bluuebunny/crossref_metadata_2025 huggingface dataset:
OC-064 CHOICE FOR ANTERIOR VERSUS POSTERIOR COMPONENT SEPARATION IN INCISIONAL HERNIA REPAIR IS IMPORTANT REGARDING POSTOPERATIVE COMPLICATIONS
Authors: Dries P , Mathias A , Eker H , Berrevoet F
Published: May 2023

Aim

Both anterior component separation technique (aCST) and posterior Transversus Abdominis Release (TAR) are valuable techniques, but the limits for using these techniques are unclear. The aim is to compare outcomes regarding postoperative wound morbidity and recurrence for both techniques.

Methods

A retrospective analysis of prospectively collected data was carried out. Patients with any form of component separation technique, aCST or TAR, between 3/2013 and 8/2022 were included. Data was analyzed for patient demographics, risk factors, surgical site occurrences(SSO), general complications and hernia recurrence. Follow up was performed at 1 month, 1 year and 2 years.

Results

A total of 258 patients underwent CST: 68 (26.4%) aCST and 190 patients (73.6%) TAR. Patients showed no significant difference for gender, risk factors and comorbidities. The aCST group showed larger defects (EHS-W3 in 64.7% vs. 45.3%, p=0.006). Intrahospital complications were lower in the TAR group (12.1% vs 29.4%, p=0.001). SSO rate at one month was significantly lower in the TAR group (12.7% vs 43.9%, p<0.001) with SSO- procedural interventions 6.3% vs 30.3%, p<0.001). Recurrence was low in both groups (aCST 3.0% vs TAR 1.6%). Follow up was complete in 93.8% of patients.

Conclusion

Although aCST and TAR are both valid options in large incisional hernia repair, postoperative wound morbidity as well as overall complication rates are significantly increased after aCST. It seems indicated to choose TAR over aCST in laterally located hernia defects and in large midline defects and only consider aCST in case of doubt about complete anterior fascial closure.
OC-071 Biomechanical Causes for Failure of The Physiomesh/Securestrap System. Experimental study
Authors: Zamkowski M , Śmietański M , Tomaszewska A , Lubowiecka I
Published: May 2023

Introduction

Physiomesh/Securestrap system entered market in 2013 and despite its producer assurence it become a spectacular disaster, eliminating Ethicon from market and resulting in multi-milion dollar lawsuits. The biological reasons for faileure of the Physiomesh implant were partly explained in animal models. However conlusions suggested that apart from biological components failure of Physiomesh/Securestrap was mainly due to biomechanical factors.

Aim

Based on above assumptions we assembled a multidisciplinary team to examine the biomechanical reasons of failure of Physiomesh/Securestrap system.

Material and Methods

Three kinds of experiments were performed with the use of porcine model to conclude on the reasons of system failure in the natural conditions: uni-axial test of mesh samples, determination of the mesh-tissue junction force limit and mesh-staples-tissue model behaviour under high “intra-abdominal” pressure load.

Results

Main reason for failure of Physiomesh/Securestrap is its primary concept. Building a mathematical model describing the forces acting on the implant anchored to anterior abdominal wall demonstrated that mesh lacked proper distribution of elasticity. Despite promising preclinical studies on the rabbit and porcine model, our experiment showed that it cannot me directly translated into humans.

Conclusions

The results of research on the cause and mechanism of failure of the Physiomesh/Securestrap system allow to draw conclusions to avoid similar errors in the future. The findings not only to expose the cause for the failure of Physiomesh/Securestrap, but also allow to better understand the forces acting within the abdominal cavity. Optimally, this will prevent similar situations from arising in the future.
OC-074 A NEW THREE-DIMENSIONAL MODEL OF THE INGUINAL REGION FOR ANATOMY TEACHING
Authors: Blazquez Lautre L , Yarnoz Irazabal C , Insausti Serrano A
Published: May 2023

Aim

The inguinal anatomy is difficult, but a correct anatomical base prevents clinical errors. We present a three-dimensional paper model the student made by himself to improve knowledge of the setup of layers and structures from the inguinal region.

Material and methods

It is a paper model that is made from a printed document, that is distributed in PDF format supported by a video tutorial. This model contains the layers of the inguinal region and other structures. Its usefulness has been tested with Medicine students in the Anatomy course.

In a practical class, before starting, the students answer a questionnaire with questions about inguinal anatomy and the self-perception of their knowledge. The individual construction of the model is carried out and at the end of the class they answer the questionnaire again.

Results

The results of the 2022–23 academic year show an improvement in the self-perception of their knowledge going from an average grade of 2.54/5 before the practice to 3.42/5 and an improvement in the correct answers going from 57.5% of correct answers to 71.42% after the construction of the model.

Conclusions

This method has the following advantages: it is built by the student, very low cost, reproducible and it is three-dimensional. Based on the preliminary results of the past academic year, we hope that students will significantly improve their theoretical knowledge about the inguinal region, and they will have improved their confidence about the knowledge of this subject.
OC-075 RADIOLOGIC TRANSVERSUS ABDOMINIS MUSCLE RETRACTION AFTER UNILATERAL TRANSVERSUS ABDOMINIS RELEASE VIA ETEP
Authors: Guevara-Martínez J , Hernández S , Gutiérrez E , Zapata C , Chavarrías N , Vicario M , Fondevila C , Salido S
Published: May 2023

Aim

Our principal aim is to determine the retraction distance (RD) of the transverse abdominis muscle after unilateral endoscopic transversus abdominis release (eTAR) for the treatment of midline and lateral hernias, and compare it with the same patient contralateral unreleased side.

Material and Methods

We performed a retrospective analysis of a prospective database collection. We defined the RD as the measure between the lateral edge of the rectus abdominis muscle and the medial edge of the transversus abdominis muscle at the level of L3-L4 and at the defect´s maximum diameter. RD was measured pre and postoperatively and compared in the eTAR side with the contralateral (non- eTAR) side.

Results

94 midline and 63 lateral hernias underwent hernia repair via endoscopic totally extraperitoneal (eTEP). Thirtyfive patients required unilateral TAR, including 1 primary and 34 incisional hernias. Lateral (65,7%) and medial (34,3%) defects were both included. The mean hernia defect was 49mm transverse diameter and 52mm longitudinal. We compared the postoperative RD at L4, obtaining 45,8mm on the eTAR side and 42,2mm on the non-eTAR side (p=0,284). At the defect site a mean of 38,3mm on the eTAR side was compared with 35,5mm (p=0.363). In our series we didn't find any statistically significant differences in the transversus muscle retraction after unilateral eTAR when compared with the unreleased side.

Conclusions

eTAR is a safe technique especially during the treatment of lateral hernias, allowing a proper mesh placement without significant transverse muscle retraction.
OC-085 APPROACH AND SURGICAL REPAIR OF RECURRENT COMPLEX PARASTOMAL HERNIA IN AN ADVANCED ABDOMINAL WALL UNIT
Authors: Castaño J C , Crusellas O , Subirana H , Comas J
Published: May 2023

Aim

We present a case of a recurrent parastomal hernia with enterocutaneous fistula and subcutaneous abscesses and their management.

Material & Methods

79-year-old patient with history of pT4b low rectal cancer treated with an abdominoperineal resection with adjuvant chemo-radiotherapy in 2000.

Parastomal hernia repair was performed in 2016 with PTFEe mesh according to the Sugarbaker technique and closing midline with double-sided inlay mesh. A plastic peritonitis was found at this moment

In July 2021 presented episodes of fever with spontaneous parastomal purulent drainage, deciding initially conservative treatment.

Due to persistence of soft tissue infection local surgical drainage was performed in September 2021, removing previous parastomal PTFEe mesh.

The patient presented multiple infectious relapses from January to March 2022, debridement was carried out combined with negative pressure therapy. During follow-up intestinal fluid was seen through the negative therapy what put on show an enterocutaneous fistula.

Finally, we decided radical surgery in May 2022 performing an in-block resection of end colostomy, 30 cm of ileum and abdominal wall area affected of chronic infection and previous meshes. A 20×20cm defect was left. Reconstruction with double-sided inlay mesh and new colostomy in the right iliac fossa was performed. Skin closure required cutaneous plastia.

Conclusions

The use of suitable prosthetic material for the repair of parastomal hernia doesn't exclude the developing of severe complications.

An early and decisive surgical approach is recommended in cases of chronic prosthetic material infection to avoid redundant and non-cost-effective treatments.
OC-090 MESH FIXATION IN LAPAROENDSOCOPIC REPAIR OF LARGE M3 INGUINAL HERNIAS – MULTICENTER, DOUBLE-BLINDED, RANDOMIZED TRIAL -> MEFI TRIAL
Authors: Zamkowski M , Śmietański M
Published: May 2023

Introduction

Guidelines of groin hernia treatment strongly recommends to fixate the mesh in large M3 medial defects during TAPP / TEP. In 2022 team consisting of hernia surgeons and scientists from universities of technology conducted an experimental study with the use of 3d groin model to verify the hypothesis that fixation is not necessary in above cases. Experiment showed that rigid and anatomically shaped meshes are able to maintain its position in groin without fixation. To confirm experimental results we decided to conduct RCT.

Study Hypothesis

Non-fixation of spatial, standard polypropylene meshes is non-inferior as compared to fixation of flat, polypropylene lightweight meshes in m3 hernias.

Materials and Methods

11 large surgery centres in poland were recruited for this study. recurrence in 12-month follow-up was set as a primary endpoint. pain sensation (vas scale) was made secondary endpoint. minimal sample sizes were established 82–103 in each arm. first arm (control): patients repaired with the use of flat, macroporous mesh with fixation. second arm (experimental): patients repaired with the use of anatomically shaped, standard mesh without fixation. after dissection of preperitoneal space, surgeon will find out the technique he will have to perform. patients won't be aware of the method. pain and reccurence will be measured during the hospital stay and then up to 12-months after surgery.

Predicted Outcomes

Based on experimental study and own experience, we believe that recurrence rate in both groups (control and experimental) would be on the same level givingba strong argument for amending the guidelines.
OC-092 Giant inguinoscrotal hernia treated with botulinum toxin, pneumoperitoneum and scrotoplasty associated to hernia repair
Authors: Tuñón-Féquant C , Rodríguez-González D , Ortega-González M Y , Casanova-Ramos R , Guil-Ortiz B , Montes-Montero A , Arteaga-González I
Published: May 2023

Aim

Inguinal hernias are the most frequent hernias of the abdominal wall, but giant hernias are a rare entity in developed countries. The surgical repair of these hernias is a challenge for surgeons, with high rates of postoperative morbi-mortality and recurrence. There are limited reports of cases of giant inguinal hernia treated with preoperative botulinum toxin and pneumoperitoneum and hernia repair associated with scrotoplasty.

Material & Methods

We present the case of a male patient of 68 years-old suffering from a giant inguinoscrotal bilateral hernia with loss of domain that was causing an extreme limitation to ambulate. The index of Sabbagh measured by images of computed tomography was 48,8%.

Results

We administrated preoperative botulinum toxin and progressive pneumoperitoneum (14100cc of air) before surgery. We realized a Rives-Stoppa technique with partial transverse abdominis release and scrotoplasty. Intra-abdominal pressures were measured during the early postoperative period. Seven days after surgery a restrictive respiratory failure was diagnosed needing non-invasive mechanical ventilation. Nevertheless, the evolution was satisfactory, and the patient was discharged on postoperative day 20. After a follow-up of 1 year neither hernia recurrence and no chronic pain were recorded. His quality of life improved notably.

Conclusions

In order to avoid the development of an abdominal compartment syndrome, the preoperative administration of pneumoperitoneum and botulinum toxin is suggested as a therapeutic option in giant hernias. Furthermore, adding scrotoplasty to hernia repair can improve functional and aesthetic results.
OC-116 IMPACT ANALYSIS OF DIASTASIS RECTI ASSOCIATION IN PRIMARY VENTRAL HERNIA REPAIR. OUR EXPERIENCE
Authors: Bravo Salva A , Bosch Silvela G , Perez Guitart M , Gimeno Lopez M , Pera Roman M , Pereira Rodriguez J A , Lorente Poch L
Published: May 2023

Aim

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

Material and methods

An observational single-center retrospective analysis was performed. We analyzed primary ventral hernia preperitoneal repairs in our Hospital from 2019 to 2021. Two groups were compared according to the presence of concomitant diastasis recti or not. We performed a descriptive analysis; comparative univariate analysis for complication and recurrence and risk factors analysis.

Results

From 312 ventral hernia repairs a total of 279 (89%) preperitoneal open hernia repairs were performed. 18 (6.5%) patients had diastasis recti. 236 (84.6%%) were day case surgery. 7 (13.4%) patients had surgical complications. There were no reoperations, 4 readmissions (1.4%%), and 1 death (0.3%) Diastasis recti group had no statistically significative difference with the control group except that more frequently were repaired by an abdominal wall surgeon specialist 1.2 vs 5.9%; p= 0.009) In complications risk factors univariate analysis higher size of mesh and hernia defect and lower mesh/defect ratio were associated with more complications. Recurrence was significatively lower in patients with chronic renal failure. No risk factors for recurrence were found.

Conclusions

In our ventral hernia repair serie small or medium size diastasis recti associated to ventral hernia repair seem not to impact in hernia repair outcomes. Diastasis repair should carefully take it into account when repairing an associated ventral hernia repair in order to not increase surgery complications. And mesh/hernia defect size ratio is related to complications.
OC-117 LIRA (LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY) TECHNIQUE FOR MIDLINE VENTRAL AND INCISIONAL HERNIAS: PRELIMINARY ANALYSIS OF A PROSPECTIVE SERIES
Authors: Hoyuela C , Pierres M , Caballero D , Navarro J , Cubel M , Rovira M , Martínez F , González I , Urdaneta G , Astete S
Published: May 2023

Objective

To analyze the safety and efficacy of the LIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) technique by evaluating postoperative pain, complications (seroma, infection, etc.), bulging, and recurrence rate.

Methods

Prospective analysis of patients who underwent elective laparoscopic repair of midline ventral and incisional hernias with defects 4 to 8 cm wide (W2, EHS classification). Endpoints: Recurrence rate (primary endpoint). Secondary objectives: acute pain, postoperative seroma, infection, chronic pain, bulging and patient satisfaction.

Results

From 2020 to 2021, LIRA repair was performed in 12 patients (mean age 51-y, mean BMI: 33.5 kg/m2). Mean defect width: 5.9 cm. Rectus diastasis>5cm. was present in 6 patients. No intraoperative complications were observed. Tension-free closure was achieved in all patients. Mean operative time: 79 minutes. Postop clinical seroma: 4/12 patients (No intervention needed).

Postoperative pain (VAS): 4 at 24h, 0.6 at one month, and 0 in those patients who have completed one year of follow-up. No clinical or radiological recurrences, nor trocar hernias have been observed. The degree of patient satisfaction is 9/10. No one complained of bulging.

Conclusions

Despite being a technically demanding procedure, the LIRA technique allowed a tension-free midline reconstruction of patients suffering from hernia defects smaller than 8 cm without relevant complications. Although the follow-up time is short, no recurrences or trocar hernias have been observed to date. Therefore, LIRA should be considered a safe and efficient therapeutic alternative in patients with ventral and incisional hernias type W2.
OC-122 CHARACTERISATION OF HUMAN POSTERIOR RECTUS SHEATH REVEALS MECHANICAL AND STRUCTURAL ANISOTROPY
Authors: Whitehead-Clarke T , Brown C , Ali G , Mudera V , Smith C , Kureshi A
Published: May 2023

Background

Our work investigated the mechanical properties of the posterior rectus sheath (PRS) in terms of its ultimate tensile stress (UTS), stiffness, thickness and anisotropy as well as assess the collagen fibre organisation of the PRS using Second-Harmonic Generation (SHG) microscopy.

Methods

For mechanical analysis, twenty-five fresh-frozen PRS samples of were taken from six different cadaveric donors. They underwent uniaxial tensile stress testing until rupture either in the transverse (n=15) or longitudinal (n=10) plane. The thickness of each sample was also recorded using digital callipers. On a separate occasion, ten PRS samples and three anterior rectus sheath samples underwent SHG microscopy and photography to assess collagen fibre organisation.

Results

PRS samples had a mean UTS of 7.7MPa (SD 4.9) in the transverse plane and 1.2 MPa (SD 0.8) in the longitudinal plane (P<0.01). The same samples had a mean Youngs modulus of 11.1 MPa (SD 5.0) in the transverse plane and 1.7 MPa (SD 1.3) in the longitudinal plane (P<0.01). The mean thickness of the posterior rectus sheath was 0.51mm (SD 0.13). Collagen fibres within the tissue could be identified with SHG microscopy, generally aligned transversely.

Conclusion

The PRS displayed mechanical and structural anisotropy with greater tensile stress and stiffness in the transverse plane compared to the longitudinal plane. The mean thickness of this layer is around 0.51mm – consistent with other studies. The tissue is constructed of transversely aligned collagen fibres that are visible using SHG microscopy.
OC-126 PRESERVATION OF DEEP EPIGASTRIC PERFORATORS DURING ANTERIOR COMPONENT SEPARATION TECHNIQUE (ACST) RESULTS IN EQUIVALENT WOUND COMPLICATIONS COMPARED TO TRANSVERSUS ABDOMINIS RELEASE (TAR)
Authors: Ayuso S , Sacco J , Salvino M , Scarola G , Ku D , Tawkaliyar R , Brown K , Colavita P , Kercher K , Augenstein V , Heniford B T
Published: May 2023

Aim

The use of component separation results in myofascial release and increased rates of fascial closure in abdominal wall reconstruction (AWR). These complex dissections have been associated with increased rates of wound complications with anterior component separation having the greatest wound morbidity. The aim of this paper was to compare the wound complication rate between PS-ACST and TAR.

Material & Methods

Patients were identified from a prospective, single institution hernia center database who underwent PS-ACST and TAR from 2015–2021. The primary outcome was wound complication rate. Standard statistical methods were used, univariate analysis and multivariable logistic regression were performed.

Results

A total of 172 patients met criteria, 39 had PS-ACST and 133 had TAR performed. The PS-ACST and TAR groups were similar in terms of diabetes (15.4% vs 28.6%, p=0.097), but the PS-ACST group had a greater percentage of smokers (46.2% vs 14.3%, p<0.001). The PS-ACST group had a larger hernia defect size (375.2±156.7 vs 234.4±126.9cm2, p<0.001) and more patients who underwent preoperative Botulinum toxin A (BTA) injections (43.6% vs 6.0%, p<0.001). The overall wound complication rate was not significantly different (23.1% vs 36.1%, p=0.129) nor was the mesh infection rate (0% vs 1.6%, p=0.438). Using logistic regression, none of the factors that were significantly different in the univariate analysis were associated with wound complication rate (all p>0.05).

Conclusion

PS-ACST and TAR are comparable in terms of wound complication rates. PS-ACST can be used for large hernia defects and promote fascial closure with low overall wound morbidity and perioperative complications.
P-006 OUR EXPERIENCE WITH TAR FOR COMPLEX INCISIONAL HERNIA REPAIR
Authors: Santidrián Zurbano M , Domínguez Bastante M , Vilchez Rabelo A , Turiño Luque J D , Díaz Ríos P , Mansilla Roselló A
Published: May 2023

Aim

Transverse abdominis muscle release (TAR) enables dissection of the preperitoneal space and the placement of large meshes. We present our experience with TAR in the treatment of complex incisional hernias (IH).

Material and Methods

Retrospective, descriptive study of patients operated with the TAR technique (October 2019-July 2022). Epidemiological characteristics, comorbidity, prehabilitation, type of IH, bridging, surgical time, hospital stay, morbidity, mortality and recurrence were studied.

Results

69 TAR (30 females/39 males); age 64.9 years (24–85), body mass index 31 (19–49), CeDAR 35% (4–92). 66 cases (96%) treated preoperatively with Botulinum Toxin A, 31 (45%), with preoperative progressive pneumoperitoneum and 29 (42%) with both. Classification (EHS): M 52 (46%), L 7 (10%), ML 9 (13%), parastomal 1 (1%), tumour 1 (1%). 36 cases R0 (52%), R1 22 (32%), R2 4 (10%) and R3 6 (9%). Median size 17.8 cm(3–30) x13.7 cm (6–25), area 694.3 cm2. Primary fascial closure was achieved in 26 cases (38%), remaining 43 (62%) with bridging (8.7 cm (2–19)x5 cm (1–16)), postoperative area 125.6 cm2 (82% reduction). Surgical time was 242 minutes (140–450). Hospital stay 9 days (3–45). Wound-related complications 35 (50%): infection 15 (21%), seroma 17 (24%), haematoma 15 (7%), skin necrosis 1 (1%). General complications 7 (10%): 2 urinary tract infection, 1 intestinal perforation, 1 pneumonia, 1 haematoma, 1 haemorrhagic shock, 1 heart failure. Mortality 2 (3%). Recurrences 0 (0%).

Conclusions

TAR is a very useful and effective technique for resolving complex eventrations. It is not exempt from morbidity, therefore adequate patient selection is recommended.
P-008 PRE-OPERATIVE PREPARATION IN HERNIAS WITH LOSS OF DOMAIN
Authors: Ribeiro Dias R , Miguel Almeida N , Fonseca T , Barbosa E , Barbosa E
Published: May 2023

Aim

Incisional hernia with loss of domain remains a surgical challenge. Its management requires complex approaches and pre-operative optimization is essential for the success of the surgical repair.

Material and Methods

We describe a case of a 59-year-old woman with a BMI of 35,4 with a recurrent hernia with significant loss of domain. The transverse hernia defect was 12cm and a Tanaka of 40%. Previous to the abdominal wall surgery, the patient had a gastric sleeve in order to lose weight. She lost 27 kilos and was proposed to surgery with a BMI of 25,2. She was also submitted to injection of 300U in six points of the abdominal wall of botulinum toxin and a progressive pneumoperitoneum with insufflation of 8000 cc of filtered air.

Results

The hernia was treated with a Rives-Stoppa-Wantz technique with placement of a macroporous polypropylene mesh with 48mg/m2 density in a retromuscular position and extensive panniculectomy was done. The postoperative course was uneventful.

Conclusions

The combination of preoperative progressive pneumoperitoneum and botulinum toxin decrease the risk of postoperative complications like abdominal compartment syndrome. Both procedures, as well as the bariatric surgery, facilitates the management the patient, allowing it to be possible to correct this type of hernias with less invasive techniques like a Rives Stoppa Wantz repair.
P-010 IS THE ONSTEP METHOD FOR INGUINAL HERNIA SIMPLE AND SAFE?-STUDY OF SHORT-MIDDLE TERM RESULTS OF THE ONSTEP METHOD IN OUR DEPARTMENT
Authors: Tsuchiya Y , Kimura D , Omura T , Ota N , Shimada K , Hojo S , Matsui K , Yoshioka I , Okumura T , Fujii T
Published: May 2023

Aim

The ONSTEP (Open New Simplified Totally Extraperitoneal) method is a new surgical procedure for inguinal hernia reported by Lourenço and da Costa from Portugal in 2013. We investigated the operative results and post operative course of the ONSTEP method in our department.

Material & Methods

Since January 2021, we performed the ONSTEP method for 36 patients who classified except for female and European Hernia Society (EHS) classification for inguinal hernia L3, and investigated patient's background, surgical procedure, and postoperative course. In addition, to investigate whether there were any differences in the simplicity and safety of this procedure between operators, we compared these points of the patients operated by Board Certified Surgeon in Gastroenterology (group A) or beginner (group B).

Results

The average height, weight and Body Mass Index of the patients was 165.9 cm, 60.6 kg, 22.1 respectively. The average operating time was 55.1 minutes, and the average blood loss was 7.0 g. 16 cases (44.4%) planned day surgery and performed it as planned, and the remaining 20 cases were discharged on the day after surgery as planned. Local swelling was observed in 19 patients (52.8%) one week after the operation, but all of them improved one month after the operation. All patients had no chronic pain or infection. There was no statistical difference between group A and B except for the average operating time (A: 50.3minutes, B: 69.4 minutes, p = 0.001).

Conclusions

The ONSTEP method is simple, highly safe, and expected to reduce chronic pain.
P-012 GARENGEOT'S HERNIA WITH ACUTE APPENDICITIS: A RARE CASE
Authors: Lourenço R , Matos D , Lopes A , Santos A , Peixoto I , Longras C , Oliveira M , Pinto R , Alpoim C
Published: May 2023

Garengeot's hernia is a rare entity that refers to the herniation of the vermiform appendix through the femoral canal, being even rarer the presence of acute appendicitis in a Garengeot hernia as presented in the clinical case, with an overall incidence of 0,08%-0,13%.

A 52 years old female patient, attended the Emergency Service complaining of abdominal pain in the right lower quadrant and fever for the last 2 days.

As pathological background, she had bilateral tubal ligation, right crural hernioplasty and iatrogenic uterine perforation after placement of a intrauterine device (IUD).

On physical examination, she complained of pain in iliac fossa/right inguinal region showing a positive Blumberg sign. Abdominal ultrasonography revealed acute appendicitis. In the laparoscopic approach, we identified the ileocecal appendix contained in a right crural hernia with abscessed acute appendicitis. We proceeded with appendectomy and, given the soiling of operative field, we chose not to correct the hernia at that moment.

Empirical antibiotic therapy with Amoxicillin/Clavulanic acid was performed and patient was discharged after 3 days.

Diagnosis of Garengeot hernia with acute appendicitis is difficult, being more frequently diagnosed intraoperatively.

There's no standard therapeutic approach regarding hernia repair simultaneously, being licit not to do it due to the risk of postoperative infection.
P-024 INITIAL EXPERIENCE OF EXTENDED TEP REPAIR FOR VENTRAL AND INCISIONAL HERNIAS IN OUR HOSPITAL
Authors: Lee E J , Park I K , Park D J
Published: May 2023

Aim

The purpose of this study was to investigate the treatment outcomes and feasibilities of the enhanced view totally extraperitoneal (eTEP) repair for ventral and incisional hernias in our hospital.

Material & Methods

We retrospectively reviewed the medical records of patients who underwent eTEP repair for ventral and incisional hernias in our hospital from October 2018 to April 2022. Demographic information, preoperative evaluations, intraoperative variables, postoperative outcomes were collected and analyzed. The surgical techniques were followed the article published by Daes et al in 2021.

Results

Thirty-two patients underwent eTEP repair during the study period. These patients had mean age of 60.8 years, mean BMI 27.1 kg/m2, and median ASA score 2. Twenty-six had incisional hernias (4 were recurrent incisional hernias) and six were primary ventral hernias. Nineteen had hernias in M3 location, mean defect width and length size were 6.00 and 7.47 cm. Sixteen had diastasis rectis and eight had incarcerations at the time of surgery. Twenty-eight underwent eTEP Rives-Stoppa (RS) repair (23 the conventional laparoscopic ports, 2 reduced ports, 1 single port, and 1 robotic). Four underwent eTEP transversus abdominis release (TAR) using the conventional laparoscopic ports. Mean operation time was 199 (±48.5) minutes and mean estimate blood loss volume was 25.8 (±27.2) ml. The common postoperative complications were seroma and voiding difficulty and mean hospital stay length was 8.25 (±4.45) days. There were two recurrences within follow-up period.

Conclusion

Our initial experience of eTEP repair for ventral and incisional hernias showed favorable treatment outcomes and feasibilities.
P-029 USE OF INTRAOPERATIVE FASCIAL TRACTION DEVICE (FASCIOTENS®). INITIAL EXPERIENCE IN A WALL SURGERY UNIT
Authors: Mellado Sánchez I , Sánchez López D , Ferrero Celemín E , García Virosta M , Rodríguez Haro C , Hernández O'reilly M , Gajda Escudero J , Picardo Nieto A L
Published: May 2023

Aim

We present the use of the Fasciotens-abdomen® fascial traction device for the closure of large eventrations in three patients treated in our department.

Material & Methods

Description of three cases of large eventration in which we used the Fasciotens-abdomen® device.

Results

The first patient is a 61-year-old woman with a history of anterior ultra-low rectal resection. She presents an M2-M4W3 10 cm eventration. A Rives eventroplasty was performed with placement of a 25×10cm retromuscular PPL mesh. Fasciotens-abdomen® device was applied with a 14–16 kg load during 25 minutes.

The second case is a 45-year-old female patient with a previous umbilical hernioplasty in 2016. She presents an M2-M4W3R1 11 cm eventration. During the eventroplasty, fascial approach with Fasciotens-abdomen® device was performed for 25 minutes/14–16 kg, and a mesh of 22×11 cm was placed onlay.

Thirdly, a 60-year-old female patient with a previous eventroplasty in 2015. She presented an M2-M3W3 14 cm eventration. During the Rives eventroplasty, 70 cm of small bowel were resected due to firm adhesions. The closure was performed with retromuscular mesh placement and fascial approximation with Fasciotens-abdomen®, for 25 minutes/14kg.

All three patients received an infiltration of 15 IU of botulinum toxin weeks before the reconstruction surgery and were discharged from the hospital uneventflul.

Conclusions

Large incisional hernias pose a challenge to the surgeon. Adjunctive procedures for abdominal wall reconstruction, like the Fasciotens®fascial traction device, help to achieve tension-free midline closure.
P-032 INCISIONAL HERNIA WITH LOSS OF DOMAIN AS A CONSEQUENCE OF BOTULINUM TOXIN A AND THE COVID-19 PANDEMIC
Authors: Rodicio J , Del Val P , Silva D , Rodriguez R , Sanz S , Suarez A , Sanz L , Garcia-Ureña M A
Published: May 2023

Introduction

Abdominal wall surgery has been one of the major victims of the COVID-19 pandemic, with a large number of patients who have seen their surgery delayed and many are still waiting to be operated on today. On the other hand, botulinum toxin is one of the main protagonists in optimizing abdominal wall surgery, especially important in complex hernia, but we must not forget that it can have adverse effects.

Case report

We present the case of a 54-year-old man with a history of obesity, diabetes, hypertension, chronic renal failure and kidney transplant in 2000, who presented a midline incisional hernia as a result of an epigastric hernia operated on in 2006 and subsequently two onlay permanent synthetic mesh in 2010 and 2015. In February 2020 he presented an incisional hernia M2–4W3R3 with a volume of 35%, botox was infiltrated as optimization for surgery and while awaiting placement of a pneumoperitoneum catheter, the surgery was suspended due to the COVID-19 situation. He returns to our clinics in 2022 with a growth of the hernia and a volume of 95%. Weight loss, botulinum toxin and preoperative pneumoperitoneum were indicated. We performed a reconstruction of the abdominal wall with bilateral transversus abdominal release and preperitoneal 45×60cm polyvinylidene fluoride mesh and abdominoplasty.

Discussion

Botulinum toxin can facilitate abdominal surgery, especially in complex hernias, but we must not forget that blocking the abdominal muscles can have adverse effects. The COVID-19 pandemic has been especially hard on surgical waiting lists, delaying surgeries and aggravating pathologies.
P-047 REDUCING THE RISK OF MESH EROSION IN A MODIFIED RETROMUSCULAR SUGARBAKER TECHNIQUE FOR PARASTOMAL HERNIA REPAIR
Authors: Ruano-Campos A , Pérez-Jiménez A E , Ossola Revilla M E , Gómez Latorre L , Del Campo Martín M , García-Galocha J L , Peña Soria M J , Torres García A
Published: May 2023

Aim

Modified retromuscular Sugarbaker procedure (SP) is a promising approach for parastomal hernia repair. However, its potential complications, including the risk of mesh erosion, encourages us to develop other techniques of mesh placement. We propose an addition to this parastomal retromuscular mesh reinforcement.

Materials and Methods

We present the case of a 53 year old-woman, with a history of proctocolectomy with end ileostomy due to anal adenocarcinoma, undergoing emergency surgery due to parastomal hernia incarceration. Sugarbaker repair was performed placing inlay composite mesh fixed with reabsorbable tackers. Subsequently, the patient was admitted for recurrent parastomal hernia and midline ventral hernia surgery.

Results

We performed a modified retromuscular SP as described by Pauli in 2016. After midline laparotomy, hernia content was reduced and extensive retromuscular dissection with transversus abdominis release (TAR) performed, placing a wide retromuscular polypropylene mesh prior to closing parastomal fascial defect. Stoma was parietalized from lateral to medial in an S-shaped configuration. We placed a segment of bioabsorbable mesh covering the parietalized stoma to avoid direct contact with the polypropylene mesh. No recurrence was detected 3 months after surgery, pending reassessment at 6 months.

Conclusions

This repair provides the benefits of an open posterior component separation with TAR, maintaining the biomechanics of a functional abdominal wall, whilst offering the advantages of mesh reinforcement in a modified Sugarbaker configuration. Our experience with this novel technique seems promising. Rate of mesh erosion is yet to be defined and requires long-term studies before widespread adoption, with special concern on mesh placement.
P-049 DAMAGE CONTROL SURGERY FOR AN INCARCERATED GIANT UMBILICAL HERNIA IN A SUPEROBESE PATIENT
Authors: Rodríguez Haro C , Mellado Sánchez I , Sánchez López J D , García Virosta M , Hernández O'reilly M , Gajda J , García-Sancho L , Ferrero Celemín E , Martínez Alegre J , Vaquero Pérez M A , Picardo Nieto A L
Published: May 2023

Aim

To report the case of the emergency management of an incarcerated giant umbilical hernia in a superobese patient with a damage control surgery as the first step for its treatment.

Material & Methods

We present the case of a 47-year-old man with a BMI of 62 kg/m2 who arrived to the emergency department for abdominal pain. Examination and CT scan revealed a giant umbilical incarcerated hernia with loss of domain, with an 8 cm hernia neck and containing the entire bowel except for the rectosigmoid and duodenum.

Results

The emergency managment was a laparotomy with a subcutaneous right lateral approach, opening first the hernia sac to verify bowel viability. Then, we performed a tranverse chelotomy on the right side of the defect, leaving the defect open and wider to prevent hernia strangulation. We left two drains in the subcutaneuos space and the wound was covered with vacuum therapy dressing. The patient recovery was uneventful and he was discharged in the sixth postoperative day.

After this episode the patient started a very strict weight loss treatment, so we coul plan the final wall reconstruction surgery, which hasn't already been performed, but which will include botulinum toxin and progressive preoperative pneumoperitoneum.

Conclusions

We belive that damage control surgery was the most appropiate option as the first step for the management of an incarcerated complex hernia, so in a second time an elective complex wall reconstruction surgery could be performed.
P-058 In the path of a hernia center?
Authors: Figueiredo J , Souto R , Trindade M , Henriques S , Branco A , Costa P
Published: May 2023

Introduction and aim

Hernia surgery is becoming more complex and demanding, increasing the need for specialization. Certification of units dedicated to hernia surgery must follow some requirements linked to surgical skills, resources, and outcomes.

We aim to analyze the outcomes and benefits of a dedicated hernia unit.

Methods

We conducted a retrospective analysis of 333 abdominal wall hernia repairs performed from the start of a dedicated unit in 2020, until 2022. A total of 187 patients underwent groin hernia repair, 70 primary ventral and 75 incisional hernia. Demographic and clinical data, surgical techniques, and outcomes were assessed. The results were analyzed according to the accreditation and certification requirements for hernia centers and surgeons from European Hernia Society.

Results

The group performed 124 open and 63 laparoendoscopic groin hernias, 50 open and 20 laparoendoscopic primary ventral hernia, and 36 open and 39 laparoendoscopic incisional hernias.

The total complication rate for groin hernia surgery, 30 days postoperatively, was 2,7% (< 5%) (1,6% wound dehiscence, 1,1% seroma, 0% pulmonary or cardiovascular), reoperation rate was 0% (<2%), recurrence 1,6%, and chronic pain 2,15%. In primary ventral repair, the morbidity within thirty days was 1,4%, infection was 1,4% and recurrence 0%. According to incisional hernias, the infection/revision rate after open surgery was 11/% (>10%), after laparoscopic surgery was 2,5% (<3%) and the reoperation rate was 0,5% (<10%).

Conclusions

Optimal results in hernia surgery can only be guaranteed in dedicated units that follow a “tailored-approach” concept, yet need expert hernia surgeons with increasing knowledge and experience.
P-073 RESORBABLE SYNTHETIC VS. BIOLOGIC MESH VENTRAL HERNIA REPAIR IN CONTAMINATED FIELDS
Authors: Amro C , Niu E F , Honig S , Davis H D , Habarth-Morales T E , Broach R B , Fischer J P
Published: May 2023

Aim

Abdominal wall reconstruction (AWR) with ventral hernia repair (VHR) in the setting of contamination poses unique and controversial challenges. The purpose of this study was to examine the efficacy of resorbable biosynthetic mesh against biologic mesh in contaminated VHR with AWR.

Methods

A single-center, retrospective review from 2015–2021 was performed examining subjects who underwent VHR with AWR in contaminated fields (CDC wound class II-IV). A matched paired analysis based on Age, BMI, and CDC wound class was conducted among patients who utilized resorbable biosynthetic mesh in an onlay fashion and biologic mesh in an underlay fashion.

Results

A total of 94 patients (47 per group) underwent VHR with AWR in contaminated fields. Patients who utilized biosynthetic mesh had an average defect size of 314.56 ± 214.65 cm2, required component separation (57.4%), and were often recurrent (61.7%). Majority of contamination were clean-contaminated (68.1%), followed by dirty/infected (19.1%), and contaminated (12.8%). Patients utilizing resorbable biosynthetic mesh experienced fewer surgical site occurrences (46.8% vs 72.3%, p <0.05) and fewer surgical site occurrence procedural interventions (19.1% vs. 38.4%, p<0.05). Patients with biosynthetic mesh had fewer hernia recurrences compared to biologic mesh use, however was not statistically significant (14.9% vs. 30.4%, p = 0.07), with a mean follow up of 25.73 ± 18.66 months.

Conclusion

Utilization of resorbable biosynthetic mesh may be preferable to biologic mesh in contaminated fields due to lower rates of surgical site occurrences and interventions, ultimately reducing the post-operative clinical and financial burden for this patient population.
P-084 INDEPENDENT PATIENT DATA META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS ON PROPHYLACTIC MESH PLACEMENT FOR INCISIONAL HERNIA PREVENTION: STUDY PROTOCOL
Authors: Van Den Berg R , Den Hartog F , Sneiders D , Stabilini C , Lange J , Muysoms F , Tanis P
Published: May 2023

Aim

In high risk groups such as patients undergoing open abdominal aortic aneurysm (AAA) surgery, the risk of incisional hernia (IH) formation is up to 69%. IH can be prevented through prophylactic mesh augmentation (PMA). Several randomized controlled trials (RCT) have shown a significant decrease in IH formation after PMA. However, due to study design and sample size issues, implementation of PMA into daily practice is lacking.

Methods

International collaboration will be initiated under the guidance of the European Hernia Society. RCTs studying PMA after open AAA surgery will be identified through a literature search. Corresponding authors of the selected studies will be approached for participation by e-mail, telephone or other means. Where independent patient data (IPD) are available, a suitable data delivery agreement (DDA) will be drafted and signed upon agreement. Pseudonymised or anonymised data sets will be securely transferred and stored, and relevant study parameters will be harmonized. A 1-stage IPD meta-analysis (IPDMA) will be performed, stratified per centre, assessing PMA effectivity according to the intention-to-treat principle. If a 1-stage IPDMA is not feasible, a 2-step IPDMA will be performed, analysing each RCT separately and pooling outcomes. Results will be published in internationally recognized, peer-reviewed journals. This study protocol was registered under PROSPERO number CRD42022347881.

Conclusions

Gathering IPD across relevant RCTs and performing an IPDMA on the combined data will help to better establish effectiveness of PMA in preventing IH after open AAA surgery. Secondarily, subgroup analyses will allow identification of patients who will benefit from PMA most.
P-094 FLAT PATCH MESH VERSUS THREE-DIMENSIONAL MESH (PLUG) FOR OPEN UMBILICAL OR EPIGASTRIC HERNIA REPAIR: A RETROSPECTIVE STUDY
Authors: Sangiorgio G , Falzone U , Sapienza E , Lombardo F M , Zanghì M , Vacante M , Zanghì G
Published: May 2023

Aim

The aim of this retrospective study was to compare open small- and medium-sized ventral hernia repair with flat patch mesh versus three-dimensional mesh (plug) in terms of recurrence and complication rates.

Methods

The medical records of 300 patients who underwent ventral hernia repair using flat mesh versus plug between January 2010 to December 2015 were reviewed. All patients were followed up after 1 month, 3 month and 1 year. The rate of recurrence, and short-term postoperative complications such as incidence of Surgical Site Infections (SSIs), hematoma and seroma were evaluated.

Results

Short-term follow-up data were available for all patients. The first group was composed of 150 patients that were treated with plug (60% presented umbilical hernia and 40% presented epigastric hernia). The second group was composed of 150 patients that were treated with flat mesh (68% presened umbilical hernia and 32% presented epigastric hernia). The majority of postoperative complications were wound related, representing superficial SSI or seroma. Our results showed a statistically significant reduction of SSIs [3 (2%) vs 13 (8.6%); p = 0.038] and seroma [2 (1.3%) vs 12 (8%); p = 0.030] in the group of patients treated with plugs. There was no statistically significant difference in hernia recurrences.

Conclusions

Usage of plugs represents a feasible and safe technique that significantly lowers the incidence of complications. Furthermore, compared to flat mesh, plugs displayed non-inferiority in terms recurrence. Further, well-designed clinical trials could be realized to investigate possible applications of plugs for umbilical and epigastric hernias repair.
V-006 Lumbar hernia: Novel eTEP robotic approach
Authors: Villalobos R , Maestre Y , González Barranquero A , Escartin A , Olsina J
Published: May 2023

Aim

Primary lumbar hernias are rare defects on the posterior abdominal wall. The study of these hernias has been described from the anatomical point of view of the anterior pathway (Petit 1783 and Grynfelt 1866). The preperitoneal/retromuscular view has interesting anatomical differences as was described by Moreno-Egea. Open and laparoscopic approach treatment have been described in different articles and lately Kudsi described in his book Robotic Hernia Surgery (2020), an incisional lumbar hernia repair by robotic extended totally extraperitoneal (eTEP) approach placing the trocars in the midline. Kudsi describes an ipsilateral retrorrectal access and a TAR procedure. The aim of this video is to describe a novel eTEP approach in a primary lumbar hernia placing the trocars beyond the semilunaris line avoiding an unnecessary dissection of the retrorrectal space.

Material and Methods

The case is a 62 years old woman patient with a BMI of 35 who presented a progressive 1-year discomfort bulging in her right lumbar back that turned in pain the last 6 months. MRI was made showing a right lumbar defect with a huge fat tissue content. Once the patient was assessed, an eTEP robotic approach was planned with a Xi Da Vinci robotic platform. The patient was in a hyperextended left-side position.

Result

The patient was discharged the same day of operation with a mild pain controlled by oral medication.

Conclusion

The eTEP robotic lumbar hernia approach beyond the semilunaris line is feasible, avoiding a retrorrectal and TAR unnecessary procedure.
V-008 RTARUP (ROBOTIC TRANSABDOMINAL RETROMUSCULAR UMBILICAL PROSTHETIC) - «BOTTOM-UP APPROACH»
Authors: Quagli O , Bertoglio C L , Alampi B , Morini L , Grimaldi S , Ferrari G C
Published: May 2023

Robotic surgery is gaining more space in every country at every level. Wall surgery is one of the fields in which technology can help the surgeons and can give more opportunities to the patients.

One of the biggest differences between laparoscopic surgery is that the use of the robot provides excellent 3D VISION of the abdomen and can ease the surgeon, during difficult and tricky situation mostly.

One of this wall affection is diastasis recti. It affects about 1/3 of women after childbirth, yet it is still little talked about today. Often underestimated or confined to a cosmetic problem, most of the times abdominal diastasis is a functional problem primary and must be addressed in the correct way.

In this video, we report a case of diastasis recti associated with a primary umbilical hernia in a multipara woman.

She was 45 with a BMI of 26.4 kg/m2 and she came to our attention after a long period of discomfort and pain. She told us that her umbilical hernia was growing fast in the last months and that the condition of her abdomen was getting worse, with pain and digestive difficulties. At the physical examination we found an umbilical hernia of 3 cm of diameter and a diastasis recti of 6 cm of width.

Due to the conditions of the patient, the young age and the will not to have children anymore, we decide to perform a robotic transabdominal retromuscular umbilical prosthetic (rTARUP) «bottom-up approach» (the patient never underwent abdominal surgery).