bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on Fresh and Hardened Properties of Nano-Concrete Under Different Curing Conditions
Authors: Krishna Kumar P , Kandasamy A , Bemisha Jeni D , Anand Solomon J
Published: October 2022

In the recent days usage of nano materials in concrete are responsible in creating ultra-high-performance concrete. Curing is another important strength enhancing parameter in all types of concrete. The nano concrete was achieved by replacing cement in the conventional concrete with Nano silica (NS) in the order of 0.5%, 1%, 1.5%, 2%, 2.5% and 3%. In the present study nano concrete was experimentally explored to mechanical properties like workability, Compressive Strength (CS), Flexural Strength (FS), Bond Strength (BS), Water Absorption (WA), and Thermal Conductivity (TC) test. The mechanical properties were examined at different ages of concrete by subjecting it to four different curing conditions such as water curing, admixture curing, membrane curing and air curing. M30 grade control concrete was compared with the test results. Totally 7 mix proportions by varying nano silica volume were casted. In total 50 cubes (150mm x 150mm x 150mm), 25 prisms (150mm x 150mm x 700mm) were casted to perform the experimental study. Polyethylene glycol 400 (PEG 400) was used an internal curing admixture. Sulpho-naphthalene formaldehyde (SNF) admixture was added by 0.85% weight of cement to enhance the workability of the mix. The results proved the performance of concrete was improved when cement was replaced by 2% of NS and water curing gives the best results in all the mechanical tests performed. Addition of NS beyond 2% weight of cement reduces the fresh and harden properties due to its high Specific Surface Area (SSA). The decrease in porosity was noted with NS addition, hence water curing was best suited curing technique for Nano-concrete.
Optimization of concrete mix design using genetic algorithms
Authors: Kondapally Pavitra , Chepuri Akhilesh , Elluri Venkata Prasad , Siva Konda Reddy B.
Published: October 2022

Most of the engineering construction projects of bridges, dams consume huge quantities of concrete and other materials. Economical design can be better achieved by optimising the quantities of materials without affecting functionalities of structures. Minimising the proportions or quantities of materials without affecting its functional characteristics in a concrete mix results in most cost efficient design process. This study presents the technique of optimisation of concrete mix design applying Genetic Algorithms using a developed MATLAB program. Concrete mix design was performed for different grades of concrete and water cement ratio. It is observed that the use of Genetic Algorithms resulted in economical mix by minimizing the cement content keeping the strength of concrete unaffected. The study results indicated that quantities of cement have been reduced by about 25-40 kg per cubic meter through mix design using GA technique. This resulted in about 6-10 percent reduction in quantities of cement for various cases of mix design considered in the study. Mix design performed using optimization techniques like GA proved to be efficient when compared to mix design using manual approach. Further, the models for predicting compressive strength under different proportions of materials can also be analyzed using GA approach presented in this study.
Controlling the photoluminescence of quantum emitters in hexagonal boron nitride by external magnetic fields
Authors: Korkut Hilal , Sarpkaya İbrahim
Published: October 2022

The recent observation of room temperature spin-dependent photoluminescence (PL) emission from hexagonal boron nitride’s (h-BN’s) defect centers motivates for performing a complementary low-temperature photophysical study of quantum emitters under relatively high magnetic fields. Here, we investigate the PL emission dynamics of h-BN’s visible single-photon emitters under an applied out-of-plane magnetic field at cryogenic temperatures. The PL intensity of the emitters in our work strikingly exhibits strong magnetic field dependence and decreases with the increased magnetic field. A substantial decrease in the integrated PL intensity of the emitters by up to one order of magnitude was observed when the applied field is increased from 0 T to 7 T. The observed reversible photodarkening of PL emission due to the applied magnetic field is in very well agreement with the predictions of a recent joint experimental and theoretical study and can happen only if the spin-selective, non-radiative, and asymmetric intersystem crossing transitions proceed from the triplet excited state to the lowest-lying spin-singlet metastable state and from the metastable state to the triplet ground state. Our results not only shed more light on the light emission paths of defect centers in h-BN but also show the use of the magnetic field as an efficient control knob in the development of magneto-optical devices.
Effect of heat treatment on structure and mechanical properties of basalt fibers and its application for fabrication Cu based composite
Authors: Zhu Weiwei , Li Qian , Zou Haohao , Han Ying , Zhao Yu , Ran Xu
Published: October 2022

This paper firstly presents an experimental investigation of the effects of heat treatment temperatures and atmosphere on the tensile strength and structure of basalt fibers. The results show that the basalt fibers after heat treatment in air (200–600 °C) have the characteristics of amorphous state due to the oxidation of Fe2+ into Fe3+. On the contrary, the vacuum heat treatment induces the crystallization of basalt fibers. The reason is that the Fe2+ cations can act as network modifiers and the Fe3+ can participate in and enhance glass network. Furthermore, the single fiber strength of basalt fiber decreases with the increase of heat treatment temperature. However, the single fiber strength of basalt fibers after vacuum heat treatment is about 3 times that of basalt fibers after air heat treatment. On this foundation, basalt fibers were used for fabrication of copper matrix composites by spark plasma sintering (SPS) and hot press sintering (HPS) for the first time. The results exhibit that the strength of basalt fibers reinforced copper matrix composites prepared by SPS is 276 MPa, which are higher than that by HPS (192 MPa) due to fast heating rate and short holding time.
Wheeling around Mazur rotations problem
Authors: Cabello Sánchez Félix
Published: October 2022

We study Mazur rotations problem focusing on the metric aspects of the action of the isometry group and semitransitivity properties.
AgingBank: a manually curated knowledgebase and high-throughput analysis platform that provides experimentally supported multi-omics data relevant to aging in multiple species
Authors: Gao Yue , Shang Shipeng , Guo Shuang , Wang Xinyue , Zhou Hanxiao , Sun Yue , Gan Jing , Zhang Yakun , Li Xia , Ning Shangwei , Zhang Yunpeng
Published: October 2022

Discovering the biological basis of aging is one of the greatest remaining challenges for biomedical field. Work on the biology of aging has discovered a range of interventions and pathways that control aging rate. Thus, we developed AgingBank (http://bio-bigdata.hrbmu.edu.cn/AgingBank) which was a manually curated comprehensive database and high-throughput analysis platform that provided experimentally supported multi-omics data relevant to aging in multiple species. AgingBank contained 3771 experimentally verified aging-related multi-omics entries from studies across more than 50 model organisms, including human, mice, worms, flies and yeast. The records included genome (single nucleotide polymorphism, copy number variation and somatic mutation), transcriptome [mRNA, long non-coding RNA (lncRNA), microRNA (miRNA) and circular RNA (circRNA)], epigenome (DNA methylation and histone modification), other modification and regulation elements (transcription factor, enhancer, promoter, gene silence, alternative splicing and RNA editing). In addition, AgingBank was also an online computational analysis platform containing five useful tools (Aging Landscape, Differential Expression Analyzer, Data Heat Mapper, Co-Expression Network and Functional Annotation Analyzer), nearly 112 high-throughput experiments of genes, miRNAs, lncRNAs, circRNAs and methylation sites related with aging. Cancer & Aging module was developed to explore the relationships between aging and cancer. Submit & Analysis module allows users upload and analyze their experiments data. AginBank is a valuable resource for elucidating aging-related biomarkers and relationships with other diseases.
DD-01 THE INVITE STUDY: INCISIONAL HERNIA PREVENTION: RISK-BENEFIT FROM A PATIENT'S PERSPECTIVE
Authors: Smith L , Cornish J , Meggy A , Torkington J
Published: October 2022

Introduction

Incisional Hernia (IH) is a common complication of abdominal surgery. IH is associated with significant morbidity to patients, and costs to the NHS. With no singular intervention demonstrated to bring the rate of IH below 12%, focus is now on pre-operative risk-prediction. High-risk patients may benefit from prophylactic mesh placement during their index operation, however with controversy surrounding the use of mesh, there is no understanding of whether this intervention is acceptable to patients.

Methods

This is a retrospective, single centre mixed-methods cohort study. Patients with and without IH who have undergone colorectal surgery will be approached, along with a smaller cohort of patients about to undergo surgery. Participants will be asked to complete a questionnaire and a sub-set of participants will be invited to semi-structured interviews. The primary objective is to assess the acceptability of prophylactic mesh to patients. Secondary outcomes include understanding patient's views on risk-predictive modelling, and factors that may influence or alter the acceptability of mesh.

Analysis

Questionnaires have been developed using a 5-point Likert scale to allow quantitative analysis. Qualitative analysis of interviews will be conducted using Clarke and Braun's framework of thematic analysis. Data will be presented using the Journal Article Reporting Standards (JARS) for mixed-methods research.

Outcomes

Ethical approval has been granted, and the trial is currently in set-up. Results from this study will be used to inform both in the design and recruitement of patients to future interventional trials using prophylactic mesh in the UK.
DD-05 INCISIONAL HERNIA PREVENTION - INVESTIGATION OF A NOVEL DEVICE FOR STANDARDIZED ABDOMINAL CLOSURE
Authors: Börner G , Montgomery A
Published: October 2022

Aim

Surgeons can reduce incisional hernia formation by adhering to standardized techniques for incisional wound closure. This is often neglected at the end of a long operation which can lead to wound infection, wound rupture and incisional hernia formation. To address this issue, a suturing device was developed for swift and standardized abdominal closure. Preclinical studies have shown an adherence to Suture-Length/Wound-Length ratio ≥4 (SL/WL ratio) of 95% with the device compared to 69% for manual suturing and a >30% reduction in closure time. The aim is to perform a first in man study to verify the device performance and user safety.

Method

The study will be performed in a four month period at a single center. Principal investigator are appointed and research nurse funded. Forty patients undergoing elective open surgery for colorectal disease will be assigned to the study and follow up time will be 45 days. Endpoints will be adherence to SL/WL ratio of 4, abdominal closure time and wound infection. The study will include usability assessment and scoring of surgeon satifaction.

Results

If previous promising results from preclinical studies in animal tissue models and cadavers are verified in patients, this novel suturing device can be an important tool to reduce abdominal wall closure related complications. This will have an impact on patient quality of life, save surgical resources and contribute to a more predictable postoperative pathway.
OC-001 SINGLE-STAGED ABDOMINAL WALL RECONSTRUCTION IN CONJUNCTION WITH ENTEROCUTANEOUS FISTULA REPAIR WITH AND WITHOUT ACELLULAR DERMAL MATRICES: A SINGLE CENTRE OBSERVATIONAL COMPARISON OF SHORT-TERM OUTCOMES
Authors: Hodgkinson J , Al-Kizwini E , Leo C A , Maeda Y , Constantinides J , Mehta A , Warusavitarne J , Vaizey C
Published: October 2022

Aim

Single-staged abdominal wall reconstruction (AWR) with simultaneous enterocutaneous fistula (ECF) repair is safe. This study aims to evaluate short-term outcomes from AWR with ECF repair and compare short-term outcomes between two commonly used acellular dermal matrices (ADM) as well as suture repair alone, with focus on ECF recurrence.

Methods

Data were collected between 2011 and 2019 from a prospectively maintained operative database. A retrospective case-note review identifed patient demographics and post-operative outcomes. Kruskal-Wallis test was used for categorical variables and one-way ANOVA for continuous variables to evaluate between groups.

Results

One hundred and fifteen cases were performed in the study period: 70 primary suture repair, 28 Surgimend and 17 Strattice. Fifty-eight patients (50.4%) were female with a mean age of 55.3 years (SD 13.9), BMI of 26.9 (SD 5.18) and 75 (65.2%) had intestinal failure. Median length of stay was 25 days (range 7–176).

Overall, fistula recurrence rate was 10.4% (12 cases). Of these, 9 (12.8%) occurred in the suture repair group, 2 (11.8%) where a Strattice mesh was used and 1 (3.6%) where a Surgimend mesh was used (p=0.54). Forty-six patients (40%) had a Clavien Dindo complication of >3 and 73 patients (53.2%) had an SSI. Mortality was low at 2.8%.

Conclusion

Single-staged AWR in conjunction with ECF repair remains a complex but safe undertaking. Initial experience suggests Surgimend is safe to use in the context of single-staged AWR and ECF recurrence rates are lower than with a comparable ADM with similar short-term outcomes.
OC-006 LAPAROSCOPIC TOTALLY EXTRA-PERITONEAL REPAIR OF BILATERAL INGUINAL HERNIAS WITH A LARGE SINGLE MESH: A SINGLE CENTER STUDY WITH MINIMUM 5 YEARS FOLLOW UP
Authors: Shaltiel T , Grassi C , Esepkina O , Issa N
Published: October 2022

Background

Laparoscopic totally extraperitoneal (TEP) surgery with a single large mesh is currently the technique of choice for repair of bilateral inguinal hernias in our institution. Most surgeons use two meshes for the TEP repair. We present our experience with a single mesh repair.

Material & Methods

Records of all patients who had bilateral inguinal hernia and underwent bilateral laparoscopic TEP repair at our institution, 2010–2016, were retrospectively reviewed. We excluded patients who had a conversion to transabdominal intraperitoneal or open approach.

Results

A total of 470 patients were identified. The median age of patients was 56 (IQR 1–3; 41–66) years and median BMI was 25.9 (IQR 1–3; 23.1–28.1). 18.7% of the cohort (88 patients) had previous abdominal surgery and 39 patients (8.41%) had a recurrent inguinal hernia. Median length of operation was 63 (IQR1–3; 48–89) minutes. Operative complication were bleeding (0.4%) and bladder injury (0.2%). Post operative complications occurred in 32 patients; among the complications were seroma (2.6%), hematoma (2.1%), surgical site infection (0.4%) urinary retention (1.5%) and intestinal obstruction (0.2%). Median length of hospitalization was 1 day (IQR1–3; 1–2). After a median follow up of 102 months, 36 patients had a recurrence. 20 patients (4.3%) had a re-operation for recurrent inguinal hernia. Post-operative groin pain was present in 48 patients.

Conclusion

The use of a large single mesh is an effective and safe technique for TEP repair of bilateral inguinal hernias. The recurrence rate and prevalence of post-operative pain is consistent with the results reported by others.
OC-007 RELIABLE AND COST-EFFECTIVE METHOD OF GROIN HERNIA SURGERY, BASED ON OPEN PRE-PERITONEAL APPROACH AND ORIGINAL MESH FIXATION
Authors: Podpriatov S , Podpryatov S , Bondar S , Levytska O
Published: October 2022

Aim

To analyze the results of original technique for groin hernia (GH) repair, via open preperitoneal approach (OPPA) had proposed by L.M.Nyhus.

Material & Methods

There were 161 patients 22–87 years old; in 25 cases GH were recurrent. After OPPA, the spermatic cord, inguinal ligament, interior inguinal ring and abdominal wall defect were always in full vision. GH sack was removed into abdominal cavity. The mesh, having spermatic cord got through a special orifice in it, was fixed to inguinal ligament along it full length, and to rectus abdominis muscle’ lateral edge. Inguinal abdominal wall defect was covered from within by mesh under visual and palpable control.

Results

Operation time takes 42.5±9.1 minutes for simple GH, and 103.5±21.4 minutes for irreducible inguinal-scrotal hernia. General burden of surgery was correspondent to minimal invasive. Follow-up to work became from 3–5th day. For 12 months 107 (60.9%) patients were followed, no hernia recurrence was found.

Conclusions

Our method has basic prevalence over: i) possibility of one-day surgery (longer hospitalization if comorbidities); ii) cost-saving because needn't in laparoscopic equipment; iii) simplicity and high reliability because of visual anatomic controlled mesh fixation and positioning for the total closing of groin gap. It may pretend for a proper approval at EHS guidelines. The learning curve and additional points, such as type and quantity of fixation points, best of mesh to be used, should be discussed after the further evaluation.
OC-010 RESULTS OF PREHABILITATION IN PATIENTS WITH COMPLEX ABDOMINAL WALL DEFECTS
Authors: De Jong D , Wegdam J , Nienhuijs S , De Vries Reilingh T
Published: October 2022

Aim

Complex abdominal wall reconstruction (CAWR) remains challenging, even in expert centers. Complication rates are still high, especially in patients with modifiable risk factors (MRF) like obesity, smoking, or diabetes. For several surgical trajectories, prehabilitation of MRF has shown to reduce complication rate. The purpose of this study was to determine the effect of prehabilitation in high risk MRF patients undergoing CAWR on convalescence.

Materials and Methods

A retrospective cohort study was performed in an expert hernia center. All patients undergoing complex abdominal wall defect reconstruction (hernia width beyond 10 cm, contaminated surgical field or relevant comorbidities) between 2015 and 2019 were included. Each patient was discussed in a multidisciplinary meeting, after which those referred for prehabilitation were compared to those with direct approval. Focus of a supervised preconditioning program could be weight loss, smoking cessation, physical training or a combination.

Results

From 418 patients discussed, 259 patients underwent CAWR and were included for analysis, of which 126 (49%) underwent prehabilitation. Hernia and intra-operative characteristics were comparable. BMI (28vs30, p<0.001), HbA1c (41vs48, p=0.014), active smokers (4%vs25%, p<0.001) and risk factors (14%vs48%, p<0.001) were higher in the latter group. After prehabilitation, characteristics were comparable. There were no significant differences in postoperative outcome measures (hospital stay 6[5–8]vs6[5–8] days, p=0.908, complication rate 39%vs33%, p=0.190).

Conclusions

Prehabilitation of modifiable risk factors is profitable in patients planned for CAWR. Subsequent postoperative results were comparable to those without or with less risk factors: prehabilitation downgrades high risk patients to low risk patients. Prospective research is advised.
OC-011 PREOPERATIVE BOTULINUM TOXIN A INJECTION CAN ACHIEVE SIMILAR OUTCOMES AS COMPONENT SEPARATION TECHNIQUES IN COMPLEX ABDOMINAL WALL RECONSTRUCTION WITH DECREASED MORBIDITY– A PROPENSITY-SCORED MATCHED STUDY
Authors: Marturano M , Ayuso S , Ku D , Raible R , Lopez R , Colavita P , Augenstein V , Heniford B T
Published: October 2022

Aims

CST have been effective in closing large defects but at the sacrifice of fascia and muscle and often increasing complication rates. Preoperative BTA has emerged as an adjunct to aid in fascial closure. Little data exist comparing pre-operative BTA versus CST, and our aim was to do so in a matched study.

Materials & Methods

A 3:1 propensity matched study of patients from a single institution hernia database undergoing AWR from 2016 to 2021 with BTA versus CST was performed based on BMI, defect width, hernia volume, and CDC wound classification. Demographics, operative characteristics, and outcomes were evaluated.

Results

35 BTA vs 105 CST matched patients were analyzed. Hernia defects and volume were large for both the CST and BTA groups (mean size:286.2+179.9cm2vs289.7+162.4cm2;p=0.73) (mean volume:1498.3+2043.4cm3vs2914.7+6539.4cm3;p=0.35). CDC wound classifications were equivalent (CDC3 and 4–39.1%vs40.0%;p=0.97). CST was more frequently performed in European Hernia Society M1 hernias (21% vs 2.9%;p=0.01). The BTA group had fewer surgical site occurrences (SSO) (32.4%vs11.4%;p=0.02) and surgical site infections (SSI) (11.7%vs0%;p=0.04). There was no difference in fascial closure (90.5%vs100%;p=0.11)) or recurrence (12.4%vs2.9%;p=0.10) with similar median follow-up (22.8+29.7vs 9.8+12.7months;p=0.13). In multivariate analysis, BTA was associated with lower rates of SSO (OR=5.3; 95% CI [1.4–34.4]).

Conclusion

There was no difference in fascial closure rates or in hernia recurrence between the two groups. Pre-operative BTA can thereby achieve similar outcomes as CST while concurrently decreasing the frequency of SSO. This similarity in outcomes is upheld when comparing BTA to both ACST and PCST separately.
OC-018 ASSESSMENT OF A SUPPORT GARMENT IN RELATION TO A PARASTOMAL BULGE – A QUALITATIVE STUDY
Authors: Krogsgaard M , Borglit T B , Theisen S Z , Rothmann M J
Published: October 2022

Aim

To investigate patients’ experiences of the assessment of support garments in relation to a parastomal bulge.

Material and Methods

A qualitative study with 11 in-depth semi-structured interviews. A preceding systematic literature review and a small field study conducted before the study informed the main topics in the interview guide.

Results

Garments had to fit patients’ needs and personal preferences; being comfortable, flexible and user-friendly. When comorbidities, e.g., incontinence, poor balance, arthritis and visual impairment were not accounted for, garments were unmanageable to patients. Patients needed guidance on how to apply and use the garment. Lack of hands-on guidance left patients confused and helpless with unworn garments. Re-assessment of a garment necessitated several visits to the manufacturer, was time-consuming and stressful for patients and required patients’ physical and mental resources. The garment created new possibilities and challenges; well-assessed garments reduced symptoms from the parastomal bulge while poorly assessed worsened or induced new symptoms and ended up unworn.

Conclusion

Exploring patients’ expectations, symptoms, needs and comorbidity were vital for patients’ subsequent use and benefit of garments. Tailor-made information, guidance and professional assistance are important in the assessment process. Interventions to support a patient-centred, individual and systematic approach are warranted.
OC-025 STRATEGY FOR SURGICAL TREATMENT OF GIANT INGUINOSCROTAL HERNIA - SERIES OF 21 CONSECUTIVE PATIENTS DURING 15 YEARS
Authors: Zuvela M , Galun D , Bogdanovic A , Palibrk I , Velickovic J , Djukanovic M , Zivanovic M , Zuvela M , Zuvela M
Published: October 2022

Aim

To present our strategy for surgical treatment of patients with giant inguinoscrotal hernia whose hernia defect is ≥10 cm or who have a loss of domain.

Material and methods

Between January 2006 - January 2022, 21 consecutive patients with giant inguinoscrotal hernia and high risk of postoperative intra-abdominal hypertension were managed. The hernia was repaired in the following manner: modified Rives technique performed through direct inguinal approach in 10 patients; additional procedures were needed to reduce the volume of organs returned to the abdomen in four patients; the primary abdominal cavity was enlarged by various components separation techniques with or without mesh hernioplasty in seven patients.

Results

The hernia defect size was in range 7–17 cm. In three patients the contents of the hernia sac accounted for more than 50% of the intestines: entire large bowel without the rectum, ileum, jejunum except proximal 15 cm and greater omentum). Postoperative complications occurred in eight patients were: scrotal hematoma, deep mesh infection, seroma and hydrocele. There were three postoperative deaths: 12 hours, 17 and 42 days after the surgery because ischemic enteritis, cerebrovascular stroke and heart failure, respectively.

Conclusion

Our strategy consisting of modified Rives technique performed through direct inguinal approach with or without additional procedures to reduce the volume of organs returned to the abdomen or to enlarge the primary abdominal cavity can be a good solution for giant inguinoscrotal hernias. Procedure is followed by the risk of deadly complications and requires trained team in intesive care unit.
OC-031 INCIDENCE AND RISK FACTORS FOR RECURRENCE OF RIVES-STOPPA REPAIR FOR INCISIONAL HERNIAS. TWENTY-YEAR RETROSPECTIVE ANALYSIS OF LONG-TERM OUTCOMES OF DIFFERENT MESH REPAIRS
Authors: Oprea V , Toma M , Buia F , Leuca D , Gheorghescu D , Grad O , Chiorescu S
Published: October 2022

Objective

the aim of this study was to determine the long-term recurrence and complication rates following Rives-Stoppa repair of midline incisional hernias with different types of synthetic materials.

Patients and Methods

medical files of 1628 patients with midline incisional hernias who underwent abdominal wall reconstruction using Rives-Stoppa repair between January 1999 and December 2019 were reviewed. All patients followed up after 1 month, 6 months, and 1year later and after that yearly.

Results

until 2007, 674 patients were operated on with available meshes for that time (mosquito net – 135, polyester mesh – 322, and polypropylene mesh – 217). After 2007, polypropylene meshes were used in 1054 patients (heavyweight in 428 patients and lightweight meshes in 626). The global recurrence rate after a mean follow-up of 96.5 months in the first group of patients was 13.3% and in the second group was 7.13% (mean follow-up of 108.4 months). The infection rate was 16.8% versus 9.2% with an increased incidence at 30 days (84 vs 62 patients). The hematoma rate was equally distributed. Seroma formation was almost 2.5-fold increased in the first group of patients (21.3% vs 8.7%). Increased rate of seroma formation were associated with mosquito net (OR = 1.7; 95% CI = 0.5–1.3; p=o.o2), heavyweight type type (OR = 0.9; 95 CI = 0.07–0.4; p=o.o31). Infection was associated with the usage of mosquito net, heavyweight type, and polyester mesh.

Conclusions

the lightweight mesh offers a safe method for abdominal wall reconstruction.
OC-040 RETAINER I (RETENTION OF URINE AFTER INGUINAL HERNIA ELECTIVE REPAIR), A PROSPECTIVE, INTERNATIONAL, MULTICENTRE COHORT STUDY
Authors: Croghan S , Fullard A , Fleming C ,   I S R C
Published: October 2022

Aim

Post-operative urinary retention (POUR) is a recognised complication of inguinal hernia repair (IHR). Reported incidence is variable, and reporting of risk factors, contradictory. We aimed to report the rate, risk factors and impact of POUR post IHR.

Methods

A prospective international observational study was performed with 4 week data collection from each centre (March-November 2021). Patients undergoing elective open/minimally-invasive IHR were eligible. Exclusion criteria included a urethral catheter at baseline. Preoperative/intraoperative/postoperative variables were analysed and data recorded via REDCap. Multivariate analysis was performed with a primary outcome of development of POUR. Secondary outcomes were risk factors for, and implications of, POUR.

Results

4,153 patients (205 centres; 35 countries) were registered. Mean age was 54.7 years (18–95) and BMI 26.5 (16–6). 80.4% (n=3167) were performed open and 17% (n=674) minimally-invasively. The overall rate of POUR was 5.8% (n=225) and increasd >9% in male patients aged >65 years old. Risk factors associated with POUR included: higher preoperative IPSS scores (mean 9.4 vs 5.6 in non-POUR cohort, p<0.001), diagnosis of BPH (p<0.001), pre-operative constipation (p=0.009) defined as no bowel opening for two days pre-operatively and pre-operative post void residual volumes (<0.001). 37% of patients developing POUR required an unplanned hospital admission.

Conclusion

This study suggests a global POUR rate of approximately 5% following elective IHR and confirm a significant impact of POUR on patients and hospital services. Findings highlight several risk factors and confirm the IPSS score as a potential risk stratification tool.
OC-047 LEARNING CURVE IN HERNIA SURGERY- A REGISTER BASED STUDY
Authors: Bladin O , Young N , Nordquist J , Roy J , Järnbert Pettersson H , Sandblom G , Löfgren J
Published: October 2022

Aim

The purpose of this study was to investigate the learning curve of open anterior mesh repair for groin hernia by assessing hernia recurrence rates, surgical complications, and operative times in relation to the number of procedures performed by surgical trainees.

Materials & Methods

Nationwide data on open anterior mesh repair for groin hernia performed by surgical residents were collected from the Swedish Hernia Register between 2005 and 2020. Data were analyzed in a cohort of procedures carried out by surgeons performing their first registered repair as resident. Repairs performed by surgeons who had carried out less than 30 repairs or any repair 1992–2005 were excluded.

Results

The study group consisted of 38 854 repairs carried out by 663 surgeons. The complication rate increased from 298/9884 (3.0%) the first 15 repairs performed to 396/10978 (3.6%) repairs 31–60 and then decreased to 4/945 (0.4%) for repairs performed after the first 240 ones. Mean operation time decreased from 79 minutes (standard deciation [SD] 26 minutes) the first 15 repairs to 60 minutes (SD 23 minutes) for repairs performed after the first 240 ones. Recurrence rates remained unchanged during the learning curve.

Conclusions

It is safe for resident surgeons to perform uncomplicated, elective, anterior groin hernia mesh repair after having completed of at least 60 procedures.
OC-050 “HAPPY TO CLOSE?”: THE RELATIONSHIP BETWEEN SURGICAL EXPERIENCE AND INCISIONAL HERNIA RATES FOLLOWING ABDOMINAL WALL CLOSURE IN COLORECTAL SURGERY
Authors: Smith L , Fegan G , Torkington J
Published: October 2022

Introduction

Incisional Hernia (IH) is a common complication of colorectal surgery. Given high recurrence rates and associated morbidity, emphasis must be on prevention of IH. There is an association between surgeon volume and outcomes in hernia surgery, yet little evidence regarding impact of the experience of the surgeon performing abdominal wall closure (AWC) on IH rate.

Our aim was to assess the rates of IH at 1 year following surgery between Registrar and Consultant surgeons in patients undergoing elective colorectal surgery.

Methods

Patients undergoing elective surgery for colorectal cancer between 2014–2018 were identified through the Hughes Abdominal Repair Trial (HART), a prospective, multicentre randomised control trial. Grade of surgeon performing AWC was categorised into “Registrar” and “Consultant” and compared with IH detected at clinical examination at 1 year following surgery.

Results

663 patients were suitable for inclusion. 44% were closed by registrars (n=289). Groups were comparable in BMI, previous surgery and pre-operative IH. The rate of IH in patients closed by registrars was significantly higher than those closed by consultants (20% vs 12%, p<0.01). Patients who underwent AWC by a registrar were 88% more likely to develop IH at 1 year (OR 1.88, 95%CI 1.23–2.86, p<0.01).

Conclusion

Patients who undergo AWC by a registrar have an increased risk of developing IH compared to those closed by a consultant. Further work is needed to determine the impact of supervised and un-supervised trainees on IH rates, but AWC should be treated as training time rather than coffee time.
OC-052 A CHANGE IN PRESENTATION OF PARAOESOPHAGEAL HIATUS HERNIA REQUIRING SURGICAL INTERVENTION IN A DISTRICT GENERAL HOSPITAL IN THE NORTHERN REGION OF THE UNITED KINGDOM
Authors: Chen E , Ng C E , Toumi Z
Published: October 2022

Aim

The incidence of paraoesphageal hiatus hernia (PEH) has changed over the last several years. This study aims to ascertain the difference in the presentation of PEH requiring operative intervention at our unit because of the COVID-19 pandemic

Material & Methods

We conducted a retrospective review of procedures performed by a single surgeon for PEH in a district general hospital. We compared cases from 2016 to March 2020 and during the initial period of the COVID-19 pandemic in 2020.

Results

39 consecutive cases were identified undergoing PEH related procedures. The median age was 66 (IQR 26), with slight female predominance (M:F ratio of 5:6). 28 cases (71.8%) were performed as elective cases.

After the 2020 March lockdown, there were 10 cases of PEH repair performed with 78% performed as emergency procedures, compared to 30 cases in the preceding 5 years and 10% performed as emergency cases. Chi-square test to examine the association between COVID-19 pandemic and emergency procedure, X2(1, N=39)=14.199, p=0.000164.

Pre-COVID19 the types of procedures included 76.7% were fundoplication with suture crural closure, 10% were fundoplication with mesh repair, 3.3% biological mesh repair, 3.3% with suture closure of the crural and 6.7% had suture gastropexy. During the COVID-19 period, 44.4% were gastropexy, 33.3% were gastrostomy tube insertion and 22.2% fundoplication performed.

Conclusion

We have seen significantly more emergency PEH related procedures performed and using a variety of procedures. This leads to the consideration of whether current emergency general surgery training can equip trainees for future independent practice.
OC-057 PREVENTION OF INCISIONAL HERNIAS BY PROPHYLACTIC MESH-AUGMENTED REINFORCEMENT OF MIDLINE LAPAROTOMIES FOR ABDOMINAL AORTIC ANEURYSM TREATMENT. 5-YEAR FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL
Authors: Dewulf M , Muysoms F , Vierendeels T , Huyghe M , Miserez M , Ruppert M , Van Bergen L , Berrevoet F , Detry O
Published: October 2022

Introduction

The incidence of incisional hernias (IHs) after open repair of an abdominal aortic aneurysm (AAA) is high. Several randomized controlled trials have reported favorable results with the use of prophylactic mesh to prevent IHs, without increasing complications. In this analysis we report on the results of the 60-month follow-up of the PRIMAAT trial (Ann Surg 2016; 263(4): 638–45).

Methods

In a prospective, multicenter, open label, randomized design, patients were randomized between prophylactic retrorectus mesh reinforcement (MESH group), and primary closure of their midline laparotomy after open AAA repair (NOMESH group). This article reports on the results of clinical follow-up after 60 months. If performed, ultrasonography or computed tomography were used for the diagnosis of IHs.

Results

Of the 120 randomized patients, 114 were included in the intention-to-treat analysis. Thirty-three patients in the NOMESH group (33/58–56.9%) and 34 patients in the MESH group (34/56–60.7%) were evaluated after 5 years. The cumulative incidence of IHs in the NOMESH group was 32.9% after 24 months and 49.2% after 60 months. No incisional hernias were diagnosed in the MESH group. In the NOMESH group, 21.7% (5/23) underwent reoperation within 5 years due to an IH.

Conclusion

Prophylactic retrorectus mesh reinforcement after midline laparotomy for the treatment of AAAs safely and effectively decreases the rate of IHs. The cumulative incidence of IHs after open AAA repair, when no mesh is used, continues to increase during the first 5 years after surgery, which leads to a substantial rate of hernia repairs.
OC-074 BILAYERED RETICULAR AND LAMINAR POLYPROPYLENE MESH AS A USEFUL TEMPORARY ABDOMINAL CLOSURE FOR THE MANAGEMENT OF THE OPEN ABDOMEN
Authors: Lopez Monclus J , Muñoz Rodriguez J , Roman Garcia De Leon L , Polaino Moreno V , Suarez Sanchez M , Gil Cidoncha L , Martin Rodrigo P , Lucena De La Poza J L , Robin A , Blazquez Hernando L , Garcia Ureña M A
Published: October 2022

Aim

To demonstrate the utility of a bilayered reticular and laminar polypropylene (PLP) mesh as a temporary abdominal closure device for the management of the open abdomen.

Patients And Methods

Prospective multicentric study including consecutive patients with open abdomen of any etiology. A bilayerede PLP mesh is used as temporary abdominal closure. The mesh has a 30×40 cm laminar PLP intraperitoneal layer that is fully deployed covering the viscera, and a 30x 40 cm large pore PLP layer that is trimmed to the size of the defect and sutured to the border of the fascia. Depending on the evolution time and the clinical situation of the patient, successive plicatures of the reticular PLP are performed to reduce the fascial defect. At the end, the mesh is explanted, and a complete fascial closure is attempted.

Results

Eighteen patients were included. Etiologies of the open abdomen were vascular (22%), trauma (28%) and sepsis (50%). There were 72% female patients, mean age of 60 years (range 19–81). Four patients died in the first 72 hours due to complications of their pathology. The other 14 patients survived, with a mean time of open abdomen of 15 days (range 1–43). In all cases a total fascial closure was achieved, with absence of adhesions between the visceral and the parietal peritoneum. No complications related with the mesh took place during the follow up

Conclusion

Temporary abdominal closure with a bilayered reticular and laminar polypropylene mesh is efficient and safe, with a 100% rate of fascial closure
OC-078 LAP-T LAPAROSCOPIC GAS-LESS TECHNIQUE FOR THE REPAIR OF RECTUS MUSCLES DIASTASIS AND HERNIA IN ATHLETES
Authors: Pozzi G
Published: October 2022

Background/Aim

Diastasis of Rectus Abdominis Muscles (DRAM) in athletes is typically associated with muscle and fascial tearing and fracture and umbilical/epigastric hernias. Parietal damage is generally located on midline, subjected to continuous efforts and overload. Contrarily to repair of DRAM consequent to pregnancy or obesity, in athletes, the trigger of injury will persist after repair. LAP-T Technique aims at Mini-Invasive restoration of anatomy and physiologic functionality through laparoscopic tailored suture&mesh repair, allowing return to full sport activity.

Methods

96 cases from January 2010 to May 2021, minimum follow-up of 12 months. Elected patients: athletes, under 60 years old, BMI < 30, ASA1 – ASA2, with maximum IRD 10cm and associated AWR. Rectus muscles are re-approximated from xiphoid to pubis with tailored sutures, and hernia defect repaired, using laparoscopic running self-locking barbed sutures. Entire procedure is performed in gas-less laparoscopy (3mmHg). Considering persistence of triggering cause after repair in athletes, the repair is consolidated placing an intra-peritoneal mesh. 10–15 days from surgery, patients start following a tailored rehabilitation program up to full resumption of sport activity.

Results

In all patients, AW anatomy and physiological functionality were successfully restored, any hernia repaired, with the restitution ad integrum of the AW; no higher pain related to the continuous suturing has been reported compared to bridge IPOM laparoscopic repair, while allowing for physiologic outcome and stronger repair. No intra operative bleeding, no seroma formation, chronic pain, nor mesh infection. All athletes retrieved full sport activity at pre-hernia and DRAM level. 98% follow up at 12 months, 91% at 24, with no recurrences observed.

Conclusions

LAP-T technique proved to be feasible technique for Athletes, allowing for sound and anatomic reconstruction of DRAM, associated hernias, and musculo-fascial tearing, with reduced trauma, fast recovery and full resumption of sport activity.
OC-081 VALIDATION OF THE DATA QUALITY OF THE SPANISH INCISIONAL HERNIA SURGERY REGISTRY (EVEREG). PILOT STUDY
Authors: Olona C , Pereira J A , Comas J , Protti G P , Alonso V , Amador S , Bombuy E , Mitru C , Gimeno M , López-Cano M
Published: October 2022

Aim

The Spanish Incisional Hernia Surgery Registry (EVEREG) is promoted by the Abdominal Wall section of the Spanish Association of Surgeons, starting data collection in July 2012 and currently has more than 13,500 cases.

The objective of this study is to validate the data collected through a pilot audit process

Material & Methods

A sample of hospitals participating in the EVEREG registry since 2012 is selected. Patients registered in these centers in the period 2012–2019 are included. A stratified random sampling is carried out, with the inclusion of 10% of registered cases per center with a minimum of 20.

In the 2020–2021 period, a selection of researchers, different from that of the center to be audited, checks the concordance between the registry data and the data collected in the patient's clinical history, either in person or online.

Results

330 patients have been analyzed, out of a total of 2673 registered, in 9 participating centers. The average accuracy has been 95.7% (99.1–79.35%). With 1.5% incorrect data and 2.28% missing data

Conclusions

This is the first validity study of an abdominal wall registry

The accuracy greater than 95% obtained allows us to determine an excellent quality in the data collection of the EVEREG registry. We believe that the confirmation of these data in all the centers participating in the registry would guarantee the quality of the studies carried out and their comparison with other international registries
P-005 LAPAROSCOPIC INGUINAL HERNIOPLASTY USING TRANSABDOMINAL PREPERITONEAL APPROACH (TAPP) IN YOUNG SURGEONS: A PERSONAL EXPERIENCE
Authors: Trujillo Díaz J , Jezieniecki Fernández C , Gómez López J R , Concejo Cutoli P , Martínez Moreno C , Atienza Herrero J , Herreros Rodríguez J , Beltrán De Heredia Rentería J , Martin Del Olmo J C
Published: October 2022

Aims

We present short-term results from the personal series of laparoscopic TAPP inguinal hernia procedures performed during the 1st year of postgraduate in General Surgery.

Material and Method

Retrospective study where we analyzed our database of patients diagnosed with inguinal hernia undergoing surgical treatment using laparoscopic approach-TAPP.

Results

A total of 77 patients diagnosed with inguinal hernia underwent laparoscopic treatment using the TAPP approach (men: 90%, age: 61(RIQ: 4 2.5–68 years)). LOS:1(RIQ:1–2 days). BMI: 2 7.3±3.3kg/m2. Overweight(57.1%).

Hernia characteristics: bilateral(84.4%), inguino-scrotal(10.4%), Lateral 66.2%), Medial(7.8%), Mixed(24.7%) and Femoral 1.3%).

Overall complications: 8(10.4%). Serious and intraoperative: 0%. Seroma: 10.4%. Hematoma: 10.4%. ISQ: 0%. Recurrence: 1(1.3%).

We performed an analysis comparing(X2) the patients operated on during the first 6 months(Period A) vs. those operated on in the second 6 months(Period B), and obtained the following results in terms of inguino-scrotal hernias (0% vs. 18.6% p = 0.008), mod-large hernias : type 2–3(44.1% vs. 65.1% p=0.065), non-fixation of the mesh(14.7% vs. 51.2% w=0.001), surgical time<60min(5.9% vs. 46.5% w<0.05), global complications (5.9% vs. 11.6% p=0.38), recurrence(2.9% vs. 0% p=0.25).

Conclusions

The laparoscopic approach to inguinal hernia offers the advantages of minimally invasive surgery: less postoperative pain, fewer complications, shorter hospital stay, and early return to usual physical activities. It is a technique that requires a learning curve but it is possible to be performed safely and effectively by a young surgeon under the supervision of a more experienced surgeon,without increasing the rate of intraoperative or postoperative complications, with short surgical times and with successful results.
P-009 OPEN VS LAPAROSCOPIC VS ROBOT-ASSISTED INGUINAL HERNIA REPAIR: A CASE SERIES
Authors: Valsamidis A , Allah Alnabhan A , Nielsen K A , Pedersen A K , Helligsø P , Mogensen C B , Nielsen M F
Published: October 2022

Aim

Minimally invasive inguinal hernia repair is thought to be associated with fewer complications. To address this hypothesis, we compared short- and long-term complications in patients undergoing elective open (Lichtenstein), laparoscopic (TAPP) and robot-assisted inguinal hernia repair (rTAPP).

Material & Methods

Patients undergoing either, Lichtenstein, TAPP or rTAPP at our institution between January 1st 2017 and December 30th 2019 were retrospectively identified. Short (haematoma, seroma, surgical-site infections) and long-term complications (chronic pain, recurrence) were recorded and compared between groups.

Results

636 patients were included in the study. 370 were treated with Lichtenstein, 125 TAPP and 141 with rTAPP. There was a significant overweight of men in all groups (p < 0,001). Among the rTAPP group, the overall rate of complications was reduced (open: 10.0%; laparoscopic: 8.8%; robot-assisted 5.7%) while the presence of chronic pain was slightly more prevalent (Lichtenstein: 1.6%; TAPP: 1.6%; rTAPP: 2.1%). The rate of recurrence was lower following rTAPP (Lichtenstein: 3.8%; TAPP: 2.4%; rTAPP: 1.4%). Same day discharged was more likely following the open technique (open: 88.9%; laparoscopic: 78.4%; robot-assisted 78.7%). Nevertheless, these results were not statistically significant (p>0.05).

Conclusions

The present case series demonstrates a comparable rate of short and long-term complications following open and minimally invasive inguinal hernia repair. The trend towards a lower overall complications rate and recurrence rate, though not statistically significant, implies that minimally invasive surgery might be associated with a lower complication and recurrence rate. However, a larger prospective study design with a longer follow-up is needed to test this hypothesis.
P-010 NYHUS AS A TREATMENT FOR STRANGULATED INGUINAL HERNIA: EXPERIENCE IN A SPECIALIZED ABDOMINAL WALL UNIT
Authors: Infantes Ormad M , Curado Soriano A , Montemuiño Chulian N , Valera Sanchez Z , Naranjo Fernandez J R
Published: October 2022

Aim

We present our experience in the repair of strangled inguinal hernias using Nyhus technique.

Material and methods

Retrospective review from 2019 to 2021 of 39 patients operated on for strangulated inguinal hernia who underwent a subsequent repair with cavity exploration using Nyhus technique, with a minimum follow-up of 12 months. There were 39 patients (77% men/23% women) with a mean age of 67 years (range 45–87 years), of which 41% were smokers, 22% obese, 10% cardiopaths and 22% COPD. 28% of hernias were recurrent.

Results

Of the 39 patients operated, intestinal resection and anastomosis were necessary in two patients; seroma was observed in 3 patients (10%), SSI in 2 patients (6%), hematoma in 4 patients (12%). During follow-up, recurrence has only been recorded in 2 patients(6%).

Conclusions

Anterior repair is the most widely used technique today for the repair of strangled inguinal hernia due to its simplicity and reproducibility. In many centers, a laparoscopic approach is being imposed, which allows, in addition to the repair of the hernia, a correct revision of the intestinal package in cases of doubtful viability. However, few surgeons today master the open preperitoneal technique, so useful in cases of recurrences, complex hernias and especially in emergencies.

The Nyhus technique is a very useful technical option in the repair of strangled inguinal hernias, allowing access with wide visibility and possibility of safe intestinal resection without the need for general anesthesia.