bluuebunny/crossref_metadata_2025 huggingface dataset:
P-058 IMMEDIATE USE OF PERITONEAL DIALYSIS AFTER SIMULTANEOUS LAPAROSCOPIC PLACEMENT OF PERITONEAL DIALYSIS CATHETER AND INGUINAL HERNIA REPAIR
Authors: Alshammari S , Binjaloud A , Aldohayan A
Published: October 2022

Background

Peritoneal dialysis is accepted renal placement therapy for end-stage renal disease (ESRD). Managing inguinal hernia in peritoneal dialysis (PD) patient is not standardized. Moreover, the occurrence of occult hernia post PD placement needs surgical planning. This work aims to report the outcome of simultaneous laparoscopic placement od PD catheter and transabdominal preperitoneal (TAPP) repair of inguinal hernia.

Methods

All patients underwent laparoscopic PD catheter placement for ESRD from September 2016 to July 2021 were reviewed. Patients who underwent Concurrent Laparoscopic Inguinal Herniorraphy and Laparoscopic PD catheter placement were involved. PD with inflow measurement of the amount and should be below the incised peritoneum by 1 inch and smooth inflow and outflow without leakage. The amount raised gradually in two weeks to reach the targeted PD.

Results

Laparoscopic PD catheter placement was inserted for 13 patients with inguinal hernia. Two patients had bilateral inguinal hernia, one patient with umbilical hernia, and one patient diagnosed with hernia intraoperatively. The safe amount of dialysate fluid was from 400 to 600ml. There was no mortality, intraoperative complications or fluid dialysis leak. One patient had catheter displacement which was repositioned laparoscopically. Three catheters were removed due to non-compliance. No hernia recurrence observed.

Conclusion

Simultaneous laparoscopic PD catheter placement and TAPP repair herniorrhaphy with immediate use of PD is safe and effective. Our surgical approach allows using minimal invasive technique in the management of both PD catheter placement and inguinal hernia repair without delaying PD.
P-066 ABDOMINAL WALL RECONSTRUCTION FOLLOWING FULL THICKNESS BILATERAL RUPTURE OF THE RECTUS ABDOMINIS
Authors: Suhail D , Smith O , Lim P , Chintapatla S
Published: October 2022

Introduction

Rupture of the rectus abdominis is rare injury with no consensus on management. Previous reported cases have been due to exercise-related injuries and blunt abdominal trauma. We report the case of a 20-year-old male trainee paratrooper who presented with severe lower abdominal pain that occurred during military training. MRI revealed full-thickness bilateral rupture of the rectus abdominis. Abdominal wall reconstruction involved bilateral rectus muscle repair and placement of a biosynthetic mesh in the retrorectus plane. Postoperatively, our patient could walk pain-free at 3 weeks, jog pain-free at 10 weeks, and run up to 2 miles at 25 weeks.

Methods

Pubmed, Medline and Embase were searched to identify relevant studies using the MeSH terms, “rectus abdominis” and “rupture”, as well as their free text counterparts and synonyms. Texts were restricted to publications in English and publications after the year 2000. The search resulted in 391 articles. Manual cross-referencing was performed, limiting the included articles to 8 for review.

Results

6 out of the 8 selected articles discussed management using conservative means, while only 2 cases were managed surgically. Interestingly, no other exercise-related cases in the literature were managed surgically. Instead, all exercise related cases were managed conservatively, while only cases of traumatic aetiology were managed surgically. Among both surgically and conservatively treated patients, none suffered any treatment related complications, and all patients returned to normal levels of activity.

Conclusion

Full-thickness, bilateral rupture of the rectus abdominis can occur during exercise. Surgical and conservative treatment yield similar results.
P-078 LAPAROSCOPIC TREATMENT OF UMBILICAL HERNIA IN A COMMUNITY HOSPITAL SETTING
Authors: Agresta F , Mazzarolo G , Licitra E , Pontarolo N , Savino G , Montori G
Published: October 2022

Introduction

Umbilical Hernia is a common ventral hernia in the adult population. The classical approach was represented by open repair, but in recent years laparoscopic treatment is increasingly adopted and it can present some intraoperative and post-operative advantages.

Materials and methods

We prospectively analyzed a case series of 50 laparoscopic primary and incisional umbilical hernia repairs performed between January 1st, 2020, and December 31st, 2021. We collected data concerning age, sex, hernia defect size, operative time, and complications according to Clavien-DindoClassification, recurrence at 6 months, and 1-year follow-up.

Results

We performed laparoscopic umbilical hernia repairs in 50 patients (32males,18females);mean age52.1year-old(range30–82y.o.).Mean defect size was4.5cm(3–6.8cm).All procedures were performed under general anesthesia and with 5mm trocars and optic and under pneumoperitoneum pressure set until 10 mmHg as the maximum value. In all cases we applied a transparent, lightweight, ultra-thin, nonabsorbable surgical prosthesis in polypropylene, made by a monofilament macroporous mesh and a transparent film. and we performed closure of fascia with adsorbable stitches. Mean Operative time:40minutes(30–65min.).No complications and recurrences were reported.

Conclusions

Laparoscopic treatment of umbilical hernia is a safe and feasible procedure; indeed, we consider reducing hernia from the abdominal cavity generally better than the open approach and composite mesh positioning with direct fascial closure usually allows a satisfying repair of the defect.
P-082 INNOVATION IN INGUINAL HERNIA REPAIR
Authors: Santilli O , Santilli H , Nardelli N , Scaravonati R
Published: October 2022

Aim

Innovation is to efficiently use knowledge to improve an existing process for the benefit of users and their environment.

The aim is to show different innovations that we are applying in inguinal hernia repair.

Material & Methods

We present: 1. data from the first 500 procedures using 5mm articulated instruments. 2. Postoperative sports rehabilitation protocol designed to improve quality of life. 3. Virtual interactive visits (VIV) to teach and learn at a distance allows interaction in the operating room between a specialist and the surgeon in training.

Results

The articulated forceps allow angulations in order to reach areas with less pulling force and movements. The accepted benefits of robotics have been achieved without significant cost impact.

The sport rehabilitation protocol after laparoscopic hernioplasty does not increase recurrence rate or complications. It probably accelerates the return to regular physical activity, improving the quality of life in the postoperative period.

The (VIV) allows us to carry out the training process of specialists from Buenos Aires to Latin America and Spain, ​​modifying and improving the education and training of the new generations.

Conclusions

The articulated graspers, the sports rehabilitation protocol, and the virtual interactive visits allow us to innovate in tools, quality of life, and education.
P-086 MINIMALLY INVASIVE TREATMENT OF PARASTOMAL HERNIA: FROM THE LAPAROSCOPIC SANDWICH TECHNIQUE TO THE ROBOTIC RETROMUSCULAR TECHNIQUE
Authors: Barranquero A G , Villalobos Mori R , Maestre González Y , Protti G P , Gutiérrez E , Kissler J O
Published: October 2022

Aim

Parastomal hernias are frequent and highly recurrent. The sandwich technique (ST) (Berger et al. [2007]) uses a double intraperitoneal mesh, whereas the retromuscular technique (RMT) (Pauli et al. [2016]) dissects the retromuscular space, releases the transversus muscle, and lateralizes the stoma to place a retromuscular mesh. The aim was to evaluate the results of these interventions.

Matherial & Methods

Observational retrospective study of patients with parastomal hernia intervened by our Abdominal Wall Unit in a tertiary referral centre. The intervention performed was the ST from February 2016 to September 2020, and the RMT from September 2020 to March 2022.

Results

A total of 12 patients were intervened with the ST, eight laparoscopically and four robotically, and 7 patients were intervened with the RMT, all robotically. There were no statistically significant differences in basal characteristics between groups. According to the European Hernia Society classification, the parastomal hernias intervened in the ST were 16.7% type I, 33.3% type II, 16.7% type III, 33.3% type IV, while in the RMT most were type II (85.7%). The surgical time was more prolonged in the RMT.

There were no statistically significant differences in early complications. Long term follow-up was longer in the ST (median: 24 months vs. 1.6 months), and the recurrences observed were 25% (3/12) for ST and 14.3% (1/7) for RMT (p:1.000).

Conclusions

RMT is a challenging procedure with similar rate of early complications and promising relapse results despite a shorter follow-up. It is currently our procedure of choice for parastomal hernia.
P-093 GASTROINTESTINAL PROCEDURES AND ANASTOMOSES CAN BE SAFELY PERFORMED DURING COMPLEX ABDOMINAL WALL RECONSTRUCTION
Authors: Wallace A , Houlton S , Garner J
Published: October 2022

Aim

The literature regarding combined abdominal wall reconstruction and gastrointestinal surgery is limited and largely suggests staged procedures due to a reported increased incidence of surgical site infections (SSIs), hernia recurrence and anastomotic leak, but this exposes patients to the risks of two substantial procedures. This study aimed to evaluate outcomes of single-stage GI surgery with complex abdominal wall reconstructions (CAWR) by a single surgeon.

Materials & Methods

Analysis of 10 years of a prospectively maintained single surgeon CAWR database compared those who had CAWR-alone with those having concomitant gastrointestinal surgery (CAWR-GI) such as stoma reversal or bowel resection but excluding cholecystectomy, gynaecological surgery and adhesiolysis alone. Groups were compared using the paired t-test (continuous data) and Fisher's exact test (nominal data).

Results

Overall, 62 elective cases (42 CAWR alone v 20 CAWR-GI) were analysed. Baseline demographics (age, BMI, co-morbidities, smoking status and hernia size) showed no differences; CAWR-GI mean operating time was significantly longer compared to the CAWR-alone group (5.4hrs vs 4.1hrs) with an increased incidence of post-operative ileus in the intestinal group (40% vs 11.9%, p<0.05). Post-operative complications were common (chest infection (32.3%) and SSI (41.9%)), but similar between groups. There were no anastomotic leaks and the hernia recurrence rate at almost 4 years follow up was 10% in both groups.

Conclusion

Performing simultaneous intestinal surgery during complex abdominal wall repair can be performed safely without increasing the risk of hernia recurrence, mesh infections or anastomotic leak.
P-094 LAPAROSCOPIC VS OPEN VENTRAL HERNIA REPAIR: AN OBSERVATIONAL SINGLE CENTRE STUDY
Authors: Badkur M , Sharma N , Lodha M , Meena S
Published: October 2022

Background

Various surgical techniques are practised to provide best possible outcome for ventral hernia patients. This study was conducted to understand the patient's perspective regarding the choice and outcome of treatment.

Aim

To determine the level of satisfaction 1 month after ventral hernia repair. To analysed various factors which affects the patient's decision regarding the choice of surgery. To compare post operative outcomes between laparoscopic and open ventral hernia repair.

Material & Methods

An observational study was conducted between January 2020 and December 2021. Total 70 patients with ventral hernia were included. Relevant data was collected and analysed using SPSS version 28.

Results

39 patients underwent open repair and 31 patients underwent laparoscopic repair. 40% patients thought that their choice is better than the other option. 18.5% patients who preferred laparoscopic surgery were scared of big incision and 5% patients opted for open surgery because of unaffordability of mesh. 11.4% patient's decision was affected by the advice from other doctors whom they may have consulted before, 2.8% patients took advise from friends and family. Almost 20% patients left the decision on the treating team. The incidence of complications was significantly less in laparoscopic repair. However, there was no significant difference in the postoperative pain, duration of hospital stay, return to activity and satisfaction at discharge. level of satisfaction at 1 month was significantly higher in the laparoscopic group compared to open group.

Conclusion

laparoscopic ventral hernia repairs should be preferred in view of fewer complications and higher satisfaction.
P-096 ASSESSMENT OF THE FASCIA HEALING PROCESS AFTER SUTURE PLICATION OF RECTUS DIASTASIS – MEASURED WITH ULTRASOUND AT ONE, TWO, THREE AND FOUR MONTHS FOLLOWING SURGERY
Authors: Olsson A , Woxnerud K
Published: October 2022

Aim

Surgical repair of postpartum rectus diastasis (RD) has proven to provide functional improvements. Several different repair techniques have been described. There is no consensus regarding postoperative management and rehabilitation regimes varies. The purpose of this observational prospective cohort study was to follow and to better understand the healing process of the reconstructed linea alba with the aim to optimize the postoperative rehabilitation.

Material and method

Forty-five patients with RD operated with a standardized plication using absorbable suture material were included consecutively. All participants underwent a standardized postoperative rehabilitation program and were followed with ultrasonography examinations of the healing abdominal wall midline at one, two, three and four months after surgery. Interpretation of the ultrasound findings were defined by a specialist radiologist. The diameter of the duplicate was measured until it was totally contracted. The linea alba was considered totally regenerated when the anterior and the posterior lining were observed parallel.

Results

Early results showed that the duplicate had shrunk and the linea alba was totally recreated in 82.2% at the four-month examination. Corresponding numbers for the three, two and one-month examinations were 15.6%, 0%, and 0%. A preoperative inter-recti distance exceeding five centimeters showed a tendency to prolong the healing process.

Conclusion

The fascia healing time following a standardized suture repair was completed within four months in 4/5 of this cohort of postpartum women undergoing a RD repair. The findings can contribute to design an optimized rehabilitation regime following RD repair.
P-110 SURGICAL MESH INFECTION SECONDARY TO SKIN NECROSIS MANAGED WITH NEGATIVE PRESSURE THERAPY IN A PATIENT UNDERGOING TAR (TRANSVERSUS ABDOMINIS MUSCLE RELEASE)
Authors: Serrano Yébenes E , Diaz Pedrero R , Lasa Unzue I , Córdova García D M , Ovejero Merino E , Allaoua Moussasi Y , Laguna Hernandez P , Bru Aparicio M , Mañes Jimenez F , Jimenez Martin R , Medina Reinoso C , San Roman Romanillos M R , Ratia Gimenez T , Gutierrez Calvo A
Published: October 2022

Aim

To Show the management of skin necrosis, wound dehiscence and mesh infection in a patient undergoing TAR (Transversus Abdominis Muscle Release) through NPT (Negative Pressure Therapy)

Material and Methods

A 55-year-old man underwent elective surgery in 2017 for a giant hydatid cyst with portal rupture during the intervention, making a subcostal incision and subsequently midline laparotomy. Subsequently, he developed portal cavernomatosis and portal hypertension. In 2018, he underwent surgery for incisional hernia in a patient with a complex abdominal wall (extended subcostal incision + median laparotomy) performing a RIVES-type hernia repair. Develops chronic wall infection, mesh rejection and hernia recurrence that required reoperation with TAR (polypropylene mesh). One month after the intervention, he presents skin necrosis, wound infection and mesh infection in the upper third of the wound, which was managed through TPN cures for a year and a half.

Results

Given the dehiscence in the upper third of about 15×7 cm, conservative management was decided with cures and debridement of non-viable tissue. In contact with the polypropylene mesh, a silver dressing was applied, as well as treatment with negative pressure therapy. This cure was carried out for a year and a half every 3–4 days, being able to cover the mesh with granulation tissue and close it by secondary intention, thus avoiding a reintervention with mesh explant.

Conclusions

TPN is a useful tool in the management of mesh infections in patients with complex abdominal wall, thus avoiding reintervention and mesh explantation.
P-112 PRE-OPERATIVE PAIN AND REDUCED QUALITY OF LIFE SCORES IN PATIENTS THAT REPORT PERSISTENT PAIN AT 365 DAYS FOLLOWING LAPAROSCOPIC INCISIONAL HERNIA REPAIR
Authors: Dave M , Pilkington J , Fullwood C , Sheen A J
Published: October 2022

Background

​The use of patient reported outcome measures (PROMs) for incisional hernia has been established. This study aims to explore relationships between persistent pain at Day365 post laparoscopic-IPOM repair and other clinical and patient-reported data for patients within the TACKoMESH randomised trial.

Methods

Clinical, operative and PROMs data were collected pre-operatively and at four post-operative time points up to one year. Pain scores were measured using a visual analogue scale (VAS). Quality of life (QoL) data were measured using the short-form 36 (SF-36) and Carolina Comfort Score (CCS). Patients reporting pain ‘at rest’ at Day365 were compared with those reporting no pain. Statistical analysis was undertaken in R studio.

Results

54/63 trial participants attended followed up at Day365; 36 were male, and mean age was 59.1.

10 patients reported persistent pain at Day365 ranging from 1–9 on VAS. Patients were found to have reported higher pre-operative pain scores ‘at rest’ (5 [2–7] vs 0 [0–3] p=0.0181) and ‘on activity’ (8.5 [5–10] vs 4 [2–8] p=0.0181). They reported lower QoL scores in every domain on the SF-36, with significantly lower score for social function (50 [31–50] vs 75 [63–100] p=0.006).

Those reporting persistent pain at Day365 were more likely to have developed hernia recurrence (4 vs 3 p=0.0171). There were no significant differences in baseline characteristics, operative variables, and other complication rates between the groups.

Conclusion

Patients that report persistent pain at Day365 following laparoscopic-IPOM repair are more likely to have reported higher pain and lower QoL scores at pre-operative assessment.
P-113 IMPACT ANALYSIS OF DIASTASIS RECTI ASSOCIATION IN PRIMARY VENTRAL HERNIA REPAIR. OUR EXPERIENCE
Authors: Bravo Salva A , Bosch Silvela G , Perez Guitart M , Pereira Rodriguez J A
Published: October 2022

Aim of study

The aim of the study is to analyse concomitant diastasis recti impact in ventral hernia repair in our experience.

Material and methods

An observational single centre retrospective analysis of our Abdominal Wall Surgery prospective data base was performed.

We analysed primary ventral hernia repairs in our Hospital during 2020 and 2021. Two groups were performed according to presence of concomitant diastasis recti or not. We performed a descriptive analysis; comparative univariate analysis and a complication risk factors analysis.

Results

A total of 194 patients were included. 16 (8.2%) associated diastasis recti. Preperitoneal open hernia repair was performed in 180 (86.1%). 141 (72.7%) patients were operated as day case surgery. There were 28 (13.4%) patients with surgical complications. There were no reoperations, 4 readmission (1.9%) and 1 death (0.5%) Diastasis recti group had no statistically significative difference with control group except for study group was more frequently repaired by an abdominal wall surgeon specialist 15.2 vs 6.1%; p= 0.049) In complications risk factors analysis only presence of preoperative comorbidities was related to worst outcomes OR 7.32 (IC 2.68–20.21; p=0.001)

Conclusions

In our series small or medium size diastasis recti associated to ventral hernia repair seem not to impact in hernia repair outcomes. Diastasis repair should carefully take it into account when repairing an associated ventral hernia repair in order to not increase surgery complications.
P-115 HYBRID REPAIR OF RECURRENT COMPLEX GROIN HERNIA - CHALLENGES AND LESSONS LEARNT
Authors: Bandyopadhyay S , Iqbal A , Sheen A J
Published: October 2022

A 45 year old lady presented with a recurrent swelling over the right groin that had gradually turned tense and tender over the last 48 hours. Having undergone an urgent right femoral hernia repair in 2002, she underwent an inguinal hernioplasty in 2004 and amesh repair of a recurrent inguinal hernia in 2008. She developed a third recurrence that slowly increased in size and needed an urgent repair. At assessment, she was found to have a large complete recurrent irreducible right inguinal hernia containing loops of bowel.

At laparoscopy, multiple loops of bowel and omentum were reduced from a large multiloculated hernial sac. In view of the large sac which had incorporated the previously placed meshes in the wall, a decision was made to abandon laparoscopic approach. The myopectineal orifice was approached through a groin incision and the hernial sac with it's locules, including a prevascular component, was defined. The posterior sheath was defined and the rigt rectus muscle, displaced by the hernia, was repositioned. The dissection was carried upto the Space of Bogros to ensure that no component of the hernia was missed out. After completing a formal herniotomy, a sandwich prosthesis, created by stitching a biomesh and a polypropylene mesh, was utilised for hernia repair.

The patient had an uneventful recovery.

The presentation is aimed at discussing the challenges of repairing a complex recurrent hernia, the possible pitfalls and lessons learnt.
P-119 A MODIFIED CHEVREL AS AN ALTERNATIVE WALL CLOSURE TECHNIQUE FOR PATIENTS WITH ABDOMINAL HYPERTENSION
Authors: Vega Novillo V , Chacón F , Suárez A , Marcacuzco A , Caso O , Loinaz C , Jiménez C , Rivas Duarte C , Justo I
Published: October 2022

Abdominal compartment syndrome is a pontentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vacular thrombosis or mesenteric ischemia. A descompressive laparotomy is sometimes required, often resulting in hernias, and subsequent definitive wall closure is challenging.

Aim

This study aims to describe short term results after a modified Chevrel technique for midline incisional repair in patients witch abdominal hypertension.

Materials & Methods

We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension.

Results

Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intra-abdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 6 of the patients (66.7%) because they required subsequent abdominal surgeries. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed buldging. A decrease in intrabdominal pressure was achieved in all patients.

Conclusion

The modified Chevrel technique can be used as a closure option for midline ventral hernias in cases where the entire abdominal wall cannot be used.
P-126 GIANT UMBILICAL HERNIAS: EMERGENCY SURGICAL TREATMENT AND DEFINITIVE SURGERY. A CLINICAL CASE
Authors: Maestre González Y , Villalobos Mori R , González Barranquero A , Semeraro Odds C , Mias Carballal M C , Olsina Kissler J J
Published: October 2022

Aim

Complex hernias with loss of domain are a challenge for the surgeon, especially when presenting with complications in the emergency room. The emergency treatment differs from definitive surgery, as the patient's scenario is very different and they often present hemodynamic instability, intestinal perforation, etc..

Clinical Case

58-year-old male patient who underwent emergency surgery for septic shock due to intestinal perforation secondary to intestinal occlusion from a primary umbilical hernia, with loss of domain. Through a median laparotomy on the hernia, intestinal resection was performed. Abdominal wall closure wasperformed directly with the hernia sac, without abdominal wall repair. The patient was discharged for outpatient follow up. We planned the definitive surgery. Prehabilitation of the patient begins with botulinum toxin infiltration one month prior to surgery and by creating a progressive pneumoperitoneum. The definitive surgical procedure consists in performing retromuscular umbilical hernioplasty with a posterior component separation technique with placement of four 30×30 cm polypropylene meshes in the retromuscular space and closure of the anterior wall, associated with dermolipectomy. The patient evolved favorably and was discharged.

Conclusions

The treatment of this type of hernia in the emergency room must be personalized in each case, prioritizing damage control, and followed up by a definitive repair of the hernia. For this repair, it is advisable to perform prehabilitation with botulinum toxin, associated or not, with progressive pneumoperitoneum depending on the characteristics of the patient and the hernia, to avoid an increase in intra-abdominal pressure and the consequent compartment syndrome.
P-128 GET THE COMPLEX HERNIA PATIENT THEATRE READY: THE PERI-OPERATIVE OPTIMISATION PATHWAY PROFORMA WE UTILISE
Authors: Sodde P , Ethisham Z , Pokusevski G , Sabri S , Mihailescu A
Published: October 2022

Aim

In modern times, complex abdominal wall herniae are an area of increased sub-specialisation for the surgeon as well as the multidisciplinary team that work together. Recent advances in pre-op optimisation pathways and protocols, several pre- and intra-operative adjuncts available for these complex cases and a multitude of surgical techniques that can be deployed in open or minimally invasive fashion, have made it increasingly difficult for surgical teams to integrate all aspects of care for their patients. We are proposing for presentation our Hospital Pathway-Proforma used for diagnosis, pre-optimisation and peri-operative care in complex ventral and groin hernias.

Material and Method

“In-house” developed pre-optimisation planning proforma taking into consideration all evidence based interventions that can lower a patient's CEDAR score: BMI reducing, smoking cessation, blood sugar control, nutritional optimisation and skin decolonisation, as well as anaesthetic specific tests and interventions aimed at optimising patient's cardiac, respiratory, renal and metabolic status before undergoing complex abdominal wall reconstruction surgery. The proforma details specific diagnostics and intervention at pre-operative clinic visit one and two, then concentrates on pre-operative and intra-operative adjuncts to be used in each individualised case (e.g. Botox, Fasciotens). Finally the post-operative pathway details specific interventions to be taken for an uneventful post-op recovery.

Results and Conclusion

By using the Profoma-Pathway, the work of the complex hernia surgeon, anaesthestist and entire team taking care of CAWR patients became more organised and streamlined. The local pathway is also useful in auditing the local work in major abdominal wall hernia reconstruction patients.
P-130 LAPAROSCOPIC LUMBAR HERNIA REPAIR. BASED ON ANATOMICAL LANDMARKS AND SAFETY STATEMENTS
Authors: Santilli O , Santilli H , Nardelli N , Scaravonati R
Published: October 2022

Aim

Lumbar hernias are a rare clinical entity (less than 1% of all abdominal hernias) and their surgical treatment is constantly evolving and changing. The aim is to propose a technical systematization of the steps and landmarks to perform a safe and effective repair of an infrequent pathology.

Material & methods

We use a tapp approach. The patient is placed in a dorsal decubitus position with a 45° elevation of the hernia side. The first port in the umbilicus access and two ports are placed along the middle line. Start the dissection using novel articulated instruments marking the anatomical limits of the rectangular trapezoid that involves the semilunar lines, epigastric vessels, spine, and imaginary line between the iliac crest and 11 th rib. Releasing the peritoneal flat until visualizing the psoas and quadratus muscles until the 12th rib, preserving the avascular plane avoids nerves and vascular damage. Hernia sac reduction. Tension-free or not closure of the orifice. Placement of a polypropylene mesh covering all the dissected areas. Mesh fixation using absorbable suture. Closure of the peritoneum.Vacuum maneuver and bulge compression.

Results

The systematic standardization has been applied to all patients. The mean operative time was 90 min. The articulated instruments were useful and allowed safe maneuvers. Outpatient surgery was achieved with a fast return to normal activity. The procedures were performed without intraoperative complications, mortality, or conversion to open surgery.

Conclusion

The step-by-step guide for anatomical landmarks and proven statements offers a safe and effective repair of this rare entity.
P-132 MANAGEMENT OF VENTRAL HERNIA IN OBESITY: OUR ALGORITHM
Authors: Baig S
Published: October 2022

Introduction

Management of ventral hernia in obese is a complex problem. The methods of weight loss, alternatives if the patient cannot undergo bariatric surgery, timing, and type of hernia surgery lacks clarity and are dependent on resources and expertise. There is a need for algorithms based on local population and expertise. In this paper, we present the outcomes of our institutional algorithm.

Methods

It was a retrospective analysis of prospectively collected data. Patients with body mass index(BMI) > 30Kg/m2 were included to undergo surgery as per algorithm considering (a) presentation(symptomatic vs asymptomatic), (b) hernia characteristics(defect width, site, reducibility), and (c) obesity characteristics(BMI, subcutaneous fat, android vs gynecoid). Data on age, BMI, comorbidities, tobacco consumption, hernia width, location, contents, previous surgery, intraoperative parameters(the type of surgery, mesh, drain, fixation), and outcomes(seroma, hematoma, infection, recurrence) were collected.

Results

50 patients underwent treatment as per the algorithm. Mean BMI was 36.6 ± 7.3 kg/m2. The mean follow-up was 17.6 ± 7.2 months. The mean defect width was 4.8 ± 2.9 cm. There were two (4%) recurrences in patients who underwent an anatomical repair under emergency conditions. None of the patients who underwent an elective repair had a recurrence. Total surgical site occurrence was 12% and surgical site occurrence requiring procedural intervention was 8%. There was one (2%) mortality on postoperative day7 due to myocardial infarction.

Conclusion

The algorithm has shown encouraging results in the short-to-medium term. Long-term evaluation with a higher number of patients is needed to confirm its usefulness.
P-133 PROSPECTIVE INTERVENTIONAL STUDY OF THE ANALGESIC EFFICACY OF A CYCLOMESH™ PARIETAL REINFORCEMENT IMPLANT SOAKED IN ROPIVACAINE HYDROCHLORIDE 10MG/ML IN THE TREATMENT FOR UNCOMPLICATED INGUINAL HERNIA
Authors: Siembida N , Ralaihova H , Moulin S , Aubert F , Boulkedid R , Zourabichvili O , Regimbeau J M
Published: October 2022

Background

20–30% of patients operated for inguinal hernia will present early postoperative pain (EPP) which is, after the organizational causes, the first cause of conversion from ambulatory to traditional hospitalization. The objective of this study was to evaluate the interest of a parietal prosthesis (Cyclomesh ™) soaked with ropivacaine in the management of EPP.

Materials and Methods

This is a randomized, phase III, comparative superiority, double-blind, international multicentre study. From October 2019 to February 2022, 290 patients underwent surgery for inguinal hernia with placement of a ropivacaine or saline soaked parietal prosthesis. The primary endpoint was the H6 coughing pain assessment (EVA).

Results

The intention to treat population (ITTp) was composed of 150 patients in the ropivacaine group and 140 in the placebo group, for the per-protocol population (PPp) it was 125 and 115. The prosthesis type had no significant effect on H6 coughing pain, either for the ITTp (3.3 vs 3.2, p=0.12) or the PPp (3.3 vs 3.7, p=0.15). The ropivaciane soaked prosthesis resulted in a decrease in the overall pain at H2 (2.3 vs 3.2, p<0.0001), H4 (2.3 vs 3.1, p<0.0001) and H6 (2.3 vs 2.7, p=0.0039). Regarding painkillers consumption, postoperative complications and number of ambulatory conversions, there was no difference between the two groups.

Conclusion

The placement of a parietal prosthesis (Cyclomesh ™) soaked with ropivacaine did not reduce the H6 coughing pain but allowed a decrease in the overall pain over the first 6 hours after surgery and could simplify the management of patients.
P-135 FIRST EXPERIENCE WITH A NEW CLOSED INCISION NEGATIVE PRESSURE WOUND THERAPY, PREVENA™, IN ABDOMINAL WALL RECONSTRUCTION PATIENTS
Authors: Dixon S , Benson A , Kalaiselvan R , Kanwar S , Samad A , Pritchard-Jones R , West C , Scott M
Published: October 2022

Aim

Surgical site infection (SSI) contributes a significant proportion of post operative morbidity in patients undergoing abdominal wall reconstruction (AWR). Prevena™ closed incision negative pressure wound therapy (ciNPT) has been demonstrated to reduce SSI rates in the elective and emergency laparotomy setting. However, there is no evidence for Prevena™ use in AWR patients. The aim of this study was to assess the safety and feasibility of Prevena™ in AWR patients.

Materials and Method

Patients undergoing AWR at a single trust were selected at random to receive Prevena™. This was applied to the incision under sterile conditions, a continuous pressure of -125mmHg was applied for 7 days. The primary outcome measure was SSI, with secondary outcomes of 90 day mortality, complications and length of stay.

Results

10 patients received ciNPT in the study period, 8 female 2 male, mean BMI was 34.5. All patients had a Rives-Stoppa repair, with 2 patients also requiring bilateral transversus abdominal release (TAR). A vertical panniculectomy with umboplasty was used in 7 cases, fleur-de-lys panniculectomy with umboplasty in 2 cases, and a single case approached via transverse panniculectomy. There were no deaths within 90 days, median length of stay was 4 days. There was a single SSI managed with oral antibiotics, not requiring admission.

Conclusion

Prevena™ has been shown to reduce SSI rates in other patient cohorts and this small series demonstrates it is feasible and safe to use in the AWR setting. Larger studies are required to demonstrate SSI rate reduction in AWR patients.
P-143 INTRAOPERATIVE FLUORESCENCE ANGIOGRAPHY WITH INDOCYANINE GREEN (ICG) IN EMERGENCY LAPAROSCOPIC HERNIA REPAIR
Authors: Bascuas B , Licardie E , Ramirez A , Guadalajara J
Published: October 2022

Aim

Bowel incarceration is common complication in incarcerated hernias, which involves one of the most frequent emergent surgical pathologies.

Real-time fluorescence angiography with ICG is a reliable technique that allows surgeons to assess intestinal blood flow. However, this technique is rarely used in emergency surgery such as incarcerated hernia repair.

Materials & methods

We present the case of a 64-year-old patient with medical history of high blood pressure, atrial fibrillation and hepatitis C, complaining of abdominal pain and vomiting associated to painful inguinal hernia in the past 12 hours. The patient presented inguinal incarcerated hernia without any signs of external complication or elevation of infection and inflammatory parameters in blood test.

Results

We decided to carry out an urgent hernia repair performing transabdominal preperitoneal (TAPP) approach.

Once the hernia was repaired, intraoperative ICG fluorescence angiography was performed in order to evaluate intestinal viability. ICG fluorescence revealed the presence of irreversible ileal ischemia (12 cm) needing resection. Through mini-Pfannenstiel incision we performed the resection and a side to side stapled anastomosis. Postoperative course was uneventful and the patient was discharged 3 days after the surgery.

Conclusions

The combination of laparoscopic approach and ICG fluorescence angiography seems to be an actual useful solution, combining the advantages of minimally invasive surgery and avoiding the risk of bowel perforation due to unnoticed ischemia thanks to the assess of intestinal perfusion.
P-146 A SYSTEMATIC REVIEW OF IMAGING MARKERS FOR HIATUS HERNIA OUTCOMES
Authors: Wei R , Gilmore K , Findlay J , Spellar K
Published: October 2022

Hiatus hernia repair is a common operation with considerable variation in anatomy and technique. At present there are very few predictors of post-operative outcomes. Certain imaging characteristics may help in operative planning and predicting outcomes. The aim of this systematic review is to identify possible radiological markers associated with clinical outcomes in hiatal hernia repair.

A literature search was performed on the 7th December 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology guidelines of the PubMed, EMBASE and Cochrane Central Register of Controlled Trials using the following search term: ((hiatus) OR (paraesophageal)) AND (hernia) AND ((computed tomography) OR (CT) OR (imaging) OR (contrast) OR (swallow) OR (magnetic resonance) OR (ultrasound)). Inclusion criteria were studies (any design) testing the association of a radiological marker with any clinical outcome (either operative or non-operative) of hiatus hernia management. Exclusion criteria were case reports, non-English articles, non-human articles. Articles were screened by 2/3 authors on the basis of title and abstract. Full text articles were then retrieved for detailed analysis. Any disagreement was resolved by consultation with a 3rd/4th author.

Initial search identified 2768 papers, 9 of which were retrieved for full paper evaluation.

Preliminary review of the literature suggests that hernia recurrence is correlated with increased hernia size, although patients tend to be asymptomatic. Multidimensional CT can accurately measure hernia surface area and this could be useful in stratifying risk of re-herniation.
P-147 LAPAROSCOPIC SURGERY IS SUITABLE FOR MOST PATIENTS FOR INGUINAL HERNIA REPAIR AND IS AN EXCELLENT OPTION IN EXPERT HANDS
Authors: Smith J J , Hayward R , Kontovounisios C , Qiu Mbbchir S , Warren O J
Published: October 2022

Introduction

This study reviews the practice of a high-volume surgeon, comparing laparoscopic and open surgery for inguinal hernia. In suitable patients the default was laparoscopic Totally Extra Peritoneal (TEP) approach.

Materials & Methods

Data from patients referred over 5 years with inguinal hernias was collated prospectively and analysed retrospectively. Short and long-term outcomes of laparoscopic and open repairs were compared.

Results

205 patients underwent repair of 288 hernias (90.7% laparoscopic, 9.3% open). 83 patients underwent bilateral repair (95.2% laparoscopic). 22 patients underwent repair of 27 recurrent hernias (68% laparoscopic).

1 case (0.5%), started laparoscopically was converted to open. Complication rates were 13.4% vs 36.8% in the laparoscopic and open arms respectively (p<0.01): superficial infection (1.6% vs 0%, p=0.58); haematoma (6.3% vs 15.8%, p=0.14); seroma (4.8% vs 5.3%, p=0.94); persisting numbness (0% vs 5.3%, p<0.01) and chronic pain (1.1% vs 0%, p=0.65). No patients suffered mesh infections or explantation.

Mean stay was significantly longer in open group (p=0.03), median stay was 0 nights in both groups. At median follow up 1.8 years (Interquartile-range 0.9–3.6 years) recurrence rate was 1.1% (0 female, 2 male) and 15.8% (1 female, 2 male) in the laparoscopic and open arms respectively (p<0.01). Open surgery was associated with significantly higher risk of recurrence (HR: 16.3, 95% CI: 2.7–97.8, p<0.01).

Conclusions

This series demonstrates the vast majority of inguinal hernias, both primary and recurrent can be treated with laparoscopic TEP repair. Higher recurrence and complication rates were associated with open repair, with a caveat of strong selection bias.
P-148 EFFECT OF MEDICAL AND SURGICAL WEIGHT MANAGEMENT PROGRAMMES FOR PRE-OPERATIVE WEIGHT LOSS PRIOR TO VENTRAL HERNIA REPAIR
Authors: Mok J , Pucci A , Markakis H
Published: October 2022

Introduction

Obesity is a recognised risk factor for perioperative morbidity in patients undergoing complex incisional hernia repair. Weight reduction can reduce risk of perioperative complications. The aim of this study was to assess the effects of the different weight management modalities prior to planned incisional hernia repair upon the Carolinas equation for Determining Associated Risks (CeDAR) score.

Method

A prospectively maintained database of patients who were referred to the weight management clinic prior to planned incisional hernia repair was reviewed. Patients’ demographics, weight loss outcomes and CeDAR scores were calculated before and after the intervention.

Results

9 patients were enrolled onto the weight management programme prior to the planned incisional hernia repair (defect size 4 – 14cm), 3 underwent bariatric surgery whilst 6 had medical weight management in the form of a 12-week pre-operative diet programme. The mean age was 54 ± 9.4 years with a mean weight pre-intervention of 110.5 ± 7.4 kg and the mean BMI was 41.78 ± 1.98 kg/m2. Bariatric surgery was associated with a higher percentage weight loss (22.6%) compared to 12week diet programme (10.4%) with an associated higher reduction of CeDAR score (14% and 4% reduction in risk respectively).

Conclusion

Formal weight management programmes prior to complex abdominal wall reconstruction leads to clinically significant weight loss with reduced CeDAR score. Patients with raised BMI considering incisional hernia repair should be counselled for this and where possible offered a suitable weight management to reduce peri-operative risk.
P-151 ROLE OF INDOCYANINE GREEN TO MITIGATE WOUND COMPLICATIONS IN ANTERIOR COMPONENT SEPARATION TECHNIQUE FOR VENTRAL HERNIA REPAIR- OUR EARLY EXPERIENCE
Authors: Gandhi J A , Churiwala J J , Banker A , Shinde P H
Published: October 2022

Aim

The subjective ease of anterior component separation technique (ACST) has made it a widely used surgical option amongst budding surgeons for ventral hernia repairs (VHR). However, surgical site occurrences (SSO) like flap necrosis due to compromised perfusion have frequently been reported. This study aims to evaluate the impact of adoption of indocyanine green-fluorescence angiography (ICG-FA) to map soft tissue perfusion on wound-related complications following open ACST in VHR.

Material & Methods

We performed a retrospective review of patients who underwent VHR with open ACST at a single centre between March 2018 and July 2020. The study comprised of consecutive cases of ACST with onlay meshplasty done before (March 2018–April 2019, n=24) and after (May 2019 to July 2020, n=19) implementation of ICG-FA for intra-operative perfusion mapping of subcutaneous tissue and skin.

Results

The pre-ICG group and post-ICG group were similar in terms of baseline patient demographics and peri-operative details. The rate of SSO was higher in the pre-ICG group, but this result was not statistically significant (46% vs. 26%; p value 0.189). Skin necrosis, however, was observed in significantly less number of patients in the post-ICG cohort (29% vs. 5%; p value 0.045). No mesh infection was observed in either group.

Conclusion

This study demonstrates the effectiveness of perfusion mapping by the use of ICG-FA to determine potential areas of decreased perfusion and thereby minimize wound complications.
P-152 COMPARISON OF ENHANCED-VIEW TOTALLY EXTRAPERITONEAL (ETEP) AND TRANSABDOMINAL (TARM) MINIMAL ACCESS TECHNIQUES FOR RETROMUSCULAR PLACEMENT OF PROSTHESIS IN THE TREATMENT OF IRREDUCIBLE MIDLINE VENTRAL HERNIA
Authors: Churiwala J J , Rege S A , Salvi V , Shah S K
Published: October 2022

Aim

Retromuscular or sublay meshplasty has been advocated to reinstate abdominal wall strength following ventral hernia repair while avoiding complications like visceral adhesions, fistula formation and mesh infection. We aim to compare two minimally invasive approaches of sublay hernioplasty for irreducible ventral midline hernia with respect to their efficacy and safety.

Material & Methods

We performed a retrospective study of 73 patients operated for primary and recurrent irreducible ventral midline hernia by eTEP or TARM repair with sublay meshplasty. We compared the intraoperative and post-operative complications, post-operative pain score, subjective technical ease of procedure, patient satisfaction and recurrence after 3 months and 12 months of surgery.

Results & Conclusion

There was no significant difference in the outcome of surgery and complications by the two techniques. However, there was a significant subjective technical ease in the TARM group (n=35) due to ergonomic port placement and adhesiolysis and reduction of hernia contents done under vision. The number of ports used and post-operative pain score were higher in the TARM group as compared to that of the eTEP group. 96% of the patients belonging to both groups were satisfied with their surgery after a year on telephonic follow-up. However, a multicentric study with a larger sample size would be required to establish the advantage of one technique over the other.
V-005 A CASE SERIES DEMONSTRATING APPLICABILITY OF LAPAROSCOPIC MANAGEMENT OF STRANGULATED OR INCARCERATED HERNIAS IN EMERGENCY GENERAL SURGERY
Authors: Latif J , Bandlamudi N , Bhatti I , Awan A , Brazkiewicz M
Published: October 2022

Aims

Acute small bowel obstruction secondary to strangulated hernias is a presentation often encountered during the acute surgical take. Despite the widespread use of a minimally invasive approach for elective hernia surgery, there is a significant reduction in use of laparoscopy in the emergency setting. We aim to describe a case series on the applicability of laparoscopy in the management of emergency strangulated or incarcerated hernias.

Materials

We describe 4 cases of patients who presented with acutely strangulated or incarcerated hernias as an emergency to a single centre in the United Kingdom. The cases demonstrated include inguinal, femoral, obturator and spigelian hernias, each presenting as an acute emergency with concomitant small bowel obstruction.

Results

The patients underwent emergency surgery using a laparoscopic approach for repair of strangulated or incarcerated hernias and assessment of obstructed small bowel. Where indicated, small bowel resection and primary anastomosis was undertaken when viability of affected segment of bowel was compromised. All procedures were completed laparoscopically, with no recurrence occurring in these patients during the follow-up period.

Conclusion

Minimally invasive surgery is an important tool in the armamentarium of the acute care surgeon. A laparoscopic approach will reduce the insult of intervention in already physiologically deplete patients. This case series demonstrates the feasibility of laparoscopy in the management of strangulated or incarcerated hernias in the emergent setting, requiring advanced laparoscopic skill as demonstrated in this video.