oTAR operations was evaluated. Patient demographics were similar between groups in terms of age, sex, body mass index and comorbidities. There were more smokers and hernias were larger in the oTAR group (width 8.7 cm vs 10.0 cm; p=0.031, length 11.6 cm vs 14.1 cm; p=0.005). Length of postoperative hospital stay was significantly shorter in the rTAR group (3.4 days vs 6.9 days; p<0.001). There were significantly more overall and serious short-term complications (Clavien-Dindo ≥ grade III) in the oTAR group (7.8% vs 20.3%; p=0.018), and surgical site infections were more common in the oTAR group (3.3% vs 12.7%; p=0.010). During a median follow-up time of 19 months in the rTAR group and 43 months in the oTAR group, reoperation rates (4.4% vs 8.9%; p=0.245) and recurrence rates (5.6% vs 5.1%; p>0.9) were similar.

Conclusion

Patients with ventral incisional hernias who undergo bilateral rTAR have a significantly shorter length of postoperative hospital stay and significantly less short-term complications when compared to patients undergoing bilateral oTAR.
DD-03 ANALYSING PORCINE ANTERIOR ABDOMINAL MIDLINE LAYERS USING RAMAN SPECTROSCOPY
Authors: Kiss S , Chintapatla S , Kroger R
Published: October 2022

Aim

Evidence shows that incisional hernia (IH) formation may result from connective tissue alterations in a subgroup of individuals. Collagen signature typical of weaker tissues and healing wounds was reported by several groups. Such changes in the incisional scar may lead to IH formation. With the use of advanced imaging (Raman spectroscopy) we aim to investigate the composition and structure of the abdominal midline. We selected the porcine model to validate the use of Raman Spectroscopy for studying the anterior abdominal wall and calibrating it as a reference tool for human studies.

Materials & Methods

Raman spectroscopy, a technique widely used in physical sciences, is deployed to provide a chemical and structural fingerprint of the midline. Collagen produces specific Raman spectra, which allows its identification and analysis in biological samples. The porcine abdomen is similar in structure and composition to the human abdomen and is therefore suitable as reference tissue to validate Raman spectroscopy for human studies.

Results

Preliminary spectral data (linea alba, rectus sheet, muscle, skin, fat) showed differential collagen, lipid and muscle fibre content in corresponding layers of the porcine abdomen. Notably, characteristic collagen related Raman bands were confirmed.

Conclusions

The porcine abdominal wall is similar to that of humans. Hence using this model system, we can validate the use of Raman spectroscopy for the investigation of collagen in IH scars. A pilot trial has now been set up to study human scar collagen in patients undergoing IH repair and patient recruitment has begun.
OC-003 PORT POSITIONS IN TEP FOR SHORT PATIENTS: OUR EXPERIENCE
Authors: Charan K , Sharma N , Baksi A , Banerjee N , Rodha M , Gupta D
Published: October 2022

Introduction

Totally extraperitoneal repair (TEP) is a popular technique for repair of inguinal hernia. One common technique of TEP involves placement of one 10 mm port 1–2 cm below the umbilicus just off the midline, one 5 mm port 2–3 cm above the pubic symphysis, and a third 5 mm port between these 2 ports in the midline (Figure 1a). In case the distance from the superior border of the symphysis pubis to the inferior edge of the umbilicus is less than 15 cm, this leads to crowding of instruments and results in ergonomic problems during the operation. Daes has popularized eTEP for this indication. The aim is to shift the first 10 mm port to a position 5 cm superior and 4 cm lateral to the umbilicus (Figure 1b). eTEP has also found application in the repair of ventral hernias. However, for most inguinal hernias, we feel that eTEP is an overkill.

Methods

We place the first 10 mm port at the level of the superior border of the umbilicus and just lateral to it (Figure 1c). The two 5 mm ports are placed in the midline. Initial dissection is performed telescopically.

Results

This technique provides 2–3 cm of extra working space, which improves ergonomics while operating on patients with a short pubo-umbilical distance. Other parameters like operating time, postoperative pain and other complications remain the same.

Conclusion

We recommend placement of the 10 mm port at the superior border of the umbilicus, particularly in short patients.
OC-015 PATIENT REPORTED OUTCOMES FOLLOWING LAPAROSCOPIC GROIN HERNIA REPAIR IN A DISTRICT GENERAL HOSPITAL USING TWO DIFFERENT METHODS OF MESH FIXATION
Authors: Charfare Z , Charfare H
Published: October 2022

Aim

Post-operative pain is recognised as an important outcome following mesh repair of groin hernias. We investigated patient reported outcomes using the Carolinas Comfort Scale (CCS) in patients who underwent laparoscopic transabdominal preperitoneal (TAPP) groin hernia repair in a district general hospital (DGH).

Methods

The CCS questionnaire was sent to 162 randomly selected patients who underwent groin hernia repair (TAPP), performed using absorbable tacks or tissue glue to fix the mesh, by a single surgeon between 2011–2021. The questionnaire is used to assess 23 patient reported parameters including sensation of mesh, pain & movement limitations in different positions e.g. laying, standing etc. The follow-up ranged between 3 months to 10 years. The median and range values for each criterion were used to determine the outcome.

Results

Seventy-six responses were received (response rate 46.91%). Our data showed excellent outcomes in all parameters measured by the CCS, with a median score of 0 out of 5. There were no hospital readmissions within 30 days or major complications. Out of 1748 measured parameters across 76 patients, only 71 scores were ≥3 (4.06%) – there was no observable correlation between these higher scores and mesh fixation device used.

Conclusions

In this study we found that it is possible to achieve excellent outcomes in a DGH following laparoscopic groin hernia repair. Initial assessment has not shown any significant difference in outcome between methods of mesh fixation but we wish to study this further with inclusion of more patient reported outcomes.
OC-019 MESH-RTL PROJECT FOR PREVENTION OF WOUND ABDOMINAL DEHISCENCE: NON-INFERIORITY CLINICAL TRIAL TO COMPARE TWO APONEUROTIC CLOSURE TECHNIQUES IN MIDLINE LAPAROTOMY IN PATIENTS WITH ELEVATED RISK
Authors: Gutierrez Nery Perez M , Ramirez Guerrero P
Published: October 2022

Aim

Abdominal wound dehiscence (AWD) has an incidence of 2–4%, which can increase to 20% in specific risk groups. The aim of this study is to report the results of the use of the reinforced tension line (RTL) technique compared with the use of onlay mesh closure (OM) in the prevention of AWD in high-risk patients undergoing laparotomy.

Material and Methods

Non-inferiority open randomized controlled clinical trial. Included were patients older than 18 years who underwent midline laparotomy, emergency or scheduled, who were considered high risk. The patients were randomized 1:1 to the RTL technique or to OM. The objective was to report the incidence of AWD and the complications associated with the closure method. Intention-to-treat analyses were performed.

Results

A total of 239 patients were randomized; 118 patients from the RTL group and 121 patients from the OM group. The global incidence of AWD was 8.8% (21 patients). We did not find a statistically significant difference between the two groups, RTL group (13/118, 11%) and OM group (8/121, 6.6%) (p=0.259, OR 0.6, 95% CI 0.25–1.39). The groups were similar in the rates of surgical site infection, hematoma, seroma, and postoperative pain during follow-up.

Conclusions

The RTL and OM techniques are useful in the prevention of AWD in high-risk midline laparotomy patients, the advantage of RTL is that it can be used in patients with a contaminated, or dirty abdomen and its cost does not go beyond a couple of sutures.
OC-026 PERFORMING A SLIT ON THE MESH TO ENCIRCLE THE CORD STRUCTURES DURING LAPAROSCOPIC INGUINAL HERNIA REPAIR - A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Demetriou G , Ahmad M S , Robinson S J
Published: October 2022

Aim

There are several modifications in the technique for the placement of mesh during laparoscopic inguinal hernia repair. The present study aimed to provide stronger evidence in establishing whether the slit mesh technique is superior to the non-slit technique (the most common practice). The primary outcome was recurrence and secondary outcomes were postoperative groin pain, bleeding, seroma formation and duration of surgery.

Material & Methods

Eligible studies had to compare the two methods of mesh placement slit Vs non slit in laparoscopic TEP or TAPP inguinal hernia repair. Databases searched were Embase, Medline, Cochrane collaboration, NICE guidelines search.

The meta-analysis was conducted using Review Manager software 5:4. The outcomes were expressed in odd ratios with their 95% confidence intervals. Where significant heterogeneity existed (I2>75%) a random effects model was used otherwise a fixed effects model was used.

Results

Five studies included, all were single centre studies, 4 retrospective and one prospective observational studies. 1076 patients included, 633 in the slit group and 434 in the non-slit group. The male to female ration was 9:1.

There were 10 (1.5%) recurrences in the slit group compared to 12 (2.5%) in the non-slit group 0.62, 95% CI (0.27–1.41). There was no difference in the incidence of post-operative bleeding (1.21, 95%CI 0.4–3.66), seroma formation (1.5, 95% CI 0.81–2.76), or post-operative neuralgia (0.98, 95%CI 0.11–8.92).

Conclusion

There is no advantage in performing a slit on the mesh to encircle the cord structures during laparoscopic inguinal hernia repair.
OC-029 LAPAROSCOPIC INGUINAL HERNIA REPAIR IS FEASIBLE IN PATIENTS WHO HAVE HAD PREVIOUS ABDOMINO-PELVIC SURGERY WITH NO INCREASED RISK OF COMPLICATIONS COMPARED TO OPEN REPAIR
Authors: Hayward R , Smith J J , Kontovounisios C , Qiu Mbbchir S , Warren O J
Published: October 2022

Introduction

This study aims to understand whether previous abdomino-pelvic (AP) surgery is a predictor of peri-operative complication in inguinal hernia surgery and if there are discrepancies between laparoscopic or open repairs.

Material & Methods

All patients operated on within a 5-year period were audited and subcategorised based upon history of AP surgery. Patients were also categorised into laparoscopic and open groups. Data collected included complication rates, recurrence rates and readmission within 30 days.

Results

205 patients underwent repair of 288 hernias. 80 (39%) patients had a history of AP surgery. 32 patients suffered a complication (15.6%). 85% of the repairs were laparoscopic in the AP group vs 96.4% in the non-AP group (p=0.02). Complication rates were 17.5% and 14.4% in the AP group and non-AP group respectively (p=0.55). These included superficial infection (0% vs 2.4%, p=0.16), haematoma (11.3% vs 4.8%, p=0.08), seroma (5.0% vs 4.8%, p=0.95), persisting numbness (0% vs 0.8%, p=0.42), and chronic pain (1.3% vs 0.8%, p=0.75). There were no mesh infections or explantation in either arm. A greater proportion of patients in AP group required overnight stays (32.5% vs 21%, p=0.08). At median follow up 1.8 years, recurrence rates were 3.8% vs 1.6%, p=0.33 in AP and non-AP groups respectively.

Conclusions

Laparoscopic inguinal hernia is feasible in most patients with a history of AP surgery. Compared to open repair, there were no significant differences in recurrence or complication rates in patients with previous AP surgery. Therefore, previous AP surgery should not be a contraindication for laparoscopic repair.
OC-032 IMAGE-BASED DEEP LEARNING MODELS (DLMS) TO PREDICT LONG TERM QUALITY OF LIFE (QOL) FOLLOWING ABDOMINAL WALL RECONSTRUCTION (AWR)
Authors: Katzen M , Murphy K , Ayuso S , Scarola G , Colavita P , Augenstein V , Heniford B T
Published: October 2022

Aim

To apply image-based DLMs to predict post-operative QOL following AWR.

Materials & Methods

A prospective, institutional hernia-database was queried for patients with preoperative abdominal CT-imaging, a preoperative and 1-year postoperative Carolinas Comfort Scale(CCS) survey, and no recurrence. “Symptomatic” was defined as CCS-score≥2(2=mild and bothersome). Google Xception existing architecture model was used with ImageNet database pre-initialized weights to classify symptomatic and non-symptomatic patients. Patients were divided into 80:20-training:testing samples for model generation and evaluation. Model training, test accuracies, and loss-functions were evaluated to determine performance and discriminative ability.

Results

Of 244 patients, mean age was 60.4±11.8 years, mean BMI:33.0±7.1kg/m2, female:57.1%, tobacco use:14.3%, diabetic: 24.5%. Median[IQR] hernia defect size was Exactly 180cm2[90–324]; 66.1% had a failed repair. CDC wound classifications Included: 75.9% class-I, 8.3% class-II, 9.1% class-III, 6.6% class-IV. Preoperatively, hernia-related pain(70.2%) and movement limitations(72.3%) were common. Mesh position was predominantly preperitoneal(91.6%). Median[IQR] mesh size was 900cm2[572–1050]. Anterior component separation was required in 17.9% and posterior in 20.4%.

One-year postoperatively, reported symptoms included: mesh sensation-39.5%, discomfort-37.8%, movement limitations-37.0%.

DLMs utilized 6,441-CT-images(5,097 training-sample). Proportions of symptomatic patients were 48.9%(85/174) in the training-sample and 50%(35/70) in the test-sample. Highest DLM training accuracy was 85.37%(loss=0.3766) at epoch 15/50 with 79.30%(loss=0.3766) comparative validation accuracy, demonstrating strong discriminative ability in model classification between symptomatic and asymptomatic patients. Lower accuracy due to model overfitting was observed after 50 epochs.

Conclusions

Image-based DLMs using standard, preoperative CT images very successfully predicted 1-year AWR QOL. The impact of DLMs on preoperative counseling/consent for surgery could be revolutionary.
OC-037 HERNIA DEFECT CLOSURE IN POLYPROPYLENE BASED LAPAROSCOPIC HERNIOPLASTY TO AVOID SEROMA FORMATION AND HERNIA RECURRENCE: A PROSPECTIVE COHORT STUDY
Authors: Sarvani M , Lokendra Venkata Prasad M
Published: October 2022

Aim

This is a Prospective Cohort study, to assess a preventive effect, through closing hernia defect in laparoscopic mesh hernioplasty with polypropylene based best hands-on surgical method. The study could provide promising outcomes with diminishing seroma formation and recurrence rate.

Methods

The study were conducted from April 2017 to until date. The study persuaded with nearly 328 cases from Tertiary Care Centre who underwent laparoscopic trans-abdominal and extraperitoneal patch plasty (TAPP) (TEPP). Hernia defect closure were performed through this polypropylene mesh and deployment using sutures to all patients. The primary outcomes regarding seroma formation, recurrence of hernia, Pre-operative status and post-operative complications was all observed and recorded.

Results

About 328 indirect and direct hernia defects were recruited and indulged for study. All the defect closure operations by polypropylene mesh hernioplasty for all types of hernia repair exhibited high success rate, without hernia reccurrence and minimal seroma formation.

Conclusions

The closure of Hernia defect in laparoscopic polypropylene mesh hernioplasty explicated to be secure and effective technique and would significantly decrease post-operative incidence of seroma formation without increasing hernia recurrence risks, chronic and acute pain. The approach can be recommended for scrotal or larger hernia repair as well.
OC-038 RISK FOR CONTRALATERAL INGUINAL HERNIA REPAIR FOLLOWING PRIMARY UNILATERAL HERNIA REPAIR – A REGISTER-BASED STUDY
Authors: Olsson A , Sandblom G , Franneby U , Sondén A , Gunnarsson U , Österberg J , Dahlstrand U
Published: October 2022

Aim

To investigate the incidence as well as the factors predictive for a subsequent hernia repair on the contralateral side following a primary unilateral hernia repair.

Material & Methods

Prospective population-based study of data from the Swedish Hernia Register based on 151,297 patients operated with an index unilateral inguinal hernia mesh repair using open and endo-laparoscopic technique, during 2007–2019. Incidence, predictive factors and time to a contralateral hernia repair was analysed.

Results

There were 7.4% registered contralateral hernia repairs with a median time of 2.7 years to a subsequent contralateral repair following the index unilateral hernia repair. Median follow-up time was 7.5 years. Significant predictors for a subsequent contralateral hernia were, male sex (HR 1.78, 95% CI 1.61–1.97), high age (HR 1.01 95% CI 1.006–1.009), medial inguinal hernia (HR 1.05, 95% CI 1.003–1.098), combined inguinal hernia (HR 1.10, 95% CI 1.03–1.18), hernia defect size 1.5–3.0 cm (HR 1.10, 95% CI 1.03–1.17), hernia defect size > 3 cm (HR 1.36, 95% CI 1.27–1.45) and a repair on the left side (HR 1.30, 95% CI 1.25–1.35). Endo-laparoscopic repairs and obesity were associated with a lower incidence of a later contralateral repair.

Conclusion

If the relevant risk factors, i.e., male sex, high age, large hernia defect size, medial or combined hernia, are present at a unilateral endo-laparoscopic groin hernia repair and the decision has been shared with the patient, exploration of the contralateral groin and prophylactic mesh placement may be considered.
OC-061 IMAGE-BASED DEEP LEARNING MODELS (DLMS) IDENTIFY ABDOMINAL WALL RECONSTRUCTION (AWR) PATIENTS RECEIVING PREOPERATIVE BOTULINUM TOXIN A (BTA) WHO REQUIRE COMPONENT SEPARATION TECHNIQUE (CST)
Authors: Ayuso S , Elhage S , Zhang Y , Katzen M , Marturano M , Salvino M , Augenstein V , Colavita P , Heniford B T
Published: October 2022

Aim

Preoperative BTA facilitates muscle/fascia elongation and fascial closure, which increases the durability of hernia repair and may reduce requirement for CST. The aim of this study was to develop image-based DLMs that predict whether patient will require CST if injected with BTA prior to surgery.

Methods

An institutional database was used to identify AWR patients who received preoperative BTA and had preoperative CT imaging. Axial CT cuts of the hernias were rendered to train and develop a DLM. The primary outcome was a ROC for predicting CST. The DLM was tested on CT scans from a pre-identified subset of patients who underwent CST and did not receive preoperative BTA.

Results

There were 116 patients who met criteria (4,580 CT images). Of these patients, 69 (59.5%) required CST (2884 images); 47 patients (40.5%) did not undergo CST (1,696 images). The DLM ROC was 0.78 (Figure 1); accuracy, sensitivity, and specificity were 0.79, 0.86, and 0.68, respectively. There were 98 patients in the test set; 57 (58.1%) were predicted to require CST and 41 (41.9%) were not. For patients with an M1 hernia component, 21.1% were predicted to be spared CST versus 46.8% those with an M2-M5 hernia component (p=0.04).

Figure 1 Model Performance for CST Prediction

Conclusions

Image-based DLMs accurately predicted which patients receiving preoperative BTA may require CST. When the DLM was applied to a test set, patients with an M1 hernias were very likely to require CST, which is consistent with previously reported data, further validating the model.
OC-069 EFECTIVENESS OF PROPHYLACTIC ONLAY MESH FOR PREVENTION OF TROCAR HERNIA: PRELIMINARY RESULTS OF A RANDOMIZED CLINICAL TRIAL
Authors: Ciscar A , Ruiz P , Saez E , Vila M , Gomez M , Troyano D , Abadal M , Pereira J A , Badia J M
Published: October 2022

Aim

Trocar site hernia (TSH) incidence is a common complication of laparoscopic surgery. In the literature there is a lack of tools to prevent it. Our aim was to assess the effectiveness and safety of a prophylactic measure to decrease it.

Methods

A multicentric randomized clinical trial was performed in high-risk patients (diabetes mellitus and/or age ≥70 years and/or BMI ≥30 Kg/m2 and/or extended incision for specimen retrieval) who underwent laparoscopic cholecystectomy in an elective or emergency setting. Patients were allocated to prophylactic onlay polypropylene mesh fixation (intervention) or standard trocar closure (control). The main aim was to analyze the efficacy of the intervention, being TSH incidence the primary outcome. Clinical and radiological follow up was atleast 1 year after surgery. Secondary endpoints were technique-related complications.

Results

134 patients were included (70 and 62 to intervention and control arm, respectively). Groups were homogeneous. Mean [SD] age, 64.8 (17.3) years; 80 (60, 6%) women. The cumulative TSH incidence was lower in the intervention group although not reaching significant differences, either when were radiologically (16 [26.7%] vs 17 [37%], p = 0.294) or clinically assessed (9 [17.6%] vs 9 [24.3], p = 0.593). No differences in surgical site infection, hematoma or seroma were detected. Mean follow-up was 736 days (min. 365 – max. 1294).

Conclusions

Our preliminary results points out that the overall TSH incidence is extremely high when properly assessed. A polypropylene onlay mesh would not be an effective measure to decrease the TSH incidence. Radiological evaluation would show more accuracy.
OC-070 A NOVEL SELF-GRIPPING LONG-TERM RESORBABLE MESH PROVIDING TEMPORARY SUPPORT FOR PRIMARY VENTRAL AND INCISIONAL HERNIA
Authors: Vestberg R , Bouré L , Lecuivre J , Payet E , Radlovic A , Bayon Y
Published: October 2022

Medtronic recently developed a novel synthetic fully long-term resorbable self-gripping mesh to reinforce soft tissue where weakness exists during ventral hernia repair procedures. This resorbable mesh is a macroporous, knitted, poly-L-lactide, poly-trimethylene carbonate copolymer monofilament mesh with the ProGrip™ technology.

The biocompatibility profile of the mesh has been extensively established and documented. No systemic nor local adverse reactions have been observed from implantation to complete resorption and metabolization of the mesh in a subcutaneous implantation preclinical rabbit model.

Its performance was evaluated at 20 weeks using a modified published preclinical porcine model of hernia repair (Martin, 2013; Deeken, 2013). Histologic examination of the implantation sites confirmed that this novel mesh was well tolerated and led to new extracellular collagen matrix formation. The burst strength of the hernia repair sites reinforced with the new mesh was statistically equivalent to the one of the native abdominal walls.

Currently marketed ProGrip™ meshes have been clinically and successfully used with less mechanical fixation devices than non-self-gripping meshes (Chastan, 2009; Rangwani, 2021). The new self-gripping long-term resorbable mesh fixation performance was demonstrated to be statistically equivalent to the one of ProGrip™ Self-Gripping Polyester Mesh both in ex-vivo testing and in an in vivo porcine model. This should support the ease-of-use feature of the mesh with a limited need for additional mechanical fixation, which will likely be associated with a shorter surgical time.

The preclinical tests of the self-gripping resorbable mesh are compelling enough to make it a new mesh candidate for future clinical use.
P-019 BIOELECTRIC IMPEDANCE ANALYSIS TO DETERMINE THE RISK FACTORS FOR INGUINAL HERNIA
Authors: Bostan M S , Ugurlu C , Sahin A , Koca B , Kocabay A , Ozkan N , Kulacoglu H
Published: October 2022

Aim

To search the risk factors for inguinal hernia development by performing bioelectrical impedance analysis.

Material & Methods

Prospective, multicenter, cross-sectional study. Patients with inguinal hernias constitues the study group (IH), and patients who admitted with other surgical problems in the control group (SC). Age, gender, and BMI of the patients were recorded. Body composition measurements were done by bioelectrical impedance analysis. The relations between the obtained parameters and inguinal hernia were evaluated.

Results

9 female and 125 male patients with a mean age of 53.4± 15.4 in IH, whereas 44 women and 24 men with a mean age of 44.5±15.9 in (SC). There were statistically significant differences between two groups regarding BMI, total body fat, lean abdominal muscle mass, abdominal fat amount, and visceral fat rates. Male gender, low total body fat rate, low total body fat amount, low lean body mass rate, and low visceral fat rate were determined as risk factors for inguinal hernia in univariate analysis. Only low total body fat rate was found to be an independent risk factor.

Conclusions

Low total body fat rate is an independent risk factor for inguinal hernia development.
P-030 LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH POLY-4-HYDROXYBUTYRATE ABSORBABLE BARRIER COMPOSITE MESH
Authors: Alshammari S , Aldohayan A
Published: October 2022

Background

Repair of ventral and incisional hernias (VIHR) is a common procedure, newly introduced resorbable mesh biomaterials provide an attractive option to reduce use of permanent synthetic mesh in hernia surgery and reduce its complications. However, data on the use of slowly resorbable mesh materials remain scarce, this study aims to evaluate the use of poly-4-hydroxybutyrate/absorbable barrier composite mesh (P4HB/ABCM) in laparoscopic repair of VIHR.

Methods

This is a retrospective study of a sequential cohort of patients undergoing 22 laparoscopic VIHR utilizing a P4HB/ABCM mesh. Perioperative characteristics and clinical outcomes were collected.

Results

In total, 26 patients including nineteen females, and seven males underwent laparoscopic VIHR using P4HB/ABCM. All surgeries were performed in a single institution by the same surgeon. The average patient age was 52.6, and the mean BMI was 35.5. All patient had a clean wound classification. The average defect size was 136.4 cm2. All patients were seen in clinic with a median follow-up of 28 months. We observed 4 wound seromas, and no wound infections or recurrences during follow up period.

Conclusion

Results of laparoscopic VIHR with P4HB/ABCM are favourable and encourages further studies on the role of absorbable biosynthetic mesh materials in hernia surgery.
P-059 ROBOT ASSISTED TRANS ABDOMINAL PRE-PERITONEAL (RTAPP) MESHPLASTY FOR GIANT GROIN HERNIAS - OUR HYBRID ROBOTIC SURGERY CHOREOGRAPHY FOR OPTIMIZING OUTCOMES
Authors: Soni V
Published: October 2022

Aim

To demonstrate our successful, cost effective & time saving choreography for managing Large Groin Hernia with Robot assisted Trans Abdominal Pre-Peritoneal (rTAPP) Meshplasty Surgery

Materials & Methods

7 patients with Groin Hernia EHS Classification P/R M/L 3 were operated using Da Vinci Xi Robotic platform and underwent TAPP Meshplasty between October 2021 & June 2022. We noted the instruments used(Robotic and Laparoscopic), the Surgery duration & Console Time, the ease of the surgery & the Choreography, Intra-operative challenges, intra-operative change in surgical steps, post-op pain scores, analgesia usage & outcomes.

Results

Laparoscopic instruments were used in 7/7 (100%) patients for accomplishing various steps. Both flat & 3D Anatomically contoured meshs were used. Usage of Laparoscopic Instruments at various steps & in tandem with Robotic instruments optimizes the cost of the surgery, helps in decreasing surgical duration & utilization of resources. The trends evolve as one negotiates the learning curve.

Conclusions

Our study demonstrated that for Large Groin Hernia it is recommended to include Laparoscopic instruments during Robot assisted surgery along with specific surgical steps for successful completion of rTAPP in a cost-effective manner.
P-068 RESULTS OF THE OPEN INTRAPERITONEAL ONLAY MESH TECHNIQUE WITH A PREFORMED PATCH FOR PRIMARY VENTRAL HERNIA AND INCISIONAL HERNIA
Authors: Barranquero A G , Villalobos Mori R , Maestre González Y , Protti G P , Gutiérrez E , Olsina Kissler J
Published: October 2022

Aim

Primary ventral hernias and incisional hernias are frequent, but long–term results of their repair with a preformed patch are scarce. The aim was to evaluate the surgical results of the treatment of these hernias with the open intraperitoneal onlay mesh (open IPOM) technique, and to determine the needed follow–up for recurrence.

Material and methods

Observational retrospective single institution study of all consecutive patients intervened for ventral or incisional hernia with diameter inferior to 4 cm, from January 2013 to June 2020. The surgical repair was performed according to the open IPOM technique with a preformed patch and the defect was left unclosed. Relapsed hernias, those with a defect ≥ 4 cm, and lateral wall hernias were excluded.

Results

A total of 146 patients were intervened: 61.6% with umbilical hernias, 8.2% with epigastric hernias, 26.7% with trocar incisional hernias, and 3.4% with other incisional hernias.

The global recurrence rate was 7.5% (11/146). Specifically, there it was 7.8% in umbilical hernias, 0% in epigastric hernias, 7.7% in trocar incisional hernias, and 20% (1/5) in other incisional hernias. The median time for recurrence was 14 months (IQR: 4,4–18,7). The median presential follow–up was 17,4 months (IQR: 6,5–27,3), and the median telematic follow-up was 36,9 months (IQR: 27,2–49,6).

Conclusions

The open IPOM technique with a preformed patch offers good results for the treatment of ventral and incisional hernias. A 2-year follow-up is still needed for the recurrence diagnosis.

Note

The preformed patch used was the Parietex™ Composite Ventral Patch (Medtronic, Minneapolis, MN, EEUU).
P-070 SYNTHETIC MESH VERSUS BIOLOGICAL IMPLANT TO PREVENT INCISIONAL HERNIA AFTER LOOP-ILEOSTOMY CLOSURE: A RANDOMIZED FEASIBILITY TRIAL
Authors: Mäkäräinen E , Wiik H , Kössi J , Pinta T , Mäntymäki L M , Mattila A , Kairaluoma M , Ohtonen P , Rautio T
Published: October 2022

Aim

The aim of this study was to evaluate the safety and efficiency of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure.

Material & Methods

Up to one third of patients experience incisional hernia after loop-ileostomy closure, justifying hernia prevention procedures. Although biological meshes have been widely used in contaminated surgical sites instead of synthetic ones due to complication concerns, previous data on the subject does not support this practice. A randomized, controlled, multi-center non-inferior feasibility trial was conducted from April 2018 – November 2021. Patients (n=102) were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene MacroTM, Medtronic) (SM) or a biological mesh (PermacolTM, Medtronic) (BM) to the retrorectus space at loop-ileostomy closure after anterior resection for rectal adenocarcinoma. The primary outcome was rate of surgical site infections (SSI) at 30-day follow-up.

Results

In total, 102 patients were randomized, of which 97 received the intended allocation. At 30-day follow-up, 94 patients (97%) were evaluated. Of patients in the SM group, 1/46 (2%) had SSI and in the BM group 2/48 (4%) had SSI (p>0.90). Uneventful wound healing was recorded in 38/46 (86%) and 43/48 (90%) patients in the SM and BM groups, respectively. One patient from each group underwent reoperation requiring mesh removal (p>0.90).

Conclusions

Both a synthetic mesh and biological mesh were safe in incisional hernia prevention after loop-ileostomy closure. Hernia prevention efficiency will be reported after long-term patient follow-ups.
P-075 DURABLE REPAIR OF INCISIONAL HERNIA BASED ON BIOMECHANICAL PRINCIPLES – 3 YEAR FOLLOW UP
Authors: Nessel R , Löffler T , Rinn J , Kallinowski F
Published: October 2022

Aim

Durable composite constructions of polymers follow specific mechanical principles. Incisional hernia can be repaired durably based on biomechanical principles. How are the results after three years?

Material and methods

The biomechanics of the abdominal wall was analyzed ex vivo with cyclic loading common in material sciences. The resulting GRIP concept was clinically applied. The tissue quality of the individual patient was assessed with computed tomography at rest and during Valsalva's maneuver. All patients recieved single-shot antibiosis. Patients were discharged after full ambulation was achieved.

Results

A total of 228 patients (120 males and 108 females) were treated for incisional hernia. Primary hernia was repaired in 166, recurrence in 62 patients. The patients had an average of 1.3 risk factors with most patients grouped as ASA III (n= 119). Emergency repairs were necessary in 11 patients. Hernia orifices were mostly median (N= 141) and lateral (63 patients) with 23 combined cases. Hernia sizes were on average 9 ± 6 cm wide and 13 ± 8 cm long. The mesh-defect area ratio was 7.75. Fixation was necessary with a median of 60 fixation points to reach adequate GRIP levels. A total of 137 patients were followed for three years so far. Four patients died during follow-up (Follow-up rate 100%). One recurrence was detected in a liver transplant patient reconstructed with a sandwich. Pain levels were low (median NAS = 0 at rest and under load, u-test: p = 0.07672).

Conclusion

Incisional hernia can be repaired durably based on biomechanical principles.
P-079 INCIDENCE AND RISK FACTORS OF ABDOMINAL FASCIAL DEHISCENCE AFTER EXPLORATORY LAPAROTOMY- AN AUDIT OF 282 CASES
Authors: Kumar Das Poddar K , Shastri S , Kumar P , Subhadarshan Mishra T , Kumar Sasmal P
Published: October 2022

Background

An audit was performed to identify the incidence and risk factors of post-operative abdominal fascial dehiscence after Exploratory laparotomy.

Methods

The prospectively maintained database of a single unit was reviewed.The demographic parameters, comorbidities, degree of contamination, type of procedures, and the types of suture & needles were reviewed.We analyzed the relation of the type of sutures, type of surgery and degree of contamination on the development abdominal fascial dehiscence within 30 days of surgery .Difference between the groups were analyzed by t tests for continuous variables and Chi squared tests for categorical variables.

Results

50 (17.7%) patients developed fascial dehiscence.Mean Albumin was 2.45 +/- 0.69 g/dl in the dehiscence group, compared to 2.97 +/- 0.86 g/dl in those without dehiscence (p= 0.00).The prevalence of diabetics, smokers and incidence of postoperative surgical site infection were significantly more in the patients with dehiscence (p value - 0.045, 0.043 and 0.00 respectively).Prevalence of class 4 wounds was higher in the group with dehiscence (70% vs 44%, p value 0.001).Type of suture used (Loop PDS No. 1 vs PDS 2–0) did not significantly influence development of facial dehiscence within 1 month.

Conclusion

Results of our study are consistent with existing literature. Important preoperative/intraoperative parameters such as smokingr, diabetics, preoperative hypovolemic shock, albumin are significant predictors of fascial dehiscence in the post operative period. This will enable surgeons to take corrective measures before the surgery
P-080 LAPAROSCOPIC TRANSABDOMINAL RETROMUSCULAR UMBILICAL PROSTHETIC HERNIA REPAIR (LAP-TARUP) & TAPP-INGUINAL IN A SINGLE TIME: A GOOD OPTION IN OBESE PATIENTS?
Authors: Trujillo Díaz J , Jezieniecki Fernandez C , Conceji Cutoli P , Gomez Lopez J R , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C
Published: October 2022

Aim

The association between midline hernias (primary-or-incisional) and inguinal-hernias is not uncommon, nor is its association with obesity, which increases its incidence every day. In obese patients, the laparoscopic-eTEP-approach to treat ventral hernias is a feasible option but with greater surgical difficulty and worse ergonomics. The laparoscopic-TARUP-approach(TransAbdominal-Retromuscular-Umbilical-Prosthetic-Hernia-Repair) offers the advantages of MIS with better ergonomics in obese patients or those with irreducible incarcerated hernias.

Material and Method

77-year-old male patient with obesity (BMI:37.58kg/m2), previous laparoscopic gallbladder surgery,who presents umbilical eventration(EHS: M2–3W2(8cm)) associated with diastasis,in addition to incoercible left inguino-scrotal hernia.

Results

5ports are used to perform the surgery.Initially,the classic TAPP-approach of the left inguinal-hernia is performed.After that the video-endoscope is changed to the location of the right flank and continues with the opening at the lateral edge of the posterior sheath of the right-rectum, the retromuscular-space is dissected and the supraumbilical cross-over and subsequent opening of the posterior contralateral sheath is performed.The dissection and reduction of the hernial sac is continued, and the dissection of the left retromuscular-space is completed.The anterior hernia defect is closed and diastasis is replicated with Stratafix-0.Closure of the posterior sheath of the rectums is performed with V-Lock 3–0. A 21×24cm PVDF-mesh is placed in a retromuscular position fixed with Fibrin, and the lateral opening is closed with V-Lock.The patient had a favourable postoperative period.

Conclusions

The TARUP-approach in midline hernias in obese patients is a valid,safe and better ergonomic option, and is also useful for simultaneously resolving large inguinal hernias by TAPP-approach,as in the case presented.
P-081 LAPAROSCOPIC RIVES-STOPPA ETEP FOR UMBILICAL HERNIA WITH RECTUS ABDOMINIS DIASTASIS: DOWN-TO-UP APPROACH
Authors: Trujillo Díaz J , Jezieniecki Fernández C , Gomez Lopez J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C
Published: October 2022

Aim

The association of umbilical or epigastric hernia and diastasis is not uncommon.Classically, it was insisted on the repair only of hernial pathology and not of diastasis.However, according to the latest recommendations,the simultaneous treatment of both pathologies is a valid and effective option.In addition, with the rise of minimally invasive surgery(MIS) of the abdominal wall, more cases of simultaneous MIS repair of midline hernias and diastasis are being reported.

Material & Methods

41-year-old female-patient with umbilical hernia of 3cm associated to diastasis with a distance of 4cm(post-pregnancy). MRI abdominal wall: umbilical hernia and diastasis, not other hernial defects. Laparoscopic management is decided by eTEP-approach .

Results

4ports are used, a dissector-balloon was used to dissect the right retromuscular-space.Another 5mm-trocar is placed in LRQ, 5mm-trocar in LLQ and 12mm in suprapubic-midline.The surgery continues with the dissection of the left retromuscular-space, with the dissection of the umbilical hernial sac and reducing its contents, the section is performed at the medial level of both posterior sheaths of the rectus abdominis muscle until reaching the xiphodeal region.Later we continue with the closure of the anterior wall of the rectums by replicating the diastasis with Stratafix-0.Then the posterior sheath was closed with V-Lock 2–0.A PVDF-mesh of 16×26cm was placed.The patient presented a favorable postoperative evolution and was discharged on 1°-POD.

Conclusions

The laparoscopic-Rives-Stoppa-eTEP-approach for hernia-pathology of the midline associated with diastasis is a valid, efficient, effective and safe option, offering the advantages of MIS:less postoperative pain, less morbidity, early return to routine daily activities with lower healthcare-spending.
P-089 SPONTAONEUS BOWEL EVISCERATION IN UMBILICAL HERNIA: CASE REPORT
Authors: Grappolini N , Garbarino S , Fanelli M , Scorza A , Marzorati A , Colombo E M , Palillo A , Palamara N , Inversini D , Ietto G , Carcano G
Published: October 2022

Aim

Spontaneous rupture of sac of hernia is a less common complication and mainly associated to persistent ascites or congenital wall defects. In literature we have few cases of spontaneous bowel eviscerations in umbilical hernias.

Case Report

a 53-year-old male years old man addicted to heroin, cocaine and alcohol, presented to the Emergency Department with evisceration of small bowel through an existing umbilical hernia. The patient was conscious and not complaining pain. He stated a protrusion of small bowel through his umbilical skin caused to sudden coughing after assumption of a dose of heroin.In emergency room showed an ileal loop with sub ischemic features. Blood test revealed an hepatitis C infection. During the urgent laparotomy there wasn't evidence of ascites and was necessary to performed an ileal resection and latero-lateral anastomosis with mechanical suturing machine. The placement of a prosthesis was performed; therefore, direct plastic surgery of the abdominal wall. After surgery with a short stay in ICU of 24 hours, the patient was discharged in POD 5. The postoperative course was regular without wound complications. After four months he was free from recurrence and VAS was 0.

Conclusions

Spontaneous bowel eviscerations in umbilical hernias is associated with refractory ascites in cirrhotic patients or congenital defect. This case is one of few case depicted in literature as spontaneous evisceration of bowel in non cirrhotic patient with umbilical hernia.