bluuebunny/crossref_metadata_2025 huggingface dataset:
OC-081 DIASTASIS RECTI REPAIR – DEVELOPMENT OF A PATIENT REPORTED OUTCOME MEASURE THROUGH QUALITATIVE ASSESSMENT
Authors: Amro C , Mcauliffe P B , Niu E F , Bilger A , Broach R B , Rendle K A , Fischer J P
Published: May 2023

Aim

Diastasis recti may lead to undesirable symptoms including aesthetic dissatisfaction and decreased quality of life (QoL). Currently, there is no validated disease-specific patient reported outcomes (PRO) measure to assess patient satisfaction and facilitate personalized care after repair. Our study aimed to develop a diastasis-specific PRO-measure through qualitative assessment within this population.

Methods

Diastasis recti repair patients were enrolled and semi-structured cognitive interviews using the think-aloud technique were conducted by a trained qualitative research member of the Mixed Methods Research Laboratory. Patients answered a 23-item questionnaire, derived from BODY-Q and AHQ, addressing four components–Physical, Appearance, Surgical Team, and Satisfaction with Abdomen.

Results

Thirteen patients who underwent diastasis repair completed the interviews, which were conducted an average of 353 days after surgery. All participants reported the questions in the survey were easy to interpret and assessed different constructs. Most questions in the study were relevant and easily interpreted, however, a few participants reported some items were unclear, specifically related to discerning between size and shape of their abdomen. When asked about aspects of their experience not addressed by the survey, patients mentioned sensory changes around the incision, and accordingly a question was added to the instrument.

Conclusion

As a first step toward creation of a diastasis recti PRO-measure, we present the results of qualitative patient assessment. Patients found the instrument clear and relevant to their experience. A void remains to optimize PROs after diastasis repair; therefore, our PRO-measure will provide surgeons a qualitative tool for quantitative assessment of their QoL.
OC-087 THE MESH AND THE MACHINE: DEEP LEARNING TO IDENTIFY HERNIA MESHES ON CT SCANS
Authors: Rengan V , Sundaram P M , Arora E , Bawa A , Alexander N , Rengan R S
Published: May 2023

Aim

To identify the presence of meshes in CT scans of patients who have previously undergone hernia repairs using our novel deep learning algorithms.

Materials & Methods

We annotated mesh data from 30 ventral hernia CT scans of patients who had undergone previous ventral hernia repairs using computer vision tools. The annotated slices from the CT scans qualified as the ground truth. 80% of the data was used for training and validation. 20% data was used for testing. The novel deep learning model we used had previously identified meshes with lower accuracy levels due to inferior data sets.

Results

Our deep learning model was able to identify the mesh with an accuracy of 70% when compared to a manual annotator. Retraining our model with more varied mesh data gave us improved results.

Conclusions

Identification of the mesh is a challenge for surgeons and radiologists. The evolution of deep learning techniques made the identification of obscure structures possible. Meshes present a unique challenge as they constitute a foreign tissue which integrates into native tissue. Our team's novel deep learning algorithms have been effective in identifying meshes, This could play a major role in automated hernia reporting. The surgeon will be benefited from additional information about the plane of mesh and level of integration while planning surgeries for recurrence or mesh explantation.
OC-091 PREVENTION OF PARASTOMAL HERNIAS WITH 3D FUNNEL MESHES IN INTRAPERITONEAL ONLAY POSITION
Authors: Köhler G
Published: May 2023

Introduction

In patients with permanently intended terminal ostomies, parastomal hernias (PSHs) occur on a frequent basis. Various strategies have been evaluated, but there is still a lack of evidence with regard to the best surgical technique for PSH- prevention

Methods

We conducted a retrospective analysis of prospectively collected data of 98 patients, who underwent elective permanent ostomy formation between 2009 and 2019 by means of prophylactic implantation of a specially designed three-dimensional funnel mesh in intraperitoneal onlay position.

Results

PSH developed in five (5.1%) of 92 patients available for follow-up (88 by CT-scan). No mesh-related complications were encountered and none of the implants had to be removed. Ostomy-related complications had to be noted in eight (8.2%) cases. Follow-up time was a median 38 (range 12–60) months.

Conclusion

The prophylactical implantation of a funnel mesh implant in IPOM technique during initial formation of a terminal enterostomy is safe, highly efficient and comparatively easy to perform. As opposed to what can be achieved with purely keyhole meshes regardless of their position in relation to the abdominal wall layers, the inner boundary areas of the ostomy itself can be well covered and protected from the surging viscera with the 3D design and there is no weak point at the lateral edge of the stoma as is typical for the sugarbaker access. A further improvement could be achieved by lengthening the tunnel by the manufacturer in order to counteract the shrinkage of the implant.
OC-095 DUTCH INGUINAL HERNIA AUDIT (DIHA): A SURVEY OF CURRENT REGISTRATION, OBSTACLES AND POSSIBLE AREAS OF IMPROVEMENT
Authors: Meuzelaar R , Den Hartog F , Tanis P , Schiphorst A , Burgmans I
Published: May 2023

Aim

Quality assessment and improvement of surgical procedures can be achieved by clinical audits that provide feedback with benchmarking of surgical outcomes. The Dutch Institute for Clinical Auditing has successfully initiated multiple audits with clear impact on quality of care. Presently, there is no Dutch national inguinal hernia (IH) registry. This survey aimed to investigate current opinions of all Dutch surgeons regarding registration, and to explore potential obstacles in the implementation of a Dutch Inguinal Hernia Audit (DIHA).

Material & Methods

A web-based survey was sent to all (> 2.000) members of the Dutch Surgical Society, including surgeons and residents in training.

Results

Two-hundred sixty-seven respondents replied (hospital distribution: 33% small peripheral, 45% large peripheral, 11% academic, 11% other). Two-thirds (67%) agreed that the quality of IH care should be improved. Similarly, 66% answered that improvement could be achieved by registration of surgical outcomes. Those opposed to registration mainly stated fear of administrative burden and that the quality of care is already adequate. The vast majority of respondents agreed that chronic pain (91%) and recurrence (91%) should be used as indicators of IH surgery, which can both be collected as patient-reported outcome measures (PROMs).

Conclusions

A two-thirds majority of Dutch surgeons agree that the quality of inguinal care should be improved by implementing a Dutch national IH registry. Almost all agree that registration of chronic pain and recurrence as quality indicators can be registered as PROMs without increasing the administrative burden, which will facilitate successful implementation.
OC-097 A THREE LAYERED REPAIR OF A LARGE PERINEAL HERNIA- CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Soback H , Lahav L , Franko R , Avital S
Published: May 2023

Background

A symptomatic perineal hernia is an uncommon complication after abdominoperineal resection (APR). Repairs of such hernias can be achieved by usage of autologous flaps, synthetic mesh or biologic mesh. Studies have shown that prophylactic repair of the pelvic floor with biologic mesh, reduces the incidence of perineal hernia. Data of perineal hernia repair methods are scarce and of poor quality.

Aim

In this paper we aim to share our experience using a non-conventional technic for the repair of A perineal hernia, as it appears to be a surgical challenge without a clear evidence based recommended technique.

Methods

A 71-year-old woman, after extended APR with primary closure of pelvic floor with a biosynthetic absorbable mesh, presented to our clinic with a symptomatic, extensive perineal hernia. The patient underwent an open reconstruction of the pelvic floor using a synthetic composite mesh in an underlay intraperitoneal position and a bilateral gluteal muscle flap closure.

Results

In post-operative-day 11 the patient developed a pelvic fluid collection and surgical site infection. The collection was surgically drained showing clear fluid negative for bacteria and antibiotic treatment was initiated. 3 months after surgery the wound had completely healed and A CT scan showed no recurrence of the hernia.

Conclusion

Considering the increased incidence of perineal hernia after APR and the superiority of a synthetic mesh in minimizing recurrence rates- a primary closure of the pelvic floor with a synthetic mesh or autologous flap might be justified.
OC-098 HERNIA BASECAMP ONLINE LEARNING PLATFORM: AN ANALYSIS OF THE UEMS CME approved module test results
Authors: de Beaux A , Becker S , Parent T , Temporal G , Kummer R , Allouard C , East B
Published: May 2023

Aim

Hernia Basecamp is an online learning platform hosted within the WebSurg website with 205 video lectures. A number of these lectures are selected to create 10 modules of 3 hours each with UEMS CME accreditation. The aim of this study was to review the CME module test results since launch in June 2021.

Methods

Hernia Basecamp was interrogated in January 2023. Data on the number of CME module tests taken, the pass rate and the country of the examinee were collected.

Results

The numbers of tests taken, the number of passes, and the pass rate per module as well as the totals is shown in the table. The UK, Switzerland and Germany were the top 3 countries representing 36% of the modules passed.

Conclusions

The UEMS approved CME accreditation tests generally had a high pass rate. BUT, detailed knowledge of the basics of groin hernia AND published guidelines was poor as reflected in the lower pass rates.
OC-101 PLACEMENT OF INTRAPERITONEAL PREFORMED PROPHYLACTIC MESH IN END COLOSTOMIES TO REDUCE PARASTOMAL HERNIA AND COMPARING WITH CONTROL GROUP. TECHNIQUE AND ANALYSIS OF OUR RESULTS
Authors: Arrayas A , Comas J , Subirana H , Crusellas O , Gonzalez V , Ortiz L , Viso L , Castellví J
Published: May 2023

Objective

To study the effect of the incidence of parastomal hernia (PSH) through the prophylactic placement of a preformed intraperitoneal mesh in patients who must undergo a definitive colostomy. The comparison is made with a homogeneous control group that did not receive prophylactic mesh.

Material and methods

Unicentric, prospective, non-randomized and observational study was performed.

Patients were divided in two groups: 30 patients with colorectal neoplastic disease, collected consecutively,who underwent an end colostomy with a profilactic preformed intraperitoneal mesh (Dynamesh IPST®) versus a homogeneous control group (30 patients) who also underwent a definitive end colostomy without prophylactic mesh placement.

Primary objective is to determine incidence of PSH in both groups. Secondary objectives were mesh related complications.

Demographic variables and early postoperative complications, clinical and radiological follow-up (18–24 months) and presence of clinical and/or radiological PSH were registered.

The surgical technique performed in our center is described.

Results

In the Mesh group there were 0 mesh-related complications at 30 days. In the long term, only 6.6% PSH were recorded in mesh group, while in the control group, a 63% of PSH were observed.

Conclusions

The incidence of PSH is significantly reduced using prophylactic mesh. Our study corroborates what has already been stated in the literature and does not associate complications.

The prophylactic placement of the IPST intraperitoneal mesh in patients who require a definitive end colostomy is a technique that is easy to use in the laparoscopic approach, safe, fast, and easily reproducible, without related complications.
OC-103 SYSTEMATISATION OF TEP IN 10 STEPS: THE WAY WE TEACH
Authors: Peinado Iribar M B , Zárate Gómez J , Fernández Luengas D , Supelano Eslait G , Álvarez De Sierra Hernández P , Conde Someso S , López Baena J Á , Gil Lopez J M , Merello Godino J
Published: May 2023

Aim

Laparoscopic total extraperitoneal approach (TEP) is a widely recognised treatment for hernia repair. As a reference group in minimally invasive hernia repair, with more than 1200 TEP cases performed in the last 5 years, and with more than 25 years of experience, we want to share our TEP systematisation in 10 steps, as we teach in our international courses.

Material and Methods

We describe the technique in 10 simple steps, attaching small video-clips to illustrate each one.

Results

Demostration of the 10 TEP steps:

Conclusions

Together with proctoring, this systematic way of teaching TEP technique allows a safer and shorter learning curve, by providing a series of simple steps to follow and repeat.
OC-104 BROADENING HORIZONS. LESSONS FROM TEP FOR INGUINAL HERNIA REPAIR TO EXTENDED TEP FOR VENTRAL HERNIA REPAIR
Authors: Peinado Iribar M B , Zárate Gómez J , Fernández Luengas D , Supelano Eslait G , Álvarez De Sierra Hernández P , Conde Someso S , López Baena J Á , Gil López J M , Merello Godino J
Published: May 2023

Aim

Laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia can be technically challenging. The learning curve is long, unless you have supervision and systematisation of the procedure. After learning curve of TEP is achieved, it is time to broaden horizons, and repair ventral hernias using the extended totally extraperitoneal laparoscopic technique (ETEP). The purpose of this paper is to describe the key points and pitfalls in the ETEP learning curve, coming from the expertise of TEP hernia repair.

Material and Methods

After overcoming the learning curve of laparoscopic TEP inguinal hernia repair, with more than 110 consecutives procedures performed in an experienced centre, and having reduced operative times and maintaining a minimal complication rate, I start my learning curve of ETEP with supervision and systematisation of the technique. We will move from the key points already known from the TEP learning curve, identifying similarities to the more complex points of ETEP learning curve.

Results and conclusions

The extrapolable key points from TEP are:

The critical points, which need enhanced surveillance, are:

It is important to emphasise that this technique requires patience and proctoring.
OC-107 IMPLEMENTATION OF LAPAROSCOPIC INGUINAL HERNIA REPAIR IN A LOCAL HOSPITAL. 2 YEARS’ EXPERIENCE AND CHALLENGES
Authors: Ye J , Gonzalo B , Lopez S , Alonso V , Morales M A , Solans M , Gonzalez J A , Moral A , Lupu I
Published: May 2023

Background

More than 30 years have passed since the first laparoscopic inguinal hernioplasty but nowadays less than 5% of patients are currently operated by this technique as recent Spanish national data suggest.

Objective

To present our experience 2 years after implementation of laparoscopic inguinal hernioplasty in our local hospital and highlight the challenges we faced.

Methods

Our hospital deals with a high volume of abdominal wall surgery and has more than 20 years experience in ambulatory surgery. A multidisciplinary clinical pathway was implemented. Strict selection criteria were established and pelvitrainer sessions were done.

Results

From January 2021 until December 2022, 196 laparoscopic repairs were performed: 167 transabdominal preperitoneal (TAPP), 29 totally extraperitoneal (TEP). The main challenge was the learning curve. 5 surgeons with experience in laparoscopic surgery were trained. Until now 2 completed their learning curve for TAPP and began training in TEP approach while the others still need senior assistance. The duration of laparoscopic hernioplasty, the need for deep relaxation and the increased carbon dioxide absorption were the biggest concerns for the Anesthesia team. The cost of new materials could be afforded, even though different sutures and types of mesh fixation devices were used until getting the non-invasive one. Surgical outcomes were good, with few minor complications. Moreover the outpatient rate could be maintained but the average time in waiting list for laparoscopic approach was increased.

Conclusion

The implementation of a laparoscopic hernioplasty program is feasible and safe but faces many challenges, especially due to long learning curve.
OC-109 ONE-YEAR FOLLOW-UP ANALYSIS OF WOUND VS SUTURE LENGTH RATIO AS A PREDICTOR OF INCISIONAL HERNIA - A COHORT STUDY (WISER)
Authors: Kumar R , Kumar P , Das Poddar K K , Shastri S , Mishra T , Sasmal P
Published: May 2023

Background

The purpose of the study was to determine if the recommended wound to suture length ratios of 1:4 and 1:6 were followed during midline laparotomy closure with loop PDS and 2–0 PDS, respectively, and whether this affected the development of an incisional hernia three years following the procedure.

Methods

This prospective study included eighty-six patients operated by the midline incision. The closures were performed as per the surgeon's choice. The length of the incision, types and length of suture used were noted. The one-year follow-up data was analyzed.

Results

In thirty cases, loop PDS was used for the closure, and in 56 patients, 2-0 PDS was used. Adherence to the recommendation was better with the loop PDS (13/30,43.33%) vs 2-0 PDS (8/56,14.28%). Eighteen patients were excluded(10-death-,5-loss to follow-up,3-reoperation).46.1%(12/26) developed incisional hernia in the loop PDS group vs 7.14%(3/42) with 2-0 PDS; total 22.05%(15/68). If the recommendations were followed or not, there were 20% (2/10) hernias in the loop PDS group compared to 62.5% (10/16); and 28.57% (2/7) compared to 2.8% (1/35) in the 2-0 PDS group. The loop PDS group had more malignancies (40% vs 20%, p=0.04).

Conclusion

The adherence to the recommendation of wound vs suture length was low. The incidence of incisional hernia was significantly low with 2-0 PDS, at one year, however the results should be interpreted with caution considering many patients closed with loop PDS had malignancies, a risk factor for incisional hernia, and low sample size due to death and loss to follow-up.
OC-110 LAPAROSCOPIC RETROMUSCULAR INGUINAL HERNIA (LRMIHR) REPAIR USING PHASIX TM AND POLYPROPYLENE MESH: 5 YEARS OUTCOME
Authors: Altowaijeri A , Aljomah N , Alshammari S , Binjaloud A , Aldohayan N , Aldohayan A
Published: May 2023

Background and objective

Inguinal hernia routinely repaired with synthetic non-absorbable mesh. However, chronic pain may affect the success of flow recurrence. In contrast, using absorbable mesh and keeping its integrity for nine months as Phasix TM may be a suitable replacement for the synthetic non-absorbable mesh. This work assesses the results and cost of TAPP repair using Phasix TM & lightweight Polypropylene mesh.

Methods

Laparoscopic retromuscular inguinal hernia repair (LRMIHR) was performed from January 2015 to January 2023 with Institutional review board approval for 58 patients, 1 female and 57 males. The average age is 55.8, with a 27.5 mean BMI. The study was done in the hospital by one surgeon. Studying post-operative pain, reaction, mesh sensation discomfort, recurrence, and cost.

Results

In 5 years follow-up, the outcome is comparable without the non-significant advantage of absorbable mesh. Moreover, the cost of absorbable mesh (Phasix ST) is higher.

Conclusion

No clinical advantage of absorbable mesh in repairing the inguinal hernia. However, using phasix TM may have a place in repairing female and sports hernias. Further work is needed to evaluate phasix in hernia inguinal in a prospective multicenter trial.
OC-112 OUTCOMES OF EMERGENCY INGUINAL HERNIA SURGERIES PERFORMED BY TRAINEES AT A TERTIARY CARE HOSPITAL- AN AUDIT OF 43 CASES
Authors: Shastri S , Poddar K K D , Kumar P , Mishra T S , Sasmal P K , Behera P
Published: May 2023

Background

An audit was performed to identify the outcomes after emergency inguinal hernia surgeries performed by trainees at our hospital from April to December 2022.

Methods

The prospectively maintained database of a single clinical unit of the Department of General Surgery of our institute was reviewed. Outcomes such as the types of surgery, SSI, length of hospital stay (LOH), re-exploration, long-term pain, recurrence, and other parameters were reviewed.

Results

43 cases were reviewed. The mean age was 58.4 years. The mean symptom duration was 3.47 days. 16 (37.2%) patients had obstruction and 11 (25.5%) patients suffered strangulation. 25 (58.1%) patients required laparotomy apart from local exploration. Hernioplasty was done in 10 (23.2%) patients. Bassini was done in 10 (23.2%), Lytle's in 10 (23.2%), and Desarda repair in 23 (53.6%) patients. The mean operating time was 116.92 mins and the average blood loss was 93.7ml. 4 (9.3%) patients developed SSI, and 1 (2.32%) patient required mesh explantation. 1 (2.32%) required re-exploration and there was 1 mortality. The mean LOH was 4.33 days (2.32%). 20.93% of patients had long-term pain and none had a recurrence.

Conclusion

Patients getting operated on by trainees had a comparable mean operative time, more blood loss (53.7ml vs 22.0ml), more long-term pain (20.93% vs 1.2%), slightly more wound complications (9.3% vs 6.74%), comparable LOH, and comparable recurrence and mortality rates, when juxtaposed against reported literature. Surgical training should hence focus on meticulous dissection and identification of nerves to reduce blood loss and long-term pain.
OC-113 GENETIC AND BIOLOGIC RISK FACTORS ASSOCIATED WITH HERNIA FORMATION: A SYSTEMATIC REVIEW
Authors: Amro C , Niu E F , Deianni E , Smith L , Qiu M , Torkington J , Broach R B , Maguire L H , Damrauer S M , Fischer J P
Published: May 2023

Aim

The aim of this systematic review is to identify genetic and biologic markers associated with abdominal hernia formation.

Methods

A systematic review, using PRIMSA-guidelines, searched PubMed, MEDLINE, Embase, Scopus, and COCHRANE databases on 25AUG2022. All articles with qualitative or quantitative data regarding biologic factors of hernia formation were included. Review articles, editorials, and non-English articles were excluded. Data from articles were collected for analysis. The Newcastle-Ottawa Scale was used to assess risk of bias.

Results

Of 5,946 initial studies, 77 were included: 17 incisional/ventral, 42 inguinal, 4 hiatal, 1 parastomal, and 13 multiple hernias. Five inguinal hernia studies identified 92 susceptible loci in regions of 66 genes involved largely in antigen processing/presentation and immune-response pathways after enrichment analysis. Three studies identified significant DNA sequence variants (DSV) of three additional genes. Among various biomarkers, eleven studies found increased MMP-2, with seven noting MMP-2 significantly higher in direct versus indirect. In incisional hernias, one study demonstrated 167 genes in skin and 7 genes in fascia with distinct gene-expression profiles associated with the activation of inflammatory response plasma proteins, regulation of immune response, and cell-adhesion. A separate genetic study identified 3 independent loci. Biomarkers were discussed in 15 studies, with inconclusive results. In both incisional/ventral and inguinal hernias, type I/type III collagen ratios were decreased. Data synthesis could not be completed for hiatal and parastomal hernias.

Conclusion

While there is reasonable consensus regarding the role of biologic risk factors in inguinal hernias, further research investigating genetic predisposition to incisional hernias is encouraged.
OC-114 FEASIBILITY OF SUBCUTANEOUS ONLAY LAPAROSCOPIC APPROACH (SCOLA) UNDER LOCAL ANESTHESIA FOR THE PATIENTS WITH INCISIONAL HERNIA
Authors: Wada N , Hori S , Takeuchi M , Shida A , Maeda K , Kitagawa Y
Published: May 2023

Aim

Incisional hernia is a benign disease and the indications for elective surgery are relative. Therefore, it is expected to expand the indications and improve patient quality of life by reducing invasiveness of surgery and anesthesia. We have been performing incisional hernia repair under local anesthesia for the past 12 years and report our clinical results.

Material & Methods

From 2009 to 2021, a consecutive group of 64 patients with incisional hernia was included. We used 0.5% lidocaine with epinephrine as local anesthesia. Pethidine was used as analgesic and dexmedetomidine as sedative. An incision of 30 mm at the top of the hernia bulge was made and a wound protector with sealing silicon cap was attached. We used three 5-mm trocars and a 5-mm flexible laparoscope. A flat self-fixating mesh with was placed over the primarily closed fascia and fixed using laparoscopic tacking devices.

Results

Forty-nine patients operated without endoscopy (Op). The others (n=15) required endoscopic subcutaneous dissection (LA). The mean ages of Op and LA were 66.9 and 64.3, respectively. The mean operating time of Op was significantly shorter than that of LA (100 vs 132, P=0.006). Similar hernia recurrence rete was observed (4.1% vs 6.7%, respectively). Clavien-Dindo Grade III and IV complications were not observed in both groups.

Conclusions

Incisional hernia repair under local anesthesia can be performed relatively safely even on elderly patients with serious co-morbidities, and the possibility of contributing to the improvement of patient quality of life by expanding the indications for surgery was expected.
OC-115 ABDOMINAL RECTUS MUSCLE THICKNESS AS A PREDICTOR FOR PARASTOMAL HERNIA
Authors: Nyman J , Huss K , Flygare L , Strigård K
Published: May 2023

Aim

To examine whether the dimensions of the abdominal rectus muscle (ARM) affect the risk of developing parastomal hernia (PSH). The hypothesis is that a thinner anteroposterior (AP) dimension of the ARM predisposes for PSH.

Material & Methods

Retrospective cohort study of rectal cancer patients undergoing tumour resection and permanent colostomy creation in two Swedish healthcare regions during 2005–2017. Patients were identified from the nationwide Swedish Colorectal Cancer Registry. Measurements of ARM dimensions in the AP and latero-lateral (LL) planes were made on preoperative (before permanent colostomy creation) and postoperative (9–18 months post stoma creation) computerised tomography images. The ARM dimensions were analysed in a multivariate logistic regression model, considering known risk factors and potential confounders.

Results

Some 151 of the planned 200 patients have been included, of which 40% are female and 20% have a radiologically evident PSH at approximately one year postoperatively. Preliminary results from the multivariate model do not indicate that ARM thickness can predict the occurrence of PSH. Body mass index seems to be the only predictor in this material. The study is still including.

Conclusions

Preliminary results indicate that ARM thickness is not an independent risk factor for PSH development. Supplementary results will be presented.
OC-118 INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE FOR THE TREATMENT OF PRIMARY AND INCISIONAL VENTRAL HERNIAS – OUR EXPERIENCE
Authors: Pepe F , Giaccone M , Gambali E , Turturica D I , Rosati S , Balestra G , Sandrucci S
Published: May 2023

Aim

IPOM technique is a well-established technique for the repair of primary and incisional ventral hernias. In this retrospective observational study, we evaluated the application of IPOM technique with the use of polypropylene composite meshes (1)

Materials and Methods

194 patients who underwent a laparoscopic hernia repair from 2011 to 2022 for either a primary(Group A= 83) or an Incisional (group B=111) ventral hernia were included in the study. The primary endpoint was the evaluation of the recurrence rate and the mean hospital stay in the two Groups. All the procedures were performed through three abdominal trocars executing cold adhesiolysis to release the contents of the hernial sac without dissecting the latter. Partial peritonectomy was then performed by blunt dissection to promote adhesion of the mesh. Mesh fixation was achieved using trans-parietal suture and resorbable tackers.

Results

The two groups showed significative differences in baseline characteristics with Group B including older patients with higher ASA scores, defect number and dimension, rate of later hernia and defect closure. One-day surgery setting was more common in group A (80.7% vs 64.0%, p=0.01). The defect closure shows increasing hospital stay in both groups, with statical significance only in group A. The recurrence rate was slightly higher in group A (3.6% vs 2.7%, p=0.41) with comparable median follow-up (42 vs 45 months, p=0.41).

Conclusion

Our clinical experience showed that IPOM technique with polypropylene composite meshes is a safe and effective approach for the treatment of primary and incisional hernias.

References

1(ClearMesh-Composite, Dipromed srl).
OC-119 Specialization is essential: our results in 139 incisional hernia repairs with a high percentage of moderate-to-high complex cases.
Authors: Trebol J , Sánchez-Casado A B , García-Plaza A , González-Muñoz I , Muñoz-Bellvís L
Published: May 2023

Aims

Presenting 139 repairs by 4 specialised surgeons, mostly of moderate/high complexity.

Material & Methods

Prospective study (EVEREG registry).

Results

65 men. 65.49 (35–93) year-old. Middle BMI 30.31 kg/m2 (52%≥30). 96.4% ASA II/III.

Hernias: 113 midline, 15 lateral, 11 combined. Mean defects 86.25cm2 (2–480). 29 W3, 92 W2, 4 paraostomal, 34 recurrent. 9 received botulinum toxin.

Surgeries: 132 elective. 89.9% open. 30 components separations (21.6%, 23 TAR). 23 (16.5%) received two meshes. Principal mesh position: 55.4% retromuscular, 34.5% preperitoneal, 6.5% intraperitoneal, 3.6% others. Defect closure: 87.1%. Mean overlap 8.3cm (1–23).

61 associated procedures highligthing 18 dermolipectomies, 10 colorectal surgeries, 8 diffuse adhesiolysis, 8 mesh explants (2 infected).

Intraoperative complications: 9 patients (6.5%). 8 bowel injuries (5 serosal tears), 1 muscular bleeding, 1 bladder injury.

Postoperative complications: 22.3% patients. 21 grade I, 6 II, 3 III, one IV. Highlighting: ileum (9), hematoma/anemia (9), general (6), seroma (4), 4 surgical site infections (SSI, 1 deep, 2 organ/space, 1 superficial), 1 bowel perforation. 4 reinterventions (2.9%), 2 due to visceral complications. No exitus. Mean stay: 4.46 days.

1 month: 36 patients complicated (25.9%); highlighting 21 seromas (76% types 0-I), 6 superficial SSIs and 3 bowel obstructions (1 required surgery).

6, 12, 24 months: complications stabilized at 8–10%. 4 bulging, 2 late seromas, 1 temporal SSI (1 year), 1 chronic SSI, 6 chronic pains (4 at 24 months), 8 recurrences (5.75%, 7 in mesh border, 1 complete; 6 in highly-complex).

Conclusions

Specialised surgeons obtained comparable to accreditation standards outcomes even the high complexity.
OC-121 TRANSVERSUS ABDOMINIS RELEASE (TAR) IN CONTAMINATED FIELDS
Authors: Giacone Aguiar J A , Valinoti A C , Olivero A A , Sadava E E
Published: May 2023

Aim

Complex abdominal wall reconstructions in contaminated fields is a controversial topic. Although some prefer a staged approach, others advocate performing a single surgery even associating bowel and colon resections with synthetic mesh reinforcement. We aimed to evaluate and compare results of Transversus Abdominis Release (TAR) in clean and contaminated fields.

Material & Methods

A consecutive series of patients undergoing TAR for complex incisional hernias between 2014 and 2022 with a minimum of 6-month follow-up was included. The cohort was divided into 2 groups according to the Modified Hernia Grading System of the Ventral Hernia Working Group (VHWG): G1, Grade 1 (low risk) and Grade 2 (comorbid); and G2: Grade 3 (contaminated). Demographics, operative and postoperative variables were analyzed and compared.

Results

A total of 69 TAR repairs were performed; 54 (78,3%) were included in G1 and 15 (21,7%) in G2. There were no differences in overall morbidity at 30 postoperative days (G1 19% vs G2 27%; p=NS). Surgical Site Infection (SSI) was significantly higher in G2 (G1 11,1% vs G2 46,6%; p=0,01), however Surgical Site Occurrence Requiring Procedural Intervention (SSOPI) was similar in both groups (G1 5,5% vs G2 11,1%; p=NS). No mesh removal was recorded. After 31 ± 10 months follow-up, the recurrence rate was 2.9% (2 patients).

Conclusions

TAR technique is feasible and safe for the treatment of complex hernias in contaminated fields. Although an increase in SSI rate might be observed, most cases are superficial without the need for invasive procedures.
OC-127 Chlorhexidine encoated thread for Trocar Incision after Laparoscopic Appendectomy and Cholecystectomy (NOVOTILAC-trial) – final results
Authors: Golling M , Breul V , Steurer W , Hoyuela C , Julián J F , Baumann P
Published: May 2023

Aim

Of this multicenter, international, prospective, randomized, controlled, double blinded trial (NOVOTILAC) was to assess the effectiveness (e.g. SSI acc. to CDC) of chlorhexidine (CHD)-coated Novosyn sutures for fascial and skin closure (trocar incisions) following laparoscopic appendectomy (APP) & cholecystectomy (CHO) compared with non-coated Novosyn sutures.

Methods

This study was performed in spanish (2) & german centers (2) and recruited 377 pts, with 54 drop-outs, eventually including 323 pts., 297 were included for a 12 month follow up. Pt. were assigned for APP (164) and CHO (159). Pat. clientel (♀:161, ♂: 162) risk factors (ASA 1–4: 200/79/43/1) hypertension etc. were comparable. A two group Chi-Square test was used to compare proportions of events.

Results

Intraoperative organ pathology and inflammation (innocent appendix, phlegmonous or gangrenous appendicitis and symptomatic vs acute cholecystitis) varied substantially, as did duration of surgery (APP: 48±20.5, CHO: 65±30.7 min). Operating Surgeons included assistants (n=140), senior registrars (n=99) and Consultants (n=84). Adverse events (AE) occurred in 12,7%, 32 patients had one, 8 pts two, and 2 pts had 3 respectively 4 events. Serious adverse events (SAE) were seen in 14 pts., 1 pt died. SSIs were seen overall in 16/323 pts (5.0%). Assigned to the groups we found 10 SSIs / 162 pts (6.1%) in the Novosyn arm & 6 SSIs / 158 pts (3.7%) in the Novosyn-CHD arm (n.s.). Incidence/severity of the infection required no postoperative revision operation.

Conclusion

The Chlorhexidine-coated Novosyn sutures (Novosyn-CHD) did not significantly reduce wound infections following laparoscopic appendectomy & cholecystectomy.
OC-128 DETERMINING THE MAXIMUM DIAMETER FOR PRIMARY CLOSURE OF AN ABDOMINAL WALL DEFECT: AN EXPERIMENTAL STUDY
Authors: Den Hartog F P , Verdonschot L , Aijtink V , Visscher L , Lange J F , Tanis P J , Kleinrensink G J
Published: May 2023

Introduction

Presently, the standard therapeutic option for ventral abdominal wall hernia is surgical repair with mesh reinforcement for all but the smallest (< 1 cm) hernias. The aim of this experimental study was to determine the maximum defect diameter that can still be closed without mesh, only using the small bites suture technique.

Methods

Hernias were simulated by creating circular defects in intact abdominal walls of fresh-frozen ­post-mortem human specimens. The defect diameter ranged from 0.5 to 5.5 cm, in 0.5 cm increments. Defects were closed in two layers using the small bites suture technique. After closure, the abdomen was insufflated in order to stress the closure. Intra-abdominal pressure (IAP) and macroscopic suture or tissue failure were recorded.

Results

Eleven defects were created in the abdominal walls of three fresh post-mortem human specimens. After defect creation, diameters were found to have increased by a median of 20% (IQR 5–53%). All defects were closed cranio-caudally. From 4 cm, it became impossible to close the posterior rectus sheath without suture pull-through. From 5 cm, the anterior rectus sheath showed tearing during suturing. During insufflation, complete suture pull-through of the anterior rectus sheath was seen at 5.5 cm.

Conclusion

Experimental findings indicate that tension-free closure of both rectus sheath layers is possible in defects with a diameter up to 4 cm. Further experiments in more specimens, using defects ranging from 4 to 6 cm, will add measurements of suture tension in order to assess failure before becoming macroscopically visible.
P-001 RISK FACTORS, HEALTHCARE RESOURCE USE AND COSTS ASSOCIATED WITH INCISIONAL HERNIA REPAIR IN ENGLAND USING HOSPITAL EPISODE STATISTICS
Authors: Torkington J , Smith L , Cornish J , Westlake P , Mccormak M , Alexander M , Rolfe C , Brooks P
Published: May 2023

Aim

To evaluate the burden of incisional hernia (IH) to patients and healthcare services in England.

Material & Methods

We conducted a retrospective observational study in Hospital Episode Statistics including adult patients who underwent stoma, transplant, or aortic surgery (index) between 01/04/2017 and 31/03/2022. We followed patients for development of incisional (including parastomal) hernia necessitating repair within 2 years post-index operation, describing patients by surgery type, number of comorbidities (prior abdominal surgery, chronic lung disease, diabetes, immunosuppressed status, obesity, smoker), and financial year. We evaluated costs associated with inpatient, outpatient, and Accident & Emergency attendances within 2 years post-index operation using National Health Service reference costs.

Results

Of 430,339 patients (132,584 stoma, 3,247 transplant, 294,508 aortic surgery), 24,949 developed IH requiring repair (6.74% overall, 13.74% stoma, 5.51% transplant, 2.80% aortic surgery). Operative IH was observed in 11.46%, 5.54%, and 1.94%, for patients with 0–2 comorbidities following stoma, transplant, and aortic surgery, respectively; for patients with 5–6 comorbidities, 29.70%, 5.97%, and 6.91% underwent repair of IH. For all years, costs were higher for patients with IH versus those without IH. Costs varied by surgery type and number of comorbidities and were driven by non-elective admissions. The difference in mean total costs for IH versus non-IH following surgery performed in 2017 was £16,350 for stoma, £19,268 for transplant, and £54,518 for aortic surgery.

Conclusions

Rates of IH repair increase alongside the number of comorbidities. A large number of patients require IH repair within 2 years of surgery, increasing the cost of care.
P-007 ACQUIRED “INTERSTITIAL” HERNIA: A REPORT OF TWO CASES
Authors: Ribeiro Dias R , Miguel Almeida N , Fonseca T , Barbosa E , Barbosa E
Published: May 2023

Aim

Acquired “interstitial” hernias are extremely rare and can be a serious complication after ventral hernia repair with placement of an onlay mesh.

Material and Methods

We describe two cases of interstitial hernias after onlay repair. Case 1: male patient of 59-year-old was submitted to a segmental enterectomy due to intestinal perforation and developed a hernia that was then surgical repaired with closure and an onlay mesh . Case 2: 58-year-old male with medical history of polimyelitis with two previous umbilical hernia repair interventions, being the last one with an onlay mesh.

Both patients at the physical examination revealed a symptomatic bulge difficult to characterize and the CT scan showed multiples defects with the hernia sac between the anterior aponeurosis and the onlay mesh.

Results

In both cases, the previous mesh was surgically removed, and repair of the abdominal wall was achieved with the placement of a macroporous retromuscular polypropylene mesh with 48mg/m2 density and complete medialization of the rectus muscles.

Conclusions

The diagnosis of interstitial hernias may be challenging, and CT imaging is mandatory for confirmation. Due to the high risk of complications such as strangulation, these hernias should always be corrected in a timely manner.
P-009 COMPLEX ABDOMINAL RECONSTRUCTION COMBINED WITH CYTOREDUCTIVE SURGERY (CRS) + HIPEC IN PATIENT WITH PARIETAL RELAPSE OF COLORECTAL CANCER
Authors: Garcia Garcia L , González Sánchez L , Antón Fernández I , López-Tomassety E , Hernández Hernández J R
Published: May 2023

Objectives

Presentation through a clinical case of complex reconstruction of the abdominal wall after resection of a parietal metastatic lesion in a difficult location.

Material and Methods

A 56-year-old male with T3N0M0 adenocarcinoma of the rectum underwent Hartmann's surgery in 2018 with subsequent cytoreductive surgery (CRS) + HIPEC in 2019 due to relapse of his disease. He presented a second relapse of CRC in the form of a parietal lesion of 8×5×6cm with bilateral involvement of the anterior rectus abdominis muscle and contact with the symphysis of the pubis.

Results

The operative findings showed a large tumor with involvement of both rectus abdominis muscles and the pubic symphysis. Complete resection of the lesion is performed and treatment is completed with HIPEC cycle with MMC in a total of 5 hours. Reconstruction was performed using intraperitoneal biological mesh prosthesis in the area of the parietal defect, together with placement of supra-aponeurotic polypropylene mesh. The patient did not present specific complications of abdominal reconstruction (SSO) and was discharged in 11 days.

Conclusions

The association of complex abdominal reconstruction techniques after cytoreduction surgery + HIPEC seems to increase the morbidity rates of these patients according to several studies. However, in our experience the use of abdominal wall reconstruction techniques after CRS and HIPEC is safe and does not increase complications, presenting good functional and oncologic results.
P-013 No recurrence after 15 years prospective long-term follow-up of open Total ExtraPeritoneal / TransInguinaI PrePeritoneal (oTEP/TIPP) inguinal hernia repair
Authors: Ribokas D
Published: May 2023

Aim

Evaluation of long-term follow-up results after open transinguinal preperitoneal (TIPP) technique with preformed lightweight mesh (PLM).

Method

This unicentric study included all consecutive 102 patients(10 women, 92 men; 93 primary, 9 recurrent hernias) operated for a groin hernia by the same surgeon using the same technique between June 2008 – September 2009.

All patients were postoperatively followed-up with a control after 1 month and a survey follow-up between 40 and 54 months after surgery with subsequent clinical control if something abnormal appeared in the survey in January 2013.

Results up until January 2023 were retrieved from the Swedish Hernia Register.

Results

102 hernia repairs - 54 in general, 48 in local anesthesia.

Clinical control after 1 month:

There was no infection of the mesh, no clinical recurrence.

-No reoperations were required.

Questionnaire follow-up:

-95 patients (93%) were followed-up.

Slight, not permanent pain in 8.8% of patients who did not require the consumption of systematic painkillers and are not limited in their activities.

No reoperations have so far been recorded in the Swedish Hernia Register with 81 patients still alive in long-term follow-up .

Discussion

-No recorded recurrences after 15 years of follow-ups is encouraging.

-This technique consisted of the placement of a patch in the preperitoneal space, which combines the benefits of the anterior approach (i.e., easy and safe technique, short learning curve, local anesthesia, low cost) and the preperitoneal placement of the mesh (less recurrence, less pain). This procedure is a good alternative to eTEP technique.

PLM=PolysoftMesh/Bard
P-014 SURGICAL TREATMENT OF COMPLEX INCISIONAL HERNIAS
Authors: Gogia B , Chertova A , Aljautdinov R
Published: May 2023

Aim

to study the early and long-term outcomes of the abdominal wall reconstruction (AWR) of complex incisional hernias.

Material & Methods

We retrospectively reviewed prospectively collected data from 121 patients with 1 to 7 years of follow-up, who underwent midline AWR between 2015 and 2022. The complexity of hernia was determined according to the criteria of N. J. Slater et all. All patients had a hernia gate width ≥10cm (W3). “Loss of domain”≥20% had 38% of patients, a recurrence after previously performed mesh-reinforced AWR (R1–5) - 36%, purulent fistulas, trophic ulcers and chronic seromas - 9%. Three laparotomies or more in anamnesis had 48.7% patients. Obesity had 74.4%; type II diabetes mellitus - 26.5%; COPD - 15.7%. Mesh-reinforced fascial repairs were used in 73 (60.33%) cases, bridged repairs were used in 48 (39.67%) cases.

Results

Wound complications in the early postoperative period were observed in 48 (40.5%) patients. Long-term outcomes: recurrence hernia - 7 (5.8%), ligature fistula - 3 (2.5%), chronic wound - 2 (1.6%), pseudocyst - 3 (2.5%), building of the mesh - 7 (5.8%). Mesh-reinforced AWRs with primary fascial coaptation resulted in fewer hernia recurrences (2.7% vs 10.4%) and fewer wound (31.5% vs 52.2%) and overall (5.5% vs 16.6%) complications than bridged repairs. At the same time, bridged repairs resulted in fewer postoperative pain (9.6% versus 4.2%) than mesh-reinforced AWRs.

Conclusions

Surgical treatment of patients with complex incisional hernias requires the use of combined techniques for AWR using a mesh, which reduces the recurrence to 5.8%.
P-015 PREVENTION OF INCISIONAL HERNIA WITH ONLAY MESH IN LOOP ILEOSTOMY CLOSURE
Authors: Olona C , Caro A , Sales R , Ruiz C , Gonçalves C , Casanova R , Jorba R
Published: May 2023

Aim

The primary aim of the study is to determine the efficacy of the placement of an onlay mesh for prevention of incisional hernia after loop ileostomy closure

Material & Methods

This is a multicentric, prospective, randomized controlled trial including patients operated on for loop ileostomy closure after a prior rectal resection for rectal cancer.

In the control group (C), after the digestive tract is reconstructed, the closure of the abdominal wall is performed by a 4:1 ratio running suture of polydioxanone. Patients in the study group (M) had the same closure procedure performed, and a light polypropilene mesh is placed onlay.

The presence of incisional hernia was evaluated by physical examination at scheduled clinical visits and radiologically by an abdominal CT scan performed at the end of follow-up (6 month after surgery)

Results

58 patients were included (27 in control group and 31 in mesh group) . Both groups had similar characteristics, except for a higher rate of smokers in the control group (48% vs 6%). During the follow-up, 5% of patients developed an incisional hernia (Group M 0 vs Group C 11%). At 30 days of follow-up 5 (16%) surgical site occurrences were detected in Group M for 4 (15%) in Group C.

Conclusions

A low incidence of IH after ileostomy closure is detected. All the IH were presented in the control group with no stadistically significant differences between groups. Larger trials with longer follow-up are needed to confirm the results.