bluuebunny/crossref_metadata_2025 huggingface dataset:
Zero thermal expansion in metal–organic framework with imidazole dicarboxylate ligands
Authors: Gao Qilong , Jiao Yixin , Li Gang
Published: December 2021

Exploring new abnormal thermal expansion materials is important to understand the nature of thermal expansion. Metal–organic framework (MOF) with unique structure flexibility is an ideal material to study the thermal expansion. This work adopts the high-resolution variable-temperature powder x-ray diffraction to investigate the structure and intrinsic thermal expansion in Sr-MOF ([Sr(DMPhH2IDC)2]
n
). It has the unique honeycomb structure with one-dimensional (1D) channels along the c-axis direction, the a–b plane displays layer structure. The thermal expansion behavior has strong relationship with the structure, ZTE appears in the a–b plane and large PTE along the c-axis direction. The possible mechanism is that the a/b layers have enough space for the transverse thermal vibration of polydentate ligands, while along the c-axis direction is not. This work not only reports one interesting zero thermal expansion material, but also provides new understanding for thermal expansion mechanism from the perspective of the structural model.
Orientation and ellipticity dependence of high-order harmonic generation in nanowires
Authors: Yang Fan , Zheng Yinghui , Zhang Luyao , Ge Xiaochun , Zeng Zhinan
Published: December 2021

It has been predicted that high-order harmonic generation (HHG) in nanowires has the potential to scale up photon energy and harmonic yield. However, studies on HHG in nanowires are still theoretical and no relevant experimental results have been reported as yet. Our experimental observation of the high-order harmonic in cadmium sulfide nanowires (CdS NWs) excited by a mid-infrared laser is, to our knowledge, the first of such study, and it verifies some of the theoretical results. Our experimental results show that the observed harmonics are strongest when a pump laser is parallel to the nanowires. Therefore, the theoretical prediction that harmonics are strongest under the nanowires parallel to the laser field is confirmed experimentally, and this can be used to determine the orientation of the nanowire. In addition, harmonics are sensitive to the variation of pump light ellipticities. This orientation dependence opens new opportunities to access the ultrafast and strong-field physics of nanowires.
Surgery obstructions and character varieties
Authors: Sivek Steven , Zentner Raphael
Published: December 2021

We provide infinitely many rational homology 3-spheres with weight-one fundamental groups which do not arise from Dehn surgery on knots in

S
3

S^3

. In contrast with previously known examples, our proofs do not require any gauge theory or Floer homology. Instead, we make use of the

S
U
(
2
)

SU(2)

character variety of the fundamental group, which for these manifolds is particularly simple: they are all

S
U
(
2
)

SU(2)

-cyclic, meaning that every

S
U
(
2
)

SU(2)

representation has cyclic image. Our analysis relies essentially on Gordon-Luecke’s classification of half-integral toroidal surgeries on hyperbolic knots, and other classical 3-manifold topology.
VAMP2 and synaptotagmin mobility in chromaffin granule membranes: implications for regulated exocytosis
Authors: Abbineni Prabhodh S. , Briguglio Joseph S. , Chapman Edwin R. , Holz Ronald W. , Axelrod Daniel
Published: December 2021

Analysis of SNARE and synaptotagmin diffusion on secretory vesicles indicates that their mobility may influence the rate of exocytosis.
Modification of the Patient Competency Rating Scale to Measure Anosodiaphoria after Severe Acquired Brain Injury: Preliminary Findings
Authors: Bivona U , Costa A , Ciurli P , Donvito T , Lombardi G , Misici I , Moretti G , Caltagirone C , Formisano R , Prigatano G P
Published: December 2021

Objective

Impaired self-awareness (ISA) of altered functional capacities is a common sequelae of severe acquired brain injury that can severely hamper neuro-rehabilitation in this clinical population. ISA is frequently associated with anosodiaphoria and/or apathy. Although several scales are available to measure apathy, no tools have been published to specifically assess anosodiaphoria after acquired brain injury. In this paper, we reported an initial effort to develop an anosodiaphoria subscale in a commonly used measure of ISA, that is, the Patient Competency Rating scale-neurorehabilitation form (PCRS-NR).

Method

A sample of 46 participants with severe acquired brain injury completed a functional, ISA, apathy, and anosodiaphoria assessment. One informal caregiver of each patient participated in the study. Thus, we were able to obtain external data on his/her level of functional competencies, and self-awareness, which allowed separating patients with low self-awareness (LSA) from those with high self-awareness (HSA). Finally, the patients were compared with 44 healthy age–gender–years of formal education matched control participants (HCs).

Results

Compared to both patients with HSA and HCs, patients with LSA demonstrated greater anosodiapvhoria and lower levels of functioning than both HSA patients and HCs. A stronger relationship emerged between ISA and anosodiaphoria rather than with apathy.

Conclusions

These initial findings provide support that PCRS scale can be adapted to measure anosodiaphoria as well as ISA. The findings reveal a stronger correlation between this measure of anosodiaphoria and ISA compared with the correlation of apathy to ISA. The present method for measuring anosodiaphoria takes into account the actual levels of patients’ functioning.
Dress to Impress: Public Perception of Plastic Surgeon Attire
Authors: Dayani Fara , Thawanyarat Kometh , Mirmanesh Michael , Spargo Tavish , Saia Whitney , Nazerali Rahim
Published: December 2021

Background

Physician attire has been shown to impact patients’ perceptions of their provider with regards to professionalism, competency, and trustworthiness in various surgical subspecialties, except in plastic and reconstructive surgery.

Objectives

The authors sought to address this knowledge gap and obtain objective information regarding patients’ preferences.

Methods

A survey was distributed to adult, English-speaking participants in the United States using the Amazon MTurk platform from February 2020 to December 2020. Participants were asked to evaluate with a 5-point Likert scale 6 attires (scrubs, scrubs with white coat, formal attire, formal attire with white coat, casual, casual with white coat) in terms of professionalism, competency, and trustworthiness for male and female plastic surgeons during their first encounter in clinic.

Results

A total of 316 responses were obtained from 43.4% men and 56.6% women. The mean age of participants was 53.2 years. The highest scores across all metrics of professionalism, competency, trustworthiness, willingness to share information, confidence in the provider, and confidence in surgical outcomes were given to the formal attire with white coat group, with average scores of 4.85, 4.71, 4.69, 4.73, 4.79, and 4.72, respectively. The lowest scores across all metrics belonged to the casual attire group with scores of 3.36, 3.29, 3.31, 3.39, 3.29, and 3.20, respectively. Patients preferred formal attire for young plastic surgeons (P = 0.039).

Conclusions

This study suggests that physician attire impacts patients’ perception of plastic surgeons regarding their professionalism, competency, and trustworthiness. White coats continue to remain a powerful entity in clinical settings given that attires with white coats were consistently ranked higher.
P005 POSTERIOR COMPONENT SEPARATION WITH TRANSVERSUS ABDOMINIS RELEASE FOR COMPLEX VENTRAL HERNIA REPAIR: A CASE SERIES
Authors: Bertoglio Camillo Leonardo , Maspero Marianna , Alampi Bruno , Morini Lorenzo , Magistro Carmelo , Grimaldi Simona , Quagli Oscar , Mastroianni Sara , Ferrari Giovanni
Published: December 2021

Aim

To assess the short- and long-term outcomes of posterior component separation with transversus abdominis release (PCS-TAR) at our Centre.

Material and methods

From 2016, our abdominal wall unit started with PCS-TAR for the treatment of patients with complex abdominal wall hernias. We report our prospectively collected preliminary results.

Results

Sixty-six patients underwent PCS-TAR. Twenty patients had already received at least one previous hernia repair, 16 with mesh implantation. The median width of the defect was 12 cm (range 3 - 35), the median length 15 (range 4 - 40). Defects were multiple in 13 cases, swiss cheese in 2 cases. Eleven defects had both a midline and a lateral component, 3 had a concomitant parastomal hernia. Thirty-eight cases were located near the abdominal wall borders. The median duration of surgery was 255 minutes (range 84 - 740). TAR was partial in 24 cases and monolateral in 24. Twelve cases involved previous mesh removal. Fifty patients received implantation of more than one mesh: the most common combination was a PVDF mesh on top of a biosynthetic mesh. The mesh seldom needed to be fixed. The median length of stay was 6 days (range 3 - 61). Postoperative complications occurred in 22 patients (3 were major). Surgical site occurrences happened in 7 cases. After at least 12 months of follow up per patient, there was 1 recurrence, 1 case of chronic pain and no chronic seromas.

Conclusions

Posterior component separation with transversus abdominis release offers a versatile solution for a variety of complex ventral hernias, with good short- and long-term results.
P017 COMPLEX ABDOMINAL WALL RECONSTRUCTION IN ELDERLY PATIENTS
Authors: Munoz-Rodriguez Joaquin , Monclús Javier López , Miguel Carlos San , Hernando Luis Blázquez , Lersundi Alvaro Robin Valle de , Perez-Flecha Marina , Iglesias Eva , Sánchez Miguel Suarez , Rodrígo Pilar Martín , Cidoncha Lucia Gil , Ureña Miguel Ángel García
Published: December 2021

Aim

Our study aims to analyze and evaluate the results obtained in patients older than 80 years old who underwent complex abdominal wall reconstruction (CAWR) in a multicenter abdominal wall unit using different surgical approaches.

Material and Methods

Patients were identified from a prospective maintained multicenter database. Demographic characteristics, incisional hernias’ (IH) characteristics, as well as postoperative outcomes, including short and long-term complications have been analyzed.

Results

21 patients were identified. The mean age was 82.5 (+/- 2.4) years old . There were 10 (47.6%) midline IH, 5 (23.8%) lateral IH, 4 (19%) synchronous midline and lateral IHs, and 2 (9.6%) parastomal hernias (PH). 9 (42.8%) Madrid TAR modification technique, 5 (23.8%) Rives-Stoppa, 3 (14.3%) lateral preperitoneal approaches, 1 (4.8%) midline preperitoneal approach and 1 (4.8%) anterior component separation were performed. In patients with PH, a modification of the Pauli technique (4.8%), and a unilateral TAR with a keyhole repair associated (4.8%) were performed.

There were 7 (33,3) surgical site occurrences (SSO), 1 (4.8%) seroma, 3 (14.3%) hematomas and 3 (14.3%) surgical site infections. Only 3 (14.3%) SSO required procedural intervention. During a mean follow-up of 20.6 (+/- 15.9) months, 1 (4.8%) hernia recurrence was diagnosed. No cases of postoperative bulging were recorded. There were also no cases of chronic pain in the sample.

During follow-up, 3 patients died from surgery unrelated causes.

Conclusions

CAWR in the elderly patient, after an adequate preoperatively selection of patients, presented acceptable short- and long-term results, despite the advanced population age.
P019 OUTCOMES OF OPEN LATERAL APPROACHES FOR L3-L4 INCISIONAL HERNIAS
Authors: Munoz-Rodriguez Joaquin , Monclús Javier López , Miguel Carlos San , Lersundi Alvaro Robin Valle de , Hernando Luis Blázquez , Equisoain Aritz , Polaino Veronica , Perez-Flecha Marina , Rial-Justo Xiana , Remirez Xabier , Ureña Miguel Ángel García
Published: December 2021

Aim

Our study aimed to compare and evaluate results of two different open lateral approaches for L3–L4 incisional hernias (IH) operated in a multicentric complex abdominal wall unit.

Material and Methods

Patients who underwent surgery for L3–L4 IH were identified from a prospective maintained multicenter database. The lateral IH were approached laterally, performing a reverse transversus abdominis release (TAR) or a lateral retromuscular preperitoneal approach (LRP).

Outcomes included short and long-term complications, such as recurrence, bulging and pain.

Results

61 patients were identified. There were 28 (45.9%) cases of L3 IH and 33 (54.1%) cases of L4 IH. 28 (34.7%) LRP approaches and 33 (24.5%) reverse TAR techniques were performed.

There were surgical site occurrences (SSO) in 13 (21.3%) patients, 7 (11.5%) in the reverse TAR group and 6 in the LRP group. 8 (13.1%) SSO required procedural intervention (4 in each group). During a mean follow-up of 26.57 (+/- 19.23) months, no cases of recurrence were diagnosed. There were 12 (19.7%) cases of asymptomatic bulging that did not required reintervention (7 in the LRP group), and only one case of symptomatic bulging that needed intervention (in the LRP group). Furthermore, two patients (3.3%) required daily no opioids treatment for pain. Two (3.3%) cases of mortality were registered (both in the LRP group).

Conclusions

Despite the high complexity associated of L3-L4 IH, both lateral approaches showed acceptable long-term results, without any statistical difference between groups.
P058 INCISIONAL HERNIA REPAIR IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Lovén Hans , Erichsen Rune , Tøttrup Anders , Bisgaard Thue
Published: December 2021

Aim

Patients with inflammatory bowel disease (IBD) are likely to undergo several abdominal operations and may thus be at increased risk for incisional hernia repair (IHR). The aim of the present study was to investigate risk and predictors of IHR in patients undergoing surgery for ulcerative colitis (UC) or Crohn’s disease (CD).

Material and Methods

Nationwide register-based study (1996-2018). Patients were followed from date of first abdominal operation until the date of the first IHR. Cumulative incidence proportion were estimated treating death as competing risk. Cox proportional hazard regression was used to explore pre-study defined predictors of IHR.

Results

Patients with inflammatory bowel disease (IBD) are likely to undergo several abdominal operations and may thus be at increased risk for incisional hernia repair (IHR). The present study analyzed the risk and predictors of IHR in patients undergoing surgery for ulcerative colitis (UC) or Crohn’s disease (CD).

Conclusions

The risk for incisional hernia repair is relatively low after IBD-surgery, although increased in UC compared with CD patients. Hernia repair predictors varied between UC and CD patients.
P059 QUALITY OF LIFE IN COMPLEX ABDOMINAL WALL HERNIA PATIENTS
Authors: Smith Olivia , Chintapatla Srinivas , Chitsabesan Praminthra
Published: December 2021

Aim

determine themes reported as important to Quality of Life (QoL) in Complex Abdominal Wall Hernia (CAWH) patients

Material and Methods

15 purposively sampled CAWH patients were interviewed using topic guides (8 men and 7 women aged between 36 to 85 years [median = 65 years] covering all VHWG grades). All verbatim transcripts were coded and analysed using NVIVO12 software and Interpretative Phenomenological Analysis (IPA) until thematic saturation.

Results

3 overarching groupings and 5 superordinate themes were identified. Each superordinate theme is associated with several subordinate themes:

Conclusions

This is the first phenomenological qualitative study in CAWH patients. The themes presented are interrelated and should shape our understanding of QoL in CAWH. Current QoL tools do not incorporate all aspects identified by this study. Further research is needed in order to generate a standardised CAWH QoL instrument which incorporates bio-psycho-emotional-social processes important to patients as identified by patients.
P070 THE IMPACT OF THE COVID 19 PANDEMY ON HERNIA SURGERY IN UNIVERSITY HOSPITAL IN CZECH REPUBLIC
Authors: Jíšová Barbora , Woleský Jakub , East Barbora
Published: December 2021

Aim

The SARS- CoV-2 pandemic has greatly affected health care systems worldwide, including the Czech Republic. However, the degree to which Covid-19 has impacted on hernia surgery is unknown. The aim of this study was to review the hernia surgery workload in a large university teaching hospital department.

Material and Methods

A computer based medical record system was used to identify all patients undergoing elective and emergency hernia repair of all types from March 1 to November 30, 2020 and for a similar time period in 2019 at the Motol University Hospital, Prague.

Results

194 elective hernia operations were undertaken over the study period in 2020, a reduction from the 285 over a similar period in 2019. The number of emergency hernia operations in 2020 was 13 compared to 25 in 2019.

Conclusions

The SARS –CoV- 2 pandemic has reduced both the number of elective and emergency hernia operations in 2020 compared to 2019. Time will tell if the reduced elective workload will subsequently increase the emergency hernia workload during the recovery from the pandemic.
P073 SYNCHRONOUS VERSUS DELAYED SURGICAL TREATMENT OF MORBID OBESITY AND VENTRAL HERNIA. PRELIMINARY RESULTS OF A RETROSPECTIVE SINGLE CENTER STUDY
Authors: Barone Gisella , Bertoglio Camillo Leonardo , Maspero Marianna , Girardi Valerio , Morini Lorenzo , Grimaldi Simona , Ferrari Giovanni
Published: December 2021

Aim

The worldwide increase in morbid obese patients raises controverises regarding the best timing of treatment for concomitant ventral hernias (VH). We present the preliminary experience at a referral center for bariatric surgery (BS): synchronous versus delayed ventral hernia repair (S-VHR, D-VHR) have been compared.

Material and Methods

From 2009, 40 consecutive morbid obese patients eligible for BS presented with concomitant VH. Symptoms and characteristics of the VH were evaluated to choose between S-VHR (28 patients), primary (n = 12) or mesh augmented (n = 16), and D-VHR (12 patients). 90-day postoperative complications and hernia recurrence were evaluated.

Results

3 patients out of 16 in the mesh group experienced superficial surgical site infections. 4 patients in the D-VHR had a bowel incarceration within 20 days after BS and required emergency surgery with mesh implantation. No complications occurred in the primary repair group. The recurrence rate was around 19% in both groups of the S-VHR. Nonetheless the group that received mesh repair had a significant higher mean value of the defect. In the D-VHR cohort 1 patient was lost at follow up while 3 patients were not operated on due to inadequate weight loss. No recurrences occurred in the 4 patients requiring emergency surgery.

Conclusions:

D-VHR is associated with worse early postoperative outcomes; primary suture repair should be considered in preventing bowel incarceration but synchronous mesh repair is preferred in large symptomatic hernias for its acceptable postoperative morbidity and hernia recurrence at 1 year.
P076 DIFFERENT SURGICAL APPROACH IN DIASTASIS RECTI REPAIR: IMPORTANCE OF AN OVERALL VIEW OF THE DISEASE
Authors: Fiori Federico , Ferrara Francesco , Gentile Daniele , Baldi Caterina , Benuzzi Laura , Boati Paolo , Stella Marco , Calì Matteo
Published: December 2021

Aim

Diastasis Recti (DR) is characterized by a defect of the linea alba sometimes associated with midline hernias, and frequent lipocutaneous excess. We present our experience in the treatment of diastasis recti with Inter Recti Distance (IRD) > 50mm -with or without umbilical hernia- by 3 different approaches.

Material and Methods

From January 2018 to February 2020, 104 patients were referred to our unit for clinical and radiological diagnosis of DR with IRD > 50 mm. Three different surgical approaches were used, based on presence of lipocoutaneous excess: laparoabdominoplasty, laparominiabdominoplasty and minimally-invasive/endoscopic with Totally Sublay Anterior Repair (TESAR) approach.

Results

We performed 28 TESAR (29.8%), 44 laparoabdominoplasties (42.3%) and 32 laparominiabdominoplasties (30.8%). Overall complication rate was 26% (27 patients). In 3 (2.9%) cases major surgical complications (Clavien-Dindo 3-4) occurred, all for open operations. Minor complications (Clavien-Dindo 1-2) included: 13 cutaneous ischemia, 10 small muscular hematomas and 1 subcutaneous seroma. The overall median post-operative stay was 3 days (range 2 – 14 days), and 3, 4 and 3 days for TESAR, laparoabdominoplasty and laparominiabdominoplasty groups, respectively. No recurrence registered to date.

Conclusions

Our experience shows the importance of an overall view of the functional and cosmetic impairment created by the DR. The surgeon must obtain an optimal functional outcome also aiming for the best cosmetic result. Therefore different approaches have to be considered, tailored to the clinical, instrumental and psychological aspects of the disease. The complication rate, while in line with the literature, emphasize how in this type of operation the critical issues of functional as well as morphological surgery coexist.
P088 SURGEON AS A RISK FACTOR OF REDUCED EURAHS QOL SCORE AFTER HERNIA REPAIR
Authors: Woleský Jakub , Jíšová Barbora , East Barbora
Published: December 2021

Aim

Our aim was to analyze patient’s reported EuraHS QoL (quality of life) scores before and after hernia surgery. And find whether the result is surgeon dependent or not, because hernia repair often serves as a training surgery for young surgeons or is performed by surgeons with no hernia interest. However, even a simple groin hernia repair can lead to life-long pain or reduced QoL and the risk of complications following incisional hernia repair is much higher.

Material and Methods

We have utilized the EuraHS database and its QoL questionnaire and prospectively entered all patients undergoing any hernia repair at our department since Jan. 2019.

Results

519 patients have been included. Many patients in the incisional hernia cohort have reported no or very little symptoms before the operation. Only 251 have completed their 1 month follow-up with the QoL questionnaire. 63 patients have been contacted and questioned 1 year post-surgery to this date. In 6 cases the QoL scores are lower than pre-repair. 45 patients had a record of major complication or reoccurrence requiring surgery so far. Unfortunately 31 of those did not fill up the QoL questionnaire. 37 were operated on by resident with a supervision of a surgeon without a hernia interest.

Conclusions

Results of hernia repair are surgeon dependent and an internal audit of current practices is needed at many general surgery departments.
P093 RESULTS OF CYTOREDUCTION SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (HIPEC) WITH SIMULTANEOUS COMPLEX RECONSTRUCTION OF THE ABDOMINAL WALL
Authors: Fernández Ismael Antón , Pérez Jorge Loro , GonzálezSánchez Laura , Tomasety Eudaldo López , Hernández Juan Ramón Hernández
Published: December 2021

Aim

“Cytoreductive surgery (CRS) together with the application of hyperthermic intraperitoneal chemotherapy (HIPEC) has proven to be a feasible and effective method in the management of selected patients with peritoneal metastases and/or primary peritoneal tumors. Infiltration of the abdominal wall is a frequent finding in these patients, which often leads to extensive resections and complex parietal reconstructions in the same surgical act. This may be associated with wound complications and the consequent delay in postoperative therapy of the patient. For this reason, an exquisite management of the abdominal wall is required. Our goal is to evaluate the technique and results of two clinical cases that required simultaneous complex reconstructions.”

Material and Methods

“Review patients undergoing CRS and HIPEC and simultaneous complex abdominal wall reconstruction between 2015 and 2020. Analysis of oncological history, description of the defect resulting from cytoreduction and the reconstruction technique used, postoperative course and medium-term results.”

Results

“Different techniques were used to reconstruct the abdominal wall according the caracteristics of the defect after cytoreduction. The simultaneous performance of reconstruction techniques did not increase the hospital stay nor the rate of complications of the surgical wound. Systemic chemotherapy was continued without delay and we have no evidence of incisional hernias in the medium term.”

Conclusions

“In our experience, the use of abdominal wall reconstruction techniques in the same surgical time after performing CRS and HIPEC is safe and with good results in the medium term.”
P106 PROPHYLACTIC MESH FOR PREVENTION OF INCISIONAL HERNIA IN HIGH-RISK PATIENTS: PVDF “VISIBLE” MESH BEHAVIOUR ON MRI
Authors: Aguilera Beatriz Carrasco , Torres Marina da Silva , Rodicio Jose , Valle Ana Fernández del , Moreno Maria , Amoza Sonia , Ruiz Pablo Del Val , Garcia Miguel Martinez-Cachero , Alvarez Lourdes Sanz , Menéndez Rafael , Ureña Miguel Ángel García
Published: December 2021

Aim

According to the guidelines, prophylactic mesh placement appears to be an effective, safe procedure in high-risk patients for the prevention of incisional hernia (IH) after midline laparotomy, without its use being standardized. Knowing its radiological behaviour can resolve doubts about its use.

Material and Methods

This was a prospective observational cohort study. The included patients needed to have more than one risk factor for IH (age> 60 years old, Body Mass Index > 30kg/m2, diabetes, chronic bronchopathy, heart disease, smoking, kidney disease, neoplasia, liver disease, immunosuppression or an emergency operation). Follow-up included 6-week and 12-month postoperative magnetic resonance imaging (MRI). If MRI was not performed, we used the follow-up computed tomography (CT).

Results

Between July 2016 and March 2021, 54 patients were enrolled in the study. Surgery was emergent in 14.8% of cases, clean-contaminated in 87% and upper gastrointestinal surgery in 51.9%. A total of 43 MRI and 3 CT at 6-week and 30 MRI and 2 CT at 12-month were carried out. The median of the mesh area were 150.7 vs 150,1cm2 respectively. 91% of cases had the mesh lined to the fascia at 12 months. The bridging in the linea alba was zero in 61% at 6-weeks and 24% at 12-month follow-up, mean 9 vs 19mm (p = 0.001).

Conclusions

The use of imaging tests to know the postoperative behaviour of a Polyvinylidenfluorid (PVDF) “visible” mesh shows us that there is no mesh contraction at one year or detachment of the fascia, however we observe a significant tendency in the separation of the linea alba.
P110 MANAGEMENT OF THE OPEN ABDOMEN WITH COMBINED THERAPIES. HOW TO AVOID THE VENTRAL HERNIA AND BE ABLE TO PERFORM THE REPAIR OF THE ABDOMINAL WALL IN A DEFINITIVE WAY
Authors: Aguirre Miguel
Published: December 2021

Aim

To demonstrate that in patients with abdominal sepsis, delayed primary fascial closure and definitive abdominal wall repair can be achieved, in the same hospitalization, using combined therapies, which reduces the percentage of ventral hernias.

Material and Methods

Medical records, tomography images and outpatient controls of 9 patients were reviewed, which required open abdomen management for abdominal sepsis using negative pressure therapy combined with a dynamic fascial mesh traction, from February 2020 until May 2021.

Results

9 patients (2 men and 7 women), all Grade 2C open abdomen according to Björck clasification, with a median age of 43 years (25-71). The median time therapy was 29±3 days. The primary fascial closure rate was 100% (n = 9), 77.8% (n = 7) underwent a definitive repair of the abdominal wall with absorbable synthetic mesh in the same hospitalization, while 22.2% (n = 2) did not, due to being cancer patients.

The mortality rate was 11.1% (n = 1) due to pneumonia and the fistula rate was 11.1% (n = 1). None developed an incisional hernia at the one-year follow-up.

Conclusions

The combination of negative pressure therapy with dynamic fascial mesh traction, in the management of the open abdomen, allows us to achieve a 100% delayed primary fascial closure, avoiding ventral hernia. In the same hospitalization, while the patient leaves the critical stage, we can achieve a definitive repair of the abdominal wall using absorbable synthetic meshes returning the biomechanics to the abdominal wall, improving the quality of life of these patients.
P126 LAPAROSCOPIC TREATMENT OF HYDROCELE IN FEMORAL CANAL: A CASE REPORT
Authors: Malaibari Zaid , Niebuhr Henning
Published: December 2021

Aim

The hydrocele of the femoral canal (Femorocele) is one of the rarest entities of femoral hernia (1). All of the reported cases were an intraoperative diagnosis and were treated with an open approach. We are reporting, the probably first femorocele diagnosed and treated laparoscopically.

Material and Methods

A 57-years-old female patient was presented in our outpatient clinic with pain and an unclear lump in the groin area for 6 months. The sonographic examination revealed a cystic structure in the groin area resampling Nuck’s cyst. An elective laparoscopic exploration and transabdominal preperitoneal (TAPP) repair was planned.

Results

A laparoscopic exploration was carried out. Intraoperatively, the cystic structure was not found in the Nuck’s Canal, but in the femoral canal as a content of a femoral hernia with some pre-peritoneal fat. By the extraction of the cyst, a gush of clear fluid was noted. After the usual preparation of the preperitoneal area, a mesh was placed in TAPP technique.

Conclusions

This rare variety of femoral hernias, femorocele, is commonly misdiagnosed as a strangulated hernia or Nuck’s cyst (as in this case) among other differential diagnoses (2). All published femorocele cases were treated with an open approach. As demonstrated here, such unclear cases can be laparoscopically explored and treated accordingly.
P131 A NEW THREE-STEP HYBRID APPROACH IS A SAFE PROCEDURE FOR INCISIONAL HERNIA: EARLY EXPERIENCES WITH A SINGLE CENTRE RETROSPECTIVE COHORT
Authors: Van den Dop Matthijs , Smet Gijs De , Bus Michaël , Lange Johan , Koch Sascha , Hueting Willem
Published: December 2021

Aim

In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined: so-called ‘three-step incisional hybrid repair’. The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh.

Material and Methods

From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤10 cm underwent an elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed.

Results

Mean operation time was 100 min. Mean hernia size was 4.8 cm; 45 patients (64.3%) had a hernia of 1–5 cm, 25 patients (35.7%) of 6–10 cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3 days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5 weeks.

Conclusions

A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low.
P138 PREPERITONEAL ENDOSCOPIC GROIN HERNIA SURGERY - REASSESSMENT OF TOPOGRAPHIC ANATOMY AS A BASIS FOR STANDARDIZED DESCRIPTION OF SURGICAL STEPS
Authors: Heimke Marvin , Heinze Tilmann , Kuthe Andreas , Wedel Thilo , Strey Christoph W
Published: December 2021

Aim

Fascial groin anatomy remains a conundrum. In particular, a clear anatomical allocation of the correct extraperitoneal dissection planes and spaces in total extraperitoneal endoscopic hernia surgery (TEP) has not yet agreed upon. The differing anatomical concepts are reflected by the variability of surgical approaches, the considerably long learning curves and subsequent complications. Thus, the aim of this study was to reassess the topographic anatomy of the groin region providing a basis to standardize the surgical steps of TEP according to clearly defined anatomical landmarks.

Material and Methods

Video analysis of intraoperative surgical anatomy of groin hernia patients was correlated with the findings retrieved by macroscopic anatomical studies. The groin region of formalin fixed body donors was subjected to a stepwise dissection exposing the fascial system of the abdominal wall layer-by-layer and via different angles. Selected areas of interest were processed for histological study. Surgically relevant anatomical landmarks were defined and termed according to the most appropriate anatomical nomenclature.

Results

The essential surgical dissection steps during TEP could be related to specific anatomical landmarks extending within the extraperitoneal space of the ventral and dorsolateral abdominal wall. The definition of fascial structures and interfaces and the identification of structures at risk allowed the identification of correct dissection planes for mesh placement.

Conclusions

Our study helps to clarify the definition and nomenclature of anatomical key structures required for a standardized description of TEP in a simplified model. The data may contribute to reduce complications and improve surgical teaching and training.
P142 IPOM PLUS: WHAT WE DO AND WE WANT SHARE AND DISCUSS
Authors: Agresta Ferdinando , Mazzarolo Giorgio , Licitra Edelweiss
Published: December 2021

Aim

In this video we want to share and discuss what we have learned from our 20 year experience in IPOM PLUS procedures

Material and Methods

We use only all 5 mm trocars , instruments and 30 degree optic and we always use a low intraabdonimal pressure (10mmHg).

The major technical trick in is to carefully prepare and manage the abdominal wall context, in order to free all the hernia areas.

Results

Our IPOM experience is almost more than 500 case, elective as emergency. Normally we use a double prolene (with the film versus the intestine) mesh with a 5 cm overlap. Besides the well known needed physical characteristics of the mesh, on the surgeon’s side, a mesh should be smooth, stiff, wide enough to cover all the possible defects, easy to handle and, especially for its possible use in laparoscopy, with a certain degree of and thickness just what it is needed in order to let it pass through a 5 mm trocar once rolled up. We use to close the defect in order to avoid serosa and SS - Morbidity and we use to fix the mesh with absorbable tackers

Conclusions

Most of the advantages of laparoscopy rely on the minimal access and the possibility to manage and examine the abdominal context, especially in emergency, and to close the defect and to fix the mesh with tackers.
P147 REHABILITATION AFTER VENTRAL HERNIA SURGERY IN THE NETHERLANDS: A SURVEY
Authors: Berkvens Elske , Bloemendaal Bob , Poelman Marijn , Reilingh Tammo de Vries , Johannes Wegdam
Published: December 2021

Aim

After any type of musculoskeletal surgery, post-operative rehabilitation with advices on weight baring and physical therapy is normal practice. Rehabilitation protocols lead to early mobilization and shorter hospitalization. Although ventral hernia repair (VHR) is musculotendinous surgery with tremendous impact on muscle strength and coordination, standardized and evidenced rehabilitation protocols for VHR are lacking. This survey aims to provide insight into the rehabilitation protocols after VHR, commonly used in the Netherlands.

Material and Methods

Hernia-surgeons in all Dutch hospitals were addressed in May 2021 by an electronic survey. Three cases were presented; non-complex (2 cm, primary umbilical repair), moderate-complex (8 cm, Rives-Stoppa) and complex (13 cm, myofascial release). Use of abdominal binders, advice on physical strain and referral for physical therapy were surveyed.

Results

75 of 75 (100%) Dutch hospitals responded. In order of increasing hernia complexity an abdominal binder was prescribed in respectively 10%, 74% and 92% with various duration. Reduced physical strain was advised in 73%, 90% and 91%, mainly with a duration of 4-6 weeks (40%, 58% and 70%). Patients were referred for physical therapy after discharge in 4%, 15% and 41%.

Conclusions

This study describes the practice of rehabilitation after VHR in the Netherlands. Although abdominal binder prescription and physical strain advices increases with hernia complexity, there is no uniformity in duration. Physical therapy was advised only in a minority of the VHR patients, even after complex reconstructions. Lack of standardized rehabilitation protocols after VHR underlines the need for guidelines.
P150 UTILISATION OF OVINE REINFORCED TISSUE MATRIX IN PAEDIATRIC RECONSTRUCTIVE SURGERY
Authors: Engall Nick , Peters Robert Thomas , Lansdale Nick , Craigie Ross James
Published: December 2021

Aim

Abdominal and thoracic reconstructive surgery has always been an aspect of surgical care in children for conditions such as congenital abdominal wall defects, large hiatus herniae, incisional herniae and chest wall defects following tumour surgery. Biosynthetic matrices are ideal for reconstructive surgery in the paediatric population as consideration needs to be given to future growth and potential need for reoperation. Moreover, the use of synthetic materials in this setting is known to be associated with long term issues.

We present the results of our experience with ovine reinforced tissue matrix1 in paediatric reconstructive surgery.

Material and Methods

All patients who underwent an operation at our institution using the biosynthetic matrix from March 2019 to April 2021 were identified retrospectively by searching theatre databases. Patient demographics, diagnoses and case notes were reviewed.

Results

The biosynthetic matrix was used in 26 children, (15 male and 11 female). Median age at insertion was 5.1 years (2.1 – 7.1 years). Median weight at insertion was 14.0kg (11.3 – 28.1kg). Patients had a history of hiatus hernia (n = 10), exomphalos (n = 6), emergency laparotomy (n = 3), congenital diaphragmatic hernia (n = 2) sternal sarcoma (n = 1), rib sarcoma (n = 1), gastroschisis (n = 1), recurrent umbilical hernia (n = 1) and direct inguinal hernia (n = 1).

There were no hernial recurrences. There was a surgical site occurrence (SSO) in 12% - skin dehiscence (n = 2) and wound infection (n = 1). Median length of follow up was 7.9 months (4.5-9.0 months).

Conclusions

Our series demonstrates that ovine biosynthetic matrices can be used safely in paediatric reconstructive surgery with excellent outcomes and a very low rate of SSO.

1. OviTex®-TELA Bio
VP026 LIRA-TAPE TECHNIQUE. A NEW PROCEDURE FOR RESTORING THE MIDLINE BY MIS IN SUPRAPUBIC AND MIDDLE SIZE MIDLINE HERNIAS
Authors: Gómez-Menchero Julio , Bohorquez Antonio Gila , Ramirez Jose Luis Guerrero , Herranz Pablo de la , Moreno Joaquin Luis García , Morales-Conde Salvador
Published: December 2021

Aim

LIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) was described in 2018 in order to reduce the tension in the midline as an alternative for Closing the defect (CD) during Laparoscopic Ventral Hernia Repair. TAPE (Transabdominal Partial Extraperitoneal) was described in 2011 in order to repair complex suprapubic hernias to reduce the recurrence rate. We present a case of suprapubic hernia associated to a medium-size midline hernia using LIRA combined with TAPE as a new procedure for abdominal wall reconstruction

Material and Methods

50 years old female affected with a M5 W2 hernia associated to a M2-3 W2. (EHS Classification). Preoperative scan was performed.

Results

3 Ports (2 of 5 mm, 1 of 12 mm) in the left mid axillary line for LIRA and supraumbilical (10 mm) and right paraumbilical (5mm) to assist TAPE were placed. A peritoneal flap is created to expose de pubic arch and the Coopeŕs Ligament. CD was performed in suprapubic defect using a barbed suture and continued for LIRA procedure in the posterior rectus sheath. An intraabdominal mesh was placed (Polyvinylidene fluoride (PVDF) mesh, Dynamesh (®)-IPOM (FEG Textiltechnik mbH, Aachen, Germany. The mesh overlapped the suprapubic arch and was fixed using helicoidal sutures and covered the whole incision in the midline. Pelvic flap covered partially the mesh. Patient was discharge in 72 h

Conclusions

Complex hernias close to bones, as suprapubic hernias, can be restored using a minimal invasive approach, even those associated to mid-line defects. LIRA-TAPE is a safe and reproducible association for restoring the midline with a low rate of complications.
O03 SMALL BITES AND PROPHYLACTIC MESH TO PREVENT INCISIONAL HERNIA IN HIGH-RISK PATIENTS. A MESH IS THE MOST POWERFUL TOOL
Authors: Amador Sara , Pereira-Rodriguez Jose Antonio , Bravo-Salva Alejandro , Ventura-Montcusí Blanca , Insenser Juan José Sancho , Román Miguel Pera , Cano Manuel López
Published: December 2021

Aim

Small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by guidelines to prevent incisional hernias (IHs) and burst abdomen (BA). Our aim was to implement a protocol combining both and to analyze its outcomes.

Material and Methods

Prospective data collection of all EMLs for one year. Results were analyzed at one month and during follow-up. The incidence of IH and BA was compared by groups depending on the use of a PM (M Group) or not (S Group), and in subgroups related to the closure technique: SB (Subgroups MSB and SSB) or not (Subgroups MLB and MSB).

Results

A lower number of BA was diagnosed in the M group (OR 0.0692; CI95% 0.008-0.56; P = 0.01) in 197 operations. 163 patients completed a mean follow-up of 29.23 months, with a lower frequency of IH in M group patients (OR = 0.769; CI 95% 0.65 - 0.91; P < 0.0001). Same differences persisted after a propensity matching score: BA (OR = 0.355; CI 95% 0.255 - 0.494; P < 0.0001) and IH (OR = 0.394; CI 95% 0.24 - 0.61; P < 0.0001). Comparing suturing techniques by subgroups any difference in IH and BA appeared. PM was the main factor related to reduction of IH (HR 11.794; CI 95% 4.29 - 32.39; P < 0.0001).

Conclusions

A PM is the most powerful tool for prevention both IH and BA after EMLs, regardless of the closure technique in patients at high-risk for IHs.
O05 1-YEAR RESULTS OF AN INTERNATIONAL RANDOMIZED CONTROLLED TRIAL (ESTOIH STUDY) COMPARING THE “SHORT STITCH” VERSUS “LONG STITCH” TECHNIQUE USING AN ULTRA-LONG ABSORBABLE ELASTIC SUTURE MATERIAL
Authors: Fortelny René , Albertsmeier Markus , Hofmann Anna , Riedl Stefan , Kewer Jan Ludolf , Shamiyeh Andreas , Maier Theo David , Schuhmacher Guido , Koeckerling Ferdinand , Pession Ursula
Published: December 2021

Aim

The aim of this multicenter, randomized, double blinded study was to compare the short stitch technique for elective, primary, median laparotomy closure with the long stitch closure using the ultra-long absorbable, elastic monofilament suture made of poly 4-hydroxybutyrate (MonoMax®).

Material and Methods

Eligible patients were randomly allocated to receive either the short or the long stitch suture technique in a 1:1 ratio in 9 centers in Austria and Germany after elective midline laparotomy.

Results

425 patients were randomized to receive either the short stitch (n = 215) or long stitch technique (n = 210). In a cox proportional hazards model, the risk for burst abdomen was reduced by 7-fold (HR 0.183 (0.0427 - 0.7435), p = 0.0179) for the short stitch group. Complications such as seroma, hematoma and other wound healing disorders occurred without significant differences between groups. After one year, the incisional hernia rate was 3.65% in the short stitch group compared to 8.80% in the long stitch group (p = 0.055). The combination of burst abdomen and incisional hernia rate had a significantly lower rate of 5.38% for the short stitch technique compared to 13.17% for the long stitch technique (p = 0.0142).

Conclusions

Both in the short-term results, the short-stitch technique showed substantial advantages in burst abdomen rate, as well as in the 1-year follow-up regarding the incidence of incisional hernias. The low incidence of incisional hernia in the short stitch technique with MonoMax® is promising in comparison to previously published data and should be confirmed in the 3-year follow-up.
O11 SEX DIFFERENCES, SLEEP DISTURBANCE AND RISK OF PERSISTENT PAIN ASSOCIATED WITH GROIN HERNIA SURGERY: A NATIONWIDE REGISTER-BASED COHORT STUDY
Authors: Bjurström Martin F. , Irwin Michael R. , Chen David C. , Smith Michael T. , Montgomery Agneta
Published: December 2021

Aim

Persistent pain after groin hernia repair is a major health problem. Sleep disturbance is associated with heightened pain sensitivity. The main objective of this study was to examine the role of sleep disturbance in the development and long-term maintenance of chronic postherniorrhaphy inguinal pain (CPIP), with exploration of sex differences.

Material and Methods

From 2012-2017, a national cohort of patients with prior groin hernia repair (n = 2084; 45.8% females) were assessed for the development of CPIP 12 months after surgery. Patients then underwent long-term (median 5.0 years) follow-up to evaluate the contribution of sex and sleep disturbance on the maintenance of CPIP. Associations between pre- and postoperative sleep problems (assessed at long-term follow-up) and CPIP were tested using logistic regression.

Results

Females had higher rates of CPIP with negative impact on daily activities 12 months after surgery as compared to males (14.6 vs 9.2%, p<0.0005), and were more likely to have moderate-severe CPIP in the long-term (3.1 vs 1.2%, p=0.003). Preoperative sleep problems predicted development of CPIP 12 months after surgery (adjusted odds ratio (aOR) 1.76 (95%CI 1.26-2.46), p=0.001) and CPIP in the long-term (aOR 2.20 (1.61-3.00), p<0.0001). CPIP was associated with insomnia and depression.

Conclusions

Sleep disturbance may increase the risk for CPIP, and contribute to maintenance of postsurgical pain. Females are at heightened risk for CPIP as compared to males. Given the robust associations between sleep disturbance and CPIP, interventions which consolidate and promote sleep, especially in females, may improve long-term pain control.
O22 ANDROGEN DEPRIVATION THERAPY AND THE RISK FOR INGUINAL HERNIA
Authors: Hermann Maria , Sandblom Gabriel , Gustafsson Ove , Stattin Pär , Styrke Johan , Katawazai Asmatullah , Vikman Hanna
Published: December 2021

Aim

To investigate whether androgen deprivation therapy (ADT) for prostate cancer increases the risk for inguinal hernia.

Material and Methods

A population-based nested case-control study based on data from the Prostate Cancer Database Sweden. The cohort included men with prostate cancer who had not received curative treatment. Men who had been diagnosed with inguinal hernia or had undergone inguinal hernia repair (n = 1324) were cases and controls were men, not diagnosed, nor operated on for inguinal hernia, matched on birth year (n = 13 240). Conditional multivariate logistic regression models were used to assess any temporal association between ADT and inguinal hernia, adjusting for confounders.

Results

Odds Ratio [OR] for repair of inguinal hernia 0-1 years from start of ADT was 0.5 (95% confidence Interval (CI)) 0.38-0.68), between 1 and 3 years after, the OR was 0.35 (95% CI 0.26-0.47), 3-5 years after, the OR was 0.39 (95% CI 0.26-0.56), 5-7 years after, the OR was 0.6, (95% CI: 0.41-0.97), and > 9 years after, the OR was 3.68 (95% CI 2.45-5.53).

Conclusions

The marked increase in OR for inguinal hernia after 9 years of ADT supports the hypothesis that low testosterone levels increase the risk for inguinal hernia. The low risk for inguinal hernia during the first eight years on ADT is likely caused by selection of men with advanced cancer unlikely to be diagnosed or treated for inguinal hernia. This finding may support the hypothesis that sex hormones plays a crucial role in inguinal hernia development.