bluuebunny/crossref_metadata_2025 huggingface dataset:
OC-016 PROSPECTIVE DATA ANALYSIS OF 1307 VENTRAL HERNIA PATIENTS: EMERGENCY HERNIA REPAIR AND SMOKING PREDICT RECURRENCE
Authors: Soppe S F , Wirsching A , Slieker J , Keerl A , Muller M K , Nocito A
Published: October 2022

Aim

Ventral hernias are frequent and hernia repair is regularly performed by general surgeons. Emergency repair is less frequent and can be challenging. Long term data comparing outcomes of emergency- vs. elective ventral hernia repair are scarce.

Material & Methods

Consecutive patients undergoing emergency and elective ventral hernia repair at our institution were prospectively entered in our HerniaMed database between August 2013 and February 2020. Patients were contacted after one-, five- and ten years to assess long-term complications. Risk factors for emergency repair and hernia recurrence were assessed by univariate and multivariate analysis.

Results

We included 1307 patients. Emergency and elective hernia repair were performed in 11% and 89% of patients with one-year follow-op rates of 94% and 92%. Female gender, BMI >40 kg/m2, ASA class 3 and 4, large size umbilical herniation (>4cm) and epigastric herniation were more frequent in emergency hernia repair. Binary logistic regression analysis identified emergency repair and smoking as predictors of recurrence (Odds ratio: 4.04 and 95% confidence interval: 1.67–14.21, p=0.004; Odds ratio: 2.94 and 95% confidence interval: 1.33–9.15, p=0.011). Furthermore, female gender and significant comorbidity (ASA class 3 and 4) were risk factors for emergency repair (Odds ratio: 1.98 and 95% confidence interval: 01.05–3.74, p=0.034; Odds ratio: 3.54 and 95% confidence interval: 1.79–6.98, p<0.001).

Conclusion

Emergency repair and smoking predicted hernia recurrence. Females and highly comorbid patients are at increased risk for emergency repair and should be prioritized for early elective hernia repair.
OC-023 USING FIBROBLAST MEDIATED MATRIX CONTRACTION TO TEST MESH SHRINKAGE - A PROTOTYPE FOR IN VITRO MESH TESTING
Authors: Whitehead-Clarke T , Khader R , Kureshi A , Mudera V
Published: October 2022

Background/Aim

Measuring how hernia meshes shrink after implantation is a commonly used parameter in in vivo mesh testing. We aim to use fibroblast populated collagen matrices (FPCMs) and their contraction to assess how different meshes shrink.

Methods/Materials

1 millilitre circular FPCMs were formed in 24 well plates. Different hernia meshes were placed halfway through the FPCMs so that they were embedded. Matrices were seeded with immortalised human fibroblasts, allowed to set and then separated form the well plate using a sterile needle. Gels were cultured in fibroblast media at 37 degrees 5% CO2 for seven days and were allowed to contract naturally. Each day, photographs were taken and the area of the collagen and the mesh were calculated.

Results

When comparing collagen contraction with/without hernia mesh, It was noted that significantly greater contraction was observed without mesh - which hampered collagen contraction. When comparing meshes, It was noted that a lightweight mesh with larger pores lead to greater collagen contraction (54% Vs 45%) and greater mesh shrinkage (55% Vs 20%) compared to heavyweight mesh with smaller pores.

Conclusion

We present a cheap, standardised and unique technique for measuring mesh contraction in vitro.
OC-024 MINIMALLY INVASIVE TREATMENT OF COMPLEX INCISIONAL/VENTRAL HERNIAS USING BOTULINUM TOXIN COMBINED WITH ROBOTIC SURGERY: ROBOTOX PROTOCOL
Authors: Villalobos R , Maestre Y , González Barranquero A , Olsina J
Published: October 2022

Introduction

Incisional/ventral hernia repair has changed in the last 20 years. Posterior component separation like TAR (transversus abdominis muscle release) has increased as a revolutionary technique. On the other hand, the use of botulinum toxin (BT) has allowed better closure defect with no tension. We present a preliminary original protocol named ROBOTOX for complex incisional /ventral hernia repair that combined BT and robotic surgery to minimize the TAR procedure.

Material and methods

BT (Dysport®) was administered in patients with a complex incisional hernia repair and a transverse defect ≧8cm one month before robotic surgery. Demographic variables (age, sex, BMI), EHS classification, need of TAR, size transverse defect, postoperative complications and recurrence were studied. All patients had a previous CT scan.

Results

Five patients were included in ROBOTOX protocol, 3 men and 2 women with a median age of 63±8, median BMI of 32±3. Four patients had a M3W3 and one a L3 W2 hernia. Median size defect of 11,2±2. Three of them only needed Rives technique, one a unilateral TAR and one a 5 cm dissection of bilateral TAR. At the moment, with a FU of 6±2 months, no recurrences have been reported.

Conclusions

Robotic surgery combined with BT would allow a downstaging treatment in patients with complex incisional/ventral hernias. A major cases and long term follow up is needed to better conclusions.
OC-027 IS THERE A CORRELATION BETWEEN TYPE OF PROSTHESIS FIXATION IN T.A.P.P. AND AFTER SURGERY RECOVERY? OUR CENTER EXPERIENCE
Authors: Gianazza S , Guzzetti L , Grappolini N , Odeh M , Scorza A , Palillo A , Gerosa S , Morabito M , Inversini D , Ietto G , Carcano G
Published: October 2022

Aim

A retrospective study was carried out on patients treated for bilateral inguinal hernia with TAPP technique by the department of Urgency Surgery and Transplantation of Varese's hospital in order to investigate the VAS one month after surgery and functional recovery in two groups of patients.

Material and Methods

38 patients treated in the last year were enrolled, dividing them in two groups: those who received a single fixing material (reabsorbable clips) and those with a double fixing material (reabsorbable clips and glue). Primary end point was the post-operative pain using the VAS scale at one month. Secondary end-point was the return to daily activities and work in days. The Mann-Whitney test with p-value set< 0.05 was used.

Results

The single fixing material group shown a 1-month VAS of 0.57 ±1, versus 1.43±4 of the second group (p-value<0.05); with a return of daily activities in 4.92± 8 days, versus 8.06 ± 11 days (p-value<0.05). In addition, analyzing the subpopulation of still active workers (28 of the 38 patient), it was assessed the working back timing. The positioning of only reabsorbable clips, compared with a double fixing material, ensured a faster return to work in 8.2 ±10 days versus 20 ± 30 days (p-value<0.05).

Conclusions

Fixing the prosthetic mesh with resorbable clips alone, could lead to a more rapid resumption of daily and work activities, with less pain one month after surgery.
OC-030 EARLY OUTCOMES OF ROBOTIC TAPP HERNIA REPAIR FOR INGUINAL HERNIA: A SINGLE SURGEON'S EXPERIENCE
Authors: Chaudhary R , Venkata Sairam M
Published: October 2022

Aim

The aim of this study was to evaluate the early outcomes of robotic TAPP (trans abdominal pre-peritoneal) inguinal hernia repair in a tertiary hospital.

Material & methods

This is a retrospective analysis of patients who underwent robotic TAPP by a single surgeon from November 2019 to May 2022. Three-arm, 4-port technique of robotic TAPP was performed. The patient cart was advanced depending upon laterality of the hernia. Three ports were placed in a linear fashion at the level of umbilicus, and the fourth port or assistant port was taken on the side opposite to the cart, triangulated from the umbilical and lateral ports.

Results

37 male patients were included, of which, 16 had unilateral hernias and 11 had bilateral hernias. Mean age was 46.2 (SD 16.5) years. One patient had a recurrent groin hernia after open repair. Mean operating time was 137.6 (SD 33.2) minutes. Operating time for the first ten cases was 158.2 (SD 25.1) min, and that of the last ten cases was 127 (SD 42.2) minutes, showing a steady decrease over time. One patient had intraoperative injury of the vas deferens, which was repaired. Mean hospital stay was 1.4 (SD 0.8) days. One patient had seroma. None of the patients had recurrence or mesh infection.

Conclusions

Robotic TAPP is a safe and effective procedure for the repair of inguinal hernias. Placing of assistant port near the umbilicus offers ergonomic advantage over linear port placement.
OC-034 EVIDENCE-BASED CHANGES IN PERI-OPERATIVE PATIENT CARE IN A TERTIARY HERNIA CENTER(THC): PROSPECTIVE STUDY OF OUTCOMES OVER 18 YEARS AND 1842 OPEN PREPERITONEAL VENTRAL HERNIA REPAIRS(OPPVHR)
Authors: Katzen M , Kercher K , Sacco J , Ayuso S , Ku D , Scarola G , Colavita P , Augenstein V , Heniford B T
Published: October 2022

Background

Over 18 years, a THC frequently changed patient-care protocols according to repeated reviews of our prospectively collected data outcomes, which have been published in peer-reviewed journals. This study aimed to describe these progressive, evidence-based changes and the subsequent results in PP-VHR.

Methods

Prospective, tertiary hernia center data(2004–2021) was examined for patients undergoing midline open PP-VHR with mesh. “Early”(2004–2012) and “Recent”(2013–2021) groups were based on surgery date.

Results

Comparison of Early(n=675) versus Recent(n=1,167) groups showed that Recent patients were older (56.9±12.6vs58.7±12.1 years;p<0.001), more comorbid(3.6±2.2vs5.2±2.6 diagnoses;p<0.001), lower BMI(33.5±8.3 vs 32.0±6.8 kg/m2; p=0.003), more prior failed VHR(46.5% vs 60.8%; p<0.001), larger hernia defects(199.7±232.8vs214.4±170.5 cm2;p<0.001), more CDC-class 3/4 wounds(11.3%vs18.6%;p<0.001), more biologic mesh(10.5% vs 25.4%;p<0.001), component separations(CST; 22.5%vs45.7%;p<0.001), and more pre-op Botox(0%vs12.3%;p<0.01). Wound complication(26.7%vs13.2%;p<0.001), mesh infection(3.1%vs0.9%;p<0.01), and hernia recurrence rates decreased over time(7.1%vs2.4%;p<0.001) with long-term follow-up(4.2±4.1vs2.2±1.8years;p<0.001).

Comparing respective multivariable analyses (Early vs Recent), wound complications were associated with panniculectomy(OR[95%CI]:2.9[1.9–4.5],p<0.001 vs 2.1[1.4–3.3],p<0.01), contaminated wounds(2.1[1.1–3.7],p=0.02 vs 1.8[1.1–3.1],p=0.02), anterior CST(1.8[1.1–2.9], p=0.02 vs 3.2[1.9–5.3],p<0.01), and operative time(per minute:1.01[1.008–1.015], p<0.01 vs 1.004[1.001–1.007], p<0.01) in both time periods. Diabetes(2.6[1.7–4.0],p<0.01) and tobacco(1.8[1.1–2.9], p=0.02) were only significant in the Early group with the Recent group requirements for preop smoking cessation and a HgbA1C of <7.2. In both groups, recurrence was associated with wound complication(8.9[4.1–20.1],p<0.01 vs 3.4[1.3–8.2].p<0.01) and prior failed VHR hernias(4.9[2.3–11.5],p<0.01 vs 2.1[1.1–4.2],p=0.036).

Conclusion

Despite increased patient and hernia complexity over time, detecting and implementing best practices, as determined by repeated self-analysis of a THC's data, significantly improved patient outcomes, including wound and mesh complications and recurrence.
OC-041 SHEEN PAAJANEN GROIN RECOMMENDED TREATMENT ‘SPORT’ SCORE FOR GROIN PAIN
Authors: Sheen A J , Biswas S , Stathakis P , Jamdar S , Harwood R , Paajanen H
Published: October 2022

Introduction

Evaluating groin pain still evades many clinicians with at times difficulty in determining the cause of pain when no true hernia exists. This study's aim was to evaluate a simple and novel reproducible scoring system, to help determine whether conservative measures or surgery should be recommended for the management of groin pain attributable to inguinal disruption.

Methods

Patients that underwent surgery or conservative management for inguinal disruption from 2018 to 2020, with at least one year follow-up, were evaluated with the proposed scoring system. The scoring system is based on MRI and ultrasound imaging as well as clinical findings, with scores given from -2 to +2 based upon the defined findings listed. The sensitivity (ability of SPoRT score to correctly identify physiotherapy required) and specificity (ability of SPORT score to correctly identify surgery required) were calculated for each potential cut off point. The Youden Index was used to find the cut off which optimises specificity and sensitivity.

Results

A total of 172 patients were evaluated over a two-year period, n=33 (19%) underwent conservative measures with physiotherapy and rehabilitation the mainstay of treatment, whilst n=139 (81%) underwent surgery to repair diagnosed inguinal disruption. All the patients were males. The table below summarises the mean scores.

A ROC curve was used to determine the optimal cut off for the SPORT score to correctly identify people who can have physiotherapy. The ROC curve has an area under the curve (AUC) of 0.936 (95% confidence interval: 0.874, 0.997) suggesting that the SPoRT scoring system is very good at distinguishing between cases requiring surgery and cases where physiotherapy can be used in this data set.

Sensitivity and specificity were weighted equally to determine the optimal cut off. SPoRT scores of 0 and lower indicate physiotherapy should be used, whilst 1 and higher indicate surgery. The sensitivity at this cut off is 0.909 (95% confidence interval 0.757, 0.981); the specificity is 0.892 (95% confidence interval 0.828, 0.938).

This means the cut off can correctly determine if someone needs physio 90.9% (95% CI: 75.7%, 98.1%) of the time and can correctly determine if someone needs surgery 89.2% (95% CI: 82.8, 93.8%) of the time.

Conclusion

In this dataset, SPoRT score of 0 or less can recommend a patient should undergo conservative measures or physiotherapy as a mainstay of treatment, a score of 1 or greater can recommend surgery. Further validation of the scoring system is required.
OC-042 HIGHER REOPERATION RATES FOR TISSUE PENETRATING FIXATION METHODS IN LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR
Authors: Mortensen A , Bodilsen A , Friis-Andersen H
Published: October 2022

Aim

The study compares three types of mesh fixation techniques of laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) in regards to recurrence: non-tissue penetrating (NP), tissue-penetrating (TP) and no fixation (NF).

Methods

The cohort was established retrospectively by way of the Danish Hernia Database, and all patients operated for inguinal hernia using TAPP from January 2010 to February 2021 in Denmark were identified. Logistic regression analyses were performed, with multivariate analysis correcting for significant confounding variables, yielding adjusted odds ratios for reoperation for the three fixation methods.

Results

A total of 38,503 primary TAPP repairs were included (penetrating fixation n=25,216, non-penetrating n=10,172, no fixation n=3,115). Overall recurrence rate was 3.57% over the 133 month follow-up period (mean length 59 months) with significant differences between the three methods: recurrence was 1.23% for NP, 2.87% for NF and 4.84% for TP. Using NF as reference, the adjusted odds ratio for reoperation was 1.80 for NF (p=0.007) and 3.51 for TP (p=0.001).

Conclusions

This comprehensive analysis demonstrated significant superiority of non-penetrative mesh fixation followed by no mesh fixation and lastly penetrative fixation. We corrected for significant confounding variables. With TP being the most widespread method of fixation, these results encourages reconsideration of standard practices for mesh fixation in TAPP.
OC-044 TOTAL EXTRAPERITONEAL ENDOSCOPIC INGUINAL HERNIOPLASTY (TEP) IN PATIENTS WITH PREVIOUS LOWER ABDOMINAL SURGERY. IS IT A WORRISOME INDICATION?
Authors: Zárate Gómez J , Álvarez De Sierra Hernández P , Bernal Marco B , Fernández Luengas D , Conde Someso S , Supelano Eslait G , Peinado Iríbar B , Merello Godino J
Published: October 2022

Aim

The purpose of the study is to analyze whether a previous medical history of lower abdominal surgery (or pelvic radiotherapy) involves a different postoperative outcome in TEP inguinal repairs.

Material & Methods

We performed a retrospective analysis of 1252 TEP procedures included from 2015 to 2019 at our institution. We compared the short-term intraoperative difficulties and the postoperative outcome in patients with and without previous lower abdominal surgeries.

The postoperative data collected included variables such as comorbidities, hernia classification, intraoperative complications, rate of conversion to open surgery, admission status, postoperative follow-up, chronic pain, and hernia recurrence.

We defined a “surgical success” dichotomous variable only for patients in an outpatient setting. It included cases with no complications during surgery, no need for conversión, and no chronic pain, no readmission or recurrence during followup.

Results

Out of the 1252 TEP procedures, 250 (19%) had previous lower abdominal surgery (or pelvic radiotherapy).

At the time of applying the “surgical success” variable we found a statistically significant difference in the conversion to open surgery rate between both groups (0.7% versus 5.6% p value 0.005). No differences were found in complications, readmissions, chronic pain, functional recovery or recurrence rates.

Conclusions

TEP procedure in patients with previous lower abdominal surgery showed a higher rate of conversion to open surgery compared to previously non operated patientes. The fact of having previous surgery did not imply however a worse postoperative outcome after a TEP procedure.
OC-053 LONG-TERM FOLLOW-UP OF A SLOWLY RESORBABLE BIOSYNTHETIC MESH IN VHWG GRADE 3 HERNIA REPAIR
Authors: Van Den Dop M , Tollens T , Jørgensen L , De Vries-Reilingh T , Piessen G , Köckerling F , Miserez M , Dean M , Berrevoet F , Dousset B , Van Westreenen G , Gosetti F , Lange J , Tetteroo G , Jeekel H
Published: October 2022

Background

Incisional hernia recurrence occurs frequently after initial repair. In potentially contaminated hernia, these numbers can rise up to 50%. Recently, resorbable meshes have been used to prevent infection in complicated incisional hernia and prevent long term mesh complications. Present study focuses on the long term outcomes of a resorbable mesh.

Methods

Patients included in the priorly conducted Phasix trial with Ventral Hernia Working Group (VHWG) grade 3 hernia were invited for an abdominal CT scan and physical examination. Primary outcome was hernia recurrence, secondary outcomes comprised of abdominal wall configuration, mesh resorption and long term mesh complications.

Results

Of the 84 patients included in the 2-year follow-up, 56 were available for long term follow-up up to five years. Mean follow-up time was 4.2 years. CT scan was made in 36 (64.3%) of patients. Kaplan-Meier analysis showed a recurrence rate of 16.7% after five years. Four (7.1%) new recurrences were found between 2-year and 4.2 years follow-up of which three by CT scan. In 50% of CT scans, no signs of postoperative distortions of the abdominal wall were observed. No long term mesh complications were reported.

Conclusion

After long term follow-up, VHWG 3 hernia repair with biosynthetic mesh demonstrated good performance with regard to hernia recurrence. Possibly, tissue reconstruction took place in the first two years after implantation by the use it or lose it principle, which led to sufficient native abdominal wall strength to prevent recurrences after resorption of the mesh.
OC-056 AUTOIMMUNE/INFLAMMATORY SYNDROME INDUCED BY SYNTHETIC HERNIA MESH IN ADULTS – DESCRIPTION OF THE PATHOPHYSIOLOGY AND SYSTEMATIC REVIEW OF THE EVIDENCE
Authors: Jíšová B , Woleský J , Střížová Z , de Beaux A , East B
Published: October 2022

Background

There is an increasing number of patients following hernia surgery with implanted mesh reporting symptoms that could indicate autoimmune or allergic reactions. ‘Allergy’ to metals, drugs, and chemicals is well recognised. However, allergy or autoimmunity caused by mesh has not been proven by a scientific method to date. The aim of this study was twofold: to describe the pathophysiology of autoimmunity and foreign body reaction and to undertake a systematic review of mesh implanted at the time of hernia repair and the subsequent development of autoimmune disease.

Methods

A systematic review using the PRISMA guidelines was undertaken. Pubmed, Google Scholar, and Cochrane databases were searched for English-written articles published between 2000 and 2021. The search was performed using keywords “hernia”, “mesh”, “autoimmunity”, “ASIA”, “immune response”, “autoimmune response”

Results

Seven papers, were included in the final analysis – three systematic reviews, three cohort studies and one case report. Much of the current data regarding the association of hernia mesh and autoimmunity relies on retrospective cohort studies and/or case reports with limited availability of cofounding factor data linked to autoimmune disease. Three systematic reviews have discussed this topic, each with different approach and none of them has identified causality between the use of mesh and development of autoimmune disease.

Conclusion

There is evidence that certain biomaterials can lead to immune dysregulation and induce autoimmunity. However, this has never been proven with synthetic hernia mesh. The bias in trials are high. And scientific studies have not been undertaken mesh-related autoimmunity.
OC-084 PRACTICE AND SHORT-TERM OUTCOMES IN VENTRAL HERNIA REPAIR: FIRST PROSPECTIVE MULTICENTER DATA ANALYSIS FROM INDIA
Authors: Sheth H , Baig S , Priya P , Ashfaque Y
Published: October 2022

Aim

Recording short and long term outcomes of primary ventral hernia (PH) and incisional hernia (IH) surgeries performed in India.

Materials and Methods

Members of Indian Association of Gastrointestinal Endo Surgeons (IAGES) were approached via mails and social media. Forty-five centres agreed to participate. The participating surgeons prospectively recorded the data of patients who underwent VHR from January 21, 2021- April 20, 2021, on a predesigned excel sheet. They were followed for 6 months.

Results

Data from 648 patients were analysed in this study for demographics, hernia characteristics, technical variations, and outcomes. 375 (57.8%) were primary ventral hernias (PH) and 273 (42.15%) were incisional hernias (IH), of which 63 (9.7%) were recurrent hernias.

In the PH group, 171 patients underwent minimal access repair (MAS) and 170 patients underwent open repair. The commonest procedure were open onlay and open pre-peritoneal repairs were performed least frequently. There were 3.73% seroma, 3.2% SSI, 0% 90-day readmission, 0% recurrence, and 0.3% mortality.

In the IH group, 164 patients underwent open repair and 104 underwent MAS repair. The most commonly performed procedure were open onlay and IPOM/IPOM plus. There were 13.92% seroma, 4.4% hematoma, 9.5% SSI, 1.1% mesh explantation, 0.4% wound sinus, 2.2% 90-day readmission, 0% recurrence, and 1.1% mortality.

Conclusion

Despite the guidelines favouring sublay repairs, onlay mesh hernioplasty is the commonest procedure practiced in India. IPOM/IPOM plus is the second commonest procedure. TAR is the preferred component separation technique in India. Complication rates in this study are comparable to published world literature.
P-001 FORMING A LIVING TISSUE MODEL OF THE POSTERIOIR RECTUS SHEATH
Authors: Whitehead-Clarke T , Mair A , Kureshi A , Mudera V
Published: October 2022

Aim

To develop an in-vitro model of the posterior rectus sheath. The model should be formed of living cells and aligned collagen that is of a similar thickness and tensile strength to the posterior rectus sheath.

Materials and Methods

Rectangular Fibroblast populated Colagen matrices (FPCMs) were formed using rat-tail collagen and seeded with an immortal cell line of human fibroblasts. FPCMs were formed into 3D-printed tethered gel moulds where they were tethered at opposing ends to induce the formation of an aligned construct. FPCMs were cultured for 10 days. After 10 days, excess fluid was removed and the constructs were plastic compressed under custom made compression blocks. Constructs were fixed in 4% paraformaldehyde. Constructs underwent flouresence icroscopy, second harmonic generation microscopy and uniaxial tensile strength analysis.

Results

6 constructs were developed. Lateral alignment of both fibroblatss and collagen were confirmed on flouresence and second harmonic generation microscopy respectively. Median construct thickness after compression was 0.57mm. Tensile strength analysis still awaited.

Conclusion

- here we present one of the first ever in-vitro models of the posterioir rectus sheath made with living human fibroblasts. It represents a novel potential development of a “living mesh” or rectus shetah transplant. Our model will be further optimised in the coming months by introducing human rectus sheath fibroblasts.
P-002 PREOPERATIVE USE OF BOTULINUM TOXIN A FOR COMPLEX ABDOMINAL WALL HERNIAS: SIMPLIFICATION OF ANATOMICAL RECONSTRUCTION AND REDUCTION OF COMPONENT SEPARATION TECHNIQUES
Authors: Wöhler A , Schaaf S , Willms A , Schwab R
Published: October 2022

Aim

Botulinum toxin A (BTA) may facilitate abdominal wall reconstruction for giant abdominal wall hernias. Complications after preoperative conditioning of the abdominal wall with BTA and subsequent surgical treatment have been poorly studied.

Methods

From 2018 to 2021, 31 patients with complex abdominal wall hernia were enrolled. Data were analyzed descriptively, risk factors, comorbidity, operative procedure, surgical site occurrences, and especially BTA-associated complications were documented. Key points were adverse effects, the rate of anatomical reconstruction, and reduction of component separation techniques.

Results

23 male and 8 female patients with a mean age of 62.7 years were included. The mean body mass index was 27.8 kg/m2. 61% had an ASA-Score over 3. The median duration of hospital stay was 11.6±5.2 days. The mean horizontal hernia defect was 13±5 cm, and the mean hernia gap area was 181.7±116 cm2. 83% were medial hernias with more than 10 cm hernia gap. Surgical reconstruction was performed using component separation techniques (CS) with mesh augmentation (61%), retromuscular sublay with CS (20%), and hybrid procedure (VAMOS) (9%). Complete closure of the anterior fascia was achieved in 100%. Anterior CS was necessary for 19%, and posterior CS was needed in 61%. The surgical site occurrences rate was 19%, with no BTA-associated complications. No hernia recurrence occurred during the follow-up period to date since 2018.

Conclusion

Preoperative conditioning of the lateral abdominal muscles with BTA seems to be a safe and effective method to facilitate tension-free anatomic reconstruction of the abdominal wall under the reduction of component separation.
P-014 RISK FACTORS FOR SHORT- AND LONG-TERM COMPLICATIONS FOLLOWING VENTRAL HERNIA REPAIR WITH THE PERITONEAL FLAP TECHNIQUE
Authors: Nielsen K A , Jogvansson B , Valsamidis A N , Pedersen A , Tulloh B , de Beaux A , Helligsø P , Mogensen C B , Nielsen M F
Published: October 2022

Aim

The peritoneal flap technique has been introduced for the repair of complex abdominal wall defects. The present study was conducted to determine the association between preoperative risk factors and the incidence of short and long-term complications.

Material & Methods

Patients undergoing abdominal wall repair between January 2010 and September 2020 were included in the study. Patient files were retrospectively reviewed and the presence of risk-factors and the incidence of postoperative short and long-term complications were recorded. A multivariable logistic regression analysis was used to estimate odds ratio (OR) for postoperative complications.

Results

327 patients were included. 48.0% were male. Median body mass index(BMI) was 30.9, 13.8% had diabetes and 23.2% were active smokers. Median defect size was 8 cm2 and median mesh size was 667.5 cm2. Median length of hospital stay was 5 days. 13.1% of patients developed a superficial wound infection, 10.4% seroma and 1.2% skin necrosis. Chronic pain was observed in 4.6% and recurrence in 2.4%. The regression analysis demonstrated a stepwise increase in OR for short and long-term complications. This risk was increased by 10% per unit BMI (P<0.01). Smoking and hernial defect size contributed only to a minor extent to the risk of postoperative complications.

Conclusion

The peritoneal flap method is a safe procedure associated with a low risk of recurrence. The risk of complications is associated with BMI whereas smoking and hernial defect size only contributes to a minor extent.
P-018 ACUTE APPENDICITIS IN DE GARENGEOT'S HERNIA - A LITERATURE REVIEW
Authors: Allu V , Chowdhury A
Published: October 2022

Aim

This study aims to undertake a systematic review of published data, focussing on the incidence of acute appendicitis within a de Garengeot hernia, the relationship between pre-operative diagnosis, surgical technique, incidence and surgical outcomes.

Methods

A PRISMA modelled literature search was carried out across PubMed, ProQuest, and BMW Case Report databases with the search terms ‘Femoral Hernia’, ‘Appendix’, ‘de Garengeot's’ in combinations, limited to English language, published between 1960 to 2019. Authors report another case study that was not included in the systematic review.

Results

Systematic review identified 84 published data reporting 112 such cases. 74(66%) presented with painful groin swellings. CT performed in 43(38%) accurately diagnosed de Garengeot's in 32(74%) patients. The most common surgical approach was low approach 35(31%) followed by the inguinal approach 23 (21%). 81 (72%) underwent herniorrhaphy with non-absorbable sutures and 20 had mesh repairs (18%). Ten (9%) patients were reported to have postoperative morbidity with wound infection being the most common complication and one recorded death.

Conclusion

Rarity of de Garengeot's hernia is shown by the limited availability of data that restricted our ability to conclude a single diagnostic pathway or a specific surgical technique for this condition. CT has shown, relatively accurate form of imaging tool, as well as Ultrasound scans in some. Sequestrated appendicectomy and hernia repair via laparoscopy is an option, however, there is lack of data to warrant its effectiveness as the surgical option of choice over an open groin approach in the presence of incarcerated groin swelling.
P-029 A NOVEL USE OF FULLY ABSORBABLE PHASIXTM MESH FOR LAPAROSCOPIC INGUINAL HERNIA REPAIR
Authors: Alshammari S , Aldohayan A
Published: October 2022

Background

An inguinal hernia is repaired usually with synthetic non-absorbable mesh resulting in collagen formation leading to chronic inflammation, and fibrosis with significant reductions in hernia recurrence. However, chronic pain may affect quality of life. The new mesh introduced to minimize complications. Poly-4-hydroxybutyrate (P4HB) mesh starts to degrade in 12–18 months. We are reporting our results of TAPP inguinal hernia repair using P4HB mesh (PhasixTM Bard in, Murray Hill, NJ).

Method

A pilot study is carried-out for laparoscopic TAPP repair for inguinal hernia using P4HB mesh assessing the recurrence rate and chronic pain for 30 months with IRB approval (E-19–3735). The study was conducted from 24 Jan 2016 to July 2017. The study included postoperative pain, reactions, mesh sensation, discomfort, and recurrence.

Results

Laparoscopic TAPP inguinal repair using P4HB mesh for 15 patients. 14 male and 1 female patient were involved, average age 55.8 years old,and an average BMI of 27.4 kg/m2. No recurrence or mesh sensation encountered except one patient has mild chronic inguinal pain for one year without affecting his usual activity.

Conclusion

Laparoscopic TAPP inguinal hernia repair using PhasixTM mesh is safe to use in combined direct (medial) and indirect (lateral) inguinal hernia with no recurrence. The use of P4HB absorbable mesh led to less chronic pain and discomfort. However, longer follow-up and a higher number of patients are needed to allocate the status and the place of P4HB in the world for inguinal hernia repairs.
P-039 COMPOSITE PP/PLLA MONOFILAMENT 4DVENTRAL® PROMOTES AN ANTI-INFLAMMATORY RESPONSE FROM HUMAN MACROPHAGES IN VITRO
Authors: Daoudi M , Myslakowski A , Abechir K , Carton A , Ouerghemmi S , Caillibotte M , Thomas P
Published: October 2022

The repair of abdominal hernias with prosthetic mesh can significantly reduce the risk of hernia recurrence. A new type of hernia implants combines monofilaments, Polypropylene (PP) and a biobased and natural slowly bioabsorbable polymer, Poly-L-Lactic Acid (PLLA). The partially (60%) resorbable PLLA/PP and PP meshes manufactured by COUSIN Surgery are 4DVentral® and Biomesh P1®. The contribution of PLLA in regulated inflammatory response and in enhancing abdominal repair remains unknown. Inflammation has a functional role during tissue regeneration process. An abnormal macrophage response characterized by an uncontrolled release of pro-inflammatory cytokines, chemokines, and tissue-degrading enzymes has been shown to be responsible for postoperative complications. In contrast, the angiogenic and tissue remodeling activities of the alternative anti-inflammatory M2 macrophages have potential use in tissue regenerative. Here, the characterization of the inflammatory response of human macrophages in vitro regarding 4DVentral® compared to Biomesh P1® was performed. Human monocytic THP-1 cells were differentiated into macrophages and polarized in M1 macrophages by incubation with IFN-γ and LPS or not (M0 macrophages). We found that 4DVentral® induced higher secretion of anti-inflammatory cytokines (IL-10 and Il1-RA) compared to PP Mesh in M0 macrophages. Interestingly, the secretion of pro-inflammatory cytokine IL-6 in M1 macrophages was dramatically reduced in the presence of 4DVentral® mesh compared to PP Biomesh P1®. However, the secretion of IL-10 was significantly increased with 4DVentral®. The composite PLLA/PP monofilament 4DVentral® positively drives human macrophages to an anti-inflammatory profile, resolving inflammation and promoting tissue repair.
P-069 A SINGLE CENTRE RETROSPECTIVE 14 YEAR REVIEW OF PATIENT OUTCOMES FOLLOWING IPOM LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH PVDF MESH
Authors: Byrne H , Ansong E , Abdul-Kaliq A , Finch G
Published: October 2022

Aim

Laparoscopic ventral hernia repair (LVHR) is a widely accepted minimally invasive technique. However, there remains debate regarding appropriate patient selection, the type of mesh used and for what size and type of defect. We aimed to review our experience of IPOM LVHR using PVDF mesh and compare our outcomes to the current literature.

Material and Methods

Operative records identified all patients who had undergone an IPOM LVHR with PVDF mesh from 2007–2021. The type, number and size of hernial defects, the sac contents, along with the size of mesh used and the type of fixation was collated. Length of stay (LoS), as well as early and late post-operative complications were also analyzed.

Results

A total of 287 patients are included in the study to date. 32.3% of patients were categorised within Obese Class II or III (BMI 35 – >40). Major early and late complications were observed in 4.6% and 3.1% of cases respectively. An 8.7% recurrence rate was observed. 87% of recurrences had an original defect classed as large (>4cm), with a median BMI of 30.5.

Conclusion

In conclusion, our post-operative outcomes are in keeping with those reported in the literature. In our experience, a high BMI does not preclude patients from undergoing a LVHR and having a good result. Debates are ongoing with regards to the timing and indication for LVHR in the obese and our results are encouraging, especially considering current national statistics estimate approximately 30% of the UK population are classed as obese.
P-074 BIOMECHANICALLY STABLE INCISIONAL HERNIA REPAIRS WITH DIS CLASS A MESHES ARE DURABLE AFTER A 3 YEAR FOLLOW UP
Authors: Kallinowski F , Löffler T , Rinn J , Nessel R , Görich J , Wielpütz M
Published: October 2022

Aim

Hernia meshes can be classified according to the tackiness towards cyclic load. Meshes with the best adhesiveness are named DIS class A. Are reconstructions with these meshes durable after 3 years?

Material and methods

Biomechanical principles of the reconstruction of the abdominal wall were analyzed ex vivo with cyclic loading common in material sciences. The resulting GRIP concept was clinically applied. The patients were followed in yearly intervals.

Results

A total of 129 patients (68 males and 61 females) were followed for 3 years after treatment for 93 primary and 36 recurrent incisional hernia. Progrip® was used in 53 cases (P), Dahlhausen® Cicat in 76 cases (C). P was used for smaller hernia with lower overlap due to the higher tackiness. Hernia sizes treated with C were significantly larger (u-test: p > 0.001). The mesh-defect area ratio was higher with P compared with C (11.9 vs 5.8). Fixation requirements were lower with 8 points for P and 80 points for C to reach adequate GRIP levels. GRIP was twice that minimally required. Larger hernia took longer OR times (median P: 104 vs. median C: 183 min; p > 0.001). Larger hernias were associated with more postoperative minor complications (6–14%, 1 re-operation for seroma). Length of stay was comparable with 5–6 days. During follow up, no recurrence was detected. Pain levels were low (median NAS = 0 after 3 years; u-test: p = 0.07672).

Conclusion

Incisional hernia can be repaired safely and durably based on biomechanical principles.
P-084 OPEN PARASTOMAL HERNIA REPAIR: STOMA RELOCATION WITH CST, MODIFIED RIVES SUBLAY MESH TECHNIQUE WITH CST OR MODIFIED SUGARBAKER INTRAPERITONEAL MESH TECHNIQUE WITH CST
Authors: Zuvela M , Galun D , Bogdanovic A , Bidzic N , Zivanovic M , Bogdanovic M , Zuvela M , Zuvela M
Published: October 2022

Aim

To presents results of various open surgical techniques for parastomal hernia repair.

Material and Method

Between January 2014 and January 2020, 22 patients with parastomal hernias were treated by three various operative techniques: a) stoma relocation using component separation techniques (CST); b) modified Rives sublay mesh technique with CST; c) modified Sugarbaker intraperitoneal composite mesh repair with or withouth CST. Stoma relocation and CST was performed in two patients, modified Rives sublay technique and CST in 15 patients and modified Sugarbaker technique with or without CST in five patients.

Results

Hernia recurrence was developed in one of two patients treated by stoma relocation and CST and in two of 15 patients treated by modified Rives sublay mesh technique and CST. In five patients treated by modified Sugarbaker technique no complications occured. Mean follow up was 28 months.

Conclusion

Modified Rives sublay technique with CST and modified Sugarbaker technique with or withouth CST provide good results in treatment of patients with parastomal hernia.
P-097 MINIMALLY INVASIVE REPAIR IN SEVERE RECTUS DIASTASIS WITH MIDLINE HERNIA ASSOCIATED IN MALES SHOWS HIGH RECURRENCE IN MID-TERM FOLLOW-UP. CASE-CONTROL STUDY
Authors: Bellido-Luque J , Licardie E , Gomez Rosado J C , Sanchez-Matamoros I , Nogales Muñoz A , Tejada Gomez A , Bellido Luque A , Morales S
Published: October 2022

Aim

Endoscopic plication could develop excessive midline tension that could increase recurrence rate in patients with severe rectus diastasis (SRD). New minimally invasive endoscopic repair (FESSA technique)(FT) was proposed to corrects both pathologies. Aim: assess clinical results, postoperative pain, functional recovery and recurrence of FT compared to endoscopic anterior rectus sheaths plication and mesh (ARSP).

Patients and Methods

male patients with ventral/incisional hernia and SRD were included. 2017–2019 patient underwent to ARSP. 2019–2020 patients underwent to FT. data: Defect and diastasis width and length. Surgical results: Operation time, Intraoperative complications, Hospital stay,Postoperative complications,Pain on 1th/7th/30th days, Functional recovery, Hernia recurrence. Statistic variables were compared using nonparametric tests.

Results

53 patients were included. 28 patients underwent FT and 25 to ARSP. operative time: 70 +/-9 min in FT, 55+/- 7 min in ARSP with significant differences.Hospital stay:1.4+/- 0,5 days for FT and 2,08+/-0,5 for ARSP with significant differences. one postoperative subcutaneous hematoma, requiring surgical removal (2%) in ARSP. Pain at postoperative day 1:21+/2 in FT and 25 +/-2 in ARSP without differences. Pain after 7 and 30 days,significant improvement were shown in favor of FT. functional recovery at 1 month: 17,8 +/-2,4 in FT and 27,8 +/-3,3 in ARSP with significant improvement in FT. recurrence after 24 months: 1 patient in FT (3.6%) and 9 patient in ARSP(36.0%) with significant differences.

Conclusions

Minimally invasive endoscopic Anterior rectus sheaths plication with mesh in SRD and midline hernias, shows higher recurrence rate, postoperative pain and worse functional recovery due to probably excessive midline tension.
P-101 EVALUATION OF PATIENTS’ QUALITY OF LIFE AFTER LAPAROSCOPIC INTRAPERITONEAL ONLAY MESH (IPOM) TREATMENT OF PRIMARY AND INCISIONAL VENTRAL HERNIA
Authors: Bellino R , Giaccone M , Peirano E , Rosati S , Balestra G , Sandrucci S
Published: October 2022

IPOM technique is a well-established technique for the repair of primary and incisional allowing a less invasive treatment compared to open approach and improving patient satisfaction. In this retrospective observational study, we evaluated the application of IPOM technique with the use of a non-absorbable, transparent, light surgical prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent film. 82 procedures of primary and incisional hernia repair from January 2018 to January 2022 have been included in this study. All the procedures were performed through 3 abdominal trocars without dissecting the hernia sac. Mesh fixation was achieved using transparietal points and resorbable tackers. The primary outcome of the study was the evaluation of patients’ Quality of Life (QoL assessed with EHS QoL scale) in two subgroups: primitive hernias (n=34) and incisional hernias (n=48). The secondary outcomes of the study were the evaluation of recurrence rate and postoperative complications rate. In both groups we recorded a significative improvement in patients’ QoL related to pain at rest, pain during physical activity and aesthetic discomfort (p <0.01). In the included cohort population, the hernia recurrence was recorded in 4 cases (4.9%, at 10, 18, 24 and 24 moths, respectively), and 3 patients experienced postoperative complications (3.7%). The recorded postoperative complications included pain (n=1, 1.2%), seroma infection (n=1, 1.2%) and intestinal obstruction (n=1, 1.2%). Our clinical experience showed that IPOM technique is a safe and effective approach, and it allows to significantly improve the patients’ QoL after surgery.
P-102 THE USEFULNESS OF EXPERIMENTAL ANIMALS IN LEARNING LAPAROENDOSCOPIC VENTRAL HERNIA SURGERY
Authors: Otegi Altolagirre I , Recreo Baquedano A , Arana Iñiguez I , Ruiz Marzo R , Ariceta López A , San José Aranda L , Rico Arrastia A , Uribazo Rodriguez M , Blázquez Lautre L
Published: October 2022

Aim

To study the usefulness of learning in simulation and animal model to incorporate laparoendoscopic techniques in ventral hernia in an abdominal wall unit.

Material and Methods

The training consists of 3 phases and four surgeons participate in it.

In a first phase, videos of laparoendoscopic ventral hernia surgeries are displayed.

In the second phase, 3 sessions are carried out in a simulation box to practice the zenith suture with a 5 cm diameter defect.

For the third phase, each surgeon has four sessions of surgery with swine models; In the first three, a retromuscular dissection procedure was performed, creating and suturing a midline defect of 15×4 cm (long and transverse diameter), placement of mesh in a retromuscular position, and closure of the posterior sheath (laparoscopic RIVES). In the 4th animal model, an extraperitoneal procedure was performed (eTEP) without closure of the posterior rectus sheath.

The total time of the intervention and the time used in the zenith suture are analyzed.

Results

With the first experimental animal, the average time used in suturing was 47.5 minutes, and in the fourth animal it dropped to 35 minutes. The time used to perform the laparoscopic RIVES in the first animal model was 102 minutes and was reduced to 72 minutes in the third.

Conclusions

Simulation and training models of minimally invasive ventral hernia surgery are useful and necessary in the training of surgeons and improve procedure times and skills.
P-107 DOES BARBED SUTURE REDUCE THE RATE OF EVISCERATIONS IN EMERGENCY MIDLINE LAPAROTOMIES?
Authors: López-Antoñanzas L , Jaimes León E , Ruano-Campos A , Garcí-Galocha J L , Del Campo M , Flores Flores C , Peña Soria M J , García A J
Published: October 2022

Introduction

Evisceration is a frequent consequence after performing midline laparotomies (ML) in urgent abdominal surgeries. The aim of this study was to compare and evaluate the results obtained after the introduction of barbed sutures in abdominal wall closure.

Materials and methods

We performed a retrospective analysis of patients undergoing emergency surgery in our hospital following a midline laparotomy approach in the last 5 years. Preoperative variables were compared between both groups and related to early surgical wound complications, depending on the type of abdominal wall closure performed.

Results

222 patients underwent surgery (Polydioxanone (P); 128; Barbed (B); 94) after ruling out exclusion factors such as neuromuscular disease, recent abdominal surgeries and whose follow-up had been lost. There were no significant differences between the two groups in terms of preoperative baseline characteristics or associated comorbidities. Furthermore, there were no statistically significant differences in type of surgery performed; the most frequent was small bowel obstruction. After data analysis, no differences were found in terms of hospital stay (P; 7.43 days vs B; 6.05 days, p=0.421) or mortality (P; 3.125% vs B; 4.25, p=0.655). Concerning immediate complications, there were no differences regarding surgical wound infection (P; 18.75% vs B; 10.63%, p=0.061) and seroma (P; 3.125% vs B; 2.12, p=0.651). Evisceration rates turned out to be more frequent in the polydioxanone group (P; 20.31% vs B; 8.51%, p=0.016).

Conclusions

The use of barbed sutures reduced the incidence of evisceration, therefore it can be considered as recommended sutures for aponeurotic closure in emergent ML.
P-114 INVESTIGATING THE ROLE OF BOTOX IN THE EMERGENCY MANAGEMENT OF COMPLEX ABDOMINAL WALL HERNIAS
Authors: Stevens J , Kostalas M , Chapman A , Prabhudesai S , Ratnasingham K
Published: October 2022

Aims

Botulinum toxin (Botox) has an established role in the elective management of complex abdominal wall hernia, but its role in the emergency setting has not been investigated. Clinical effects of Botox peak at 2–3 weeks after injection, but effects become apparent within 48 hours. We aimed to determine if these early effects can facilitate the acute reduction of irreducible hernia.

Materials and methods

Patients with irreducible abdominal wall hernias over a 30 month period were considered for Botox therapy. Suitable patients were given 300 units of Botox under ultrasound guidance into the anterolateral muscles bilaterally. Data were collected on outcomes.

Results

Twelve patients received Botox. All had incisional hernias and an ASA of 3 or more. Six were on antiplatelets and/or anticoagulation. All received Botox with standard conservative management. In ten patients, the hernia was reduced and symptoms resolved. One patient required surgery at 48 hours due to bowel ischaemia from inter-sac adhesions. A second patient experienced recurrent obstruction despite successful hernia reduction but was palliated due to advanced age and frailty.

Conclusions

This case series is the first study to investigate the role of Botox in the acute management of irreducible hernias. Our findings suggest that in selected patients, Botox can aid hernia reduction and avoid the morbidity of emergency repair. This is of particular value in high risk patients and those with complex defects who benefit from preoperative optimisation techniques. The accurate identification of strangulation is crucial however, as it excludes patients from this approach.