bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphological analysis of the distal femur as a surgical reference in biplane distal femoral osteotomy
Authors: Sano Shohei , Matsushita Takehiko , Nagata Naosuke , Tokura Takeo , Nukuto Koji , Nakanishi Yuta , Nishida Kyohei , Nagai Kanto , Kanzaki Noriyuki , Hoshino Yuichi , Matsumoto Tomoyuki , Kuroda Ryosuke
Published: May 2024

Distal femoral osteotomy (DFO) is performed alone or with high tibial osteotomy (HTO) for patients with osteoarthritis and distal femur deformities. DFO is technically demanding, particularly when creating an anterior flange. Herein, we examined the morphological characteristics of the distal femur based on the cortical shape as a surgical reference for biplanar DFO. Computed tomography images of 50 valgus and 50 varus knees of patients who underwent biplanar DFO or total knee arthroplasty were analyzed. Axial slices at the initial level of the transverse osteotomy in the DFO and slices 10 mm proximal and 10 mm distal to that level were selected. The medial and lateral cortical angles and heights (MCLA, LCLA, MCH, and LCH) were measured on axial slices. Statistical comparisons were performed between the medial and lateral cortices and valgus and varus knees. MCLA and MCH were significantly smaller and lower, respectively, than LCLA and LCH (P < 0.01). The MCLA and MCH of varus knees were significantly smaller and lower, respectively, than those of valgus knees (P < 0.01). Surgeons should carefully observe morphological differences in the distal femur cortex, distinguishing between medial and lateral knees and varus and valgus knees during the creation of the anterior flange in the DFO.
Stabilization and correction of aberrated laser beams via plasma channelling
Authors: Rondepierre Alexandre , Zhidkov Alexei , Oumbarek Espinos Driss , Hosokai Tomonao
Published: May 2024

High-power laser applications, and especially laser wakefield acceleration, continue to draw attention through various research topics, and may bring many industrial applications based on compact accelerators, from ultrafast imaging to cancer therapy. However, one main step towards this is the arch issue of stability. Indeed, the interaction of a complex, aberrated laser beam with plasma involves a lot of physical phenomena and non-linear effects, such as self-focusing and filamentation. Different outcomes can be induced by small laser instabilities (i.e. laser wavefront), therefore harming any practical solution. One promising path to be explored is the use of a plasma channel to possibly guide and correct aberrated beams. Complex and costly experimental facilities are required to investigate such topics. However, one way to quickly and efficiently explore new solutions is numerical simulations, especially Particle-In-Cell (PIC) simulations if, and only if, one is confidently implementing such aberrated beams which, contrary to a Gaussian beam, do not have analytical solutions. In this research, we propose two new advancements: the correct implementation of aberrated laser beams inside a 3D PIC code, showing a great consistency, under vacuum, compared to the calculations with Fresnel theory); and the correction of their quality via the propagation inside a plasma channel. We demonstrate improvements in the beam pattern, becoming closer to a single plasma mode with less distortions, and thus suggesting a better stability for the targeted application. Through this confident calculation technique for distorted laser beams, we are now expecting to proceed with more accurate PIC simulations, closer to experimental conditions, and obtained results with plasma channels indicate promising future research.
Numerical investigation of the effect of air layer on drag reduction in channel flow over a superhydrophobic surface
Authors: Nguyen Hoai-Thanh , Lee Sang-Wook , Ryu Jaiyoung , Kim Minjae , Yoon Jaemoon , Chang Kyoungsik
Published: May 2024

This study investigates the effects of an air layer on drag reduction and turbulence dynamics in channel flow over a superhydrophobic surface (SHS). Employing the OpenFOAM platform, direct numerical simulation was conducted to investigate turbulent channel flow with an air layer over an SHS. The simulations, which take into account the interaction between water and air, analyze various parameters such as velocity distribution, drag reduction (DR), Reynolds stress, turbulent kinetic energy (TKE), and coherent structures near the water–air interface. The presence of an air layer significantly alters the velocity distribution, leading to higher velocities at the interface compared to simulations without the air layer. Notably, the thickness of the air layer emerges as an important factor, with larger thicknesses resulting in increased velocities and drag reduction. This study underscores the substantial impact of the air layer on TKE near the superhydrophobic surface, emphasizing its role in understanding and optimizing drag reduction. Furthermore, the nonlinear relationship between slip velocity, Q contours, and coherent structures near the SHS are investigated.
Multifaceted mitochondria in innate immunity
Authors: Marques Eloïse , Kramer Robbin , Ryan Dylan G.
Published: May 2024

The ability of mitochondria to transform the energy we obtain from food into cell phosphorylation potential has long been appreciated. However, recent decades have seen an evolution in our understanding of mitochondria, highlighting their significance as key signal-transducing organelles with essential roles in immunity that extend beyond their bioenergetic function. Importantly, mitochondria retain bacterial motifs as a remnant of their endosymbiotic origin that are recognised by innate immune cells to trigger inflammation and participate in anti-microbial defence. This review aims to explore how mitochondrial physiology, spanning from oxidative phosphorylation (OxPhos) to signalling of mitochondrial nucleic acids, metabolites, and lipids, influences the effector functions of phagocytes. These myriad effector functions include macrophage polarisation, efferocytosis, anti-bactericidal activity, antigen presentation, immune signalling, and cytokine regulation. Strict regulation of these processes is critical for organismal homeostasis that when disrupted may cause injury or contribute to disease. Thus, the expanding body of literature, which continues to highlight the central role of mitochondria in the innate immune system, may provide insights for the development of the next generation of therapies for inflammatory diseases.
Photoredox/copper-catalyzed gem-difluoroalkylation-cyanation of 1,3-enynes
Authors: Wang Yachen , Liu Shuai , Huang Yangen
Published: May 2024

A photoredox/copper catalyzed three-component reaction of 1,3-enyne, difluoroalkylating reagent, and TMSCN has been developed. A diversity of difluoroalkylated allenes were generated in good yields and regioselectivity.
Novel semi-aromatic polyesters based on the biobased diol 2,2′-((3S,3aR,6S,6aR)-hexahydrofuro[3,2-b]furan-3,6-diyl)bis(ethan-1-ol): synthesis, characterization and properties
Authors: Xu Huixuan , Sun Weigang , Wei Zhonglin , Cao Jungang , Liang Dapeng , Lin Yingjie , Duan Haifeng
Published: May 2024

Herein, we provide the synthesis and characterization of a novel 2-carbon-extended diol derived from isohexide and the corresponding semi-aromatic copolyester (PIeT) based on it.
Metal-free living cationic ring-opening polymerization of cyclic esters using selenonium salts as Lewis acids
Authors: Shu Wenjing , Cheng Xiaoying , Gao Yihan , Lin Xia , Pan Xiangqiang , Li Jiajia , Zhu Jian
Published: May 2024

Selenonium salts were employed as a new class of metal-free Lewis acid catalysts for the cationic ring-opening polymerization (ROP) of various cyclic esters.
One-step preparation of hydrophilic–hydrophobic asymmetric bilayer microcapsules via photopolymerization
Authors: Wu Kaiyun , He Yongbin , Liu Jiangqing , Sun Guanqing , Liu Ren , Luo Jing
Published: May 2024

The bilayer microcapsules with balanced water-dispersibility, water-resistance properties and outstanding mechanical properties were prepared in one step by combining “phase separation inside an emulsion droplet” with photopolymerization.
A high-performance triboelectric nanogenerator with dual nanostructure for remote control of switching circuit
Authors: Dong Yanhong , Feng Yange , Wang Daoai
Published: May 2024

A high-performance triboelectric nanogenerator with dual nanostructure is fabricated and further enhanced by surface chemical modification. The triboelectric signal is used to control an optocoupler switch for remote control of a switching circuit.
Schematheorien als Grundlage von Psychotherapie
Authors: Babl Anna
Published: May 2024

In der Psychotherapie gibt es zahlreiche theoretische Ansätze und Modelle, um psychische Probleme zu
verstehen und zu behandeln. Schematheorien haben zunehmend an Bedeutung gewonnen. Sie bieten einen
faszinierenden Einblick in die Art, wie Menschen ihre Realität wahrnehmen, Beziehungen gestalten und mit
emotionalen Herausforderungen umgehen.
Superconducting single-photon detector integrated in DBR with optical microconnector for MM or SM fiber
Authors: Shibalov M V , Asharchuk I M , Epifanov E O , Trofimov I V , Mumlyakov A M , Minaev N V , Anufriev Y V , Tarkhov M A
Published: May 2024

This paper presents the development of a superconducting nanowire single-photon detector (SNSPD) integrated into a distributed Bragg reflector (DBR) with a design center wavelength of 830 nm and a bandwidth of 200 nm. This SNSPD is made of a superconducting niobium nitride (NbN) thin film that is produced using plasma-enhanced atomic layer deposition. The DBR is made of 15 alternating layers of silicon nitride and silicon oxide that are produced through plasma-enhanced chemical vapor deposition. The reflection efficiency of the mirror is 90% at a wavelength of 830 nm. For sufficient optical coupling, an optical micro-connector optimized for multimode or single-mode optical fibers with a diameter of 128 μm was formed using two-photon polymerization techniques. The niobium nitride film was deposited onto the DBR surface in-situ in two separate reactors connected by a vacuum transfer. The in-situ technique of deposition of a superconducting niobium nitride film and a DBR has allowed achieving a system detection efficiency of 90% at a wavelength of 830 nm and a dark count rate of 10 s−1 at a temperature of 2.5 K. Additionally, the detector jitter was 50 ps.
Temperature-dependent indirect gaps for two-dimensional bismuth oxychalcogenides probed by spectroscopic ellipsometry
Authors: Liu Hsiang-Lin , Chen Hsiao-Wen , Tuan Hung Nguyen , Chen Yi-Cheng , Liu Heng-Jui , Chen Chieh-Ting , Chueh Yu-Lun , Chu Ying-Hao , Saito Riichiro
Published: May 2024

In-plane optical properties of two-dimensional bismuth oxychalcogenides Bi2O2X (X = S, Se, and Te) are reported for a wide spectral range of 0.73–6.42 eV and at temperatures of 4.5–500 K by spectroscopic ellipsometry. At room temperature, Bi2O2S, Bi2O2Se, and Bi2O2Te exhibit an indirect band gap of 1.18 ± 0.02, 0.95 ± 0.01, and 0.60 ± 0.01 eV, respectively. As the temperature decreases, the indirect absorption edge of Bi2O2S undergoes a blueshift, while the indirect band gap of Bi2O2Se shows a redshift, and Bi2O2Te remains independent of temperature. The chalcogenide-dependent behavior as a function of temperature may be relevant to electron–phonon interactions in Bi2O2X materials. The observed pseudo-isotropic complex dielectric function and optical absorption coefficient by spectroscopic ellipsometry are directly compared with the first-principles calculations with a hybrid functional approach.
Indigenous Rights and the Legacies of the Bible
Authors: Brett Mark G
Published: May 2024

A Christian imagination of colonial discovery permeated the early modern world, but legal histories developed in very different ways depending on the imperial jurisdictions. This volume explores the contradictions and ironies that emerged in the interactions between biblical warrants and colonial theories of Indigenous “natural” rights. The early debates in the Americas mutated in the British colonies with a range of different outcomes after the American Revolution, and tracking the history of biblical interpretation provides an illuminating pathway through these historical complexities. A ground-breaking legal judgement in the High Court of Australia, Mabo v. Queensland (1992), demonstrates the enduring legacies of debates concerning Indigenous rights over the previous five centuries. Among other peculiarities, the case reveals that the Australian colonies represent the only jurisdiction of the English common law tradition within which no treaties were made with the First Nations. Instead, there is a peculiar development of terra nullius ideology, which can be traced back to the historic influences of the book of Genesis in Puritan thought in the seventeenth century. Bearing in mind the differences between ancient and modern notions of indigeneity, a fresh understanding of this history is timely as settler colonial states reflect on the implications of the United Nations Declaration on the Rights of Indigenous Peoples (2007). The discussion is particularly relevant for the four states who initially voted against the Declaration: the USA, Canada, New Zealand, and Australia.
Polities in Place
Authors: Brett Mark G
Published: May 2024

The chapter examines the ancestral traditions in Genesis and Exodus in light of archaeological studies. I show how the biblical othering of the “prior” inhabitants of Canaan arose not from the historical origins of Israel but from a series of imperial incursions into Israel and Judah. The chapter traces the expansion and contraction of the Levantine political identities over the centuries in response to the tides of ancient empires. An historical overview of this kind enables fresh reflections on the tensions between indigenous and exoganous (insider and outsider) motifs in the Hebrew Bible itself—long before the modern discourses of indigeneity or natural rights were invented. The chapter in no way seeks to deny that modern settler colonialism has been underpinned by biblical imagination in various ways, but shows that the ancient literature of Israel and Judah was shaped by entirely different cultural assumptions.
EVALUATING EHS PARASTOMAL HERNIA CLASSIFICATION FOR SURGICAL PLANNING: A RETROSPECTIVE ANALYSIS OF 160 CONSECUTIVE HyPER TECHNIQUE CASES IN A SINGLE CENTER
Authors: Szczepkowski M , Zamkowski M , Witkowski P , Przywózka-Suwała A , Śmietański M
Published: May 2024

Introduction

Parastomal hernia (PH) is a prevalent complication following ostomy formation, presenting significant challenges in surgical management. This study aims to validate the European Hernia Society (EHS) classification for PH through the application of the Hybrid Parastomal Endoscopic Repair (HyPER) method. The study focuses on establishing the practical utility of the EHS classification in a clinical setting, particularly in guiding surgical approaches and improving patient outcomes.

Materials and Methods

This retrospective observational study was conducted at Bielanski Hospital in Warsaw and involved a cohort of 160 patients treated using the HyPER method. Patients were classified according to the EHS criteria, and data were collected on patient demographics, clinical presentations, and surgical outcomes. The study aimed to assess the consistency and applicability of the EHS classification in predicting surgical challenges and outcomes.

Results

The study found a predominance of complex Type III and IV hernias. The EHS classification was effective in categorizing PH, aiding in surgical planning and highlighting the increased complication rates associated with more complex hernia types. This study represents the largest single-center cohort treated for PH by a single team, providing a controlled evaluation of the HyPER technique's effectiveness.

Conclusions

The validation of the EHS classification in this study is a significant advancement in the standardization of PH management. The findings demonstrate the classification’s utility in enhancing surgical planning and patient-centered care. The study also opens avenues for further research into standardized approaches and techniques in PH treatment. The single-center, single-team nature of the study, while offering consistency, invites further investigation into the generalizability of these results across different clinical settings.
STRENGTHENING PRIMARY HEALTH CARE THROUGH A LONGSTANDING GLOBAL HEALTH PARTNERSHIP: CHARTING THE TRANSITION FROM SHORT-TERM HERNIA MISSIONS TO A SELF-SUSTAINING HOSPITAL
Authors: Asubiojo B , Inchley J , Smith A , Leyden K , Wilson J , Hicks R
Published: May 2024

Aim

Hernia missions to low- and middle-income countries (LMIC) are well described and effectively reduce the global public health burden of this condition. When linked to wider health care interventions, education, and training, they deliver a more sustainable impact. The considerable impact of a 15-year-long global health partnership in the Savannah region of Ghana is described.

Methods

Since 2008, 13 hernia teams have visited the village of Carpenter to perform surgery. These visits have taken place alongside a team of health professionals from Canada and the UK, supported by charities and working in partnership with a Ghanaian non-governmental organisation (NGO).

Results

2,618 hernia patients, 55,000 medical patients, 6,335 eye patients and 2,120 dental patients have been treated. Scholarships support training of rural health care workers, and have supported health care management training, specialist training in obstetrics and gynaecology, general surgery and orthopaedics, pharmacy, nursing, and midwifery. In 2023, a 100-bed general hospital, the Leyaata Hospital, opened and has become the area’s essential health care hub. It offers specialist care, maternity, chronic disease management clinics, diagnostic imaging services and emergency services. The global health partnership has pivoted to teaching, training, and supporting the Leyaata house staff based on identified needs. This partnership continues to make significant contributions to UN Sustainable Development Goals 3, 4, 10, 17.

Conclusions

Humanitarian missions in the context of a longstanding global health partnership can have a considerable impact in an LMIC by strengthening primary health care, improving equity, and driving sustainable change.
DELPHI CONSENSUS STATEMENT FOR UNDERSTANDING AND MANAGING THE SUBCOSTAL HERNIA: SUBCOSTAL HERNIAS COLLABORATIVE REPORT (SCHOLLAR STUDY)
Authors: Baig S J , Kulkarni G V , Priya P , Afaque M Y , Bueno-Lledo J , Chintapatla S , de Beaux A , Gandhi J A , Garcia Urena M A , Hammond T M , Lomanto D , Liu R , Mehta A , Miserez M , Montgomery A , Morales-conde S , Palanivelu C , Pauli E M , Rege S A , Renard Y , Rosen M , Sanders D L , Singhal V K , Slade D A J , Warren O J , Wiejrathne S
Published: May 2024

Aim

Subcostal hernias are categorized as L1 and frequently involve M1, M2, L2 sites. The literature on subcostal hernias comprises poor-quality retrospective reviews of small heterogenous cohorts, unsurprisingly leading to no consensus or guidelines. Given the limited literature, we planned for a modified Delphi consensus to establish consensus regarding the definition, characteristics, and surgical aspects of managing subcostal hernias (SCH).

Materials and Methods

It was a four-phase Delphi study reflecting the widely accepted model, consisting of the phases: 1. Creating a steering panel and a query. 2. Building an expert panel. 3. Executing the Delphi rounds. 4. Analyzing, presenting, and reporting the results. More than 70% of agreement was defined as a consensus statement.

Results

The 22 experts who agreed to participate in this Delphi process for Subcostal Hernias (SCH) comprised 7 UK surgeons, 6 mainland European surgeons, 4 Indians, 3 from the USA, and 2 from Southeast Asia. This Delphi study on subcostal hernias achieved consensus on the following areas – definition, use of mesh in elective cases; the retromuscular position with strong discouragement for onlay mesh; use of macroporous medium-weight polypropylene mesh; use of the subcostal incision over midline incision if there is no previous midline incision; TAR over ACST; defect closure where MAS is used; transverse suturing over vertical suturing for closure of circular defects; and use of peritoneal flap when necessary.

Conclusion

This Delphi consensus defines subcostal hernias and gives insight into the incision, dissection plane, mesh placement, mesh type, and mesh fixation for these hernias.
THE IMPORTANCE OF HERNIA CENTERS TO IMPROVE ABDOMINAL WALL RECONSTRUCTION OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Balthazar da Silveira C A , Dias Rosador A C , Lima D L , Nogueira R , Sanha V , Kasakewitch J P G , Cavazzola L T , Sreeramoju P , Malcher F
Published: May 2024

Aim

Hernia registries report that general surgeons do not always implement guidelines and suggest that the success rate of this procedure is higher in hernia specialty centers. There are many definitions of hernia centers, but their objectives consist of improving health care by homogenizing the clinical practice. We performed a systematic review and meta-analysis to analyze hernia centers' definitions and compare outcomes for inguinal and ventral hernia repairs from hernia centers with non-specialized centers.

Material and Methods

Cochrane Central, Scopus, Scielo, and PubMed were systematically searched for studies defining a hernia center or comparing hernia centers and non-specialized centers. Outcomes assessed were recurrence, surgical site events, hospital length of stay (LOS), and operative time (OT). Statistical analysis was performed with R Studio.

Results

3,260 studies were screened and 13 studies were included. Five studies defined a hernia center and eight studies, comprising 141,366 patients, compared a hernia center with a non-specialized center. The definitions were similar, but differed in structural aspects and the steps required for the certification. We found lower recurrence rates for hernia centers for both inguinal (1.08% versus 5.11%; RR 0.21; 95% CI 0.19 to 0.23; P < 0.001) and ventral hernia (2.03% versus 4,16%; RR 0.54; 95% CI 0.3 to 0.96; P = 0.03). Hernia centers also presented lower surgical site infection (RR 0.43; 95% CI 0.21 to 0.9; P = 0.03), and hematoma (RR 0.21; 95% CI 0.06 to 0.81; P < 0.02) rates in ventral hernia repair.

Conclusion

Our study support that the establishment of a hernia center can improve postoperative outcomes.
TIPP VERSUS TAPP/TEP FOR PRIMARY INGUINAL HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Balthazar da Silveira C A , Dias Rasador A C , Kasakewitch J P G , Lima D L , Nogueira R , Sreeramoju P , Malcher F
Published: May 2024

Aim

The transinguinal preperitoneal (TIPP) technique is an open approach to groin hernia repair (GHR) with posteriorly positioned mesh supposed to reduce recurrence rates. However, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques have similar mesh positioning with the advantages of minimally invasive surgery (MIS). Hence, we performed a systematic review and meta-analysis comparing TIPP and MIS for GHR.

Material and Methods

Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing TIPP and MIS techniques for GHR. Outcomes assessed were recurrence, chronic pain, surgical site infection (SSI), seroma, and hematoma. We performed a subgroup analysis of TAPP and TEP techniques separately. Statistical analysis was performed with R Studio.

Results

81 studies were screened and eight studies were included, of which three compared TIPP with TEP technique, three compared TIPP with TAPP, and two compared TIPP with both MIS techniques. The TEP technique was associated with lower recurrence rates when compared to TIPP (0.38% versus 1.19%; RR 2.68; 95% CI 1.01 to 7.11; P = 0.04). The TIPP approach was associated with lower seroma rates when compared with MIS (RR 0.21; P = 0.002). There were no differences regarding overall recurrence (RR 1.54; P = 0.2), chronic pain (RR 1.39; P = 0.26), SSI (RR 2.51; P = 0.47), and hematoma (RR 1.2; P = 0.77) between MIS and TIPP. There was no difference in outcomes when comparing TIPP and TAPP techniques for all outcomes.

Conclusion

There may be benefit in using the MIS techniques to prevent recurrence in patients undergoing inguinal hernia repair when compared with the TIPP technique.
ANATOMICAL AND MECHANICAL PROPERTIES OF DIFFERENT ABDOMINAL WALL CLOSURE METHODS: THE NEW DAWN OF THE MECHANICAL CLOSURE OF THE ABDOMINAL WALL
Authors: Costa T
Published: May 2024

Aim

The closure of the abdominal wall remains one of the most debated issues in the field of hernia. Years ago we developed the usage of surgical staplers to perform this closure. That has the rationale of the small bites, with tension distribution and the usage of non-absorbable material.

However, there is a question if the stapler could hold the tension of the abdominal wall compared with a standard suture. Hence, we developed a study to compare the anatomical and mechanical properties of both types of closure.

Methods

Using a validated model, 8 male pigs, weighing between 30 and 35 kg were randomized into two groups: 1) running suture using PDS 0 and 2) Stapler (4,5 mm).

After the closure of the aponeurosis, gas was inflated into the peritoneal cavity until the evidence of friction of the aponeurosis and the tension in the wall was measured, as well as its elasticity.

Comparisons were performed using the Mann-Whitney non-parametric test.

Results

The study showed that the resistance of a continuous suture was 93 mmHg, with a standard deviation of 8.54 mmHg. The closure of the aponeurosis with a stapler showed a result of 105 mmHg, with a standard deviation of 22.73 mmHg.

There was no statistical difference (p = 0.083) between groups, showing non-inferiority of the stapler compared to the suture.

Conclusion

This study demonstrated that the stapled technique is viable compared to the standard type of closure. The non-inferior results shows that this technique may become an excellent option.
PERSISTENT MORE EMERGENCY HERNIA REPAIR BEYOND THE PANDEMIC
Authors: de Jong D L C , de Vries Reilingh T S , Hoek P E N , Zwaans W A R , Nienhuijs S W
Published: May 2024

Introduction

During the COVID-19 pandemic, elective surgeries including hernia repairs, were postponed, or cancelled completely. However, it has been stated previously that the volume of surgical emergency hernia repairs did not drop during this period. Due to the disruption in elective surgeries, waiting lists have increased rapidly, causing a suspected treatment delay.

To gain improve preoperative patient prioritization, the aim of this multicenter study was to track volumes of hernia surgery before, during and after the pandemic to investigate for a shift from elective towards emergency hernia surgery.

Methods

A retrospective study using hernia databases from four regional hospitals to account for altered referral patterns (elective versus emergent), capturing patients’ admissions and surgery times for both groin and ventral hernia repair was conducted. Study period was predefined from March 2019 to March 2023. Data are presented as descriptive statistics.

Results

During the historic period, 106 of 2267 hernia surgeries (4.7%) performed were defined as emergency repairs. During the pandemic, 1551 elective surgeries were executed, of which 103 (6.6%) emergencies. During the current period, the portion of emergencies dropped to 5% (205 emergency hernia repairs); (p = 0.039). A significant increase in emergent hernia cicatricalis repair during the pandemic period was found: chronologically 9.9%, 19.2% and 9.3% emergent repairs (p = 0.005).

Discussion

Regionwide data showed a 34% decline in hernia repairs during the pandemic compared to historical levels. Surgery rates are still convalescent, with a persistent proportion of emergent surgeries. These numbers emphasize the challenges in selecting patient whose hernia repair should not be postponed.
PREVENTION OF COMPONENT SEPARATION IN COMPLEX ABDOMINAL WALL SURGERY BY BOTOX PREHABILITATION: A PROPENSITY-MATCHED STUDY
Authors: de Jong D L C , Wegdam J A , Van der Wolk S , Nienhuijs S W , de Vries Reilingh T S
Published: May 2024

Aim

To facilitate midline fascial closure in complex abdominal wall surgery, component separation techniques (CST) are usually required. However, CST is associated with enlarged morbidity. Prehabilitation could increase the compliance of the abdominal wall and decrease the necessity of myofascial release. This can be accomplished by administration of Botulinum Toxin Type A (BTA) in the lateral abdominal wall musculature. The aim of this study was to determine the effect of BTA on the necessity to perform CST in patients with complex abdominal wall hernias.

Methods

Patients with a complex abdominal wall hernia, planned to undergo CST by myofascial release (MFR) between July 2020 and November 2022 were included. Outcome of procedures with 300U BTA 4[2–6] weeks prior to surgery, were retrospectively analyzed by comparison with propensity matched subjects of an historical group. Muscle length was assessed by CT and operative details were included.

Results

13 patients with a median hernia width of 12 cm (IQR 9–14, range 24) were prehabilitated with BTA between July 2020 and November 2022. An MFR was planned for all, however not required in 6/13 patients (46%) to accomplish midline fascial closure. A mean elongation of lateral abdominal wall musculature of 4.01 cm was seen in patients not requiring MFR. Compared to the propensity score matched control group, a 27% reduction (p = 0.08) in the need for MFR was observed.

Conclusion

There is a tendency for decrease of necessity for MFR by preoperatively administered BTA in patients with complex abdominal wall defects. Although small, as this study used propensity matched comparison, further exploration of BTA should be encouraged.
THE INCIDENCE AND SEVERITY OF ANXIETY, PAIN, SUBCLINICAL STRESS, SLEEP DISTURBANCES, AND DELIRIUM IN THE SURGICAL POPULATION: A PROSPECTIVE COHORT STUDY
Authors: Geensen R , Kakar E , Stoop J , Van Rosmalen J , Verhofstad M , Jeekel J , Klimek M
Published: May 2024

The BIG-5; anxiety, pain, stress, sleep impairment and delirium, are frequent problems among surgical patients. However, incidence, mutual correlations and correlations with patient related factors are still largely unknown. Therefore, a prospective cohort study was executed.

Patient inclusion occurred in 2021. Repeated, validated questionnaires were assessed daily in hospitalized, surgical patients until discharge.

500 patients were included. Postoperative pain and anxiety were found in 13.5% and 67% of participants. Impaired sleep quality and increased stress during hospitalization were found in 87.6% and 61.9% of all participants. Significant differences were found between all post-operative and pre-operative scores (p < 0.001). Delirium incidence was 3.4%. Impaired postoperative sleep quality was positively correlated with hospital length of stay (ρ = 0.425, p < 0.001) and surgical duration (ρ = 0.357, p < 0.001). Postoperative anxiety and postoperative stress had the strongest correlation (ρ = 0.573, p < 0.001). Woman had a relative risk (RR) of 1.32 (95% CI: 1.00–1.27) of postoperative anxiety compared to men. Non-oncological procedures are associated with an RR of 0.792 (95% CI: 0.63–1.00) of preoperative anxiety, RR of 0.84 (95% CI: 0.75–0.95) of postoperative anxiety and an RR of 0.84 (95% CI: 0.73–0.97) of stress, compared to oncological surgeries.

The BIG-5 are highly frequent complications in surgical patients, with an incidence of up to 87.6%. Adequate measures should be taken for prevention and treatment. Multiple correlations have been found amongst the BIG-5. The risk of BIG-5 differs in certain subgroups.
INCIDENCE OF AUTOIMMUNE DISEASE AFTER PLACEMENT OF A POLYPROPYLENE MESH: COHORT STUDY USING A NATIONAL HOSPITAL BILLING DATABASE
Authors: Gielen M J C A M , Roumen R M H , Bouvy N D , Zwaans W A R
Published: May 2024

Purpose

A number of patients claim to suffer from diverse systemic symptoms after surgical placement of a polypropylene (PP) implant, including unexplained fatigue, joint pain, and muscle weakness. As these complaints could resemble systemic disease, or Autoimmune disease (AID), commotion among patients exists that PP could induce such disease. The aim of this study was to identify the incidence of AID after PP-implantation, compared to controls where no PP was implanted.

Methods

In this retrospective cohort study with Dutch health insurer ‘Coöperatie VGZ’, over four million insurees were screened between January 2013 and January 2022, to identify operative procedures for inguinal hernia repair and incisional hernia repair. Cholecystectomy patients were included as controls without PP-implantation. Patients were followed from two years before, to three years after surgery, in which AID diagnoses were registered, as well as age, sex, and socio-economic status. Primary outcomes were incidence of AID after implantation of a PP mesh, and incidence of Not-Otherwise-Specified AID, compared to an index-operation without implant.

Results

The cohort consisted of 37,723 patients (19,464 inguinal/incisional hernia, 86% male vs. 18,259 cholecystectomies, 32% male). Baseline characteristics were comparable after correction by Propensity Score Matching (N = 1,500/group, Table 1). Incidence of new AID during follow-up was not statistically different between both groups (intervention 0.01 ± 0.11; control 0.01 ± 0.12; p = 0.4).

Conclusion

Incidence of AID after implantation of PP is comparable to surgery without PP-implantation, in the three years following surgery. Based on this cohort study, PP-implants do not increase medium-term risk for developing AID.Table 1.Patient characteristics after Propensity Score MatchingCharacteristicsNTotal, N = 3,000aHernia-repair with mesh, N = 1,500aCholecystectomy,N = 1,500ap-valuebSex3,000>0.9 Male2,550 (85%)1,275 (85%)1,275 (85%) Female450 (15%)225 (15%)225 (15%)Age3,00061.22 (14.39)61.12 (14.43)61.31 (14.35)0.8SES3,000-0.07 (1.92)-0.06 (1.89)-0.09 (1.95)0.5AID_before3,0000.6 Absent2,949 (98%)1,477 (98%)1,472 (98%) Present51 (1,7%)23 (1.5%)28 (1.9%)AID_after3,0000.01 (0.11)0.01 (0.11)0.01 (0.12)0.4an/N (%); Mean (SD)bFisher's Exact Test for Count Data; Wilcoxon rank sum testAbbreviations: AID, Autoimmune Disease; SES, socio-economic status.
LINEA ALBA 3D MORPHOMETRIC VARIABILITY BY CT SCAN EXPLORATION
Authors: Gueroult P , Joppin V , Chaumoitre K , Di Bisceglie M , Masson C , Bege T
Published: May 2024

Purpose

The width of the Linea alba, which is often gauged by inter-rectus distance, is a key risk factor for incisional hernia and recurrence. Previous studies provided limited descriptions with no consideration for width, location variability, or curvature.

Aim

We aimed to offer a comprehensive 3D anatomical analysis of the Linea alba, emphasizing its variations across diverse demographics.

Material and Methods

Using open source software, 2D sagittal plane and 3D reconstructions were performed on 117 patients’ CT scans. Linea alba length, curvature assessed by the sagitta (the longest perpendicular segment between xipho-pubic line and the Linea alba), and continuous width along the height were measured.

Results

The Linea alba had a rhombus shape, with a maximum width at the umbilicus of 4.4 ± 1.9 cm and a larger width above the umbilicus than below. Its length was 37.5 ± 3.6 cm, which increased with body mass index (BMI) (p < 0.001), and was shorter in women (p < 0.001). The sagitta was 2.6 ± 2.2 cm, three times higher in the obese group (p < 0.001), majorated with age (p = 0.009), but was independent of gender (p = 0.212). Linea alba width increased with both age and BMI (p < 0.001 to p = 0.002), being notably wider in women halfway between the umbilicus and pubis (p = 0.007).

Conclusion

This study provides an exhaustive 3D description of Linea Alba’s anatomical variability, presenting new considerations for curvature. This method provides a patient-specific anatomy description of the Linea alba. Further studies are needed to determine whether 3D reconstruction correlates with pathologies, such as hernias and diastasis recti.
COMPLICATIONS AND RECONSULTATION PATTERNS IN PREOPERATIVE WEIGHT OPTIMIZATION FOR COMPLEX ABDOMINAL WALL HERNIA SURGERY: A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Jaume-Bottcher S , Bravo-Salva A , Casajoana A , Pera M , Pereira J
Published: May 2024

Background

Prehabilitation is known to enhance postoperative outcomes after different surgical procedures, but no such evidence is found in abdominal wall surgery. Our aim is to analyse the complications and need for reconsultation in patients undergoing weight optimization prior to abdominal wall hernia surgery.

Methods

Prospective observational study including all patients diagnosed with complex abdominal wall hernia and IMC > 30 kg/m2 between January 2019 and December 2022. Patients were included in a pre-intervention weight optimization circuit. The need for reconsultation to the emergency room or outpatient clinic during the prehabilitation period was analysed, as well as the surgical results and post-surgical complications of those patients who underwent elective or emergency hernia repair.

Results

83 patients were included (56 female, mean age 62 years, 18 patients with Charlson ≥3). The primary hernia defect averaged 7.9 cm (SD 3.9), with 4.8% having a primary ventral hernia and 37.2% having recurrent hernias. During prehabilitation, 22.9% of patients reconsulted in the outpatient clinic, while 31.3% consulted in the emergency service. 37.3% underwent surgical hernia repair, with 12.9% of them requiring emergency surgery. Postoperative complications, classified according to the Clavien-Dindo system as >IIIa, occurred in 6.2% of cases. One patient (3.2%) required readmission after emergency hernia repair. After a median follow-up of 15 months, a recurrence rate of 3.2% was observed in the emergency hernia repair group.

Conclusion

Preoperative weight loss prehabilitation is associated to high outpatient-clinic consultation, emergency consultation and emergency hernia repair rates. Patients with a need for emergency surgery have worse postoperative outcomes.
AUTOIMMUNE RESPONSE TO HERNIA MESH
Authors: Jisova B , Strizova Z , Smetanova J , Benesova I , East B
Published: May 2024

Introduction

Hernioplasty is a widely performed surgical procedure globally. And usage of hernia mesh is often recommended. However, with the increasing prevalence of allergies and some intolerances, concerns about polypropylene have arised. So we tried to dispel the myths about allergies to hernia mesh. And in our previous research, there was no relevant information about polypropylene.

Methodology

In our database, we selected patients who underwent hernia surgery with polypropylene mesh implantation. inclusion criteria involve patients under 60 years without a history of allergy, autoimmune diseases or cancer. They provided us with a sample of venosus blood.

Database was included 34 patients in the study. 7 women and 27 men. With an additional control group of 4 women and 4 men.

Results

The initial phase of the study- lab test examination- show just a few relevant results. The control group has a higher CD4 / CD8 ratio.

Absolute number of lymphocytes was lower in the health control group, while leukocytes were elevated in study patients. Complement factor C3 is part of the innate immune system and shows variation between the two groups.

The subsequent phase of the study involved examination of specific immune reactions. Blood samples were analyzed for immune response to mesh microparticles, cultivated with T-lymphocytes.

Discussion

Although the study results are currently incomplete, we found significant differences between patients with mesh and control group. And the second part of study – the specific immune reactions will provide further insights.

Conclusion

We anticipate obtaining comprehensive results by May. And we will have clear information if polypropylene mesh should cause an autoimmune reaction.
ENDOSCOPIC RETROMUSCULAR MESH REPAIR OF SUBCOSTAL INCISIONAL HERNIA-OUR EXPERIENCE AND EARLY OUTCOME
Authors: Khetan M , Kalhan S
Published: May 2024

Aim

Subcostal lateral abdominal wall defects are encountered less frequently and their surgical management is difficult and not standardized. They vary in their anatomy and behaviour and can lead to significant comorbidity, therefore need to be managed differently.

We are presenting our experience of utilising the enhanced view total endoscopic preperitoneal (e-TEP) technique and Tranversus abdominis release (TAR) for the management of subcostal incisional hernia with early outcome.

Material and Methods

All patients with subcostal incisional hernia managed by e-TEP technique from August 2018 – December 2020 were included and data analysed. Besides recording patient demographics and hernia characteristics, the intraoperative findings and postoperative complications were also analysed.

Results

We found that out of total seven patients operated, 3 required hybrid approaches because of scar revision or bowel adhesions. In all patients endoscopic Rives-Stoppa with TAR is done with wide mesh coverage and defect closure. All patients had uneventful recovery except two who had small seroma formation, and one had local wound infection which were managed conservatively.

Conclusions

No best approach for lateral abdominal wall hernia repair has been described in the available literature. Regardless of the technique, it is recommended that the mesh area be much greater than the area of the hernia defect, i.e., the mesh should overlap the defect by 5–10 cm in all directions.

With our experience we want to emphasise that e-TEP TAR repair of lateral subcostal incisional hernia is feasible with acceptable postoperative complication rates.
PROSPECTIVE COHORT STUDY OF THE CAROLINAS EQUATION FOR QUALITY OF LIFE IN MULTIPLE LANGUAGES AMONGST THE ASIAN POPULATION AFTER INGUINAL HERNIA SURGERY
Authors: Loo L M A , Mani H , Arunoda M K P D , Madeeha A , Richie G , Lee K F S , Wijerathne S , Lomanto D
Published: May 2024

Introduction

Despite the ubiquity of inguinal hernia repair, evidence remains sparse about the validity of tools that assess post-repair Quality of Life (QoL) outcomes in Asian populations. This prospective observational study assessed the QoL outcomes post-surgical repair via the Carolinas Comfort Scale (CCS) to validate translated versions in the multi-lingual Singaporean population.

Methods

Patients undergoing elective inguinal hernia repair surgery were enrolled in this study from the National University Hospital (n = 156). Clinical data was extracted from electronic records. QoL was assessed using CCS administered at 4 time-points: pre-operatively (baseline), and post-operatively short-term (1 day–POD1), mid-term (3 months–POD3M) and long-term (1 year–POD1Y), available in English, Mandarin and Malay.

Results and Discussion

Median age and BMI of this cohort were 65 years and 23.39 kg/m2 respectively with a preponderance of males (92.9%), laparoscopic surgery (91.6%) and bilateral operations (65.6%). Post-surgery, while the mean scores for sensation of mesh, pain and movement limitation all decreased with time, only the reduction in pain scores between baseline and POD1 was statistically significant. ASA status was determined to be a significant risk factor for all 3 aspects at POD3M whilst age, race, BMI, ASA status, previous abdominal surgery, laterality of operation, smoking history and surgical approach did not significantly affect the QoL outcomes at baseline and POD1. However, smoking history and laterality of operation significantly affected scores at POD1Y.

Conclusion

QoL in terms of pain significantly improved in the immediate post operative period. Risk factors for poorer long-term QoL outcomes included worse ASA status, smoking history and unilateral operations.
THE IMPACT OF A CLOSING PROTOCOL (CP) IMPLEMENTATION ON WOUND MORBIDITY IN ABDOMINAL WALL RECONSTRUCTION (AWR) WITH MESH
Authors: Lorenz W , Polcz M , Holland A , Scarola G T , Ku D , Kercher K , Ayuso S , Augenstein V , Heniford B
Published: May 2024

Background

Wound complications (WC) are associated with increased cost, recurrence, and mesh infection. Operative CPs have not been evaluated in AWR. Our aim was to evaluate the effect of a CP on wound infection (WI) and WC.

Method

A prospective, institutional database was used to compare AWR with and without CP. Descriptive statistics and a Bayesian Structured time series analysis (BSTA) were performed to evaluate rates of WI and WC. Data is reported as means unless stated. The CP involves antibiotic wound irrigation, glove and instrument exchange, re-draping the field, surgeon-only handling the mesh prior to mesh implantation. The introduction of on-going quality improvement efforts were accounted for in the model.

Results

A total of 2541 patients were examined with an age of 57.9 ± 12.6 years, 56.7% female, BMI 32.9 ± 9.8 kg/m2, 24.2% diabetic, and 41.2% former-smokers. Defect size was 203.1 ± 205.8 cm2 and 83.1% were CDC Class 1 or 2 wounds. Follow-up was 31.5 ± 41.4 months. Overall WI and WC rate decreased after CP (14.5% vs. 2.6% and 29.3% vs. 10.3%, P < 0.001). Specifically, the rate of wound cellulitis (9.7% vs. 2.7%, P < 0.001), wound infection (13.8 vs. 1.8%, P < 0.001), and mesh infection (2.1% vs. 0.6%, P < 0.004) were reduced after CP.

For WI, BSTA revealed a relative effect of 83% (±2%, 95%CI:-87%,-78%; P = 0.0002) reduction compared to counterfactual. For WC, the BSTA revealed a relative effect reduction compared to counterfactual of 67% (±3%, 95%CI:-60%, -72%; P = 0.0002).

Conclusion

Introduction of a CP prior to mesh implantation in open AWR led to a significant reduction in overall wound infections and wound complications. The use of a CP should be strongly considered.
IS MESH TERROR ENDEMICAL? A GEOGRAPHICAL ANALYSIS OF TRENDS
Authors: Martin-del-Campo L A , Cethorth Fonseca R K
Published: May 2024

Introduction

Mesh reinforcement for hernia repair has demonstrated to reduce recurrence rates for many scenarios of ventral and inguinal defects. In recent years, many hernia surgeons from specific geographies have encountered patients who feel strongly against the use of mesh, while physicians from other areas of the world have not reported this situation. This study aims to explore the regional trends associated with this phenomenon.

Methods

A global Google Trends search using the query “hernia”, “mesh complications” and “hernia mesh lawsuit” was used for data analysis. Search results are normalized to the time and location of a query by the following process: each data point is divided by the total searches of the geography, language, and time range it represents to compare relative popularity. The popularity index is represented as a percentile.

Results

An increase in popularity of hernia-related topics has been consistent for the past 15 years and this phenomenon has been consistent almost worldwide. The search term “mesh complications” also showed an increase in popularity mainly among English-speaking countries: the average popularity index since 2004 for this term has been 12% for the United States, 8% for the United Kingdom and <1% for Australia. “Hernia mesh lawsuit” has shown a significant increase in its popularity within the United States with an average popularity index score of 4% since 2004 and growing to 10% after 2016; while remaining relatively low (1–2%) for the rest of English-speaking countries. Even after adjusting for proportionality, non-English (Spanish, Mandarin, Portuguese and Hindi) mentions of “mesh complications” and “hernia mesh lawsuit” were significantly less frequent and were, in fact, very often advertising translations of legal firms within the United States.

Conclusion

Parallel to a global increase in the interest in hernia knowledge, there has been an escalation in the search for mesh complications information especially within the United States. This increase appears to be related to a surge in law firm advertising for hernia related issues. Further studies should focus on improving understanding of the general public perception and refining education mechanisms to assist patients and surgeons.