bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamics of epigenetic modifiers and environmentally sensitive proteins in a reptile with temperature induced sex reversal
Authors: Whiteley Sarah L , McCuaig Robert D , Holleley Clare E , Rao Sudha , Georges Arthur
Published: December 2021

The mechanisms by which sex is determined, and how a sexual phenotype is stably maintained during adulthood, have been the focus of vigorous scientific inquiry. Resources common to the biomedical field (automated staining and imaging platforms) were leveraged to provide the first immunofluorescent data for a reptile species with temperature induced sex reversal. Two four-plex immunofluorescent panels were explored across three sex classes (sex reversed ZZf females, normal ZWf females, and normal ZZm males). One panel was stained for chromatin remodeling genes JARID2 and KDM6B, and methylation marks H3K27me3, and H3K4me3 (Jumonji Panel). The other CaRe panel stained for environmental response genes CIRBP and RelA, and H3K27me3 and H3K4me3. Our study characterized tissue specific expression and cellular localization patterns of these proteins and histone marks, providing new insights to the molecular characteristics of adult gonads in a dragon lizard Pogona vitticeps. The confirmation that mammalian antibodies cross react in P. vitticeps paves the way for experiments that can take advantage of this new immunohistochemical resource to gain a new understanding of the role of these proteins during embryonic development, and most importantly for P. vitticeps, the molecular underpinnings of sex reversal.
P024 BIOMECHANICAL INFLUENCES TO BE CONSIDERED FOR A DURABLE INCISIONAL HERNIA REPAIR
Authors: Kallinowski Friedrich , Ludwig Yannique , Gutjahr Dominik , Gerhard Christian , Schulte-Hörmann Hannah , Krimmel Lena , Lesch Carolin , Uhr Katharina , Lösel Philipp , Voss Samuel , Heuveline Vincent , Vollmer Matthias , Görich Johannes , Nessel Regine
Published: December 2021

Aim

Recurrence indicates a failed repair. Which biomechanical factors have to be considered to reduce failure rates? How can surgeons enhance the interface between mesh and tissue?

Material and Methods

The strength of the mesh-tissue interface was evaluated by cyclic loading. A self-made bench test was used to apply dynamic intermittent strain (DIS) to model preparations in order to evaluate the tissue quality and the material properties of hernia meshes and fixation devices.

The influences and the properties were condensed in coefficients representing their relative strengths. The strain of the individual human abdominal wall were determined with computerized tomography at rest and during Valsalva’s maneuver.

Results

The strain observed in porcine, bovine and human tissue was in the same range. Tissue samples exhibited both brittle and ductile failure patterns. Both the load duration and the peak load increased destruction. Stress concentration elevated failure rates. Regional areas of distorsions increase stress concentrations. Hernia repair has to counteract individual strain levels. Measures to improve hernia repair include closure of the defect, use of higher DIS class meshes, increased mesh overlap and additional fixation. In the clinical routine, all measures must be adapted to the individual tissue quality.

Conclusions

Using the conception of GRIP as the gained resistance towards pressure related impacts, a durable hernia repair can be designed from coefficients determined with a bench test or with computerized tomography of the human abdominal wall. Pain levels and hernia recurrence rates can be reduced in incisional hernia repair when biomechanical principles are considered.
P034 STRANGULATED DIAPHRAGMATIC HERNIA: TEN CASES REPORTS
Authors: Gunay Mehmet , uzunyolcu gorkem , iscan yalın , gok kaan , yanar hakan , ertekin cemalettin
Published: December 2021

Aim

A diaphragmatic hernia (DH) is a protrusion of abdominal contents into the thoracic cavity as a result of a defect within diaphragm. It is most common as a congenital phenomenon; however, there have also been cases where it can be acquired. DH can be life-threatening, resulting in incarceration and strangulation.

Material and Methods

From June 2009 to April 2021, ten cases of strangulated diaphragmatic hernia were admitted to our Emergency Surgery Department of General Surgery with respiratory and abdominal symptoms. Patients' characteristics, operation details, and postoperative complications were retrospectively analyzed.

Results

There were 5 (50%) men and 5 (50%) women with a mean age of 66 years (range, 20–85 years). . Emergency surgery was performed by laparoscopic in 4(40%) patients and open in 6(60%) patients. Two patients had a history of penetrating trauma to the left thoracoabdominal region. Segmental bowel resection was performed in 3 patients and total gastrectomy in 1 patient. Reconstruction was not performed in the patient who underwent total gastrectomy due to ischemia and perforation. In the postoperative period, wound infection was observed in 2 patients. Anastomotic leakage was observed in 1 patient and treated with end enterostomy. Empyema was observed in one patient after discharge, the empyema was evacuated and thoracoscopic decortication was performed .The patient who underwent total gastrectomy died due to septic shock and comorbid diseases.

Conclusions

Strangulated diaphragmatic hernia is a life-threatening condition and requires emergency surgery. Laparoscopic techniques can also be used in treatment.
P035 EMERGENCY BILATERAL GORIN HERNIA REPAIR IN UNILATERAL COMPLICATED INGUINAL HERNIA REAPIR WITH CONCOMITNAT CONTRALATERAL HERNIA. COHORTS COMPARATIVE OUTCOMES ANALYSIS USING PROPENSITY SCORE MATCHING
Authors: Bravo-Salva Alejandro , Ochoa-Segarra Francisco Rómulo , Gonzálz-Castillo Ana María , Sancho-Insenser Joan , Pera-Roman Miguel , Rodrigues-Gonçalves Victor , Pereira-Rodriguez Jose Antonio , Cano Manuel López
Published: December 2021

Aim

Aim of our study was to analyze outcomes and safety of bilateral inguinal hernia repair in unilateral groin complicated hernia with contralateral groin hernia.

Material and Methods

Retrospective cohorts study following STROBE statements on a prospective Emergency Surgery Department database. Inclusion criteria were: patients with emergency hernia repair from 2008 to 2018, 18 years old. Unilateral or bilateral inguinal hernia repair without other abdominal wall hernia repairs. Comparative analysis between two group unilateral hernia repair (UH) vs bilateral hernia repair (BH) those patients with unilateral complicated inguinal hernia with contralateral inguinal hernia. Propensity score matching (PSM) between groups was performed to eliminate statistically groups differences. Outcomes between groups were analyzed with special attention to postoperative morbimortality and hernia recurrence.

Results

341 patients were included, 38(11.1%) were performed bilateral hernia repair. Groups differences were: higher rate of inguinoscrotal inguinal hernia (36.8 vs 22.8), prophylactic antibiotics use (94.7 vs 81.8) and general Anesthesia use (52.6% vs 50.2%). General high rates of morbidity and mortality were observed (5.9% and 41.9) and 22 (6.5%) hernia repair recurrence were detected. After PSM no differences between surgery outcomes groups were observed with similar morbidity, recurrence or hospital stay.

Conclusions

Emergency inguinal hernia repair has high morbidity and mortality rates in our experience. Emergency Bilateral inguinal hernia repair in context of hernia complication seems safe without recurrence or hospital stay increase.
P054 REDUCTION OF FAILURE RATES AFTER INCISIONAL HERNIA REPAIR BY ADDING A PROPHYLACTIC MESH
Authors: Lesch Carolin , Kallinowski Friedrich , Uhr Katharina , Vollmer Matthias , Gerhard Christian , Gutjahr Dominik , Krimmel Lena , Ludwig Yannique
Published: December 2021

Aim

“Can a mesh reduce failure rates after closure of a hernia defect?”

Material and Methods

“Porcine abdominal walls and bovine flanks were used as model tissues. After preparation, a 15 cm long incision was placed in the linea alba of the porcine abdominal wall. An additional round 5 cm defect was punched in the middle of the incision. The bovine flank was prepared in a similar manner.

The incisions with the defects were closed with running sutures in a small stitch, small bite technique. Monomax® 2-0 sutures were used with suture to wound lengths above 4:1.

Dynamesh® CiCAT meshes of three different sizes were placed in the sublay position.

The mesh-tissue compounds were investigated on our self-built hydraulic bench test simulating coughs. Dynamic intermitted strain (DIS) was repeatedly delivered with impacts around 210 mmHg. Each of ten preparation was loaded 425 times by the pressure peaks.”

Results

“Small stitch, small bite sutures using 2-0 Monomax® with a suture-incision-ratio of 4.5:1 can provide a durable defect closure. Under other conditions, suture lines can reopen. A mesh reduces the recurrence of incisional hernia depending on the mesh size.”

Conclusions

“An additional DIS-class A mesh in sublay position can provide sufficient support for a suture closing the defect of the abdominal wall. It can prevent a tear-out of the suture from the tissue. On average, a mesh-augmented defect closure reduces the recurrence rate of incisional hernia.”
P060 TROCAR SITE HERNIA AFTER GASTRIC SLEEVE
Authors: Ahlqvist Sandra , Edling Axel , Alm Magnus , Dackhammar Johan Blixt , Cengiz Yücel
Published: December 2021

Aim

Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position upon a ring was found to be a reliable method for the detection of TSH in obese.

Our aim was to examine the incidence of TSH after gastric sleeve.

Material and Methods

79 patients subjected to laparoscopic gastric sleeve in 2011-2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey.

Results

The incidence of trocar site hernia was 17 out of 79 (21,5 %), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no clear correlation between symptomatic TSH and TSH on CT.

Conclusions

The incidence of TSH is high in this group of patients. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of trocar site hernia can be serious, the proportion of symptomatic TSH is unknown.
P071 SURGERY DURING COVID ERA - IMPACT IN ABDOMINAL WALL SURGERY - OUR EXPERIENCE
Authors: Gonçalves Mário Rui , Antunes Conceição , Carneiro Teresa , Liorci Milena , Capinha Mariana , Pereira Joaquim Costa
Published: December 2021

Aim

“COVID pandemic created unprecedented challenges for actual health care systems with hundreds of surgeries suspended with impact in Abdominal Wall Surgery (AWS) and other benign diseases. With this in mind, we implemented new and dedicated clinical pathways to allow more patients to be operated in outpatient regime, so we could have more availability of beds, staff and resources for COVID assistance.”

Material and Methods

“A retrospective observational study was conducted using data since January 2018 to May 2021. Our Hospital and Surgical Department suffered great organizational changes, namely creation of: dedicated medical and staff teams for COVID + (C+) and COVID- (C-) patients; dedicated pathways in our operating rooms for C+ cases; and, ultimately, designed and implemented protocols and agreements to maintain our Department fully operational, with a secure shift from elective to outpatient surgeries.”

Results

“During the study, a global number of 2541 AWS were performed. In the era pre-COVID (2018 - February 2020), we performed 968 surgeries with an average number of 37,2 AWS/month. Despite COVID pandemic (march 2020 - may 2021), our department performed a total of 1573 AWS, with an average number of 112,4 AWS/month. In resume, during COVID era, we increased AWS by more than 300%.”

Conclusions

“This study found that, inner organizational adaptations and creation of dedicated protocols/clinical pathways can maintain surgical departments performance despite the stress and uncertainty of a pandemic like COVID-19 with a very positive impact on benign pathologies such as AWS.”
P094 DIASTASIS POST-PREGNANCY PROGRAM
Authors: Santilli Osvaldo
Published: December 2021

Aim

This study aims to summarize our knowledge in rectus abdominis diastasis based on the experience collected by the multidisciplinary program.

Material and Methods

Retrospective analysis of a prospective database. The diastasis post-pregnancy program is an interdisciplinary protocol that aims to restore the anatomical and functional structure of the abdominal wall after the degenerative process of pregnancy. Used a systematic multidisciplinary evaluation that included an abdominal walls surgeon, plastic surgeon, physiotherapist, and radiologist. Following the findings, we propose a classification, adapting the specific treatment according to the degree of the patient's condition. Grade I only performed physiotherapy; Grade II: started physiotherapy plan, with associated surgical treatment due to lack of response; Grade III underwent surgery as the first treatment in addition to physiotherapy protocol.

Endoscopic-assisted linea alba reconstruction plus mesh have using to repair midline hernias in association with diastasis.

Results

From January 2017 and June 2019, 1085 patients completed the program. Clinical classification: Grade I: 760 patients (70 %) and Grade II: 248 patients (64%) performed physiotherapy as first-line treatment, with associated surgical treatment being necessary for 89 patients (36%); Grade III: 77 patients (7%) underwent surgery as first-line treatment, associated with physiotherapy postoperative protocol. Postoperative complications were: 31 seromas(14%) , 11 omphalitis (5%), 5 hematoma (2%) 1 (0.44%) required surgical dressing. Mc Gill and Us Check-up post-treatment test showed improvement in 77 % of patients. Please insert your text here.

Conclusions

Evaluation and treatment, in post-pregnant patients, using a multidisciplinary approach concept showed good initial results with important improvement anatomical, functional, clinical, and aesthetic.
P100 EARLY POSTOPERATIVE WOUND COMPLICATIONS AFTER MIDLINE LAPAROTOMY CLOSURE WITH SMALL BITES TECHNIQUE: EXPERIENCE FROM A TERTIARY REFERRAL CENTRE
Authors: Gudelis Adomas , Simutis Gintaras , Pacevicius Julius
Published: December 2021

Aim

To analyze the incidence and risk factors of surgical site infections (SSI) and wound dehiscence (WD) after closure of primary midline laparotomies with small-bites (SB) technique.

Material and Methods

Retrospective analysis using hospital prospective database of all midline abdominal wall closures (AWC) with SB technique performed in a University Hospital between December 2019 and February 2021. To achieve a proper protocol of AWC with SB technique, it is advised to have suture/wound length (SL/WL) – ratio of more than 4:1. Statistical analysis of the incidence of SSI and AWD, comparing the results when the protocol was properly used (A group) or not (B group), was performed. Between groups, no relevant differences were observed for patient characteristics.

Results

A total of 108 midline laparotomies were included for analysis. 55.5% of patients were male. The mean age was 62.8 years, mean body mass index was 24.3 kg/m2. 78.7% (85/108) were operated electively. SSI and WD have been recorded in 7 (6.5%) and 8 (7,4%) cases respectively. In 65 (60,2%) patients abdominal wall closure after primary laparotomy was achieved with proper protocol (group A). Median SL/WL in A and B group was 4.57 and 3.43 respectively. The rate of WD in A group (n = 1, 1,5%) was significantly (P=.006) lower than in B group (n = 7, 16,3%). Incidence of SSI was 7,7% (n = 5, A group) vs. 4,7% (n = 2; B group) (P=.420).

Conclusions

Using a proper AWC protocol has been effective to prevent WD in midline laparotomy.
P107 PREVENTION OF INCISIONAL HERNIA AFTER MIDLINE LAPAROTOMY WITH MODIFICATION OF CLOSURE TECHNIQUE: SYSTEMATIC REVIEW AND META ANALYSIS
Authors: Hernandez Edgard Efren Lozada , Bonilla Juan Pablo Hernandez , Moreno Enrique Obregon , Ugarte Diego Hinojosa , Herevia Aldo Jimenez , Gonzalez Juan Carlos Mayagoitia , Garcia Miguel Magdaleno
Published: December 2021

Aim

“Incisional hernia is the main complication after laparotomy, the prevention of this is currently aimed at preoperative rehabilitation, modification of the closure technique and the use of prophylactic mesh. The objective of the study was to measure the effectiveness of the modification in the laparotomy closure technique to reduce the incidence of incisional hernia.”

Material and Methods

“A systematic review and meta-analysis were carried out following the PRISMA guidelines. The first objective was to determine the incidence of incisional hernia at one year of follow-up, comparing the modification in the closure technique with the usual closure. The secondary objective was to determine the difference in wound dehiscence and surgical site infection between these two groups. Only clinical trials were included, and the random effects method was used for their analysis. PROSPERO registration number: CRD42021231107”

Results

“Seven clinical trials were included, comparing 1612 patients, the incidence of incisional hernia was significantly lower in the surgical technique modification group OR 0.55 (95% CI 0.38-79). Efficacy to reduce the incidence of wound dehiscence was also analyzed without finding a difference between the two groups OR 0.58 (95% CI 0.27-1.21). There was no statistically significant difference between both groups when comparing seroma hematoma and surgical site infection.”

Conclusions

“The modification in the laparotomy closure technique reduces the incidence of incisional hernia. However, when analyzing globally, only the Small bites and Reinforced tension line techniques contributed to this result.”
P112 INCIDENTAL INGUINAL HERNIA IN MEN
Authors: Burgmans Ine , van Coen Hessen , Bakker Wouter , Verleisdonk EgbertJan , Sanders Floris
Published: December 2021

Aim

“Ultrasound may contribute to establish the cause of nonspecific groin complaints. However, the risk is diagnosing an incidental inguinal hernia whereas the pain has an alternative cause. Overtreatment is to be prevented. Therefore, the aim of this study is to determine the prevalence of a previously unknown inguinal hernia among working-age men without groin complaints.”

Material and Methods

“A cross sectional study was conducted in healthy men aged 45-67 years. Men with a Body Mass Index (BMI) > 40, a history of groin complaints, a known inguinal hernia or previous inguinal surgery were excluded. Ultrasound of both groins was performed in supine position with and without a Valsalva manoeuvre by a specialised ultrasound technician in consultation with a radiologist. In all groin ultrasounds showing an inguinal hernia, physical examination was executed by a hernia surgeon.”

Results

“In the months June and November of 2018, 200 groins of 100 men were analysed. In 16 (16%) men an inguinal hernia was found on groin ultrasound (95% confidence interval [8.8 – 23.2]). In 12 men this was a unilateral inguinal hernia and in 4 men a bilateral inguinal hernia. Ultrasound yielded no other pathology.”

Conclusions

“In a population of men aged 40-67 years without groin complaints, ultrasound detects an inguinal hernia in 16%. Hence, the probability of wrongly attributing groin complaints to an incidental inguinal hernia, diagnosed on ultrasound, is considerable. ”
P113 SPIN IS PRESENT IN THE MAJORITY OF THE ARTICLES EVALUATING ROBOT-ASSISTED GROIN HERNIA REPAIR: A SYSTEMATIC REVIEW
Authors: Hansen Danni , Fonnes Siv , Rosenberg Jacob
Published: December 2021

Aim

The number of articles published each year are increasing, resulting in greater competition to get work published. Spin is defined as specific reporting strategies used to distort the readers’ interpretation of results so that they are viewed more favourable. However, prevalence of spin in studies comparing robot-assisted groin hernia repair with traditional methods is unknown. The aim of the study was to determine the frequency and extent of misrepresentation of results, spin, in studies assessing robot-assisted groin hernia repair.

Methods

This systematic review was reported according to PRISMA guidelines, and a protocol was registered at PROSPERO before data extraction. Database search included PubMed, EMBASE and Cochrane Central.

Results

Of 35 included studies, spin was present in 57%. Within these, 95% had spin present in the abstract and 80% in the conclusion of the article. There was no association between study size and spin (p > 0.05). However, presence of spin in studies positively minded towards robot-assisted hernia repair was higher (p < 0.001) compared with those against or being neutral in their view of the procedure. Furthermore, being funded by or receiving grants from Intuitive Surgical were associated with a higher prevalence of spin (p < 0.01) compared with those who were not.

Conclusion

Spin was found to be common in articles reporting on robot-assisted groin hernia repair, and presence of spin was higher in studies funded by or receiving grants from the robot company. This suggests that readers should be cautious when reading similar literature.
P117 INFLUENCE OF THE MESH FIXATION METHOD ON THE RESULTS OF OPEN INGUINAL HERNIA REPAIR
Authors: Navid Maria , Protasov Andrey , Guseinov Ilgar , Titarov Dmitriy , Podolskiy Mikhail , Khallyieva Ogulgerek
Published: December 2021

Aim

Study of postoperative outcomes after Liechtenstein inguinal hernia repair using self-gripping mesh and polypropylene mesh with suture fixation.

Material and Methods

Medical records of 289 open inguinal hernia repairs were analyzed: 176 – with sutured polypropylene mesh and 113 – using self-gripping mesh. To assess the quality of life we have used EuraHS Qol and SF-36. Statistical analysis was performed using SPSS.

Results

There were no significant differences in wound complications (such as swelling, seroma, hematoma, orchitis) between these groups (p > 0,05). The duration of operation was significantly shorter with self-gripping mesh compared to sutured mesh (42,2 min. sd = 23,42 vs 58,5 min. sd = 16,70; p < 0.001). Pain on the first and 6th days after implantation self-gripping mesh was present significantly less frequently in comparison with sutured mesh (χ2 (1, N = 289) =7.925, p = 0.005 and χ2 (1, N = 289) =24.740, p < 0.001). NSAIDs intake time was less in self-gripping mesh group (3.01±1,07 vs 4.43±1,75 days; U = 11723, p < 0.001). We have found no significant differences in both groups for all quality-of-life indicators EuraHS (p = 0.234) and SF-36 (p = 0.190).

Conclusions

Self-gripping mesh has comparable outcomes with sutured polypropylene mesh regarding the frequency of wound complications and quality of life on long-term follow-up. However, self-gripping mesh is associated with reduced operation time, pain in the short-term postoperative period, and taking NSAIDs compared to sutured mesh.
VP019 TESAR - TOTALLY ENDOSCOPIC SUBLAY ANTERIOR REPAIR - IN MIDLINE DEFECTS REPAIR
Authors: Fiori Federico , Ferrara Feancesco , Gentile Daniele , Boati Paolo , Calì Matteo
Published: December 2021

Aim

In recent years, many minimally invasive techniques have been presented in abdominall wall repair. Since 2018 we have been using TESAR techinque, an anterior endoscopic approach with mesh sublay, published in 2019 from our group.

Material and Methods

From May 2018 to May 2021 58 Patients referred to our Unit for clinical and radiological diagnosis of ventral defect (Midline hernia, Incisional hernia, Diastasis Recti>5 cm). Exclusion criteria were: maximum defeact width 8 cm, and contraindications to general anesthesia

Results

All the patients underwent midline repair with TESAR technique. Three TAR were performed, with defect of 8 cm width previously treated with botox. No conversion to laparotomy occured, no intraoperative complications were registered. Total mean operative time was 156 +- 21,5 min. No postoperative major complications, 3 subcoutaneous seromas occurred ,all treated conservatively. The mean Hospital stay was 2.7 + 0.8 days.

Conclusions

TESAR is a feasible technique for extraperitoneal repair of midline defects with a totally endoscopic approach, allowing a safe repair with good outcomes in terms of resolutions of symtoms and postoperative complications. The video shows the main steps of the technique in diastasis recti and complicated ventral hernia repair.
O06 PATIENT-REPORTED KNOWLEDGE OF HERNIA SURGERY: A QUANTITATIVE STUDY OF FIRST TIME REFERRED PATIENTS TO AN ABDOMINAL WALL UNIT FOR HERNIA REPAIR
Authors: Jimenez Daniel Rosselló , Cano Manuel López , Gonçalves Victor Rodrigues , Tremolosa Mireia Verdaguer , Serra Judit Saludes , Salvá Alejandro Bravo , Pereira-Rodriguez Jose Antonio
Published: December 2021

Aim

The objective of this study was to gather information on patient-reported knowledge (PRK) in the field of hernia surgery.

Material and Methods

A prospective quantitative study was designed to explore different aspects of PRK and opinions regarding hernia surgery. Patients referred for the first time to a surgical service with a presumed diagnosis of hernia and eventual hernia repair were eligible, and those who gave consent completed a simple self-assessment questionnaire before the clinical visit.

Results

The study population included 449 patients (72.8% men, mean age 61.5). Twenty (4.5%) patients did not have hernia on physical examination. The patient’s perceived health status was “neither bad nor good” or “good” in 56.6% of cases. Also, more patients considered that hernia repair would be an easy procedure (35.1%) rather than a difficult one (9.8%). Although patients were referred by their family physicians, 32 (7.1%) answered negatively to the question of coming to the visit to assess the presence of a hernia. The most important reason of the medical visit was to receive medical advice (77.7%), to be operated on as soon as possible (40.1%) or to be included in the surgical waiting list (35.9%). Also, 46.1% of the patients considered that they should undergo a hernia repair and 56.8% that surgery will be a definitive solution.

Conclusions

PRK of patients referred for the first time to an abdominal wall surgery unit with a presumed diagnosis of hernia was quite limited and there is still a long way towards improving knowledge of hernia surgery.
O09 CLINICAL FEASIBILITY OF THE Q1.6 INGUINAL HERNIA APPLICATION: A PROSPECTIVE COHORT STUDY
Authors: van Hout Ludo , Bökkerink Willem , Vriens Patrick
Published: December 2021

Aim

Patient Reported Outcomes (PROs) are essential for evaluating hernia surgery. Current measuring instruments for PROs have disadvantages: often lengthy and burdensome paper questionnaires, used at predetermined moments with low patient compliance and time-consuming data processing. The Q 1.6 Inguinal Hernia application was developed to overcome these challenges. This pilot study reports the first clinical feasibility results.

Materials and Methods

the ‘twitch crowdsourcing’ concept was applied: during the interval of unlocking a smartphone or tablet a short question is asked, multiple times a day. Questions from validated questionnaires were implemented. The adaptive question engine generates an individualized set of questions. Alerts are automatically generated when a complication is suspected. All inguinal hernia patients in a high-volume inguinal hernia center were eligible for inclusion. Patients signed informed consent.

Results

229 patients answered over 50.000 pre- and postoperative questions of which 92% were answered. Pre- and postoperative patient characteristics and clinical outcomes confirmed a standard inguinal hernia population. Compliance was 91.7% after 14 days, 69.0% after 3 months and 28.8% after one year. Pain and functional limitations were measured with a numerical scale from zero to ten. After 3 and 7 days, 7.7% and 44.3% returned to work, respectively. Patients were highly satisfied (92.8% preferred the app to usual care).

Conclusions

this smartphone application shows promising results for clinical practice. Remote monitoring may become standard postoperative care after (inguinal) hernia surgery. The current application will be further improved and evaluated for cost-effectiveness, safety and validity.
O31 SUTURE OR MESH REPAIR FOR THE SMALLEST UMBILICAL HERNIAS: A NATIONWIDE DATABASE STUDY
Authors: Henriksen Nadia , Jensen Kristian Kiim , Bisgaard Thue , Helgstrand Frederik
Published: December 2021

Aim

High level evidence recommends the use of mesh for umbilical hernias with defects >1 cm to reduce recurrence rates without increasing the risk of postoperative complications. For umbilical hernias with defect width ≤1 cm, the literature is sparse. The aim of the study was to assess outcomes after suture and mesh repair of umbilical hernias with defect width <1 cm on a nationwide basis, and to evaluate outcomes after onlay mesh repair specifically.

Material and Methods

By merging data from the Danish Hernia Database and the National Patients Registry from January 2007 until December 2018, patients receiving elective repair of an umbilical hernia with defect width ≤1 cm were identified. Available data included details about comorbidity, surgical technique, 90-days readmission, 90-days reoperation and reoperation for recurrence.

Results

A total of 7,849 patients were included, of whom 25.7% (2,013/7,849) underwent mesh repair. The cumulative 5-year incidence of reoperation for recurrence was significantly decreased after mesh repair 3.1% (95% C.I. 2.1-4.1) compared with suture repair 6.7% (95% C.I. 6.0-7.4), P < 0.001. Onlay mesh repairs had the lowest cumulative risk of recurrence at 5 years 2.0% (95% C.I. 0.6-3.5). For onlay mesh repairs, readmission 7.9%, (65/826)) and reoperation (3.9% (32/826)) rates within 90-days were comparable to suture repairs (6.5% (381/5,836) and 3.3% (192/5,836), P = 0.149 and P = 0.382, respectively.

Conclusions

Even for the smallest umbilical hernias, mesh repair significantly decreased the recurrence rate. Onlay mesh repair was associated with the lowest risk of recurrence without increasing early complications.
O36 LOD (LOSS-OF-DOMAIN) HERNIA TREATMENT WITH INTRAOPERATIVE FASCIA TRACTION. DOES THIS TECHNIQUE MAKE RELEASE OPERATIONS SUPERFLUOUS?
Authors: Niebuhr Henning , Aufenberg Thomas , Dag Halil , Reinpold Wolfgang , Peiper Christian , Schardey Hans Martin , Renter Marc Alexander , Aly Mohamed , Eucker Dietmar , Köckerling Ferdinand , Eichelter Jakob
Published: December 2021

Aim

Measurable and controlled stretching of the fascia for 30 minutes during surgery to achieve primary tension-free abdominal wall closure in LOD hernias. This prospective observational study aimed to clarify the extent to which this traction method can function as an alternative to component separation methods.

Material and Methods

We have already applied this technique in > 50 procedures of LOD hernias. We published the data of first 21 patients treated with intraoperative fascia stretching in seven specialized hernia centers between November 2019 and August 2020. The average patient age was 58 years with a gender ratio of 2.5 males: 1 female. ASA scores were III in 66.7% and II in 33.3%. The body mass index (BMI) averaged 32.5 kg/m2. Thirteen patients were treated with BTA 4 weeks before surgery.

Results

Intraoperatively-measured fascial distance averaged 17.3 cm (range 8.5–44 cm). After application of diagonal-anterior traction >10 kg for an average duration of 32.3 min (range 30–40 min), the fascial distance decreased by 9.8 cm (1–26 cm) to an average 7.5 cm (range 2–19 cm), which is a large effect (r = 0.62). The fascial length increase (average 9.8 cm) after applied traction was highly significant. All hernias were closed under moderate tension after the traction phase. In 19 patients, this closure was reinforced with mesh using a sublay technique.

Conclusions

This method allows primary closure of complex LOD hernias and is potentially less prone to complications than component separation methods.
O39 ASSOCIATION OF DIFFERENT MESH AND MESH FIXATION COMBINATIONS WITH REOPERATION RISK AFTER LAPAROSCOPIC GROIN HERNIA SURGERY. A SWEDISH HERNIA REGISTRY STUDY OF 25,190 TEP AND TAPP REPAIRS
Authors: Novik Bengt , Sandblom Gabriel , Ansorge Christoph , Thorell Anders
Published: December 2021

Aim

The HerniaSurge guidelines concerning mesh and fixation options in laparoscopic totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. We hypothesized that the value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The present registry-based nationwide cohort study compared different mesh/fixation combinations regarding relative risks for reoperation after TEP and TAPP.

Material and Methods

All TEP and TAPP with standard polypropylene (StdPPM) or lightweight (LWM) flat meshes, combined with either tacks, fibrin glue, or no fixation, registered in the Swedish Hernia Registry 2005-2017 were included. Endpoint was reoperation due to recurrence as of December 31, 2018. Multivariable Cox regression rendered relative risk differences between the exposures, expressed as hazard ratios (HR) with 95% confidence intervals (CI).

Results

Of 25 190 repairs, 924 (3.7%) were later reoperated for recurrence.

The lowest, mutually equivalent, reoperation risks were associated with StdPPM without fixation (HR 1), StdPPM with metal tacks (HR 0.8, CI 0.4-1.4), StdPPM with fibrin glue (HR 1.1, CI 0.7-1.6), and LWM with fibrin glue (HR 1.2, CI 0.97-1.6). LWM correlated otherwise with increased risk, whether without fixation (HR 2.0, CI 1.6-2.6), or affixed with metal (HR 1.7, CI 1.1-2.7), or absorbable tacks (HR 2.4, CI 1.8-3.1).

Conclusions

With StdPPM, fixation seems not to improve outcomes, despite being costlier. Thus, for this mesh category, we recommend non-fixation. With LWM, we recommend fibrin glue fixation, which was the only LWM alternative on par with non-affixed StdPPM.
O43 INTRA-ABDOMINAL PRESSURE VARIATIONS IN HUMANS DURING PHYSICAL EXERCISES AND DAILY LIFE BY INTRAGASTRIC WIRELESS SENSOR
Authors: Soucasse Andréa , Jourdan Arthur , Edin Lauriane , Gillion Jean-François , Masson Catherine , Bege Thierry
Published: December 2021

Aim

The conflict between the intra-abdominal pressure (IAP) applied to the abdominal wall and its resistance determines the occurrence of ventral hernia. Knowledge about IAP variation in everyday life is limited and mainly obtained by invasive methods. The objective of the study is to propose a comprehensive evaluation of IAP based on a limited risk and discomfort method.

Material and Methods

A prospective study was carried out in 20 healthy volunteers. The intragastric pressure, validated for estimating IAP, was assessed by an ingestible pressure sensor*. Volunteers realized a set of supervised exercises, including breathing, apnea after calm exhalation and seven muscle contraction stereotyped exercises in three different positions (supine, sitting, standing). Then the volunteers resumed their daily activities with the pressure continuously recorded until gastric emptying. Pressure variations and rates were computed.

Results

The highest IAP levels were reached during coughing and jumping. Maximum peaks were respectively 65 ± 35 and 67 ± 31 mmHg with pressure rates of 121 and 114 mmHg.s−1 for these two exercises. The position did not affect the IAP variation. Men had significantly higher pressure values for pushing against a wall (P < 0.01), Valsalva maneuver and legs raising (P < 0.05) exercises. During daily life, peaks greater than 50, 100, and 150 mmHg occurred on average five times, twice, and once per hour, respectively.

Conclusions

This study provides a real-life characterization of IAP allowing the quantification of mechanical solicitation applied to the abdominal wall and the identification of risk situations for the occurrence of ventral hernias.

* (SmartPill™, Medtronic, Minneapolis, MN, U.S.A)
OV06 EXTENDING THE INDICATIONS OF TRANSVERSUS ABDOMINIS RELEASE: SUBLAY MESH REPAIR FOR A RARE CASE OF ACQUIRED DIAPHRAGMATIC HERNIA
Authors: Bertoglio Camillo Leonardo , Quagli Oscar , Morini Lorenzo , Grimaldi Simona , Ferrari Giovanni
Published: December 2021

Aim

Acquired diaphragmatic hernia (ADH) is rare and its treatment is challenging. Posterior component separation (PCS) with transversus abdominis release (TAR) is gaining wide acceptance for the repair of complex abdominal hernia, including those located in proximity of the abdominal borders. In this view the central tendon of the diaphragm could be intended as the rooftop border of the peritoneal sac. We describe an original application of TAR for the treatment of an unusual case of ADH.

Material and Methods

a 54 year-old man was referred to our department for an ADH, following two previous sternotomies for an aortic aneurysm, conditioning respiratory symptoms. A thoraco-abdominal contrast enhanced CT-scan confirmed an anterior left diaphragmatic defect with a transverse diameter of 8.5 cm and a huge sac containing the great omentum and the distal transverse colon, with atelectasis of the inferior lobe of the lung. A subxiphoid M1W2L2 incisional hernia was also detected. The patient underwent a midline xipho-umbilical laparotomy and a repair by partial TAR with posterior rectus sheath release and progressive dissection of the diaphragmatic muscular fibers far beyond the DH. A sublay repair with a large dual layer PVDF mesh was then accomplished.

Results

Postoperative course was uneventful and no recurrence was recorded at 6 months follow up.

Conclusions

partial-TAR could be a good option for repair of anteriorly placed ADH, ensuring a stable anatomical repair with an overlap that is usually wider than after laparoscopic IPOM repair. This novel indication confirms the extreme versatility of TAR for the repair of complex ventral hernia
Management of acute type A aortic dissection in the elderly: an analysis from IRAD
Authors: Hemli Jonathan M , Pupovac Stevan S , Gleason Thomas G , Sundt Thoralf M , Desai Nimesh D , Pacini Davide , Ouzounian Maral , Appoo Jehangir J , Montgomery Daniel G , Eagle Kim A , Ota Takeyoshi , Di Eusanio Marco , Estrera Anthony L , Coselli Joseph S , Patel Himanshu J , Trimarchi Santi , Brinster Derek R ,   the IRAD Investigators
Published: December 2021

OBJECTIVES

We sought to examine management and outcomes of (Stanford) type A aortic dissection (TAAAD) in patients aged >70 years.

METHODS

All patients with TAAAD enrolled in the International Registry of Acute Aortic Dissection database (1996–2018) were studied (n = 5553). Patients were stratified by age and therapeutic strategy. Outcomes for octogenarians were compared with those for septuagenarians. Variables associated with in-hospital mortality were identified by multivariable logistic regression.

RESULTS

In-hospital mortality for all patients (all ages) was 19.7% (1167 deaths), 16.1% after surgical intervention vs 52.1% for medical management (P < 0.001). Of the study population, 1281 patients (21.6%) were aged 71–80 years and 475 (8.0%) were >80 years. Fewer octogenarians underwent surgery versus septuagenarians (68.1% vs 85.9%, P < 0.001). Overall mortality was higher for octogenarians versus septuagenarians (32.0% vs 25.6%, P = 0.008); however, surgical mortality was similar (25.1% vs 21.7%, P = 0.205). Postoperative complications were comparable between surgically managed cohorts, although reoperation for bleeding was more common in septuagenarians (8.1% vs 3.2%, P = 0.033). Kaplan–Meier 5-year survival was significantly superior after surgical repair in all age groups, including septuagenarians (57.0% vs 13.7%, P < 0.001) and octogenarians (35.5% vs 22.6%, P < 0.001).

CONCLUSIONS

When compared with septuagenarians, a smaller percentage of octogenarians undergo surgical repair for TAAAD, even though postoperative outcomes are similar. Age alone should not preclude consideration for surgery in appropriately selected patients with TAAAD.
Novel carotenogenic gene combinations from red yeasts enhanced lycopene and beta-carotene production in Saccharomyces cerevisiae from the low-cost substrate sucrose
Authors: Watcharawipas Akaraphol , Sansatchanon Kitisak , Phithakrotchanakoon Chitwadee , Tanapongpipat Sutipa , Runguphan Weerawat , Kocharin Kanokarn
Published: December 2021

Carotenoids (C40H56) including lycopene and beta-carotene are relatively strong antioxidants that provide benefits to human health. Here, we screened highly efficient crt variants from red yeasts to improve lycopene and beta-carotene production in Saccharomyces cerevisiae. We identified that crt variants from Sporidiobolus pararoseus TBRC-BCC 63403 isolated from rice leaf in Thailand exhibited the highest activity in term of lycopene and beta-carotene production in the context of yeast. Specifically, the phytoene desaturase SpCrtI possessed up to 4-fold higher in vivo activity based on lycopene content than the benchmark enzyme BtCrtI from Blakeslea trispora in our engineered WWY005 strain. Also, the geranylgeranyl pyrophosphate (GGPP) synthase SpCrtE, the bifunctional phytoene synthase-lycopene cyclase SpCrtYB, and SpCrtI when combined led to 7-fold improvement in beta-carotene content over the benchmark enzymes from Xanthophyllomyces dendrorhous in the laboratory strain CEN.PK2-1C. Sucrose as an alternative to glucose was found to enhance lycopene production in cells lacking GAL80. Lastly, we demonstrated a step-wise improvement in lycopene production from shake-flasks to a 5-L fermenter using the strain with GAL80 intact. Altogether, our study represents novel findings on more effective crt genes from Sp. pararoseus over the previously reported benchmark genes and their potential applications in scale-up lycopene production.
Randomized sparse grid algorithms for multivariate integration on Haar wavelet spaces
Authors: Wnuk M , Gnewuch M
Published: December 2021

The deterministic sparse grid method, also known as Smolyak’s method, is a well-established and widely used tool to tackle multivariate approximation problems, and there is a vast literature on it. Much less is known about randomized versions of the sparse grid method. In this paper we analyze randomized sparse grid algorithms, namely randomized sparse grid quadratures for multivariate integration on the $D$-dimensional unit cube $[0,1)^D$. Let $d,s \in {\mathbb {N}}$ be such that $D=d\cdot s$. The $s$-dimensional building blocks of the sparse grid quadratures are based on stratified sampling for $s=1$ and on scrambled $(0,m,s)$-nets for $s\ge 2$. The spaces of integrands and the error criterion we consider are Haar wavelet spaces with parameter $\alpha $ and the randomized error (i.e., the worst case root mean square error), respectively. We prove sharp (i.e., matching) upper and lower bounds for the convergence rates of the $N$th minimal errors for all possible combinations of the parameters $d$ and $s$. Our upper error bounds still hold if we consider as spaces of integrands Sobolev spaces of mixed dominated smoothness with smoothness parameters $1/2< \alpha < 1$ instead of Haar wavelet spaces.
Modelling the functional dependency between root and shoot compartments to predict the impact of the environment on the architecture of the whole plant: methodology for model fitting on simulated data using Deep Learning techniques
Authors: Masson Abel Louis , Caraglio Yves , Nicolini Eric , Borianne Philippe , Barczi Jean-Francois
Published: December 2021

Tree structural and biomass growth studies mainly focus on the shoot compartment. Tree roots usually have to be taken apart due to the difficulties involved in measuring and observing this compartment, particularly root growth. In the context of climate change, the study of tree structural plasticity has become crucial and both shoot and root systems need to be considered simultaneously as they play a joint role in adapting traits to climate change (water availability for roots and light or carbon availability for shoots). We developed a botanically accurate whole-plant model and its simulator (RoCoCau) with a linkable external module (TOY) to represent shoot and root compartment dependencies and hence tree structural plasticity in different air and soil environments. This paper describes a new deep neural network calibration trained on simulated data sets computed from a set of more than 360 000 random TOY parameter values and random climate values. These data sets were used for training and for validation. For this purpose, we chose VoxNet, a convolutional neural network designed to classify 3D objects represented as a voxelized scene. We recommend further improvements for VoxNet inputs, outputs and training. We were able to teach the network to predict the value of environment data well (mean error < 2 %), and to predict the value of TOY parameters for plants under water stress conditions (mean error < 5 % for all parameters), and for any environmental growing conditions (mean error < 20 %).
Comparison of electronic versus manual abstraction for 2 standardized perinatal care measures
Authors: Schmaltz Stephen , Vaughn Jocelyn , Elliott Tricia
Published: December 2021

Objective

Given that electronic clinical quality measures (eCQMs) are playing a central role in quality improvement applications nationwide, a stronger evidence base demonstrating their reliability is critically needed. To assess the reliability of electronic health record-extracted data elements and measure results for the Elective Delivery and Exclusive Breast Milk Feeding measures (vs manual abstraction) among a national sample of US acute care hospitals, as well as common sources of discrepancies and change over time.

Materials and Methods

eCQM and chart-abstracted data for the same patients were matched and compared at the data element and measure level for hospitals submitting both sources of data to The Joint Commission between 2017 and 2019. Sensitivity, specificity, and kappa statistics were used to assess reliability.

Results

Although eCQM denominator reliability had moderate to substantial agreement for both measures and both improved over time (Elective Delivery: kappa = 0.59 [95% confidence interval (CI), 0.58–0.61] in 2017 and 0.84 [95% CI, 083–0.85] in 2019; Exclusive Breast Milk Feeding: kappa = 0.58 [95% CI, 0.54–0.62] in 2017 and 0.70 [95% CI, 0.67–0.73] in 2019), the numerator status reliability was poor for Elective Delivery (kappa = 0.08 [95% CI, 0.03–0.12] in 2017 and 0.10 [95% CI, 0.05–0.15] in 2019) but near perfect for Exclusive Breast Milk Feeding (kappa = 0.85 [0.83, 0.87] in 2017 and 0.84 [0.83, 0.85] in 2019). The failure of the eCQM to accurately capture estimated gestational age, conditions possibly justifying elective delivery, active labor, and medical induction were the main reasons for the discrepancies.

Conclusions

Although eCQM denominator reliability for the Elective Delivery and Exclusive Breast Milk Feeding measures had moderate agreement when compared to medical record review, the numerator status reliability was poor for Elective Delivery, but near perfect for Exclusive Breast Milk Feeding. Improvements in eCQM data capture of some key data elements would greatly improve the reliability.