bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Parental Control and Support in Declining Adolescent Drinking: A Multi-Level Study Across 30 European Countries
Authors: Vashishtha Rakhi , Pennay Amy , Dietze Paul M , Livingston Michael
Published: November 2021

Background

Adolescent drinking has declined in many high-income countries since the early 2000s. It has been suggested that changing parenting practices may have contributed to the decline. However, previous studies investigating parenting have focused on single countries and have provided conflicting evidence. This study tested the association between changes in individual- and population-level parental control and parental support and changes in past month adolescent drinking.

Methods

A total of 271,823 adolescents aged 15–16 years, from 30 European countries between 2003 and 2015 were included in this study. Our key independent variables were adolescent reports of parental control and parental support. Our outcome measure was a dichotomous measure of any alcohol use in the 30 days before the survey, referred as past month drinking. Aggregated measures of parenting variables were used to estimate between-country and within-country effects of parenting on adolescent drinking. Data were analysed using three-level hierarchical linear probability methods.

Results

At the individual-level, we found a negative association between the two parental measures, i.e. parental control (β = −0.003 and 95% CI = −0.021 to 0.017) and parental support (β = −0.008 and 95% CI = −0.010 to 0.006) and past month drinking. This suggests adolescents whose parents exert higher control and provide more support tend to drink less. At a population level, we did not find any evidence of association on between-country and within-country parenting changes and past month drinking.

Conclusions

It is unlikely that changes in parental control or support at the population-level have contributed to the decline in drinking among adolescents in 30 European countries.
Public Perception of Ideal Breast Shape
Authors: Kelly Jason D , Comstock Bryan , Shauly Orr , Smartt James M , Gould Daniel J
Published: December 2021

Background

In the past decade, there has been a dramatic increase in trends related to body-shaping procedures. According to the American Society of Plastic Surgeons, nearly 300,000 breast augmentation procedures were conducted in 2019. Learning the ideal shape of a breast and which esthetics lead to public perception of the most attractive breast is beneficial to properly performing these procedures.

Objectives

The authors aimed to quantify the public’s perception of attraction to breast shape by measuring public opinion for various esthetic elements of breast anatomy and linking this to various demographic factors.

Methods

Survey responses were collected from 1000 users of Amazon Mechanical Turk to collect demographic data and ask users to rank preferences for randomized image panels of breast proportions.

Results

960 responses were used for analysis. A majority of respondents were male (60%), with a plurality being 25 to 34 years old (49.3%). The most notable preferences between all groups were breast projection proportion and nipple direction, with preferences of 1.0 and frontal nipple direction, respectively. Breast width to shoulder width ratio also had a clear preference among the crowd, with 105% being the preferred percentage, and the 25 to 34 age group having a very strong preference for this.

Conclusions

The authors used a crowdsourcing survey technique with randomized image panels to analyze ideal breast preference using images of various anatomical traits of the female breast. It was concluded that crowdsourcing can be a favorable technique for learning ideal overall preferences for specific anatomy.
P003 SUMMER TRIAL: MESH VERSUS SUTURE REPAIR IN SMALL UMBILICAL HERNIAS IN ADULTS: A STUDY PROTOCOL FOR A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, MULTICENTER CLINICAL TRIAL
Authors: Melkemichel Maria , Bringman Sven , Granåsen Gabriel , Widhe Björn
Published: December 2021

Aim

A gold standard procedure for small umbilical hernia repairs is still lacking today. There is an increasing evidence that mesh could be advantageous in lowering recurrence rates. A question remains with regard to optimal anatomical positioning of the mesh. We hypothesize that the use of an onlay-mesh can reduce recurrence rates without increasing complications compared to a simple-suture repair.

Material and Methods

A prospective, national, multicenter, randomized, double-blind clinical trial comparing a standardized 4x4 cm onlay mesh to a conventional suture repair will be conducted. 288 patients with a primary elective umbilical hernia ≤ 2 cm from 7 participating Swedish surgical centers will be enrolled. Intraoperative randomization will take place. Trial participants and follow-up clinical surgeons will be blinded to the assigned allocation. The primary outcome assessed will be postoperative recurrence at 1 and 3 years. Secondary outcomes assessed will be postoperative complications at 30 days and pain 1 year after surgery.

Results

140 participants are included since February 2020 and 95 participants are randomized.

Conclusions

How to best repair a small umbilical hernia continues to be debated. A small onlay-mesh may become an easy and a safe method of choice to reduce recurrence rates in small umbilical hernia defects. This trial design should allow for a good assessment of differences in recurrence rate with due to the large sample size and the adequate follow-up. Guidelines for small umbilical hernia repairs have stressed the need for reliable data to improve treatment recommendations. We can expect that this trial will have a direct implication on small umbilical hernia repair standards.
P004 TREATMENT OF RECURRENT INGUINAL HERNIA AFTER TRANSINGUINAL PREPERITONEAL (TIPP) SURGERY
Authors: van Silfhout Lysanne , van Hout Ludo , Jolles Myrthe , Theeuwes Hilco P. , Bökkerink Willem J.V. , Vriens Patrick W.H.E.
Published: December 2021

Aim

To report feasibility and surgical outcomes of recurrent inguinal hernia repair after TransInguinal PrePeritoneal (TIPP) repair.

Material and Methods

Patients who underwent recurrent IHR after TIPP between January 2013 and January 2015 in a single hernia-dedicated teaching hospital were included. Exclusion criteria were femoral hernia, incarcerated hernia and reasons for unreliable follow-up. Electronic medical records were assessed retrospectively to register surgical outcomes and complications.

Results

Thirty-three patients underwent surgical repair of recurrent inguinal hernia after TIPP. Twenty patients were treated with a “re-TIPP when possible” strategy; resulting in 13 successful re-tipps and 7 conversions to Lichtenstein repair. Eleven patients underwent primarily a Lichtenstein’s repair, the remaining two patients underwent recurrent IHR using other techniques (transrectus sheath Pre-Peritoneal and transabdominal preperitoneal repair). Mean time of surgery was 44.7 minutes (standard deviation 16.7). There was one patient (3.0%) with a re-recurrent inguinal hernia during follow-up. Other minor complications included urinary tract infection. There were no significant differences in post-operative results between the different surgical techniques used for recurrent IHR.

Conclusions

These results indicate that after TIPP it is feasible and safe to perform re-surgery for recurrence with an anterior approach again. For these recurrences, a Lichtenstein can be performed, or a ‘re-TIPP if possible’ strategy can be applied by experienced TIPP surgeons. Whether a re-TIPP has the same advantages over Lichtenstein as is for primary inguinal hernia surgery, needs to be evaluated in a prospective manner.
P009 BEYOND TANAKA INDEX: PREOPERATIVE ASSESSMENT WITH 3D TECHNOLOGY IN LARGE HERNIAS WITH LOSS OF DOMAIN
Authors: Ramos Alexander Osorio , Diaz Rafael , Sanchez Raquel , Sanchón Lorena , Guariglia Claudio , Pardo Sara , Farré Roser , Guell Mercé , Ayala Bartomeu , Collera Pablo
Published: December 2021

Aim

“Demonstrate step by step the planning that was carried out using 3D technology in pre-surgical assessment for complex hernia.”

Material and Methods

“57-year-old female, surgical record of laparoscopic uterine myomectomy 20 years ago, has an eventration with loss of domain on the left flank and a giant uterine myoma.

A multidisciplinary assessment was carried out for surgical decision, myomectomy was rejected.

Presurgical preparation was decided with progressive pneumoperitoneum (PPP) technique (1 week before surgery) associated with botulinum toxin (4 weeks before surgery).

The patient specific volumes of the abdominal cavity and the eventration were measured with 3D technology resulting in a volume ratio (VR) of 34% pre-PPP, VR post-PPP and botulinum toxin was 9,8%.

We compared these results to Tanaka index and we found a significant difference between the two techniques.”

Results

“During surgical intervention, multiple tumors were evidenced in the hernia content, distal ileum, cecum and omentum, peroperative pathological anatomy reported leiomyomas.

An ileocecal resection+Omentectomy+TAR was performed.

Patient was discharged on the 5th day without incidents.

A definitive diagnosis of Diffuse Peritoneal Leiomyomatosis was made.”

Conclusions

“3D technology might represent a better tool to calculate intraabdominal and hernia volume, providing greater safety for the patient and the surgeon to avoid compartment syndrome.

We found a significant difference between volumes measurements between Tanaka index and 3D technology.

3D technology gives us an unprecedented perspective for surgical planning in complex abdominal wall surgery

The use of PPP and botulinum toxin is a safe and reproducible technique for hernia with loss of domain.”
P020 ESTABLISHING PEER-CONSENSUS ABOUT THE USE OF LONG-TERM BIOSYNTHETIC ABSORBABLE MESH FOR VENTRAL HERNIA (GRADE 2-3) AS THE STANDARD OF CARE
Authors: Morales-Conde Salvador , Berrevoet Frederik , Jorgensen Lars Nannestad , Marchi Domenico , Ortega-Deballon Pablo , Windsor Al
Published: December 2021

Aim

“This consensus project was initiated to provide insight into those situations where a long-term biosynthetic absorbable mesh (LTBA) might be considered the standard of care in repair of ventral hernia grades 2 and 3 (original Ventral Hernia Working Group Classification, 2010).”

Material and Methods

“A steering group of surgical experts developed 35 initial statements formed from six domains. These statements were used to develop an online survey which was sent to surgeons involved in hernia repair surgery within Europe. Agreement (consensus) with the statements was defined as high if ≥ 70% and very high if ≥ 90% of respondents agreed with a statement. After the initial survey round, some statements were revised and these were then reissued, 34 statements were included in the final analysis”

Results

“A total of 255 responses were received over the two rounds of survey. Respondents (n = 255) were all surgeons involved in hernia repair in Europe. Fourteen statements (41%) achieved very high consensus (≥ 90%), 24 statements achieved consensus (≥70% to < 90%) while one statement (3%) fell short of consensus with an agreement score of 69%.”

Conclusions

“Expert consensus opinion about the use of LTBA for hernia (Grades 2-3) as the standard of care was achieved. Based on the consensus scores, the steering group derived eleven key recommendations which, if implemented, should result in a clearer understanding of how and when a LTBA might be used in hernia repair, aiming for improvement in surgical and patient related outcomes”
P031 OPEN VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: A NATIONWIDE DATABASE STUDY
Authors: Henriksen Nadia , Andersen Hans Friis , Jorgensen Lars Nannestad , Helgstrand Frederik
Published: December 2021

Aim

Although laparoscopic repair of incisional hernias decreases the incidence of wound complications as compared with open repair, there has been a rising concern related to intraperitoneal mesh placement. The aim of this study was to examine outcomes after open or laparoscopic elective incisional hernia mesh repair on a nationwide basis.

Material and Methods

A merge of data between the Danish Hernia Database and the National Patient Registry provided data on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence from 2007-2018.

Results

A total of 3,090 (57.5%) and 2,288 (42.5%) patients were operated by laparoscopic and open approach, respectively. The defect was closed in 27.9% (865/3,090) of the laparoscopic cases. The median follow-up time was 4.0 (1.8-6.8) years. Rates of readmission (16.2%, 502/3,090) and re-operation for complication (7.0%, 216/3,090) were significantly lower for laparoscopic compared to open repairs (19.3%, 442/2,288, P = 0.003 and 12.5%, 288/2,288, P < 0.001). Re-operation for bowel obstruction or bowel resection was twice as high after laparoscopic repair (0.6%, 20/3,090) compared with open repair (0.3%, 6/2,288, P = 0.044). Patients were significantly less prone to undergo repair of recurrence following laparoscopic compared with open repair of defect widths 2-6 cm (P = 0.002).

Conclusions

Laparoscopic intraperitoneal mesh repair for incisional hernia should still be considered for fascial defects between 2 and 6 cm, because of decreased incidences of early complications and repair of hernia recurrence compared with open repair.
P044 ATRAUMATIC AND CONSISTENT HERNIA MESH FIXATION: PERFORMANCE AND SAFETY IN A LAPAROSCOPIC IPOM PORCINE MODEL
Authors: Lopes Miguel , Bitton Elisa , Devries Elise , Pereira Maria
Published: December 2021

Aim

Demonstrate the performance and safety of TISSIUM on-demand activated adhesive for atraumatic hernia mesh fixation in a laparoscopic IPOM porcine model.

Material and Methods

Full thickness 4 cm in diameter excisional abdominal defects (n = 14) were created in pig (n = 8). The defects were repaired through laparoscopic intraperitoneal mesh placement using commercial composite meshes fixed with TISSIUM adhesive (n = 8) or resorbable tacks (n = 6). The animals were sacrificed after 28 and 90 days. An independent pathologist evaluated abdominal adhesion, mesh shrinkage, local tissue tolerance and tissue ingrowth through histological analysis (H&E and Movat Pentacrome) at sacrifice. Fixation strength of the explanted abdominal walls was also assessed via burst-ball.

Results

No adverse events were observed at implantation or during the survival period. All the meshes were in place at sacrifice. Mesh shrinkage and abdominal adhesion scores were similar between the two groups. Histological analysis of the mesh demonstrated equivalent quality of tissue ingrowth and excellent local tissue tolerance with minimal/mild foreign body response and mononuclear cells inflammation. The repair strength, evaluated through a burst ball method 90 days after implantation, showed no significant difference between the TISSIUM adhesive and tacks. Usability is currently being evaluated in clinically relevant models.

Conclusions

In this preclinical study the TISSIUM adhesive demonstrated similar fixation strength and quality of repair when compared to commercial tacks. This technology has the potential to impact hernia procedures standardization and reduce pain often associated with current fixation technologies.
P046 ATRAUMATIC AND CONSISTENT HERNIA MESH FIXATION: PERFORMANCE AND SAFETY IN A LAPAROSCOPIC IPOM PORCINE MODEL
Authors: Lopes Miguel , Bitton Elisa , Devries Elise , Pereira Maria
Published: December 2021

Aim

Demonstrate the performance and safety of TISSIUM on-demand activated adhesive for atraumatic hernia mesh fixation in a laparoscopic IPOM porcine model.

Material and Methods

Full thickness 4 cm in diameter excisional abdominal defects (n = 14) were created in pig (n = 8). The defects were repaired through laparoscopic intraperitoneal mesh placement using commercial composite meshes fixed with TISSIUM adhesive (n = 8) or resorbable tacks (n = 6). The animals were sacrificed after 28 and 90 days. An independent pathologist evaluated abdominal adhesion, mesh shrinkage, local tissue tolerance and tissue ingrowth through histological analysis (H&E and Movat Pentacrome) at sacrifice. Fixation strength of the explanted abdominal walls was also assessed via burst-ball.

Results

No adverse events were observed at implantation or during the survival period. All the meshes were in place at sacrifice. Mesh shrinkage and abdominal adhesion scores were similar between the two groups. Histological analysis of the mesh demonstrated equivalent quality of tissue ingrowth and excellent local tissue tolerance with minimal/mild foreign body response and mononuclear cells inflammation. The repair strength, evaluated through a burst ball method 90 days after implantation, showed no significant difference between the TISSIUM adhesive and tacks. Usability is currently being evaluated in clinically relevant models.

Conclusions

In this preclinical study the TISSIUM adhesive demonstrated similar fixation strength and quality of repair when compared to commercial tacks. This technology has the potential to impact hernia procedures standardization and reduce pain often associated with current fixation technologies.
P064 DURABLE REPAIR OF PRIMARY AND RECURRENT INCISIONAL HERNIA BASED ON BIOMECHANICAL PRINCIPLES
Authors: Nessel Regine , Löffler Thorsten , Rinn Johannes , Philipp Lösel , Voss Samuel , Heuveline Vincent , Vollmer Matthias , Görich Johannes , Al-Hileh Liung , Kallinowski Friedrich
Published: December 2021

Aim

Durable composite constructions of polymers follow specific mechanical principles. Can incisional hernia can be repaired durably based on biomechanical principles considering the abdominal wall a polymer composite?

Material and Methods

Biomechanical principles of the reconstruction of the abdominal wall were analyzed ex vivo with cyclic loading common in material sciences. The resulting GRIP concept was clinically applied. The tissue quality of the individual patient was assessed with computed tomography at rest and during Valsalva’s maneuver. Hernia meshes with high GRIP factors (Progrip®, Dahlhausen® Cicat) were used. All patients recieved single-shot antibiosis. Patients were discharged after full ambulation was achieved.

Results

A total of 163 patients (82 males and 81 females) were treated for incisional hernia. Primary hernia was repaired in 119, recurrence in 44 patients. Recurrent hernia was significantly larger (median 161 cm² versus 78 cm²; u-test: p = 0.00714) resulting in a 30 % lower mesh defect area ratio. Redo-surgery took significantly longer (median 229 min versus 150 min; p < 0.00001) as recurrent disease is more likely to require transversus abdominis release (70 % versus 47 %). GRIP tended to be higher in recurrent repair (p = 0.01828). Complication rates (15 %) and duration of hospitalization were the same (6 days; p = 0.28462). After one year, no recurrence was detected in either group. Pain levels were equally low in both groups (median NAS = 0 at rest and under load, p = 0.88866).

Conclusions

Incisional hernia can be repaired safely and durably based on biomechanical principles.
P065 LONG TERM OUTCOMES AFTER LAPAROSCOPIC REPAIR OF VENTRAL HERNIAS LOCATED ON THE ABDOMINAL BORDERS
Authors: Bertoglio Camillo Leonardo , Maspero Marianna , Morini Lorenzo , Alampi Bruno , Grimaldi Simona , Quagli Oscar , Ferrari Giovanni
Published: December 2021

Aim

To assess the long-term outcomes after laparoscopic repair (LR) of ventral hernias located on the abdominal borders.

Material and methods

Out of our prospectively collected LR database, all cases of ventral hernias were reviewed. Defects located near the abdominal borders were identified (M1, M5, L1 and L4 according to the EHS classification). All patients received intraperitoneal implantation of an e-PTFE mesh. The primary aim of this study was to assess long-term outcomes.

Results

Out of 175 LR, 105 (60%) had a M1 component, 61 (35%) an M5, 24 (14%) an L1 and 5 (3%) an L4. The median defect width was 9 cm (range 2.5 - 30), the median length 13 (range 2 - 30), with a median defect area of 92 cm2 (range 5 - 471). Two (1%) cases required conversion to open approach. After a median follow up of 55 months, there were 7 recurrences: 4/105 in M1 patients, 1/61 M5 patients, 1/24 L1 patients and 1/4 L4 patients. 41 patients (23%) experienced chronic seroma, while 24 (14%) had chronic pain. 6 patients (3%) required a reoperation with mesh removal. At univariate analysis, only previous hernia repair was associated with recurrence; COPD, hypertension and M5 defect were associated with seroma development; seroma development and chronic pain were mutually associated.

Conclusions

Laparoscopic repair for ventral hernias is safe and feasible, with good long term outcomes.
P067 HUMANITARIAN HERNIA SURGERY - 10 YEARS OF PERSONAL EXPERIENCE AND THE SAFETY OF LDPE MOSQUITO MESH
Authors: Bystřický Petr
Published: December 2021

Aim

Many people from low-income countries suffer from late or no treatment of incarcerated hernias. That can cause permanent consequences or even death. Hernia International is a 100% volunteer organisation, delivering humanitarian hernia surgery in the countries of the third world. A LDPE mosquito mesh is widely used. Its safety and full functionality was described.

Material and Methods

A LDPE Mosquito mesh was a subject of testing for a heavy metal content; the same-size piece of a mosquito mesh, and a standard commercial mesh, were tested by spectral photometry.

I have had the chance to join 11 international voluntary teams in the years of 2011-2019. More than 1000 procedures were performed, including large inguinoscrotal, incisional, and pediatric hernias. The conditions were often very basic, and a LDPE mosquito mesh and local anaeshesia were used in most adult cases.

Results

The test shows comparable or less presence of heavy metals in the LDPE mosquito mesh, in comparison with a standard polypropylene mesh.

A very low number of early post-op complications, such as haematoma and wound infection, were recorded (less than 1%) in a group of patients operated during voluntary missions. 1-2 local young surgeons were trained in basic hernia procedures.

Conclusions

Hernia International provides a high-quality surgical care to the patients from the developing countries. Using a mosquito mesh is a safe and effective method with a comparable low complication rate but with minimal costs.
P074 PARASTOMAL AND INCISIONAL HERNIAS FOLLOWING EMERGENCY SURGERY FOR HINCHEY III-IV DIVERTICULITIS: A SYSTEMATIC REVIEW
Authors: Mäkäräinen Elisa , Rautio Tero , Muysoms Filip , Kauppila Joonas
Published: December 2021

Aim

The aim of this systematic review was to report the risk of parastomal and incisional hernias after emergency surgery for Hinchey III–IV diverticulitis.

Material and Methods

The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. All randomized controlled trials (RCTs) and cohort studies comparing HP with other surgical treatment options for perforated diverticulitis classified as purulent or faecal (Hinchey III–IV) were considered for inclusion. Exclusion criteria were case series and reports, letters, editorials, reviews and conference abstracts. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence. Seven studies (six randomized controlled trials and one retrospective cohort) with a total of 831 patients were eligible for inclusion.

Results

The parastomal hernia incidence was 15.2–46.0% for Hartmann procedure, 0–85.2% for primary anastomosis, 4.3% for resection and 1.6 % for laparoscopic lavage. The incisional hernia incidences were 7.8–38.1% for Hartmann procedure, 4.5–27.2% for primary anastomosis, 3.2–25.5% for primary resection, 2.7–11.1% for laparoscopic lavage and 16.1–45.8% for secondary resection. Due to heterogeneity of follow-up methods, follow-up time and lack of both parastomal and incisional hernia as outcome, no meta-analysis was conducted.

Conclusions

The hernia incidences reported after surgical treatment for complicated diverticulitis may be biased and underestimated. For future RCTs, researchers are encouraged to pay attention to hernia diagnosis, symptoms and prevention.
P078 SURGICAL PLANNING WITH 3D TECHNOLOGY UN PATIENT WITH MORGAGNI HERNIA AND INGUINAL HERNIA
Authors: Sanchon Lorena , Gobbo Rafael Diaz del , Sanchez Raquel , Osorio Alexander , Guariglia Claudio , Pardo Sara , Collera Pablo
Published: December 2021

Aim

The use of 3D technology is increasingly used for surgical planning in cases of complex surgery. In the case of the abdominal wall, its use is not very widespread. In this video we present the case of a patient with inguinal hernia and Morgagni hernia in which 3D planning provided us with multiple benefits

Material and Methods

71-year-old patient awaiting intervention for right inguinal hernia, presenting progressive dyspnea, abdominal pain and vomiting. A thoraco-abdominal CT scan was performed, which reported a Morgagni hernia containing the transverse colon and omentum.

Due to 3D planning, we were able to obtain the abdominal and hernial sac volumes, evaluate the hernial orifice and its relationship with the adjacent structures.

Results

Laparoscopic repair of the Morgagni hernia was performed by reducing the hernial content, placement of visceral contact mesh fixed with resorbable tackers. In the same surgical act, an inguinal hernioplasty was performed via TAPP.

The postoperative period was correct, without complications, and the patient was discharged after 3 days. Two years after the intervention, the patient remains asymptomatic.

Conclusions

The use of 3D technology for surgical planning facilitates the repair of complex hernias, helping us to assess the surgical indication, hernial volumes and hernial content. Good surgical planning facilitates the performance of the intervention through minimally invasive surgery, in this case two hernias were repaired in the same surgical procedure and with the same incisions, which facilitated the recovery of the patient.
P102 FEMORAL NERVE PALSY POST OPEN INGUINAL HERNIA REPAIR - CASE REPORT AND LITERATURE REVIEW
Authors: Salama Mohamed , Salama Mahmoud , shabaz c. , Yadav Himanshu
Published: December 2021

Aim and Introduction

“Inguinal hernia repair is one of the most common surgical procedures performed worldwide. Postoperative pain control is very important and recently nerve block has gained popularity as an alternative to opioid use. Transient femoral nerve palsy (TNFP) is a potential complication of ilioinguinal nerve block, but it is extremely rare with only a few cases reported. We discuss a case of TNFP post-left inguinal hernia repair to highlight this rare complication.”

Material and Methods

“Case Report: A 17-year-old male with clinically and radiologically confirmed left inguinal hernia underwent open mesh repair (Lichtenstein repair). At the end of the procedure, he had ilioinguinal and iliohypogastric nerve block (10ml, 0.5% bupivacaine). In the recovery room, he developed numbness of his anteromedial aspect of his left thigh with weakness of hip flexion and paralysis of quadriceps with an inability to extend his knee. He was reviewed by the anaesthetic team and was admitted overnight. His symptoms resolved spontaneously within 18 hours. He was subsequently discharged and followed up in the surgical OPD 2 weeks, 6 weeks and 6 months later and there were no residual neurological symptoms.”

Results and Conclusion

“TNFP post open hernia repair is very rare. Mechanisms of femoral nerve injury include suturing, stapling, scar tissue entrapment or direct compression. Careful attention is needed to the technique of local anaesthesia post-operatively (avoid deep infiltration, lowest volume and concentration used, ultrasound use) to avoid potential morbidity if this complication is not recognised.”
P121 ONLAY MESH FOR TREATMENT OF SMALL UMBILICAL HERNIAS IN ADULTS - A SINGE CENTER INVESTIGATION
Authors: Stjärne Ludvig , Melkemichel Maria , Bringman Sven , Widhe Björn
Published: December 2021

Aim

Previous studies on the repair of small umbilical hernias have suggested a lower recurrence rate with mesh compared to suture repair. A remaining important question is in what anatomical position the mesh should be placed. The purpose of this study was to investigate the outcome of using a standardized 4x4 cm onlay-mesh for umbilical hernias ≤2cm.

Material and Methods

A retrospective study was conducted at a single institution in Sweden on all umbilical hernia repairs during 2015-2019. The follow up time was at least four months. Patients were identified using the hospital medical record database. Repairs performed with suture, sublay, ventral patch or laparoscopic mesh positioning were excluded. Patient’s demographics, comorbidities, intra – and postoperative details were considered. Primary outcome was surgical site complications within 30 days. Secondary outcome was recurrence.

Results

80 patients were repaired with a small onlay-mesh for an umbilical hernia ≤ 2 cm and were included for statistical analysis. Median (range) follow-up time was 29.0 (4.3-50.1) months. Median age was 46 (26-76) years old. Median body mass index was 28 (19-38) kg/m2. Men to female ratio was 2.1. 4 patients were identified with a surgical site postoperative complication; 3 with seroma and 1 with superficial wound infection. 3 of these were given antibiotics. 2 patients were treated with wound opening bedside. There were no registered cases of a recurrence.

Conclusions

Repairing small umbilical hernias with a small onlay-mesh was safe with a low surgical site complication rate. Randomized trials are needed to assess weather mesh reduce recurrences in umbilical hernia repairs ≤2cm.
P128 BOTULINUM TOXIN A IN CONJUNCTION WITH NEGATIVE PRESSURE WOUND THERAPY AND MESH-MEDIATED FASCIAL TRACTION PROVIDES HIGH RATE OF FASCIAL CLOSURE IN PATIENTS WITH OPEN ABDOMEN
Authors: Schmidt Irene , Andersen Hans Friis , Zinther Nellie
Published: December 2021

Aim

Presentation of our data on Vacuum-Assisted Wound Closure and Permanent Onlay Mesh-Mediated Fascial Traction (VAWCPOM) in combination with Botulinum Toxin A (BTX-A) injection in the lateral abdominal wall as a treatment of the open abdomen (OA).

Material and Methods

This is a retrospective case series including patients treated for OA from January 2017 till March 2021 with VAWCPOM and BTX-A. Patient records were collected from medical charts, incl. age, sex, body mass index (BMI), comorbidity, initial fascial defect size, time until fascial closure, complications and, when available, outpatient follow-up.

Results

A total of 33 patients with OA were included. The mean age was 62,5 years, male/female ratio was 15:18, with a mean BMI of 35,4 kg/m2. The mean width of the fascial defect was 13,5 cm (5 - 25cm). The rate of fascial closure was 96,9%, achieved within a mean of 22,7 days. Fascial closure was not attainable in one patient who developed enterocutaneous fistula under treatment. 22 patients experienced in-hospital complications. Short-term follow-up was conducted in 22 patients, with hernia recurrences in three.

Conclusions

Treatment of OA remains a surgical challenge. This case series shows promising results with a high rate of fascial closure using a combination of VAWCPOM and BTX-A and an acceptable rate of postoperative complications in this severely challenging patient group. The rate of primary closure indicates that this may be the future management of open abdomen.
P132 TRANSABDOMINAL PREPERITONEAL REPAIR (TAPP) FOR DE NOVO TYPE INGUINAL HERNIAS
Authors: Hirukawa Hiroshi
Published: December 2021

Aim

In Japan, the de novo type inguinal hernia is defined as a hernia that develops without being related to the vaginal process of peritoneum. The pathological condition of a de novo type hernia is considered similar to that of a sliding hernia. the aim of this study is to discuss about the operative procedure for de novo type inguinal hernia, with a particular focus on lipomas.

Material and Methods

We examined surgical procedures, rate of combined lipoma, postoperative complications, and recurrence rates of de novo cases among TAPP cases performed in our department from 2018 to 2020.

Results

We performed 230 TAPP repairs during the period, included 56 de novo type hernia. 19 cord lipomas were found in de novo type hernias but none in non de novo type hernias. The lipomas prolapsed from the lateral side of the internal inguinal ring in 6 cases, medial side in 9 cases, In 4 cases, lipoma or lipomatous tissue were embedded in the spermatic cord and they could not be extracted. There were no postoperative complications. The average postoperative hospital stay was 1.2 days. There were no chronic pain nor recurrence.

Conclusions

It is important to note that the de novo hernia is associated with a high incidence of lipoma. Since lipomas are often attached to the peritoneum, dissecting the peritoneum at the internal inguinal ring has the risk of missing the presence of lipomas, and in de novo hernias, the peritoneum must be pulled out.
P133 ROBOTIC ASSISTED REINFORCED BIOLOGIC AUGMENTED REPAIR (REBAR) IN INGUINAL HERNIA: TWO-YEAR OUTCOMES
Authors: Banaschak Cory , Szotek Paul , Sowers Briana
Published: December 2021

Aim

The objective of this study is to identify two-year recurrence and complication rates using robotic assisted reinforced biologic augmented repair (ReBAR) in inguinal hernia repair.

Material and Methods

A retrospective review identified all robotic inguinal hernia repairs utilizing a reinforced biologic mesh performed by a single surgeon from May 2018 through May 2019. All repairs employed the robotic transabdominal preperitoneal (rTAPP) approach combined with the ReBAR technique. Patients with prior repairs and bilateral hernias were included. All patients were followed post-operatively using secure messaging to assess outcomes, including hernia recurrence and other complications.

Results

A total of 57 patients undergoing the rTAPP ReBAR were identified. Of these patients, there were 18 bilateral hernias repaired for a total of 75 inguinal hernia repairs. In addition, 5 of the hernias had previously been repaired. Two-year outcomes identified 1 recurrence (1.3%) at 345 days post-operatively and one complication of small bowel obstruction requiring takeback unrelated to the ReBAR. There were no complications of chronic groin pain or seromas in this cohort.

Conclusions

In conclusion, the two-year recurrence rate in this population of 75 inguinal hernias repaired using the robotic assisted ReBAR was 1.3%. With low recurrence and complication rates, the robotic assisted ReBAR technique appears to be a safe and durable option for inguinal hernia repairs.
P144 SPERMATIC CORD LIPOSARCOMA - A VERY RARE FINDING DURING INGUINAL HERNIA SURGERY
Authors: Gröger Christian , Kundel Lena , Riediger Hardwig
Published: December 2021

Aim

Repair of inguinal hernia is one of the most common operations in general surgery in industrialized countries. Isolated spermatic cord liposarcoma is a very rare soft tissue tumor. Despite standardized diagnostic algorithms for inguinal hernia, it could be difficult to predict such a rare finding.

Material and Methods

We report a case of inadvertent inguinal liposarcoma excision during hernia surgery in a 72-year-old male patient. Except for polyposis coli there were no further illnesses.

Results

After a minimal invasive transabdominal preperitoneal (TAPP) repair of a symptomatic inguinal hernia last year a persistent scrotal swelling developed. Computed tomography (CT) showed a protrusion of fatty tissue into the scrotal sac. Diagnosis of scrotal hernia was made. We performed an open Lichtenstein procedure. The final pathologic examination revealed a highly differentiated liposarcoma. Staging was completed and the case was presented to a multidisciplinary sarcoma tumor board at our institution. As recommended, a inguinal reoperation was performed with wide excision.

Conclusions

Although a very rare condition, spermatic cord liposarcoma should be considered as a possible differential diagnosis for inguinal hernia surgery.
P162 POLY-4-HYDROXYBUTYRATE MESH (PHASIX MESH) FOR VENTRAL HERNIA REPAIRS: A SINGLE SURGEON RETROSPECTIVE SERIES
Authors: Klifto Kevin , Othman Sammy , Weiss Eric , Kovach Stephen
Published: December 2021

Aim

To compare a single-surgeon experience using poly-4-hydroxybutyrate mesh (Phasix™ Mesh) for ventral hernia repairs (VHR).

Material and Methods

A retrospective series was performed from 2014-2020. Inclusion criteria were patients ≥18 years of age with open VHR using poly-4-hydroxybutyrate mesh, with a minimum follow-up of 12-months. Comparisons were performed between no prior VHR versus prior VHR; no mesh infections versus mesh infections; onlay versus retrorectus; no recurrences versus recurrences; no readmissions versus readmissions; no reoperations versus reoperations.

Results

Poly-4-hydroxybutyrate mesh was used for VHR in 179 patients. Compared to 90 patients with no prior VHR, 89 patients with prior VHR had higher BMIs (31.1kg/m2versus33.3 kg/m2; p = 0.042). Compared to 146 patients with no mesh infections, 33 patients with mesh infections had more prior VHR (97%versus39%; p < 0.001). Compared to 101 patients with onlay approaches, 79 patients with retrorectus approaches had more component separations (89%versus31%; p < 0.001). Compared to 168 patients with no recurrences, 11 patients with recurrences had more complications (55%versus23%; p = 0.031), reoperations (82%versus16%; p < 0.001), and readmissions (91%versus20%; p < 0.001). Compared to 136 patients with no readmissions, 43 patients with readmissions had more hypertension (81%versus56%; p = 0.004), COPD (28%versus10%; p = 0.011), complications (79%versus8%; p < 0.001), and recurrences (23%versus0.7%; p < 0.001). Compared to 142 patients with no reoperations, 37 patients with reoperations had more hypertension (89%versus55%; p < 0.008), diabetes (43%versus25%; p = 0.042), COPD (30%versus11%; p = 0.007), hyperlipidemia (57%versus32%; p = 0.008), larger defect sizes (300cm2versus200cm2; p = 0.032), complications (78%versus11%; p < 0.001), readmissions (92%versus6%; p < 0.001), and recurrences (24%versus1%; p < 0.001).

Conclusions

VHR with poly-4-hydroxybutyrate mesh can include prior VHR, different anatomical locations, mesh infections, recurrences, readmissions and reoperations.
VP010 INTRA-ABDOMINAL HERNIA AS A CAUSE OF ACUTE SMALL INTESTINE OBSTRUCTION. LAPAROSCOPIC EMERGENCY TREATMENT - SMALL INTESTINE OBSTRUCTION DUE TO INTERNAL HERNIA WITH CONCOMITANT ACALCULOUS CHOLECYSTITIS
Authors: Świątkiewicz Janusz , Kabala Przemysław , Tomaszewski Dariusz , Jasiński Szymon
Published: December 2021

Aim

Nowadays, in vast majority of emergency patients with gastrointestinal obstruction laparoscopy is not the treatment of choice. In our department laparoscopy is routinely used in emergency admitted patients, also those with abovementioned condition, sometimes yielding unexpected and thrilling results. The aim of this work is to present a laparoscopic internal hernia repair with simultaneous “Phrygian-cap-type” gallbladder excision, performed on a patient with small intestine obstruction and chronic acalculous cholecystitis.

Material and Methods

A 57-year-old patient was admitted to our department as an emergency, with a one week history of symptomatic cholecystitis accompanied by gastrointestinal obstruction. CT revealed atypical suprahepatic displacement of the small intestine. An attempt of conservative treatment failed after the re-initiation of oral nutrition. The patient was qualified for laparoscopy.

Results

An anatomical variant of the liver ligaments was visualized with two defects in the anteriorly displaced coronary ligament and shortening of the falciform ligament. Those defects formed the hernia ring entrapping a small intestine of a total length of about 1.5 m. The falciform ligament was dissected. To avoid re-entrapment of the intestine, most of the coronary ligament was severed. Consecutively the inflamed gallbladder was removed. The unusual anatomical variation of its structure, the so-called “Phrygian cap”, was an additional difficulty.

The postoperative course was uneventful.

Conclusions

The presented material demonstrates the possibility of immediate treatment of intestinal obstruction, even in a complicated cases, with laparoscopic manner, without the need of conversion to the open method.
O13 BIOLOGIC VERSUS SYNTHETIC MESH IN VENTRAL HERNIA REPAIR: PARTICIPANT-LEVEL ANALYSIS OF TWO RANDOMIZED CONTROLLED TRIALS AT ONE YEAR
Authors: Dhanani Naila , Olavarria Oscar , Lee Kyung Hyun , Young Charlotte , Primus Frank , Mukhtar Rita , Holihan Julie , Liang Mike , Harris Hobart
Published: December 2021

Aim

Biologic mesh has been increasingly utilized in complex ventral hernia repair despite limited evidence at low risk of bias supporting its growth. We hypothesized biologic mesh when compared to synthetic mesh would have fewer major complications at one year.

Material and Methods

We performed a participant-level meta-analysis of published randomized controlled trials (RCTs) comparing biologic to synthetic mesh at one year. Primary outcome was major complication (composite of mesh infection, recurrence, reoperation, or death) at one year post-operative. Secondary outcomes included length of index hospital stay, surgical site occurrence, and surgical site infection. Outcomes were assessed using frequentist generalized linear models.

Results

A total of 252 patients from two RCTs were included, 126 patients randomized to the intervention arm of biologic mesh and 126 patients randomized to the control of synthetic mesh. Median follow-up was 15 (12, 27) months. Major complication occurred in 41 (33%) patients randomized to biologic mesh, and 44 (35%) patients randomized to synthetic mesh, (relative risk [RR] 0.91, 95% confidence interval [CI] 0.54-1.55, p-value 0.740). There were 36 total recurrences, 23 (18%) in the biologic arm, and 13 (10%) in the synthetic arm (RR 1.83, 95% CI 0.84-3.99, p-value 0.130). The remainder of outcomes demonstrated no statistically significant differences.

Conclusions

The risk of major complication did not differ between biologic versus synthetic mesh. In patients undergoing ventral hernia repair, there was no clinical benefit with biologic mesh as opposed to synthetic mesh at one year post-operative.
O21 EVALUATION OF THE TREATMENT OF PARASTOMAL HERNIA IN THE NETHERLANDS: A NATIONAL SURVEY
Authors: van Egmond Sarah , Poelman Marijn , Wegdam Johannes , Bloemendaal Bob
Published: December 2021

Aim

The incidence of a parastomal hernia (PSH) is approximately 40% two years after stoma construction and can even increase to 50% after a longer period. The European Hernia Society (EHS) published a guideline showing that the evidence for treatment of a PSH is of low quality. Due to the lack of evidence, a survey was conducted to provide insight into the Dutch approach.

Material and Methods

A survey was sent to 104 surgeons in the Netherlands representing their surgical department. The survey was developed by three hernia surgeons and a physiotherapist specialized in abdominal wall pathology.

Results

The survey was completed by 103 surgeons (99%) from 75 hospitals. 75% of the respondents perform a laparoscopic Sugarbaker for the treatment of PSH after colostomy, ileostomy or Bricker deviation. Most respondents (75%) replied that they never use a prophylactic mesh to prevent for the occurrence of PSH, although more than half of them do wish to introduce this.

Conclusions

Authors believe that the implementation of minimally invasive surgery and the systematic review performed by Hansson et al. in 2012, shifted the treatment strategy for PSH towards the use of a laparoscopic Sugarbaker. Nevertheless, little is known about the results of this treatment. Although there is a high level of evidence for the use of prophylactic mesh placement in reducing the incidence of PSH development, this has not been implemented in daily practice for colorectal and/or hernia surgeons. Authors aim for registration of PSH repair to evaluate the outcomes in terms of recurrence, pain and quality of life.
O32 TREATMENT OF FASCIAL DEHISCENCE IS IMPROVED BY MESH REINFORCEMENT
Authors: Pettersson Patrik Kjärsgård , Petersson Ulf
Published: December 2021

Aim

In 2014 fascial dehiscence (FD) was treated with re-suturing the fascia as the only measure in half of the cases at our institution, with discouraging re-rupture and incisional hernia (IH) rates. A changing path away from fascia closure (FC) by re-suturing solely towards reinforcement of the closed fascia is now evaluated.

Material and Methods

Retrospective chart review of consecutive patients operated for FD 2016-2020. Available CT scans were scrutinized for IH.

Results

58 patients (14 women) with a mean age of 71 years and a mean BMI of 27.3 were treated with: FC by re-suturing as the only measure (n = 1, 1.7%); FC preceded by a reinforced tension line (RTL) suture (n = 9, 15.5%); FC and on-lay mesh reinforcement (n = 23, 39.7%); retromuscular mesh closure (n = 10, 17.2%); open abdomen treatment with retromuscular mesh reconstruction (n = 1, 1.7%); and, open abdomen treatment with vacuum assisted wound closure and permanent on-lay mesh-mediated fascial traction (VAWCPOM) (n = 14, 24.1%). One patient in the RTL-group suffered a re-rupture (1.7%). The in-hospital mortality was 5%. Wound healing problems were seen in 29 (51.9%) patients. IH was evaluable in 49 patients with a total incidence of 22.4% at mean follow-up of 21 months. The hernia incidence for mesh reinforced or reconstructed patients was 17.5% compared to 44.4% in re-sutured or RTL patients.

Conclusions

FD treatment with mesh reinforced FC prevented re-rupture and resulted in a lower rate of IH. Additional standardization and refining the mesh techniques may further improve results.
OV14 POSTERIOR COMPONENT SEPARATION FOR A GIANT LUMBAR HERNIA IN A KIDNEY TRANSPLANT PATIENT
Authors: Maspero Marianna , Bertoglio Camillo Leonardo , Morini Lorenzo , Alampi Bruno , Ferrari Giovanni
Published: December 2021

Aim

Posterior component separation with transversus abdominis release (PCS-TAR) represents a good option for challenging complex ventral hernia repairs. We present a case of PCS-TAR for a giant lumbar hernia in a patient with a transplanted kidney.

Material and Methods

The patient is a 46 years old man with a Charlson Comorbidity Index of 2 and a BMI of 27.5 kg/m2 who underwent a kidney transplant in 2005 and a subsequent open repair with mesh implantation for an incisional hernia in 2007. Two years later, he experienced a hernia recurrence, but chose conservative management. In 2019, the patient complained of progressively worsening pain and bulky sensation. Due to the size and location of the defect and the massive relaxation of the muscle fibers, open repair with PCS-TAR was indicated.

Results

In 2019, the patient underwent right-sided PCS-TAR with retromuscular placement of one polyvinylidene fluoride (PVDF) mesh and one biosynthetic mesh. Duration of the procedure was 295 minutes. Two drains were placed, respectively in the subfascial and in the subcutaneous plane. Postoperative course required non-invasive ventilation for respiratory distress, but was otherwise uneventful and he was discharged on postoperative day 8. After 12 months, the patient showed no signs of recurrence.

Conclusions

PCS-TAR is a versatile technique for the repair of complex ventral hernias, with an acceptable rate of postoperative complications and good long-term outcomes.