bluuebunny/crossref_metadata_2025 huggingface dataset:
P109 MANAGEMENT OF THE OPEN ABDOMEN WITH COMBINED THERAPIES. HOW TO AVOID VENTRAL HERNIAS AND BE ABLE TO PERFORM THE REPAIR OF THE ABDOMINAL WALL IN A DEFINITIVE WAY
Authors: Aguirre Miguel
Published: December 2021

Aim

To demonstrate that in patients with abdominal sepsis, delayed primary fascial closure and definitive abdominal wall repair can be achieved, in the same hospitalization, using combined therapies, which reduces the percentage of ventral hernias.

Material and Methods

Medical records, tomography images and outpatient controls of 9 patients were reviewed, which required open abdomen management for abdominal sepsis using negative pressure therapy combined with a dynamic fascial mesh traction, from February 2020 until May 2021.

Results

9 patients (2 men and 7 women), all Grade 2C open abdomen according to Björck clasification, with a median age of 43 years (25-71). The median time therapy was 29±3 days. The primary fascial closure rate was 100% (n = 9), 77.8% (n = 7) underwent a definitive repair of the abdominal wall with absorbable synthetic mesh in the same hospitalization, while 22.2% (n = 2) did not, due to being cancer patients.

The mortality rate was 11.1% (n = 1) due to pneumonia and the fistula rate was 11.1% (n = 1). None developed an incisional hernia at the one-year follow-up.

Conclusions

The combination of negative pressure therapy with dynamic fascial mesh traction, in the management of the open abdomen, allows us to achieve a 100% delayed primary fascial closure, avoiding ventral hernia. In the same hospitalization, while the patient leaves the critical stage, we can achieve a definitive repair of the abdominal wall using absorbable synthetic meshes returning the biomechanics to the abdominal wall, improving the quality of life of these patients.
P114 ROBOTIC INGUINAL HERNIA REPAIR (RTAPP): ANATOMY LESSONS AND RESULTS OF A CASUISTIC OF 302 OPERATED HERNIAS
Authors: Dietz Ulrich
Published: December 2021

Aim

The purpose of this study is to apply the resources of robotics to inguinal hernia repair (r-TAPP) and to investigate where specific optimizations to the surgical technique of can be achieved.

Material and Methods

The results of 302 consecutive r-TAPP surgeries performed over an 18-month period are presented. It is a cohort study without a control group. The study was approved by the ethics committee (Ref. No. 2019-02046). Decisions on interventions (suturing of the transverse fascia or fibrin glue sealing of the inguinal canal) and mesh size were made intraoperatively. Patients were followed up six weeks postoperatively.

Results

In every fourth patient, a femoral, obturator, or Spieghel hernia was diagnosed in addition to symptomatic inguinal hernia. Mesh fixation with absorbable suture at 4 points was matured. The operative time averaged 71 minutes for unilateral, 103 minutes for bilateral and 95 minutes for unilateral recurrent hernias. 48% of procedures were performed by residents. Seroma incidence decreased from 15.0% in the first period to 5.1% in the third study period. None of the patients experienced pain symptoms due to nerve lesion. The study provided new clarity about the blood supply patterns of the lipoma, the course of the genital branch and the constitution iliac fascia.

Conclusions

Suturing of the transversal fascia, fibrin glue sealing of the inguinal canal, and suture fixation of the mesh are steps who must be validated in future studies. Robotics provides optimal conditions for residents training, without learning curve on the patient and with predictable OR times. Postoperative seroma formation and complication rate of r-TAPP are low.
P119 THE IMPLEMENTATION OF ROBOTIC TEP AND ETEP APPROACH IN THE MODERN INGUINAL HERNIA REPAIR : A SINGLE CENTER EXPERIENCE
Authors: Archontovasilis Fotis , Tselios Ioannis
Published: December 2021

Aim

In a robotic surgery era, the totally extraperitoneal (TEP) inguinal hernia repair is less common than the transabdominal preperitoneal (TAPP) approach. The enhanced-view TEP (eTEP) has been proposed as a modification to the standard TEP technique. The aim of this study is to present a single centre’s experience in Robotic TEP and eTEP inguinal hernia repair technique.

Material and Methods

This is a case-series presentation of patients with inguinal hernia that underwent robotic TEP and eTEP repair in a single institution. Patients’ characteristics were reviewed and perioperative outcomes were extracted. All patients were followed-up at the outpatient surgical unit. Intraoperative and postoperative parameters were analyzed.

Results

21 patients (10% females) with a mean age of 58.5 years underwent robotic TEP (14 patients) and eTEP (7 patients) inguinal hernia repair. Eight patients were treated for bilateral hernia (total number of 29 hernias) and two were operated for recurrence. No conversion to open or TAPP repair was required. The mean operative time was 108 minutes for the bilateral hernias and 75 minutes for the unilateral cases. All patients were discharged the same day, after 3 to 5 hours postoperatively. Four of the patients used pain medication postoperatively. No major complications or recurrences were revealed during a mean postoperative follow-up time of 14 months

Conclusions

Robotic TEP and eTEP are safe and efficient surgical options in the treatment of inguinal hernia in experienced centres. The two techniques can result in high-quality outcomes regarding hospital stay, pain control and elimination of hernia recurrence.
P120 ASSOCIATION BETWEEN SERUM ESTRADIOL LEVELS AND MEN WITH GROIN HERNIA : A CASE - CONTROL STUDY
Authors: Muduli Nikhil , Sahu Alok , Barik Haramohan , Dalai Parikshita
Published: December 2021

Aim

To assess if increased serum levels of estradiol is an independent risk factor for occurrence of groin hernia in men.

Material and Methods

We performed a hospital based case-control study. Men diagnosed with groin hernia were taken as cases and men who did not have groin hernia but were admitted for other elective surgery were taken as controls. Cases were matched to controls based on age and BMI. Morning fasting blood sample was collected from both cases and controls used to measure serum estradiol levels.

Results

A total of 46 hernia cases and 91 non-hernia controls were included in the study. The mean age and BMI of both cases and controls were not significantly different. The mean serum estradiol level for cases was 53.5 ±7.11 pg/ml. This value was significantly higher (p < 0.001) than for the control group which was 28.3 ± 3.14 pg/ml. A strong positive association was observed between increasing serum estradiol levels and hernia incidence. Men in 4th (highest) quartile of estradiol levels had a relative risk of 2.27 (95% CI:1.33-3.04) compared to men in 2nd quartile. Men in 1st (lowest) quartile didn’t have any hernia cases.

Conclusions

The knowledge may allow treatment or prevention with novel nonsurgical approaches. Therapy with aromatase inhibitors might prevent recurrence after hernia repair or even help men avoid surgery in the first place. Prevention of hernia will lead to decrease in morbidity and cost burden due to surgical treatment to a long extent.
P123 TAPP - THE BEST APPROACH FOR INGUINAL HERNIA ASSOCIATED WITH ADULT CRYPTORCHIDISM: CASE REPORT AND LITERATURE REVIEW
Authors: Ungureanu Claudiu , Octav Ginghina , Mirica Radu , Niculae Iordache
Published: December 2021

Aim

Cryptorchidism is a rare condition of adult male. The diagnosis is based on examination: impalpable testis and CT/MRI. The surgical correction of cryptorchidism is possible in childhood, but in adult orchiectomy is recommended, considering the malignancy risk. The association with hernia is uncommon.

Material and Methods

We report the case of a 23 years old male with left inguinal hernia and concomitant left cryptorchidism. MRI revealed the intra-abdominal left testicle, with reduced size and short vessels. Lab analysis were normal. We underwent laparoscopic exploration: the left testicle was small and had pelvic localization. A large inguinal hernia was also confirmed. We decided to perform laparoscopic TAPP (transaabdominal preperitoneal repair) and left orchiectomy. The evolution was uneventful and patient discharged 1st day postoperatively. Histology revealed testicular atrophy with no malignancy, also no spermatogenesis was present. No recurrence was found during follow-up.

Results

Cryptorchidism in adult is rare. The association with hernia is even more rare. The open management is not easy, often in pelvic/abdominal localization, the inguinal approach can be cumbersome. There is no standard of care for these cases, but we found the minimally invasive approach to be a good choice. Laparoscopic surgery has the advantage of enhanced exploration and orhidectomy can be easily performed. Associated with the orchidectomy, hernia cure can be facilitated by laparoscopic TAPP procedure.

Conclusions

In cases of concomitant hernia and cryptorchidism, we emphasize the idea of simultaneously cure hernia via laparoscopic TAPP procedure associated with orchidectomy as feasible and safe.
P129 THORACIC VS. ABDOMINAL APPROACHES FOR DIAPHRAGMATIC HERNIA REPAIR: A NATIONWIDE STUDY OF CLINICAL OUTCOMES
Authors: Centeno Andrea Carolina Quiroga , Navas Orlando , Serrano Juan Paulo , Ochoa Sergio Alejandro Gómez
Published: December 2021

Aim

“To compare the outcomes of different surgical approaches for diaphragmatic hernia (DH) repair.”

Material and Methods

“Adult patients with a principal admitting diagnosis of uncomplicated DH registered in the National Inpatient Sample in the period 2010-2015 were included. Patients with obstruction, gangrene, or congenital hernias were excluded. The primary outcome was in-hospital mortality. Secondary outcomes were the incidence of complications, length of stay, and hospital charges. A multivariate logistic regression model adjusted by age, sex, elective admission, comorbidities, and hospital characteristics was used to analyze the impact of the surgical approach on the evaluated outcomes.”

Results

“A total of 14910 patients with DH were included (median age 65 years, 74% women). Abdominal approaches were the most commonly performed (78.9% laparoscopy and 13.6% open). Patients that underwent open abdominal and thoracic repairs had a higher risk of complications (sepsis, pneumonia, surgical site infection, prolonged postoperative ileus, and acute myocardial infarction), longer hospital stay, higher total hospital costs, and a significantly higher risk of mortality (OR 2.62. 95% CI 1.59-4.30 and OR 4.60; 95% CI 2.37-8.91, respectively) compared to patients that underwent laparoscopic abdominal repair. Individuals whose DH repair was performed through thoracoscopy had a similar mortality risk to those who underwent laparoscopic abdominal repair (OR 0.87; 95% CI 0.11-6.43).”

Conclusions

“Nowadays, laparoscopy has become the most used approach for DH repair. In the present cohort, it was associated with better outcomes in terms of complications, length of hospital stay, and mortality, as well as lower health costs. Additional studies assessing hernia characteristics are required to validate this result.”
P130 HYBRID OPERATION TECHNIQUE FOR INCISIONAL HERNIA REPAIR, A SYSTEMATIC REVIEW AND META-ANALYSIS OF INTRA- AND POSTOPERATIVE COMPLICATIONS
Authors: Van den Dop Matthijs , Smet Gijs De , Kleinrensink Gert-Jan , Hueting Willem , Lange Johan
Published: December 2021

Aim

Incisional hernia (IH) occurs approximately in 15% of patients after midline surgery. Surgical treatment for IHs include a solely open or solely laparoscopic approach with mesh placement. Recently, hybrid (combined laparoscopic and open) approaches are being performed. This systematic review evaluates the perioperative complications of hybrid incisional hernia repair (HIHR).

Material and Methods

EMBASE, Medline via OvidSP, Web of Science, Cochrane and Google Scholar databases were searched. Studies providing data on intra- and postoperative complications in patients who underwent HIHR were included. Data on intra- and postoperative complications were extracted and meta-analyses were performed. Study quality was assessed with the Newcastle Ottowa Scale, ROBINS-I tool, and Cochrane risk of bias. PROSPERO registration: CRD42020175053.

Results

Results: Nine studies (n = 1596 patients) were included. Five studies compared intra-operative complications between HIHR and laparoscopic incisional hernia repair (LIHR) with a pooled incidence of 1.8% in HIHR group and 2.8% in LIHR group (p = 0.13). Comparison of postoperative prevalence of surgical site occurrences (SSOs) (24% versus 31%, p = 0.02) and surgical site occurrences requiring interventions (SSOPIs) (1.5% versus 4.1%, p < 0.01) were in favour of the HIHR group. Overall postoperative complications seemed to occur less frequent in the HIHR group, though no hard statements could be made due to the vast heterogeneity in reporting between studies.

Conclusions

Although the majority of studies were retrospective and included a small number of patients, HIHR led to less SSOs and SSOPIs compared to LIHR. This systematic review forms a strong invitation for more randomized controlled trials to confirm the benefits of this approach.
P141 USE OF POLYPROPYLENE STRIPS FOR REINFORCEMENT OF THE CRUROPLASTY IN LAPAROSCOPIC PARAESOPHAGEAL HERNIA REPAIR: A RETROSPECTIVE COHORT STUDY
Authors: Van den Dop Matthijs , Smet Gijs De , Mamound Aziz , Lange Johan , Wijnhoven Bas , Hueting Willem
Published: December 2021

Aim

Laparoscopic paraesophageal hernia repair is an effective treatment for symptomatic paraesophageal hernias. To reduce recurrence rates, the use of prosthetics for the crural repair has been suggested. Mesh-related complications are rare, but known to be disastrous. To address another form of crural repair, polypropylene strips are suggested. This study aimed to assess peri- and postoperative complications of reinforcement of the cruroplasty with polypropylene strips.

Material and Methods

From 2013 to 2020, patients with a type II, III or IV primary or recurrent paraesophageal hernia that underwent cruroplasty with polypropylene strips were retrospectively reviewed. Intra- and postoperative complications were graded according to the Clavien-Dindo classification. The incidence of symptomatic recurrent hiatal hernia (CT or endoscopy proven) and hospital stay were assessed.

Results

One-hundred-and-fifty-eight patients were included. Mean age was 65 years (standard deviation 10.4), 119 patients were female (75.3%). Almost 50% of surgeries took place between 2018 and 2020. Median follow-up was 7 months (interquartile range 17.5). Mean operation time in the primary hernia group was 159 minutes (standard deviation 39.0), and length of stay was 4.4 days. In 3/158 patients (2.0%) intra-operative complications occurred. Two patients developed a grade IV and seven patients a grade III postoperative complication. No mortality was recorded. Twelve recurrences (8.2%) were detected in the primary hernia group, and one (9.1%) in the recurrent hernia group.

Conclusions

There were no mesh-related complications seen and symptomatic recurrence rate was low, but longer follow up is needed.
P157 EFFECTS OF COVID-19 PANDEMIC ON THE SCIENTIFIC PUBLICATIONS IN HERNIA FIELD
Authors: Kulacoglu Hakan , Celasin Haydar
Published: December 2021

Aim

The increase in the number of publications in the hernia field has been higher than the most of our areas of surgery. COVID-19 pandemics has affected many elective surgical procedures like hernia repairs. We assumed that the declines in case volumes might cause some falls in related publications, and searched the literature in order to find the number of herniology publications before and during the pandemic.

Material and Methods

A systematic PUBMED search was done for three consecutive decades “1991-2000”, “2001-2010” and “2011-2020” by using the key words “inguinal and hernia”, “umbilical and hernia”, “incisional and hernia”, “mesh and hernia”, “laparoscopic and hernia”, “robotic and hernia”, and “experimental and hernia”. Later, a comparison of years 2019 and 202o was done.

Results

Although increases were detected for all searches with the key words, the largest rise was seen in publications related to “robotic and hernia”. Some undulations were recorded during the years, but the number of publications showed obvious increases decade by decade. A very small decrease was found in the number of publications for “experimental and hernia” only, however all other searches presented increases during the first year of the pandemic, 2020 in comparison with 2019.

Conclusions

The increases in the number of publications in hernia field continued during the last decade. COVID-19 pandemic did not cause a decrease in these publications the first year. We assume that year 2021 can be a more correct criteria in order to observe the potentially negative effect of the pandemic.
P161 EMERGENCY LAPAROSCOPIC REPAIR OF A PARASTOMAL HERNIA
Authors: Cuevas María Jose , Pinilla Diego , Sánchez Alejandro , Tinoco José , Tallón Luis , Padillo Francisco Javier
Published: December 2021

Aim

The aim of this video is to present the laparoscopic approach to an incarcerated parastomal hernia, using the modified Sugarbaker technique.

Material and Methods

A 50-year-old man with a definitive terminal colostomy after undergoing an abdominoperineal resection due to a rectal cancer, consulted in the emergency room with abdominal pain and an incarcerated mass below the colostomy, without evidence of intestinal obstruction. A CT scan was performed, with the finding of infarcted epiploic appendages inside the parastomal hernia. After evaluation of the case, emergency surgery was decided, opting for a laparoscopic approach to the parastomal hernia, employing the modified Sugarbaker technique.

Results

Following the dissection of the hernial sac and resection of the necrotic fat content, a partial closure of the hernial orifice was done. A hernioplasty was performed using a composite synthetic mesh, that was fixated with helical sutures. After surgery, the patient evolved favorably and was discharged 72 hours after the procedure. In the one year of follow-up, the patient was asymptomatic and there were no data of recurrence either on the clinical examination or the control CT scan.

Conclusions

The laparoscopic approach to an incarcerated parastomal hernia is possible and safe when performed in well-selected cases by the hands of experienced surgeons, offering good short and long-term results.
VP020 ENDOSCOPIC PREPERITONEAL APPROACH IN STRANGULATED INGUINAL HERNIA
Authors: Gómez Jorge Zárate , Hernández Pedro Álvarez de Sierra , Luengas David Fernández , Someso Silvia Conde , Eslait Guillermo Supelano , Iribar Begoña Peinado , Godino Jesús Merello
Published: December 2021

Aim

According to the clinical sympthoms and radiological findings minimal invasive surgery can be an option to repair an strangulated inguinal hernia.

Material and Methods

We present the different ways we have used in our Hospital to treat incarcerated inguinal hernia combining endoscopic preperitoneal and laparoscopic approach

Results

Multiple treatment schemes are possible for inguinal incarcerated hernia. The choice must be made according to the surgeońs experience, patient´s characteristic and the risk of intestinal ischemia.

Laparoscopy combined with preperitoneal endoscopic inguinal repair allows us to explore and to treat possible complications of intestinal ischemia with no need of laparotomy.

Conclusions

Laparoendoscopic techniques are an option to consider when treating an incarcerated inguinal hernia, even if bowel resection is needed.

Thanks to laparoscopic approach, laparotomy can be avoided in many cases.
O04 DETERMINING THE EFFECT OF MESH WIDTH AND FIXATION PATTERNS ON THE STRENGTH OF PROPHYLACTICALLY REINFORCED LAPAROTOMY INCISIONS
Authors: Christopher Adrienne , Sanchez Jonathon , Fischer John
Published: December 2021

Aim

Research indicates that prophylactic mesh may help prevent incisional hernia after laparotomy, but best practice patterns in these situations are still evolving. Here, we compare the failure loads (FLs) and biomechanical stiffness (BMS) of 35 porcine abdominal wall laparotomy incisions reinforced with meshes of various widths and fixation distances using biomechanical testing.

Material and Methods

In each specimen, a ten centimeter (cm) incision was made and closed using continuous 1-0 Maxon suture. Specimens were randomized to mesh width (none, 2.5cm, 3cm, 4cm, 6cm, 8cm) and tack separation (1.5cm, 2cm apart), and the meshes secured in an onlay fashion. Cyclic loads oscillating from 15 Newtons (N) to 140N were applied to stimulate abdominal wall stress, and the specimens subsequently loaded to failure. FLs (N) and BMS (N/mm) were comparatively analyzed.

Results

All specimens failed via suture pull-through. FLs and BMS were lowest in specimens with suture-only (421.43 N; 11.69 N/mm). FLs and BMS were significantly higher in 4cm mesh specimens (567.51N) than those with suture, 2.5cm, and 3.0cm mesh (all p < 0.05). FLs in specimens with a greater number of tacks were consistently higher in meshes of similar sizes, although these did not reach significance.

Conclusions

Four cm mesh re-enforcement is superior to suture-only and smaller meshes at preserving strength in laparotomy closure in the early stages of healing, but larger meshes (6cm, 8cm) do not provide additional benefit. Meshes with more fixation points may be advantageous, but additional data is needed to make definitive conclusions.
O12 OPEN PREPERITONEAL INGUINAL HERNIA REPAIR, TREPP VERSUS TIPP IN A RANDOMIZED CLINICAL TRIAL
Authors: Bökkerink Willem , Koning Giel , Vriens Patrick , Mollen Roland , Akkersdijk Willem , van Laarhoven Kees
Published: December 2021

Aim

The preperitoneal mesh position for inguinal hernia repair showed beneficial results regarding Chronic Postoperative Inguinal Pain (CPIP) with low recurrence rates. Two open preperitoneal techniques, the TransREctus Sheath PrePeritoneal (TREPP) and the TransInguinal PrePeritoneal (TIPP) technique, were compared in a randomized clinical trial with the hypothesis of less patients with CPIP after TREPP due to complete avoidance of nerve contact.

Materials and Methods

Adult patients with a primary unilateral inguinal hernia were randomized to either TREPP or TIPP in four hospitals. Prior to the trial’s start the study protocol was ethically approved and published. Outcomes included CPIP after 1 year (primary outcome) and recurrence rates, adverse events and Health related Quality of Life (secondary outcomes). Follow-up was performed at 2 weeks, 6 months and 1 year.

Results

Baseline characteristics were comparable in both groups. Pain was less often present after TREPP at 2 weeks and 6 months, but the CPIP at rest at 1 year was comparable 1.9% after TREPP vs 1.4% after TIPP, p = 0.535). The overall recurrence rate was higher in the TREPP group, 8.9% vs 4.6%, p = 0.022). Corrected for a learning curve for TREPP, no significant difference could be assessed (TREPP 5.7% and TIPP 4.8%, p = 0.591).

Conclusions

both the TREPP and TIPP technique resulted in a low incidence of CPIP after 1 year follow-up. The TREPP method can be considered a solid method for inguinal hernia repair if expertise is present. The learning curve of the TREPP techniques needs further evaluation.
O16 THE TOR-CONCEPT (TRAINING-OPERATION-REHABILITATION) APPLIED TO A COHORT OF POST-PARTUM WOMEN WITH SYMPTOMATIC DRA (DIASTASIS RECTI ABDOMINIS). EVALUATION OF PHYSICAL FUNCTION AND QUALITY OF LIFE ONE YEAR AFTER SURGERY
Authors: Olsson Anders , Woxnerud Katarina , Sandblom Gabriel , Stackelberg Otto
Published: December 2021

Aim

Management of diastasis recti abdominis (DRA) differs regarding core training, surgical repair methods and post-operative rehabilitation. The purpose of this prospective cohort study was to evaluate the effect of a novel concept of treatment for DRA, the TOR-concept (Training, Operation and Rehabilitation). The concept includes preoperative evaluation of symptoms and instructed abdominal core training; tailored surgical repair of the DRA; and an individualized postoperative rehabilitation program.

Material and Methods

A cohort of seventy-five post-partum women with diagnosed DRA and training resistant core dysfunctions were evaluated and included to the study during 2018-2020. After surgery, all participants underwent an individualized supervised rehabilitation program with progressive increasing load for four months. Physical function was registered preoperatively and one year after surgery with the disability rating index (DRI) questionnaire. Quality of life (QoL) was assessed with the SF-36 questionnaire. The DRA and the surgical result were assessed with ultrasonography before and one year after surgery.

Results

Sixty-nine participants, 92%, completed the study. There were no DRA-recurrences at the 1-year follow-up. Early results shows that self-reported physical function, (DRI), improved in 88.8 % of patients, with a mean score improvement of 78.5 %. Quality of life, (SF-36), improved significantly compared with the preoperative scores, and reached a level similar to, or higher than, the normative Swedish female population.

Conclusions

In this cohort of post-partum women with DRA combined with core instability symptoms resistant to training, surgical reconstruction within the TOR-concept resulted in a significant improvement of physical function and QoL.
O18 LONG-TERM CROSSOVER RATE FROM WATCHFUL WAITING TO SURGERY OF INITIALLY MIDLY SYMPTOMATIC OR ASYMPTOMATIC INGUINAL HERNIAS IN MEN AGES 50 YEARS AND OLDER
Authors: Van den Dop Matthijs , van Egmond Sarah , Wijsmuller Arthur , Goede Barry De , Kleinrensink Gert-Jan , Jeekel Hans , Lange Johan
Published: December 2021

Aim

Inguinal hernia (IH) belongs to the most common surgical pathology worldwide. Approximately, one third of patients are asymptomatic. Watchful waiting (WW) has been regarded as a justifiable treatment option, but doubts still exist since high crossover (CO) rates to surgery may occur. The aim of this study is to assess the CO rates after 13-year follow-up of our randomized controlled trial (RCT).

Material and Methods

In our original study, 496 men with an asymptomatic or mildly symptomatic IH were randomly assigned to elective repair or WW. A retrospective review was conducted of patients initially assigned to WW. Primary outcome was CO rate to surgery. Secondary outcomes included reason for crossing over and time between initial randomisation and the CO to surgery.

Results

In the original RCT, 95 of 262 WW patients electively crossed over to surgery (35.4%) after 32.9 months. Currently, 212 of the 262 (81.0%) WW patients were reviewed, and 133/212 (62.7%) crossed over to surgery. Median follow-up was 13 years (range, 8-15 years). Mean time to CO was 35.2 months SD (40.8). Motivations for crossing over to surgery were predominantly due to progression of symptoms (83.5%), and in 8 (3.8%) cases due to an emergency event.

Conclusions

In the presented population, WW on the long-term remains a safe strategy, saving one third of patients an operation, although CO to surgery will likely occur. Insights into the natural course of untreated inguinal hernia that are valuable during patient counseling can be offered in the form of long-term CO rate due to progression of symptoms.
O19 5-YEAR OUTCOMES OF A RANDOMIZED CLINICAL TRIAL OF MESH FIXATION WITH CYANOACRYLATE OR SUTURES FOR LICHTENSTEIN HERNIA REPAIR: RECURRENCE, CHRONIC PAIN AND QUALITY OF LIFE
Authors: Hoyuela Carlos , Guillaumes Salvador , Veres Antoni , Hidalgo Nils Jimmy , Juvany Montserrat , Ardid Jordi , Martrat Antoni , Bachero Irene , Cano Manuel López
Published: December 2021

Aim

To assess the 5-year outcomes of mesh fixation with cyanoacrylate or sutures for Lichtenstein hernioplasty (recurrence rate, chronic pain, and patient’s quality of life (QoL).

Methods

370 patients who underwent Lichtenstein hernia repair were randomized to receive either cyanoacrylate or non-absorbable sutures for lightweight polypropylene mesh fixation. Postoperative outcomes were evaluated by an independent blinded observer. QoL was assessed using the EuraHS-QoL questionnaire (European Registry for Abdominal Wall Hernias).

Results

Initially 188 patients received Glue and 182 Suture. Mean follow-up: 72.6±7.8 months. 78.1% patients (Glue:147,Suture:142) completed 5-years follow-up. No significant differences were observed in terms of chronic pain. VAS score≥3: 8.1% vs 9.1%, Glue vs. Suture, respectively (P = 0.836). 8 patients (2.7%) (4 in each group) reported pain at rest, reaching 10.7% when analyzing pain during activity.

QoL was unaffected (EHS-QoL score=0) in the majority of patients: 131 (89.2%) vs. 127 (89.5%) for Glue or Suture respectively (p = 0.930). QoL-score greater than 20/90 points: 2 patients (Glue) vs. 6 (Suture) (p = 0.099). The Suture group QoL-score was higher in all domains but without statistical significance. Foreign body sensation was slightly higher in Suture group (7.5% vs. 9.3%) but without reaching statistical significance (p = 0.534). There were no differences in the recurrence rate (2.6% vs. 3.8% for Glue and Suture respectively) (p = 0533).

Conclusions

Chronic discomfort rate after Lichtenstein hernioplasty is not negligible. Atraumatic mesh fixation with glue was quicker and resulted in less acute postoperative pain than sutures for Lichtenstein hernia repair, but with no statistical differences in terms of chronic pain nor the long-term patients’ QoL.
O25 MORTALITY AFTER EMERGENCY VERSUS ELECTIVE GROIN HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Saeter Ann Hou , Fonnes Siv , Rosenberg Jacob , Andresen Kristoffer
Published: December 2021

Aim

This systematic review and meta-analysis aimed to investigate 30- and 90-day postoperative mortality in patients undergoing emergency or elective groin hernia repair.

Material and Methods

This review is reported after the PRISMA 2020 guidelines. A protocol (CRD42021244412) was registered to PROSPERO. Three databases (PubMed, EMBASE, and Cochrane CENTRAL) were searched in April 2021. The identified studies were screened for eligibility and included if they reported 30- and/or 90-day mortality following emergency or elective groin hernia repair. Meta-analyses were conducted when possible, and a subgroup analysis on patients undergoing bowel resection was made.

Results

We included 37 studies with a total of 30,740 patients receiving emergency repair and 457,253 receiving elective repair. Meta-analyses could not be conducted for the two repair settings separately due to heterogeneity. However, the 30-day mortality ranged from 0.0–1.7% following elective repair and 0.0–11.8% following emergency repair. The risk of 30-day mortality following emergency repair was estimated to be 26-fold higher than after elective repair. A subgroup meta-analysis on bowel resection in emergency repair estimated 30-day mortality to be 7.9%.

Conclusions

Emergency groin hernia remains a challenging and potentially fatal surgical emergency. This review emphasizes the importance of performing hernia repair in an elective setting to prevent a potential acute presentation with acute surgical intervention. Patients presenting with symptoms of emergency groin hernias should receive particular attention to minimize the high risk of mortality and morbidity following emergency repair.
O33 TREATMENT OF INCARCERATED GROIN HERNIA - EMERGING EVIDENCE BASED ON THE SWEDISH HERNIA REGISTER
Authors: Lederhuber Hans , Croix Hanna de la , Dahlstrand Ursula
Published: December 2021

Aim

The evidence base for statements about risk factors, morbidity and mortality for emergency hernia repair is mostly low quality. The aim of this study is to elucidate risk factors for the development of incarcerated hernia and outcome after adult emergency hernia repair using data from the Swedish Hernia Register (SHR).

Material and Methods

Data in this observational study were extracted from the SHR. It included registered cases between January 1, 2009 and December 31, 2019. Maximal follow-up was until December 31, 2020. Demographic data were analysed descriptively, risk analyses were performed using multivariate- and Cox-regression models.

Results

A total of 164.844 cases could be included after application of the in- and exclusion criteria. Women [odds ratio (OR) 1.42 99%CI 1.32–1.51], patients with lateral hernia [OR 1.54, 99%CI 1.47–1.61], femoral hernia [OR 14.63, 99%CI 13.32–16.06] and hernia recurrence [OR 2.46, 99%CI 2.33–2.60] were at higher risk of developing an incarcerated hernia. The highest strangulation risk was seen among women [OR 2.36, 99%CI 1.91–2.90], femoral hernia [OR 7.00, 99%CI 5.40–9.11] and recurrent hernia [1.90, 99%CI 1.54–2.33]. Patients with hernia incarceration or strangulation suffer significantly more frequent from postoperative complications [16.7% and 40.9% respectively, both p < 0.001].

Conclusions

The data demonstrate that certain risks groups exist, which are prone to suffer from hernia incarceration and strangulation. These at risk patients should be prioritized, especially during the reorganisation of services to cope with the massive surgical backlog in the aftermath of the COVID-19 pandemic.
O46 SUTURABLE MESH IMPROVES OUTCOMES FOR LAPAROTOMY CLOSURE IN COMPARISON TO POLYPROPYLENE SUTURE IN A REALISTIC PORCINE MODEL
Authors: Dumanian Gregory
Published: December 2021

Aim

Laparotomy closures fail due to suture pull-through.  We hypothesize that a novel suturable mesh device may limit pull-through via mechanisms of force distribution at the suture-tissue interface and fibrous encapsulation of the device filaments. This new tissue approximation device may lead to improved outcomes for laparotomy closure.

Material and Methods

Fifteen domestic swine 74 kg in size were randomly allocated to three groups for epigastric laparotomy closure with either size 0 suturable mesh, number 1 suturable mesh, or number 1 polypropylene.  All three devices were placed in running fashion with 1 cm bites and 1 cm travels. Primary endpoints were hernia formation at 13 weeks and a semiquantitative analysis of the histological tissue response.  Secondary endpoints included adhesions, surgical site occurrence (SSO), and documentation of “loose sutures”. 

Results

There were numerically fewer hernias in the number 1 suturable mesh group.    Nine of the 10 suturable mesh devices were well encapsulated within the tissues and could not be pulled away, while 4 of the 5 polypropylene sutures were loose.   Adhesions were least for number 1 suturable mesh. Histologically, the suturable mesh implanted devices showed good fibrovascular ingrowth and were judged to be “non-irritants”.  The soft tissue response was statistically greater (p = .006) for the number 1 suturable mesh than for the number 1 polypropylene.

Conclusions

The mechanism of how meshes support closure sites is clearly demonstrated with this model. Suturable mesh has the potential to change surgical algorithms for abdominal wall closure.
OV09 ROBOTIC REPAIR OF SUBXIPHOID INCISIONAL HERNIA POST CABG
Authors: El-Matbouly Moamena , Janahi Yaser , Suliman Ahmed , Atalah Hany , Albahrani Ahmed
Published: December 2021

Aim

A median sternotomy that extends toward the epigastric area can weaken the upper abdominal wall and result in the development of subxiphoid incisional hernia. We aim to assess the efficacy and the feasibility of repair of subxiphoid incisional hernia post CABG robotically. In this video; we will also review the surgical technique and the steps for robotic repair of subxiphoid incisional hernia

Material and Methods

57-year-old female presented with subxiphoid swelling post CABG in 2019. Her surgery was complicated with sternotomy wound infection with VAC dressing application and ARDS with prolonged intubation. She had 5x7 cm hernia defect that showed on the CT thorax along with sternal wound dehiscence. She underwent robotic repair of her hernia with phasix mesh and recovered well after surgery.

Results

The subxiphoid hernia is known for its repair complexities and high recurrence rate because the subxiphoid area is a complex structure consisting of boney structures, the rectus abdominis muscles, linea alba, and the diaphragm. The Da Vinci platform allows for accessing hard-to reach area with enhanced precision in dissection and superior dexterity compared to laparoscopy. The Robotic platform allows for manipulation of the camera to assess and operate on the abdominal wall with ease as compared to laparoscopy.

Conclusions

robotic repair of subxiphoid incisional hernia with mesh is safe and effective method of repair. There are no short-term or long- term side effects of the procedure with no recurrence at 6 months follow up.
OV12 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: VIDEO PRESENTATION
Authors: Birolini Claudio , Tanaka Eduardo , Miranda Jocielle , Murakami Abel , Utiyama Edivaldo
Published: December 2021

The early outcomes of abdominal wall reconstruction with polyvinylidene (PVDF) mesh in the infected setting: video presentation

Aim

The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. The study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting.

Material and Methods

Video presents the technical aspects and some of the outcomes of patients included in a prospective clinical trial designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects.

Results

The technical aspects of the operation, and the management of complications such as wound breakdown, exposed mesh and post-operative seromas are shown in this short video. The early and late outcomes are presented for discussion.

Conclusions

The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.
Maribavir for Refractory Cytomegalovirus Infections With or Without Resistance Post-Transplant: Results From a Phase 3 Randomized Clinical Trial
Authors: Avery Robin K , Alain Sophie , Alexander Barbara D , Blumberg Emily A , Chemaly Roy F , Cordonnier Catherine , Duarte Rafael F , Florescu Diana F , Kamar Nassim , Kumar Deepali , Maertens Johan , Marty Francisco M , Papanicolaou Genovefa A , Silveira Fernanda P , Witzke Oliver , Wu Jingyang , Sundberg Aimee K , Fournier Martha ,   SOLSTICE Trial Investigators
Published: December 2021

Background

Therapies for refractory cytomegalovirus infections (with or without resistance [R/R]) in transplant recipients are limited by toxicities. Maribavir has multimodal anti-cytomegalovirus activity through the inhibition of UL97 protein kinase.

Methods

In this phase 3, open-label study, hematopoietic-cell and solid-organ transplant recipients with R/R cytomegalovirus were randomized 2:1 to maribavir 400 mg twice daily or investigator-assigned therapy (IAT; valganciclovir/ganciclovir, foscarnet, or cidofovir) for 8 weeks, with 12 weeks of follow-up. The primary endpoint was confirmed cytomegalovirus clearance at end of week 8. The key secondary endpoint was achievement of cytomegalovirus clearance and symptom control at end of week 8, maintained through week 16.

Results

352 patients were randomized (235 maribavir; 117 IAT). Significantly more patients in the maribavir versus IAT group achieved the primary endpoint (55.7% vs 23.9%; adjusted difference [95% confidence interval (CI)]: 32.8% [22.80–42.74]; P < .001) and key secondary endpoint (18.7% vs 10.3%; adjusted difference [95% CI]: 9.5% [2.02–16.88]; P = .01). Rates of treatment-emergent adverse events (TEAEs) were similar between groups (maribavir, 97.4%; IAT, 91.4%). Maribavir was associated with less acute kidney injury versus foscarnet (8.5% vs 21.3%) and neutropenia versus valganciclovir/ganciclovir (9.4% vs 33.9%). Fewer patients discontinued treatment due to TEAEs with maribavir (13.2%) than IAT (31.9%). One patient per group had fatal treatment-related TEAEs.

Conclusions

Maribavir was superior to IAT for cytomegalovirus viremia clearance and viremia clearance plus symptom control maintained post-therapy in transplant recipients with R/R cytomegalovirus. Maribavir had fewer treatment discontinuations due to TEAEs than IAT.

Clinical Trials Registration. NCT02931539 (SOLSTICE).
Chronic prescription of antidepressant medication in patients with chronic kidney disease with and without kidney replacement therapy compared with matched controls in the Dutch general population
Authors: van Oosten Manon J M , Koning Dan , Logtenberg Susan J J , Leegte Martijn J H , Bilo Henk J G , Hemmelder Marc H , Jager Kitty J , Stel Vianda S
Published: December 2021

Background

Chronic kidney disease (CKD) is associated with a higher prevalence of depression, neuropathic pain and insomnia. These conditions are often treated pharmaceutically. In this study we aimed to determine the prevalence of chronic antidepressant use among CKD patients with and without kidney replacement therapy (KRT).

Methods

By using the Dutch health claims database, we were able to determine the prevalence, type and dosage of chronic antidepressant prescriptions in patients with CKD Stage G4/G5 without KRT (n = 14 905), patients on dialysis (n = 3872) and patients living on a functioning graft (n = 8796) and compared these to age-, sex- and socio-economic status (SES)-matched controls from the general population.

Results

Our data show that the prevalence of chronic antidepressant prescription is 5.6%, 5.3% and 4.2% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively, which is significantly higher than in matched controls. Although our data revealed more prescriptions in female patients and in the age category 45–64 years, our data did not show any association between antidepressant prescriptions and SES. Selective serotonin reuptake inhibitors were the most prescribed drugs in all patient groups and controls. Tricyclic antidepressants were more often used in patients compared with controls.

Conclusion

This nationwide analysis revealed that chronic antidepressant prescription in the Netherlands is higher in CKD patients with and without KRT than in controls, higher in middle-aged patients and women, unrelated to socio-economic status and lower than chronic use reported in other countries.
Validation study of the use of the HRVCAM software for the evaluation of heart rate and heart rate variability at rest
Authors: Martins Patrícia Cândida de Matos Lima , Barbosa Talles Marcelo Gonçalves de Andrade , Lima Lucas Monteiro , Souza Israel Machado Brito , Ramos Gabrielly Craveiro , Souza Pedro Henrique de Brito , da Rocha Adson Ferreira , Barroso Weimar Kunz Sebba , Vitorino Priscila Valverde de Oliveira
Published: December 2021

Aims

The existing instruments for assessing heart rate (HR) and heart rate variability (HRV) require contact area. This is difficult to obtain from specific groups of patients and from those moving. The aim of this study was to validate the use of the HRVCam software for measuring HR and HRV in healthy adults.

Methods and results

The HR and HRV variables were evaluated in terms of time and frequency using a webcam and Polar® S810i. The Shapiro–Wilk test was used to test the normality of the data, and the Pearson’s correlation coefficient (r) was used to identify the possible correlation between the two instruments. The size of the effect was calculated based on a generalized linear model, and the Bland–Altman plots were used to analyse the agreement between the methods. The level of significance for all analyses was set at P < 0.05. We evaluated 102 participants, of whom 52% were men; 83.3% were aged between 18 and 29.9 years; and 84.3% were single.

Conclusion

There was a good agreement and moderate to strong correlations among all analysed variables. The biases were low, except for the low frequency/high frequency measures. Moreover, the difference between the samples was small to moderate. The results of this study corroborate the use of HRVCam for measuring HR and HRV.
Long-term mortality and cardiovascular outcomes in patients with atrial flutter after catheter ablation
Authors: Yugo Dony , Chen Yun Yu , Lin Yenn Jiang , Chien Kuo Liong , Chang Shih Lin , Lo Li Wei , Hu Yu Feng , Chao Tze Fan , Chung Fa Po , Liao Jo Nan , Chang Ting Yung , Lin Chin Yu , Tuan Ta Chuan , Kuo Ling , Wu Cheng I , Liu Chih Min , Liu Shin Huei , Li Cheng Hung , Hsieh Yu Cheng , Chen Shih Ann
Published: December 2021

Aims

For patients with typical and atypical atrial flutter (AFL) but without history of atrial fibrillation (AF), the long-term cardiovascular (CV) outcomes after catheter ablation for AFL remain unclear. We compared the long-term all-cause mortality and CV outcomes in patients with AFL receiving catheter ablation compared with the results with medical therapy.

Methods and results

Atrial flutter patients receiving catheter ablation for typical AFL were identified using the Health Insurance Database, and constituted the ‘AFL ablation group’. Patients with typical and atypical AFL but without ablation (AFL without ablation group) were propensity matched to the AFL ablation group. Patients with prior AF diagnosis were excluded. Primary outcomes included all-cause and CV mortality, heart failure (HF) hospitalization, and stroke. The multivariable cox hazards regression model was used to evaluate the hazard ratio (HR) for study outcomes. A total of 3784 AFL patients (1892 patients in each group) was studied. Their mean follow-up durations were 7.85 ± 2.57 years (AFL without ablation group) and 8.31 ± 4.53 years (AFL ablation group). Atrial flutter with ablation patients had lower risks of all-cause mortality (HR: 0.68, P < 0.001), CV deaths (HR: 0.78, P = 0.001), HF hospitalization (HR: 0.84, P = 0.01), and stroke (HR: 0.80, P = 0.01).

Conclusions

Catheter ablation for AFL in patients without prior AF was associated with lower risks of all-cause mortality and CV events compared with AFL patients without ablation during long-term follow-ups.
La Cité de demain: French urbanism in war and reconstruction, 1914–1928
Authors: Purseigle Pierre
Published: December 2021

Urbanists have long condemned the reconstruction of France after the Great War as a failure. Articulated in the 1920s, this distorted view has largely gone unchallenged and continues to frame the historiography. This article revisits dominant assessments of the post-1918 urban reconstruction and positions the mobilization of French urbanists in the wider transition from war to peace. Urban reconstruction underlined the uncertain nature of the aftermath of the conflict and proved both contested and uneven. While French urbanists imputed its failure to the local populations, this article argues that, if failure there was, it should be laid at their feet. Urbanists proved unable to apprehend the specificities of the post-war reconstruction and of the political economy in which they, as well as the devastated cities, had to operate. As those practitioners floundered, key tenets of urbanist thinking nonetheless prevailed.