bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative analysis of the properties of cookies containing oleogel based on beeswax and its fractions
Authors: Frolova Yu V , Sobolev R V , Kochetkova A A
Published: December 2021

The article presents a comparative analysis of the properties of dough and cookies based on oleogels structured with various substances. Oleogels based on beeswax and its fractions were used as an alternative to solid fat in cookies. We found out that the use of separate beeswax fractions in oleogels makes it possible to obtain dough with different rheological characteristics. It was revealed that there is no regularity in the change in the rheological properties of cookies from the properties of the dough and oleogels. Analysis of the organoleptic profile of the cookie samples showed high values. This fact indicates the acceptability of using oleogels based on individual wax fractions in the biscuits cookies. The results obtained indicate the potential of using oleogels based on beeswax fractions in cookies as an alternative to solid fats.
Digital Transformation in the Agrarian and Industrial Sectors of the Russian Regional Economics
Authors: Kupriyanova M V , Evdokimova E N , Soloviova I P , Simikova I P
Published: December 2021

The article displays the results of comparing the digitalization process in agrarian and industrial production. The objects of study are the companies of the eighty-two Russian regions. The information was obtained from open-access resources of the Russian State Statistics Bureau. The research aims at revealing the differentiation and the specific interconnection of digital transformation in agriculture and industrial production at the regional level. The observations prove the idea that the digitalization path and tempo depend on the unique regional conditions and the accumulated level of scientific and innovative potential. A controversy is revealed in the methodology of evaluating the digital maturity rate which was proposed by the Russian regulators for assessments at the federal and regional scale. The methodology implies equal weights of significance attributed to various sectors when measuring the regional level of digital transformation. Consequently, the socioeconomic context of the diverse regional systems is treated as a barrier to digitalization and an obstacle to intensive development. At the same time, it is a question of open discussion if digitalization of such peculiar sectors as agriculture and industrial production should be measured with similar methods.
Meeting the physiological requirements for energy and nutrients to manifest the genetic potential of dairy cattle
Authors: Moshkina S V , Kharitonova A S , Khimicheva S N , Yu Kolganova T , Smagina T V , Lyakhova O L
Published: December 2021

The paper presents the results of the scientific and economic experiment for the evaluation of the influence of the energy supplement included in the diet of lactating cows of the Brown Swiss breed. During the research period, all animals were kept in the same conditions, corresponding to zootechnical standards. They were divided into two groups differentiated only by the feed ration. The cows of the first (control) group were given rations typical for the farm corresponding to the feeding norms of dry and lactating cows. For the cows of the second group in the dry period (14 days before calving) the feeding ration was changed with a change in structure towards an increase in the proportion of concentrated feed, and immediately after calving, they received an energy feed supplement to maintain the physiological status of dairy cows after calving. Only clinically healthy animals participated in the experiment. It was revealed that the inclusion of the energy feed supplement in the diet of lactating cows in the experimental groups during lactation led to an increase in the productivity of livestock as compared with those in the control group.
Tailoring linear and nonlinear surface plasmon responses in borophene nanostructures
Authors: Zhou Renlong , Yang Sa , Lin Qiawu , Tang Liangpo , Li Yong , Nie Guozheng
Published: December 2021

The newly reported 2D material ‘borophene’ provides a novel building block for nanoscale materials and devices. In this work, the linear and nonlinear plasmonic response of the electric dipole (ED) moment in metallic borophene is theoretically investigated. In our proposed model, a borophene nanostructure is deposited on the top of a dielectric layer sandwich with a silver layer acting as a mirror. It was found that the scattering at the scattering peak originates mainly from the exciting total ED. Our calculations demonstrate that scattering in the proposed model can be tuned well with carrier relaxation time, effective electron mass and free carrier density. The strongly localized fundamental field induces the desired increase in the second harmonic wave, which is discussed in detail by introducing the second-order nonlinear source. In addition, the evolution of the lifetime of linear and nonlinear plasmonic modes is also investigated, which helps us to study the underlying mechanism of microprocessing in the borophene plasmonic–photonic interaction. The manipulation of plasmonic behaviour and lifetime evolution makes borophene an excellent platform for tunable plasmonic–photonic devices.
Spatial personalities: a meta-analysis of consistent individual differences in spatial behavior
Authors: Stuber Erica F , Carlson Ben S , Jesmer Brett R
Published: December 2021

Individual variation in behavior, particularly consistent among-individual differences (i.e., personality), has important ecological and evolutionary implications for population and community dynamics, trait divergence, and patterns of speciation. Nevertheless, individual variation in spatial behaviors, such as home range behavior, movement characteristics, or habitat use has yet to be incorporated into the concepts or methodologies of ecology and evolutionary biology. To evaluate evidence for the existence of consistent among-individual differences in spatial behavior – which we refer to as “spatial personality” – we performed a meta-analysis of 200 repeatability estimates of home range size, movement metrics, and habitat use. We found that the existence of spatial personality is a general phenomenon, with consistently high repeatability (r) across classes of spatial behavior (r = 0.67–0.82), taxa (r = 0.31–0.79), and time between repeated measurements (r = 0.54–0.74). These results suggest: 1) repeatable spatial behavior may either be a cause or consequence of the environment experienced and lead to spatial personalities that may limit the ability of individuals to behaviorally adapt to changing landscapes; 2) interactions between spatial phenotypes and environmental conditions could result in differential reproduction, survival, and dispersal, suggesting that among-individual variation may facilitate population-level adaptation; 3) spatial patterns of species' distributions and spatial population dynamics may be better understood by shifting from a mean field analytical approach towards methods that account for spatial personalities and their associated fitness and ecological dynamics.
P033 IMPLEMENTATION OF A ROBOTIC VENTRAL HERNIA REPAIR PROGRAM IN A EUROPEAN CENTER: RESULTS DURING THE LEARNING CURVE AND EARLY DEVELOPMENT
Authors: Douissard Jonathan , Dupuis Arnaud , Hagen Monika , Mareschal Julie , Inan Ihsan , Toso Christian
Published: December 2021

Aim

This study aims to describe the early results after implementing a robotic ventral hernia repair (RVHR) program in a European university center.

Material and Methods

All patients undergoing primary (PH) or incisional (IH) RVHR were included in an institutional open-label prospective quality database. Patients' baseline characteristics, intra-operative data, postoperative, and follow-up outcomes recorded from September 2018 to September 2020 were analyzed.

Results

Twenty-six PH and 58 IH were included; respectively, mean BMIs were 32.8±7.1 and 30.3±5.0kg/m2. Hernia resulted from median laparotomies in 69.0% of the IH patients; 5 patients (8.6%) had defects >10cm in width. In the PH group, the mean total operative room (OR) time was 98.1±42.5min. Mean VAS (Visual Analog Score) was 2.5±1.7 at day 0, 61.5% of patients were ambulatory, and 38.5% stayed 1-2 nights. One (3.8%) recurrence and 1(3.8%) surgical complication (umbilical perforation) occurred with no general complications. In the IH group, 15 patients required transversus abdominis release (TAR, 25.9%). Mean OR time was 179.6±82.3min, mean VAS 1.9±2.0 at day0, 19% of patients were ambulatory, 44.8% stayed 1-2 nights and 27.6% 3-4 nights. Mean follow-up was 71.6±51.8 days. One (1.7%) postoperative complication (bleeding, embolization, no reoperation), 2(3.4%) recurrences occurred. Successful completion of an extraperitoneal (eTEP) RVHR with bilateral TAR was achieved after 18 months and 40 cases, after which we began training a second surgeon.

Conclusions

Implementation of a RVHR program showed promising results with acceptable operative time even during the learning curve. Postoperative outcomes suggest a potential advantage in postoperative recovery.
P038 MINIMALLY INVASIVE SURGERY & INCARCERATED INGUINAL HERNIA. CAN WE COMBINE THEM?
Authors: Gómez Jorge Zárate , Hernández Pedro Álvarez de Sierra , Luengas David Fernández , Someso Silvia Conde , Eslait Guillermo Supelano , Iribar Begoña Peinado , López Jose María Gil , Godino Jesús Merello
Published: December 2021

Aim

After a long experience of more than 20 years in TEP hernioplasty we explore if it can also be suitable for emergency patients.

Material and Methods

We present different laparoendoscopic schemes that we have used in our Hospital to treat strangulated inguinal hernia according to clinical and radiological findings.

Results

TEP in now assumed to be one of the best options in scheduled surgery to treat inguinal hernia. Is now the time to change the paradigm by using it also in emergency surgery?

Incarcerated inguinal hernia presents two problems: first of all the clinical emergency, an irreducible inguinal bulge that causes pain, obstruction and bowel ischemia; and second, the need to repair inguinal wall.

While treating both problems, we have explored different minimally invasive surgery approaches according to each patient´s characteristics and the preoperative risk of intestinal resection based on CT findings.

To reduce the incarcerated bulge, we use a laparoendoscopic methods. After a preperitoneal dissection, and with the help of external maneuvers, we try to reduce the content. If we are not successful, a quelotomy becomes necessary.

To treat the inguinal defect we use TEP or TAPP approaches.

Conclusions

We seek to show that endoscopic preperitoneal approach in an incarcerated inguinal hernia is safe and possible, allowing us to maintain minimal invasive techniques.

Laparoscopy allows us to explore and to treat possible complications of intestinal ischemia with no need of laparotomy.

Multiple treatment schemes are possible for inguinal incarcerated hernia. The choice must be made according to the surgeońs experience, patient´s characteristic and the risk of intestinal ischemia.
P039 INTERCOSTAL HERNIA FOLLOWING DIEP RECONSTRUCTION: A CASE PRESENTATION
Authors: Robinson Jordan , Robinson John
Published: December 2021

Aim

Intercostal lung herniation is a rare clinical condition defined as the protrusion of lung parenchyma beyond the anatomic boundaries of the thoracic wall. Acquired lung hernias are typically occur secondary to trauma or are associated with severe pulmonary disease. We present a case of lung herniation following DIEP breast reconstruction which is the first reported case to date.

Material and Methods

40-year-old woman with a history of bilateral mastectomy for breast cancer and subsequent delayed, bilateral DIEP breast reconstruction. She returned to the emergency department four days after her reconstruction with chest pain, shortness of breath and swelling of her chest. CT angiography of her chest demonstrated a focal protrusion of her right lung into her anterior chest wall (Figure 1). Thoracic surgery was consulted for repair which was achieved with a patch technique using Allomax dermal matrix.

Results

We describe the first reported intercostal lung hernia following DIEP breast reconstruction reported in scientific literature. Our patient had no history of trauma, thoracic surgery or pulmonary disease which are considered the greatest risk factors for acquired intercostal lung herniation. Much like abdominal wall hernias, protrusion of tissue through a small defect places tissue at risk for ischemia. Early recognition is thus essential to avoid tissue loss.

Conclusions

Intercostal lung hernia is an uncommon clinical entity that has not previously been described as a complication of DIEP breast reconstruction. Its development is associated with significant morbidity including flap loss in this case. Early recognition of this rare complication is essential to avoid more severe sequelae of tissue ischemia.
P047 SUTURE-TOOL: A SUTURING DEICE FOR SWIFT AND STANDARDIZED ABDOMINAL APONEUROSIS CLOSURE
Authors: Börner Gabriel , Edelhamre Marcus , Rogmark Peder , Montgomery Agneta
Published: December 2021

Aim

Introduction Surgeons can reduce incisional hernia formation by adhering to standardized techniques for incisional wound closure. This is often neglected by the time a long operation is to be ended and can lead to the risk of developing an incisional hernia or a wound rupture. To address this issue, a suturing machine (Suture-TOOL) was developed for swift and standardized abdominal closure. The aim was to compare the user safety, speed, and suturing quality between Suture-TOOL and manual Needle-Driver suturing.

Material and Methods

Fifteen surgeons who were specialists in surgery, urology, and gynaecology as well as surgical trainees were invited. The Suture-TOOL was presented to the surgeons who read the instructions for use before starting the test. Each surgeon closed nine 15-cm-long incisions in a human body model; six with Suture-TOOL and three with the Needle-Driver technique. Gloves were examined for puncture damage. Endpoints were suture-length/wound-length (SL/WL)-ratio, closure time, number of stitches, learning curve, and glove puncture rate. A VAS-evaluation concerning different Suture-TOOL user impressions was completed.

Results

SL/WL-ratio ≥4 was 98% for Suture-TOOL versus 69% for Needle-Driver (p < 0,001). Suture time was shorter for Suture-TOOL (p = 0,013). The median SL/WL-ratio was similar between the groups. The learning curve plateaued after three closures using Suture-TOOL. Two glove punctures were detected—all in the Needle-Driver group. Suture-TOOL received high VAS scores for all measured functionalities.

Conclusions

Suture-TOOL is a promising device for clinical use. It is safe, easy, and fast resulting in a high-quality suture lines with a short learning curve and a high functionality ranking.
P048 A NEW MODALITY FOR BIOMECHANICAL VALIDATION OF CLOSURE TECHNIQUES OF LAPAROTOMIES
Authors: Hartog Floris den , Sneiders Dimitri , Vlot John , Kleinrensink Gert-Jan , Jeekel Johannes , Lange Johan
Published: December 2021

Aim

Incisional hernia remains one of the most frequent complications after abdominal surgery. Several closure techniques exist. However, fundamental biomechanical understanding of these techniques and of the differences in clinical outcomes are still lacking. It is thought that distribution of lateral forces on the midline plays a role. Testing in a clinical setting is limited by sample sizes, costs and ethical regulations. We propose a preclinical ex vivo model in which multiple closure configurations can be tested in a controlled setting, eliminating interfering variables existing in previously published, more complex abdominal wall models. Consequently, this allows a valid comparison between closure modalities based on biomechanical merits.

Material and Methods

The experimental set-up is represented by a vertical tensile load tester, in which a sutured tissue sample is clamped. The tissue samples are covered with a fine, random speckle pattern via miniscule ink droplets. A high-resolution camera captures the speckles as the tissue is subjected to linear pulling forces. Image analysis documenting relative movement of speckles as a means for measuring tissue deformation is performed in ex-vivo tissue samples, resulting in specific objective biomechanical characteristics for each closure configuration.

Results

Local tissue strain fields are visualized, and compared between closure modalities and correlated to known linear forces applied to the tissue. The latest results will be shared and discussed.

Conclusions

A new modality for biomechanical evaluation of closure techniques has been developed. Further validation and serial experiments with different closure modalities with and without mesh reinforcement can be performed in order to determine the biomechanically optimal suture-technique for fascial closure.
P050 INTRODUCTION OF MINIMAL INVASIVE PROCEDURES WITH EXTRAPERITONEAL MESH PLACEMENT MAY REDUCE MORBIDITY AND LENGTH OF HOSPITAL STAY IN PATIENTS WITH INCISIONAL HERNIA - A SINGLE CENTER'S EXPERIENCE
Authors: Kundel Lena , Gröger Christian , Adam Ulrich , Riediger Hartwig
Published: December 2021

Aim

“Sublay mesh placement is the gold standard in the treatment of incisional hernias. In open surgery, high rates of wound complications are reported. Various minimal invasive procedures with extraperitoneal mesh placement (MIPEX) are currently under evaluation in order to improve the clinical results. We report our experience with an increased use of MIPEX techniques”

Material and Methods

“The perioperative results of all consecutive patients from 1/2018 to 4/2021with incisional hernia surgery were reviewed. For the purpose of this study, the results of patients with MIPEX were compared to STANDARD treatment (open surgery and/or intraperitoneal mesh). All patient data were registered prospectively in the Herniamed database. ”

Results

“103 out of 170 patients were treated with MIPEX and 67 with STANDARD. MIPEX were MILOS/E-MILOS (n = 48), TAPP (n = 15), laparoscopic sublay (n = 5), ETEP (n = 17) and other (n = 18) with additional TAR in (n = 16). Five procedures were performed robotically. Mean duration of surgery (DOS) was 150 minutes in MIPEX and 116 minutes in STANDARD (n.s.). Morbidity was 7% in MIPEX and 19% in Standard (p < 0.5). Mean length of hospital stay (LHS) was 4 days in MIPEX and 8 days in STANDARD (p < 0.5). In subgroup analysis of patients with large hernias (EHS-3, n = 31), DOS was 320 minutes (MIPEX) vs. 159 minutes (STANDARD); p < 0.01 and LHS was 8 days (MIPEX) vs. 12 days (STANDARD), p < 0.01.”

Conclusions

“MIPEX included a broad spectrum of procedures. With the implementation of MIPEX, DOS increased significantly in large hernias. Morbidity and LHS were significantly reduced in all patients.”
P052 EARLY OPERATIVE OUTCOMES OF ENHANCED-VIEW TOTALLY EXTRA PERITONEAL REPAIR(ETEP) FOR VENTRAL HERNIAS
Authors: Imamura Kiyotaka , Takada Minoru , Ambo Yoshiyasu
Published: December 2021

Aim

Early operative outcomes of enhanced-view totally extraperitoneal repair (eTEP) for ventral hernias

Material and Methods

We have retrospectively analysed the date of 41 patients who underwent an eTEP procedure on between November 2018 and April 2021 by a single surgeon and monitored until May 2021.

Results

During the study period, 29 endoscopic transversus abdominis muscle release and 12 endoscopic Rives-Stoppa techniques were performed to repair incisional (30), umbilical (6), epigastric (3), and spigelian, and parastomal hernias occurred in 1 patient each. The mean age was 68.0 years, mean BMI was 26.4 kg/m2. The hernial orifice centers were as follows: M2 in 7, M3 in 23, M4 in 5, L2 in 4, L4 in 1, and M2 and L2 (2 orifices) in 1 patient. Nine cases of large incisional hernia (width ≥10cm) were included. An average mesh area of 624cm2 was used for an average defect area of 57cm2. Mean operative time, blood loss, and length of hospital stay were 278 min, 5 ml, 6 days, respectively. Only one case was converted to an open operation due to presence of severe adhesions. Postoperative complication consisted of hematoma (n = 1) and a small bowel obstruction due to a tear of the posterior sheath (n = 1). There was no hernia recurrence at mean follow-up of 448 days. No patient reported significant pain at the surgical site at the first postoperative follow up.

Conclusions

Judging from our short-term results, eTEP approach for ventral hernias can be an attractive option for selected cases.
P056 RETROSPECTIVE ANALYSIS OF LONG-TERM INCIDENCE, RISK FACTORS AND SURGICAL REPAIR OF VENTRAL INCISIONAL HERNIAS AFTER LIVER TRANSPLANTATION
Authors: Augustin Cäcilia , Lorenz Andreas
Published: December 2021

Aim

“Assess risk factors and incidence of ventral incisional hernia (VIH) following liver transplantation (LT).”

Material and Methods

“Retrospective analysis of clinical or radiological signs of VIH during a systematic ten year follow up after liver transplantation. Descriptive statistics and a binary logistic regression analysis were performed to identify possible risk factors.”

Results

“Between 01/2007-12/2017, 708 LT were performed in 660 patients at our institution. Following LT, 122 patients (18.5%) had a VIH as identified per clinical examination. Further to this, 85 patients (12.9%) had CT findings consistent with VIH adding to a total of 207 (31.4%) patients with VIH after LT. Male gender (p < 0.001), BMI (p < 0.001), age at LT (p < 0.001), alcohol induced cirrhosis (p = 0.032) and reoperation after 180 days following LT (p = 0.007) were identified as risk factors in a multivariate analysis. An incisional hernia repair was performed in 76 patients (11.5%) at 22.9 months (median, 5.7-101.5). Laparoscopic IPOM repair was performed in 46 (60.5%) patients and 30 patients had an open hernia repair including 26 (34.2%) with mesh augmentation and 4 (5.3%) with primary closure. Five patients (6.6%) needed a reoperation for postoperative complications related to hernia repair. Recurrent VIH occurred in 12 (15.8%) patients. In 131 patients, no hernia repair was performed because of only mild clinical symptoms, patient preference and/or poor general condition.”

Conclusions

“The incidence and burden of incisional hernia following LT is significant. Many cases of VIH are clinically mild but radiomorphologically manifest.”
P057 THE ACCURACY OF INCISIONAL HERNIA CODES IN ADMINISTRATIVE DATA: A VALIDATION STUDY
Authors: Rios-Diaz Arturo , Hsu Jesse Y. , Broach Robyn , Bormann Bradford , Fischer John
Published: December 2021

Aim

Administrative databases contain valuable information for studying incisional hernia (IH) following intra-abdominal procedures at a large scale. We assessed the validity of billing codes for the identification of IH in patients following abdominal surgery.

Material and Methods

Using International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM), a random sample of 1,000 patients who underwent abdominal operations between 2006-2020 within a large health system-wide administrative database and ≥1 year of follow-up were screened for eligibility. Validation of IH codes was performed using the electronic medical record as reference. Validity metrics of interest included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Patient factors associated with false positive (FP) and false negative (FN) were also explored within univariate and multivariate analyses.

Results

759 patients were included. The sensitivity of IH codes was 94.7% (CI 91.4 – 97.0), specificity was 94.9% (CI 92.6 – 96.7), PPV was 84.4% (CI 78.5 – 88.9), NPV was 98.4 (CI 97.4 – 99.0), accuracy was 94.9% (CI 93.0 – 96.3). Within adjusted analyses, patients admitted to a non-surgical service (relative to patients admitted to surgical services; OR 4.46 [95% CI 1.06-18.66]; p = 0.04) were associated with FP; whereas every one-year increase in age was associated with a 5.0% (95% CI 1.0%-10.0%) increase in FN (p = 0.03).

Conclusions

We have validated the use of ICD-9-CM and ICD-10-CM codes for accurately identifying IH following abdominal surgery. This method yields >94% for key validity measures.
P066 ELECTIVE LICHTENSTEIN INGUINAL HERNIOPLASTY IN GERIATRIC PATIENTS WITHOUT ANTIBIOTIC PROPHYLAXIS : HOW SAFE IS IT ?
Authors: Cijan Vladimir , Bojovic Predrag , Bojicic Jovana
Published: December 2021

Aim

Elective surgery is becoming increasingly common in geriatric patients, particularly as the population is aging. The incidence of inguinal hernia in the elderly is also increasing. Lichtenstein inguinal hernioplasty is the most frequent procedure for the elective repair. There is ambiguity about the usefulness of antibiotic prophylaxis in inguinal mesh hernioplasty and the evidence for its value is still a matter of debate. Our aim was to evaluate the outcomes of Lichtenstein inguinal hernioplasty without antibiotic prophylaxis in geriatric patients.

Material and Methods

A database of patients aged 70 and more undergoing elective Lichtenstein inguinal hernioplasty was established. Patients were randomly categorized in antibiotic (received antibiotics) and placebo group (received placebo). Demographics, American Society of Anesthesiologists (ASA) classification, comorbidity, hernia type, operating time and hospitalisation were analyzed. Infections were evaluated 1 week, 2 weeks and 1 month postoperatively according to Center for Disease Control criteria.

Results

Between 2015.-2019., 400 patients were evaluated, 200 patients in each group. All patients were operated under local anaesthesia with 24-hours hospitalisation. Groups were well matched regarding demographics, ASA-type, comorbidity, hernia type, operation time. Superficial surgical site infection developed in 16 patients from the antibiotic and 19 from the placebo group. Three from each group developed deep infection. Two mesh removal was required in the placebo group.

Conclusions

Prophylactic antibiotic usage in geriatric patients undergoing Lichtenstein inguinal hernioplasty did not show any significant beneficial efects in reduction of surgical site infection. Our results do not support the routine use of antibiotics for elective inguinal hernioplasty.
P092 EVOLUTIVE MANAGEMENT OF THE OPEN ABDOMEN WITH POSTERIOR SEPARATION TECHNIQUE FOR DEFINITIVE RECONSTRUCTION
Authors: Pérez Jorge Loro , Fernández Ismael Antón , Sánchez Laura González , Rivera Nestor Betancort , Hernández Juan Ramón Hernández
Published: December 2021

Aim

Traumatic evisceration in politrauma patients is rare, with a prevalence of 1 in 40,000 trauma patients. The main mechanism is high-energy trauma to an acute surface. Our objective is to apply theoretical knowledge regarding the complex abdominal wall as an independent entity, analyzing the particular case of a patient operated in our center.

Material and Methods

Description of a clinical case using data extracted from the electronic medical record and bibliographic search in Pubmed.

Results

The reviewed literature was applied to a traumatic evisceration case with a Grade IV on the Dennis Abdominal Trauma Scale. The decisions made during the different stages in the multidisciplinary management of the traumatic evisceration were discussed. The role of Negative Pressure Therapy, the use of biological meshes, full thickness grafts and / or the Posterior Separation of Components were used to achieve a continent and functional abdomen after an injury of that magnitude during a 4-year follow-up with excellent results.

Conclusions

At the moment there is no consensus on the management of these traumatic evisceration situations. It depends in many cases on the experience of the surgeon. These cases should be treated individually based on the size and location of the lesions. The approach must be carried out in different stages, always thinking about achieving an early closure of the abdomen and preserving the anatomy of the abdominal wall. The best strategy for open abdomen reconstruction is not well defined, but we believe that Posterior Component Separation is a good option.
P111 HIGH RATE OF INCISIONAL HERNIA AFTER MASS CLOSURE OF BURST ABDOMEN
Authors: Jensen Thomas Korgaard , Gögenur Ismail , Tolstrup Mai-Britt
Published: December 2021

Aim

This study investigated the long-term effect of a standardized strategy of fascial closure with a mass closure technique, using a slowly absorbable running stitch for burst abdomen and evaluated the incidence of incisional hernia in these patients.

Material and Methods

A single-center, retrospective study including all patients that underwent surgery for burst abdomen between June 2014 and April 2019 was followed up in October 2020 to report the rate of incisional hernias.

Results

94 patients underwent surgery for burst abdomen. 80 patients was enrolled for follow up. Index surgery was acute in 78%. Incisional hernia rate was 33%. 30-day mortality rate was 24%.

Conclusions

Standardized surgery for burst abdomen with a standardized mass-closure technique still results in high rates of incisional hernias.
P116 “KIGNSNORTH MODIFIED SCORE” FOR OPEN INGUINAL HERNIA REPAIR COMPLICATIONS PREDICTION. POINTHER STUDY
Authors: Bravo-Salva Alejandro , Gonzalez-Martin Alba , Salva-Puigserver Margarita , Tellez-Marques Clara , Sancho-Insenser Joan , Pera-Roman Miguel , Pereira-Rodriguez Jose Antonio
Published: December 2021

Aim

Aim of our study is to analysis of postoperative outcomes (30 days) after elective unilateral open anterior inguinal hernia repair and prove correlation to modified Kingsnorth (MK) score classification system.

Material and Methods

Prospective registered (NTC 04806828) study of all consecutive unilateral open anterior groin hernia repair performed at a University Hospital General Surgery Department from January 2019 to December 2020. Data was stored at National Spanish Groin Hernia Registry (EVEREG). All patients were preoperatively classified using MK score. Statistical analysis of postoperative complications and their relation to preoperative modified Kingsnorth scale was performed.

Results

403 patients were included. 61% were performed as ambulatory surgery. 15.7% had more than 5-8 MK punctuation. A total of 62 patients had postoperative complications, 81% of all complications were classified as Clavien I. Higher Surgery duration was directly related to higher MK (Pearson's correlation 0.291; P < 0.0001score.) Statistically significant relationship with the presence of higher rate of complications were a KN score of 5-8 (OR 2.7; 95% CI 1.07-4.82; P = 0.03) whereas performance of surgery by an abdominal wall surgery specialist had less complications (OR 0.28; 95% CI 0.08-0.92; P = 0.03)

Conclusions

MK classification predicts surgical wound complications on patients who undergo a primary unilateral inguinal hernia surgery. A KN score of 5-8 had a higher probability of wound complications. When surgery was performed by a specialist in abdominal wall surgery, less postoperative complications were observed.
P125 MANAGEMENT OF PERICAECAL HERNIA CAUSING SMALL BOWEL OBSTRUCTION IN THE EVOLVING ERA OF LAPAROSCOPY. A CASE REPORT AND LITERATURE REVIEW
Authors: Salama Mohamed , Salama Mahmoud , Nasr Abdulrahman , Yadav Himanshu , Sami Babur
Published: December 2021

Introduction

“Internal hernias are an unusual cause of intestinal obstruction. Pericaecal hernias are an exceptionally rare type of internal hernia.

Laparoscopy for small bowel obstruction was previously considered inappropriate. We present a case of Pericaecal hernia causing small bowel obstruction treated successfully with a laparoscopic approach.”

Case-Report

“64 year old man presented with abdominal pain, vomiting and constipation for 3 days, no previous surgery. Small bowel obstruction confirmed on PFA and CT. He was treated conservatively for 10 days without settling. A an exploratory laparoscopy revealed a Pericaecal hernia. This was reduced with gentle manoeuvre and the peritoneal folds were divided to prevent recurrence. Recovery was uneventful.”

Discussion

“Perioperative diagnosis of internal hernia is extremely difficult. Pericaecal hernia is an uncommon type of internal hernia. CT diagnosis of internal hernia remains difficult. Laparoscopy is a valuable tool for diagnosis and treatment with the advantage of minimal invasiveness. However, the laparoscopic manipulation of distended bowel loops remain controversial because of high risk of perforation, reduced space to work in the peritoneal cavity and requirement of advanced laparoscopic skills. Laparoscopic treatment of Pericaecal hernia was reported about 17 years ago but has since been reported more frequently and in recent years there is a move towards laparoscopic diagnosis and management of Pericaecal hernias.”

Conclusions

“CT diagnosis of internal hernia remains difficult. With the advent of minimal access surgery, diagnostic laparoscopy may be a safe and feasible modality to diagnose and deliver definitive treatment of small bowel obstruction secondary to Pericaecal hernia.”
P135 ESTABLISHMENT OF MINIMALLY INVASIVE VENTRAL HERNIA REPAIR WITH EXTRAPERITONEAL MESH PLACEMENT AS A STANDARD APPROACH OF VENTRAL HERNIA REPAIR USING THE ROBOTIC PLATFORM
Authors: Mück Björn , Heinzelamann Frank , Vogel Robert , Büchler Peter
Published: December 2021

Aim

Several meta-analyses indicated, that extraperitoneal mesh placement in the retromuscular or preperitoneal space shows advantages over intraperitoneal mesh placement. Previous surgical interventions which included extraperitoneal mesh placement were usually performed using open surgery. For several years now, our hospital has pursued to treat ventral hernias using a minimally invasive approach with extraperitoneal mesh placement. A Da Vinci X system has been available since the beginning of 2019. The aim of this analysis is to show the process of changing the operative procedure in ventral hernia repair over the period from 2016 to 2020.

Material and Methods

All hernia operations from 2016-2020 were evaluated using our hospitals information system. Every surgical intervention which included ventral hernia repair with the indication for mesh implantation was taken into the analysis.

Results

In 2016, the proportion of minimally invasive procedures was 36.67%. In all of these cases an intraperitoneal mesh was implanted in the abdominal cavity (laparoscopic IPOM operation). Open surgery was performed in 63.33%, out of which we implanted an intraperitoneal mesh in 23.68%, a retromuscular mesh in 73.68% and an onlay mesh in 2.63% of the cases. In 2020, the proportion of minimally invasive operations was already 87.5%, of which 83.33% were performed robotically assisted and 16.67% laparoscopically. In 94.29% of the minimally invasive operated patients an extraperitoneal mesh implantation was carried out, among which 75.76% were placed in the retromuscular and 24.24% in the preperitoneal position.

Conclusions

The majority of elective operations on ventral hernias can be performed in a minimally invasive technique with retromuscular mesh placement, using the robot.
P137 DEGRADATION RESISTANCE OF PVDF MESH IN VIVO IN COMPARISON TO PP MESH
Authors: Wang Hongshi , Klosterhalfen Bernd , Müllen Andreas , Jockenhövel Stephan , Dievernich Axel , Otto Thomas
Published: December 2021

Aim

To researched the degradation resistance of PVDF mesh by comparing its morphological and chemical condition with PP mesh.

Material and Methods

PVDF and PP meshes analysed in this study were received from a previous animal experiment. To expose the surface of explanted meshes, a tissue removing method with protease was used and the result of this cleaning process was tested by X-ray Photoelectron Spectroscopy (XPS). The morphological condition of the mesh surface was compared using Scanning Electron Microscopy (SEM) and the chemical condition concerning degradation was analysed through Fourier Transform Infrared Spectroscopy (FTIR). The surface condition of PVDF mesh after 3-, 6-, 12- and 24-month implantation was illustrated and compared with two types of PP meshes.

Results

XPS revealed an absence of nitrogen, confirming the successful removal of tissue residues using protease. SEM results presented no notable morphological surface change of the PVDF mesh and progressive surface cracking processes over time of both types of PP meshes. FTIR spectra of the implanted PVDF meshes had no considerable difference from the spectrum of the pristine mesh, while FTIR spectra of both types of PP meshes had extra chemical functional groups increasing with implantation time, indicating progressive degradation.

Conclusions

PVDF mesh does not show signs of degradation up to 24 months after implantation while PP meshes progressively degrade with increasing time under the same conditions, which appears as worsening Environmental Stress Cracks. This study highlights the morphological and chemical stability of the PVDF mesh and demonstrates that the PVDF mesh is more resistant to degradation in comparison to the PP meshes.
P143 INSTRUCTION AND FEEDBACK METHOD FOR LAPAROSCOPIC HERNIA REPAIR USING SELF-MADE MANUAL WITH SELF-ASSESSMENT SHEET
Authors: Tanioka Toshiro , Yatabe Yusuke , Honda Masaki , Yagi Kenta , Saito Toshifumi , Ito Koji
Published: December 2021

Aim

We use the self-made manual to understand procedures easily, and the self-assessment sheet to improve trainees' skills efficiently. We investigated the effect of this method for trainees in laparoscopic inguinal hernia repair.

Material and Methods

In the original manual, surgical procedures and how to make surgical fields are explained using intraoperative photos, in order to clarify the purpose of the procedures in each scene of surgery. We also made the self-assessment sheet that sets goals according to the manual, and evaluates the trainee's attainment objectively. Trainees score the assessment sheet after every surgery. Trainers evaluate their sheets and give feedback on their skills with a radar chart.

Results

By using the same manual, trainees and trainers could share the same terms and thoughts easily during surgery. The self-assessment sheet made trainees effective to understand their weak points and improve their skills. At the beginning of the training, the much-experienced trainee got a higher score. As trainees experienced surgeries, they became getting higher scores. There was a significant correlation between a high score and a short operation time. A radar chart helped efficiently to understand trainees' weak points.

Conclusions

Using the self-made manual and the self-assessment sheet together was useful for both the trainer and the trainees to evaluate their attainment objectively. Scores and graphs helped trainees assess their skills efficiently.
P149 THE IMPACT OF COVID-19 ON TACKOMESH RANDOMISED CONTROLLED TRIAL COMPARING SPIRAL-TACK MESH-FIXATION DEVICES IN LAPAROSCOPIC INCISIONAL HERNIA REPAIR USING THE MANCHESTER TECHNIQUE
Authors: Pilkington James , Fullwood Catherine , Sheen Aali
Published: December 2021

Aim

Provide a report on all patients who underwent laparoscopic incisional hernia repair as part of the TACKoMesh RCT prior to unblinding of treatment arms.

Material and Methods

Trial recruitment was for primary incisional hernia with a defect diameter of 3–10cm. 63 patients (target 74-136) were operated on prior to the outbreak of COVID-19. Post-operative pain is the primary trial outcome.

Surgery was performed with either spiral-tack mesh-fixation device (Protack (permanent) or Reliatack (absorbable)), Symbotex IPOM mesh, and fascial closure with no 1 Maxon suture(s) using extracorporeal knot ties – the Manchester Technique.

Data was collected on trial forms and lifestyle questionnaires (SF-36 and CCS). All data were explored and described in RStudio v1.4.1106.

Results

Patients were aged 36-80 and 36(57.1%) patients were male. Mean preoperative BMI was 30.91(sd5.11,range21.15–43.93).

Mean operating time was 80.81(37.34,20-240)minutes. In 13(20.6%) patients multiple hernia defects were identified. A good degree of fascial closure was achieved in all patients using a median of 3(IQR 2.0-3.5)knots.

Median mesh-fixation time was 286(159.5-428.0)seconds and a mean 25.24(5.49,14-41)tacks/patient were used. Median length of hospital stay was 3.5(2.0–6.0)days.

Patients were asked “Please indicate on this scale [VAS 0–10] the pain that you currently experience from your incisional hernia during activity?”. Median responses for Day0/pre-op, Day1, Day6, Day30 and Day365 were 4.5, 8.0, 6.0, 3.0 and 1.5 respectively.

At one year, 7(11%) patients had experienced hernia recurrence and 33(52%) post-operative seroma.

Conclusions

Target recruitment was not possible owing to COVID-19. The Manchester Technique has comparable recurrence rates. Reported pain increases post-operatively but is reduced at post-operative day30 and day365.
P163 ROLE OF THE LAPAROSCOPIC APPROACH IN EMERGENT INGUINAL HERNIA REPAIR
Authors: Frias Joan Ricard Soler , León Anabel García , Tallon-Aguilar Luis , González Jose Tinoco , Arteaga Alejandro Sánchez , Ruiz Francisco Javier Padillo
Published: December 2021

Aim

Analyze the evolution of the laparoscopic approach in emergent inguinal hernia repair at our center.

Material and Methods

Retrospective review of patients with emergent inguinal hernia repair in our center from January 2011 to June 2020. Demographic, clinical and postoperative data were analyzed as well as the evolution of the laparoscopic approach.

Results

385 patients with incarcerated/strangulated inguinal hernia were registered. 58.96% were men, with a median age of 71. Of those, 22 patients (5.71%) were treated by laparoscopic approach and 363 (94.29%) by open approach. The open approach had a longer median hospitalization (4.82 vs 1.66 days), higher rate of surgical wound infection (5.51% vs. 0%), higher reoperation rate (3.31% vs 0%) and higher incidence of respiratory complications (1.97% vs 0%). 1 patient (4.54%) with laparoscopic approach required intestinal resection vs 48 patients (13.22%) of the open group, with a dehiscence rate of 0% vs 4.76% respectively. Mortality rate was 0% for the laparoscopic group and 2.75% in the open group.

In the last 18 months, 28.98% of urgent hernias repaired have been performed laparoscopically, while previously from 2011 to 2017 only 0.95%, due to the learning curve obtained in elective surgery where the laparoscopic approach has had a major development in the last 3 years.

Conclusions

Despite the evident patient selection bias because the approach choice by the surgeon in emergent inguinal hernia repair, laparoscopic approach is feasible and has lower morbidity-mortality compared to open approach in our center. In specialized centers this may be a treatment option for selected patient groups.
VP021 A WAY TO TREAT SPIGELIAN HERNIA
Authors: Barbosa Bruno , Pereira Raquel , Prudente Cesar , Diogo Maria Joao , Casimiro Carlos , Marques Vitor
Published: December 2021

Aim

“Spigelian hernia is uncommon and accounts for only 0.12–2% of all abdominal hernias. It is mandatory to perform surgical correction and in recent years the laparoscopic approach is gaining ground. The authors pretend to demonstrate a video of an outpatient laparoscopic repair of Spigelian hernia.”

Material and Methods

“53-year-old woman with a left Spigelian hernia referred to laparoscopic repair via intraperitoneal approach.”

Results

“The patient was submitted to laparoscopic correction with a Ventralex® mesh. The surgery went without any complication and under 30 minutes. A few hours after the surgery, the patient was discharged. In the follow-up appointment, the patient had no complaints or evidence of recurrence.”

Conclusions

“Spigelian hernias are rare and have a mandatory surgical indication. Traditionally, open surgical repair is most commonly used. However, laparoscopic approach is becoming increasingly popular since it allows faster recovery, shorter hospital stay, and less pain, with no commitment to recurrence. Currently, there are no studies that demonstrate the superiority of a laparoscopic technique (intraperitoneal, TAPP or TEP). The intraperitoneal route is a simple, faster, and easily reproducible approach.”
VP028 TAPP REPAIR FOR INCISIONAL LUMBAR HERNIA
Authors: Ribas Sónia , Pereira Ana Peixoto , Antunes Conceição
Published: December 2021

Aim

“Incisional hernias are very common and can present even after minimally invasive surgery for other pathologies. Laparoscopic ventral hernia repair first described by LeBlanc in 1992, gained great popularity, because of its known advantages over the open techniques.

In the last decade because of increasing concerns about the future risks of using an intra-peritoneal mesh, several minimally invasive techniques using a mesh outside abdominal cavity have been described. We report the use of a TAPP technique.”

Material and Methods

“48 yo female patient, that underwent a laparoscopic right adrenalectomy, for myelolipoma, in 2015, with subsequent incisional lumbar hernia (L4W1) in the extraction incision.”

Results

“The patient was submitted to a laparoscopic TAPP repair in ambulatory surgery with extended recovery. The hernia defect was closed with a barbed suture and it was used a 15x15cm medium weight polypropylene mesh without traumatic fixation. For pain control it was done a TAP block guided by laparoscopy. The duration of surgery was 90 minutes. The patient had no complications. No recurrence on follow-up (4 months).”

Conclusions

“New minimally invasive procedures for the repair of incisional hernias avoid the intraperitoneal mesh position and maintain all the advantages of the minimally invasive approach. Some of these techniques may be complex and have a long learning curve. TAPP seems reproducible and a good option if a good extra-peritoneal dissection is possible.

Larger series are needed, to accurately compare these new techniques with IPOM, open sublay and to select the best technique for each patient.”
P097 SHORT AND LONG-TERM COMPLICATIONS FOLLOWING ROBOTIC-ASSISTED RETROMUSCULAR VENTRAL HERNIA REPAIR
Authors: Nielsen Kristian Als , Frederichsen Mathias , Valsamidis Alexandros , Harthimmer Mads , Helligsø Per , Nielsen Michael
Published: December 2021

Aim

Robotic-assisted ventral hernia repair (rVHR) has become an attractive alternative to current laparoscopic and open procedures. The present study aims to determine short-and long-term complications following rVHR

Material and Methods

Patients undergoing rVHR from 01/01 2017 until 21/06 2020 were identified from the electronic medical record system. The medical case notes were reviewed and a telephone interview conducted to determine short and long-term complications. Patients with symptoms related to the repair were examined by a specialist in hernia surgery. US or CT scan was performed to determine the presence of absence of complications

Results

85 patients were included. Mean age was 57.8 years, 54 were males (63.5%). Mean ASA-score was 2.12 and BMI was 30.2 kg/m2. 11 patients (13%) had diabetes, 22 (26%) were active smokers, 37 (44%) had hypertension and 7 (8%) were taking anti-coagulants. The mean hernial defect was 16.1 cm2 and the mesh size was 205.4 cm2. Mean length of stay was 0.5 days and the follow-up time was 94 weeks. Hematoma was encountered in 10 (11.8%) patients. 8 (9.4%) reported of seroma and 1 (1.2%) of a superficial wound infection complicated by skin necrosis. 5 patients (5.9%) reported of chronic pain. 2 patients (2.3%) developed recurrence.

Conclusions

The study demonstrates that rVHR is feasible and associated with few complications and a very low recurrence rate. Patients who had pain before surgery were likely to have less pain following the procedure. Due to the short hospital stay the procedure is suitable as an outpatient procedure.