bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation of a frontal vehicle collision in order to study the comparison between a forward facing and rear facing child occupant
Authors: Radu A I , Tolea B A
Published: October 2022

Child occupants are considered very vulnerable in the case of vehicle accidents due to the fact that their bodies are not fully developed and thus they have a higher risk of injury. Because of this, child seats have been developed to be mounted on the backseat of the vehicle and have 2 seating positions, facing the rear of the vehicle or facing the front of it. This paper aims to analyse the two seating positions of a child seat and to determine the injury risk of a child occupant using a virtual simulation of a vehicle crash at different velocities and a multibody model for the occupant. The results of the simulation show that a rear-facing child seat has better occupant protection and overall could reduce the injury probability in case of frontal vehicle collisions.
The study of the spark ignition engine performance at fueling with n-butanol-gasoline mixture
Authors: Sandu Cr , Pana C , Negurescu N , Cernat Al , Fuiorescu D , Georgescu R , Nutu C
Published: October 2022

The actual challenges regarding renewable energy sources, pollution and climate changes have pushed industries sectors (including the automotive sector) to find sustainable solutions for long-term. Numerous studies have been conducted for to find the alternative fuels sources to solve the energetic and pollution problems. A special attention was given to alcohols use (ethanol, butanol, methanol) in mixture with the conventional fuels like gasoline or diesel. Butanol has a great advantage comparative with other alcohols due its better miscibility properties, allowing a butanol higher percentages use in mixture with gasoline or diesel fuel. Butanol is also less corrosive VS ethanol or methanol, which makes it ideal for the spark-ignition engines. An automotive gasoline engine with a 1.5L displacement was fueled with butanol in mixture with gasoline in deferent percentages, deferent dosages and deferent engine operation regimes. In the paper the effects are presented of the engine fueling with B15 fuel (15%-vol. n-butanol in mixture with 85%-vol. gasoline) on the combustion, on the engine energetic performances and pollutants. The experimental investigations (engine load 55% and 2500 rpm engine speed) showed the brake specific energetic consumption and the level of the pollutants emissions decrease at the butanol and the lean mixtures use, at the same engine power, comparative to engine gasoline. Another advantage of n-butanol is the stable engine operation at lean mixtures use.
Study of a new support system JNG 20 equipping recycled batteries containers powered by solar energy for isolated farms or agri-food micro-factories
Authors: Jinga T I , Zăpodeanu C V
Published: October 2022

Even though the world’s population is constantly developing and growing, there are still large areas where electricity is a luxury, which is why, in recent years researchers have tried to use alternative sources to supply electricity in underdeveloped areas or affected by military conflicts. The aim of the study is to ensure energy independance of small villages, isolated farms or agri-food micro-factories. This paper incorporates the implementation of a combined system for using the largest available energy source, more precisely the solar energy by reusing electric batteries that were drained out of life from Renault ZOE 2012 vehicles. The studies were conducted in order to find a viable constructive solution for an independent support system, type JNG 20, attached to containers with a capacity up to 20,000 kg, capable of transporting and storing batteries for long periods, regardless of the type of terrain on which the system will be installed on or the climatic conditions to which the assembly will be subjected. At the same time, the system has a manually operated hydraulic lifting-lowering mechanism to ensure easy loading and unloading of the container, without the requirement for additional handling equipment in hard-to-reach areas. The JNG 20 system is based on two concepts: the hydraulic lifting-lowering mechanism and the self-adjusting ground support model. Through this paper, following the effort analysis performed using the AutoDesk Fusion 360 software of the new model adopted, the optimal constructive solution for the intended purpose has been identified.
Facile copper ferrite/carbon quantum dot magnetic nanocomposite as an effective nanocatalyst for reduction of para-nitroaniline and ortho-nitroaniline
Authors: Naghash-Hamed Samin , Arsalani Nasser , Mousavi Seyed Borhan
Published: October 2022

Para-nitroaniline (PNA) and ortho-nitroaniline (ONA) are highly toxic contaminants in aqueous solution and must be treated. In the current investigation, novel magnetic nanocomposites containing copper ferrite (CuFe2O4) and gelatin-derived carbon quantum dots (CQDs) were successfully synthesized. The prepared nanocatalyst was characterized by scanning electron microscopy, x-ray diffraction, transmission electron microscopy, Brunauer–Emmet–Teller (BET), Fourier transform infrared and ultraviolet–visible techniques. The mesoporous structure of the CuFe2O4/CQD nanocomposite was shown using the BET/Barrett–Joyner–Halenda technique. The catalytic performance of the nanocatalyst during the reduction of PNA and ONA was assessed in an aqueous medium at 25 °C. The complete reduction of PNA and ONA using the CuFe2O2/CQDs nanocomposite occurred in 13 s and 35 s, respectively. The pseudo-second-order rate constant (K
app) was obtained as 2.89 × 10−1 s−1 and 9.3 × 10−2 s−1 for reducing PNA and ONA, respectively. Moreover, the magnetic nanocatalyst was easily separated from the reaction solution and recycled for up to six consecutive cycles without significant loss of catalytic activity.
Outdoor luminescence imaging of field-deployed PV modules
Authors: Kunz Oliver , Schlipf Jan , Fladung Andreas , Khoo Yong Sheng , Bedrich Karl , Trupke Thorsten , Hameiri Ziv
Published: October 2022

Solar photovoltaic (PV) installations have increased exponentially over the last decade and are now at a stage where they provide humanity with the greatest opportunity to mitigate accelerating climate change. For the continued growth and success of PV energy the reliable inspection of solar power plants is an important requirement. This ensures the installations are of high quality, safe to operate, and produce the maximum possible power for the longest possible plant life. Outdoor luminescence imaging of field-deployed PV modules provides module image data with unparalleled fidelity and is therefore the gold standard for assessing the quality, defect types, and degradation state of field-deployed PV modules. Several luminescence imaging methods have been developed and some of them are already routinely used to inspect solar power plants. The preferred luminescence inspection method to be used depends on the required image resolution, the defect types that need to be identified, cost, inspection throughput, technological readiness, and other factors. Due to the rich and detailed information provided by luminescence imaging measurements and modern image analysis methods, luminescence imaging is becoming an increasingly important tool for PV module quality assurance in PV power plants. Outdoor luminescence imaging can make valuable contributions to the commissioning, operation, and assessment of solar power plants prior to a change of ownership or after severe weather events. Another increasingly important use of these technologies is the cost-effective end-of-life assessment of solar modules to enable a sustainable circular economy.
Quantifying Mycobacterium tuberculosis Transmission Dynamics Across Global Settings: A Systematic Analysis
Authors: Smith Jonathan P , Cohen Ted , Dowdy David , Shrestha Sourya , Gandhi Neel R , Hill Andrew N
Published: October 2022

The degree to which individual heterogeneity in the production of secondary cases (“superspreading”) affects tuberculosis (TB) transmission has not been systematically studied. We searched for population-based or surveillance studies in which whole genome sequencing was used to estimate TB transmission and in which the size distributions of putative TB transmission clusters were enumerated. We fitted cluster-size–distribution data to a negative binomial branching process model to jointly infer the transmission parameters $R$ (the reproduction number) and the dispersion parameter, $k$, which quantifies the propensity of superspreading in a population (generally, lower values of $k$ ($<1.0$) suggest increased heterogeneity). Of 4,796 citations identified in our initial search, 9 studies from 8 global settings met the inclusion criteria (n = 5 studies of all TB; n = 4 studies of drug-resistant TB). Estimated $R$ values (range, 0.10–0.73) were below 1.0, consistent with declining epidemics in the included settings; estimated $k$ values were well below 1.0 (range, 0.02–0.48), indicating the presence of substantial individual-level heterogeneity in transmission across all settings. We estimated that a minority of cases (range, 2%–31%) drive the majority (80%) of ongoing TB transmission at the population level. Identifying sources of heterogeneity and accounting for them in TB control may have a considerable impact on mitigating TB transmission.
Serum Galectin-3 and Mucin-1 (CA15-3) in Relation to Renal Function in Untreated Chinese Patients
Authors: Huang Qi-Fang , Cheng Yi-Bang , Guo Qian-Hui , Wang Ying , Chen Yi-Lin , Zhang Dong-Yan , An De-Wei , Li Yan , Wang Ji-Guang
Published: October 2022

Background

Galectin-3 is a multi-functional lectin protein and a ligand of mucin-1 (CA15-3), and has been linked to renal fibrosis in animal models and renal function in humans. However, no population study has ever explored the associations with both ligand and receptor. We therefore investigate the independent association of renal function with serum galectin-3 and mucin-1 (CA15-3) in untreated Chinese patients.

METHODS

The study participants were outpatients who were suspected of hypertension, but had not been treated with antihypertensive medication. Serum galectin-3 and mucin-1 (CA15-3) concentrations were both measured by the enzyme-linked immunosorbent assay (ELISA) method. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine by the use of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

Results

The 1,789 participants included 848 (47.4%) men. Mean (±SD) age was 51.3 ± 10.7 years. Multiple regression analyses showed that eGFR was significantly associated with serum galectin-3 and mucin-1 (CA15-3) concentration (0.68 and 1.32 ml/min/1.73 m2 decrease per 1-SD increase in log transformed serum galectin-3 and mucin-1 (CA15-3) concentration, respectively; P ≤ 0.006). The association of eGFR with serum mucin-1 (CA15-3) concentration was significantly stronger in the overweight (BMI 24.0–27.9 kg/m2) and obese (BMI ≥ 28.0 kg/m2) than in normal weight subjects (BMI < 24.0 kg/m2, P for interaction 0.018). Path analysis showed that serum galectin-3 concentration had both a direct (P = 0.016) and a mucin-1 mediated indirect effect (P = 0.014) on eGFR.

Conclusions

Both circulating galectin-3 and mucin-1 (CA15-3) were significantly associated with renal function. The role of galectin-3 on renal function might be partially via mucin-1.
Competition induces negative conspecific allelopathic effects on seedling recruitment
Authors: Yuan Ling , Li Junmin , van Kleunen Mark
Published: October 2022

Background and Aims

Some plant species suppress competitors through release of chemical compounds into the environment. As the production of allelochemicals may be costly, it would be beneficial if their production would only be induced when plants experience competition. We tested whether two plant species that frequently co-occur show evidence for induced allelopathy in response to intra- and interspecific competition.

Methods

We used the annual forb Crepidiastrum sonchifolium and the perennial forb Achyranthes bidentata, which are native to China and predominantly occur in ruderal communities, as focal species. We first grew the species without competition, with intraspecific competition and in competition with each other. We chemically analysed aqueous extracts made from these plants to test for evidence that the competition treatments affected the metabolomic profiles of the species. We then tested the effects of the aqueous extracts on seed germination and seedling growth of both plant species.

Key Results

Metabolomic analysis revealed that competition treatments modified the chemical profiles of the two study species. The root lengths of A. bidentata and C. sonchifolium seedlings were reduced by the aqueous plant extracts. For seedling root length of A. bidentata, heterospecific allelopathy was more negative than conspecific allelopathy, but for germination of C. sonchifolium seeds, the reverse was true. Moreover, conspecific allelopathic effects on germination of A. bidentata seeds and on seedling root length of both species were most negative when the aqueous extracts were made from plants that had experienced competition. In the case of seedling root length of A. bidentata, this effect was most negative when the plants had experienced interspecific instead of intraspecific competition.

Conclusions

We showed that plants change their metabolomic profiles in response to competition, and that this correlated with allelopathic inhibition of conspecific seed germination and seedling growth. We suggest that autoallelopathy for seed germination could function as a mechanism to avoid strong competition by keeping the seeds in a dormant state.
Viability and Stability of Various-Sized Free Diced Cartilage in an Experimental Study
Authors: Dong Wenfang , Wang Xin , Zhao Zhenmin , Fan Fei
Published: October 2022

Background

Historically, research of diced cartilage for rhinoplasty has mainly explored the efficacy of wrapped materials, with few studies dedicated to various sizes of diced cartilage.

Objectives

The authors of this study sought to evaluate the viability and stability of various-sized free diced cartilage.

Methods

The remaining costal cartilage was harvested during rhinoplasties and implanted into subcutaneous pockets on the backs of nude mice: shaved cartilage (group A, n = 8), diced cartilage with a diameter <0.5 mm (group B, n = 8), 0.5 to 1.0 mm (group C, n = 8), and 1.0 to 1.5 mm (group D, n = 8). After 12 weeks, weight and volume retention rates, histopathological examinations, and biomechanical properties were evaluated.

Results

Cartilage grafts in groups A and B showed an obvious loss of contour and severe dispersion. The weight and volume of cartilage graft in group A were significantly decreased (all P < 0.05). Although there was no significant difference, group D (122.8 ± 15.4%) achieved the highest weight retention rate compared with groups B and C (114.6 ± 7.1% and 114.3 ± 10.1%, respectively). Group A showed the most apparent chondrocyte nucleus loss with the least peripheral proliferation, and group D showed the best regeneration potential (all P < 0.05). Group C achieved less chondrocyte nucleus loss than group B (P < 0.05). The compressive elastic modulus increased with the diameter of diced cartilage (all P < 0.05).

Conclusions

Diced cartilage with a diameter of 1.0 to 1.5 mm may have the highest viability and stability, followed by those of 0.5 to 1.0 mm and <0.5 mm.
BJS-02 LONG-TERM REOPERATION RATE FOLLOWING PRIMARY VENTRAL HERNIA REPAIR: A REGISTER-BASED STUDY
Authors: Katawazai A , Sandblom G , Wallin G
Published: October 2022

Aim

The aim of this study was to analyse the risk for reoperation following primary ventral hernia repair.

Methods

The study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010–2019. Reoperation was defined as repeat repair after primary repair.

Results

Altogether 30,253 umbilical hernia repairs and 7407 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.284 (95% confidence interval (CI) 0.106–0.760) after open onlay mesh repair, 0.476 (CI 0.359–0.629) after open interstitial mesh repair, 0.368 (CI 0.230–0.590) after open sublay mesh repair, 0.446 (CI 0.167–1.194) after open intraperitoneal onlay mesh repair, 0.931 (CI 0.639–1.357) after laparoscopic repair, and 0.939 (CI 0.502–1.757) after other (unknown) techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged ≤49 years (HR 1.669, CI 1.391–2.002), for women (HR 1.390, CI 1.178–1.641), and for patients with liver cirrhosis (HR 2.546, CI 1.050–6.174). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age ≤49 years (HR 2.079, CI 1.380–3.134).

Conclusions

All types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.
DD-06 SPIN (SURGICAL PRACTICES IN INCISIONAL HERNIA REPAIR). A NATIONAL TRAINEE-LED COLLABORATIVE MULTICENTRE PROSPECTIVE OBSERVATIONAL STUDY
Authors: Kingston J , Tarazi M , Burns K , Kirwan C , Moinuddin Z , Van Dellen D
Published: October 2022

Aim

There is currently no established UK database establishing reliable outcome data for surgical repair of incisional herniae (IH). Their heterogeneity (variability in size, patient comorbidity, and multiple repair techniques) has resulted in no surgical management or outcome reporting consensus.

This study aims to utilise national trainee led research collaboratives to perform a multi-centre, observational, prospective study to assess variation in IH defects (by utilising pre-defined criteria from The European Hernia Society (EHS) classification for IH and a Modified Ventral Hernia Working Group) and their subsequent operative management. This study will yield valuable, standardised data on variation in practice and outcomes (complications and 3 and 12-months follow-up) to provide a platform for expanding IH research.

Materials and Methods

All NHS hospitals in England undertaking elective IH repair will be eligible for inclusion. Dissemination of and recruitment to the study will be driven by regional research collaborative networks.

This study will include all elective adult IH repairs with. Data will be collected and managed using REDCap electronic data capture tool. There will be three distinct phases comprising;

The study is currently unfunded. Funds are sought to obtain NHS Trust sponsorship and proceed to phase 3 of the study.
OC-004 LIGNOCAINE INFILTRATION FOR LICHTENSTEIN REPAIR UNDER LOCAL ANESTHESIA: TECHNIQUE AND RESULTS
Authors: Sharma N
Published: October 2022

Background

Lichtenstein inguinal hernia repair (LIHR) is the most commonly performed operation for inguinal hernia, even in developed nations. The European Hernia Society (EHS) guidelines recommend that local anesthesia (LA) should be considered an option in all patients undergoing LIHR. However, most patients still undergo this repair under general anesthesia (GA) or spinal anesthesia (SA). Even in a low resource area like North Ghana, only 37% patients had LIHR under LA. Specialty hernia clinics perform a majority of inguinal hernia repairs under LA. They have standardized their technique of administration of LA and the technique described by Amid et al. is simple, easily learnt, and works well in the hands of an average surgeon as well as a surgical trainee. However, not all surgeons are comfortable in performing this operation under LA. One possible reason for this is that the surgeon prefers a relaxed operating feld and he has heard stories of bad experiences with LA because of non-optimal technique of LA with unacceptable intensity of pain during LA.

Aim

To present a short video demonstrating the technique of infiltration of lignocaine for Lichtenstein repair under LA.

Materials and methods

Video.

Results

In our series of 30 patients, median intra-operative pain VAS was 2.5(0,5). 30% patients reported a VAS>3 during operation. All patients successfully underwent operation using LA.

Conclusion

LA should be strongly considered for all patients with unilateral inguinal hernia undergoing open repair.
OC-028 LAPAROSCOPIC INGUINAL HERNIA REPAIR AS A DAY SURGERY PRACTICE
Authors: Gelebeševa Mateska T , Jakomin T , Avguštin M , Sojar V
Published: October 2022

Aim

Up to 300 hernia operations are performed each year in Iatros Medical Center. In our clinic the standard TAPP laparoscopic technique as a day surgery is performed. Since May 2020, we have been actively collaborating with the Herniamed registry to follow up results of hernia repair.

Methods and patients

Between Sept 2020 and Feb 2022, 72 male patients were operated, using the TAPP technique. 21 to 86 years old underwent 100 hernioplasty (44 unilateral inguinal hernias and 27 bilateral), 35 hernias were direct (medial), and 65 hernias were indirect (lateral), 92 primary and 8 recurrent hernias. Prophylactic antibiotics were given as a single preoperative dose. All the patients were operated on under general anesthesia as day surgery cases. A Strict clinical protocol is followed for day surgery practice.

Results

The median age of patients was 53 years old, ASA 1–3. Participants were followed-up at 7 days and 12 mounts. There was no recurrence during follow- up of 2 to 17 months. One patient was diagnosed with postoperative dysesthesia in the right leg- dermatome L3, managed conservatively. Seven patients was diagnosed with acute pain (VAS 1–3) 7 days after surgery, two patients had a postoperative seroma and five patients had a hematoma around the ports, managed conservatively.

Conclusion

Day-surgery is as safe as an overnight stay in laparoscopic hernia repair under a strict clinical protocol of a day surgery practice. Low postoperative complications rates were found in our series.
OC-033 SLOWLY RESORBABLE VERSUS PERMANENT SYNTHETIC MESH IN OPEN RETROMUSCULAR VENTRAL HERNIA REPAIR - 3 YEAR RESULTS OF A RANDOMIZED CONTROLLED TRIAL
Authors: Vandenheede M , Miserez M , Jorgensen L N , Berrevoet F
Published: October 2022

Introduction

Implantation of synthetic meshes provides long-term hernia repair, but may result in mesh-related complications. The longterm resorbable mesh used in this study maintains more than 50% of its strength for 6 months and is completely resorbed after 3 years.

Methods

This multi-centre, randomized controlled trial compared the use of the TIGR® Matrix Surgical Mesh (Novus Scientific, Sweden) with a large-pore polypropylene mesh (Soft®mesh, BD, UK) in primary ventral and incisional hernia repair. Retromuscular mesh repair was performed. Primary endpoint was hernia recurrence rate after a 3 year follow-up period. Secondary endpoints were hernia recurrence rate at 1 year and 2 years, as well as perioperative morbidity and longterm complications including pain.

Results

Seventy-nine patients were included, but 69 patients received study treatment. Fifty-seven patients (82.6%) completed follow-up of 3 years. One patient (2.9%) developed a seroma after hernia repair with TIGR mesh. Three patients had a reintervention for hematoma (8.6%) in the control group versus two reinterventions (5.9%) after repair with TIGR mesh (p=0.673. One patient underwent late re-operation and mesh removal after hernia repair with TIGR mesh due to chronic wound infection. During three years follow-up, seven (10.1%) patients experienced a hernia recurrence, two (5.7%) in the control group and five (14.7%) after TIGR mesh (p=0.15).

Conclusion

Although not statistically significant, this multicentric RCT showed a higher recurrence rate for longterm degradable mesh patients after 3 years of follow-up. These results call for larger studies with long-term follow-up comparing slowly resorbable mesh materials with permanent mesh products.
OC-051 MANAGEMENT OF EPIGASTRIC, UMBILICAL, SPIGELIAN AND SMALL INCISIONAL HERNIA AS A DAY CASE PROCEDURE: RESULTS OF LONG–TERM FOLLOW–UP AFTER OPEN PREPERITONEAL FLAT MESH TECHNIQUE
Authors: Zuvela M , Galun D , Bogdanovic A , Bidzic N , Zivanovic M , Zuvela M , Zuvela M
Published: October 2022

Aim

To investigate short and long-term outcome after the open preperitoneal flat mesh technique (OPPFMT) for umbilical, epigastric, spigelian, small incisional and “port-site” hernia performed as a day case procedure.

Materials and Methods

We retrospectively analyzed records of patients who underwent OPFMT for umbilical, epigastric, Spigelian, small incisional and “port-site” hernia. All patients were operated under local anesthesia in ambulatory settings. The operative technique is as follows: polypropylene flat mesh exceeding the size of the hernia defect for 2–3 cm in all directions is placed into a pre-peritoneal position above the intrabdominaly repositioned hernia sac (mesh is placed into hernia sac) and fixed by at least 8 transfascial “U” sutures.

Results

In the period from January 2004 to April 2022, 531 patients with ventral hernias (272 with umbilical, 155 with epigastric, 69 with small incisional, 17 with “port site” and 18 with Spigelian hernia) underwent surgery. During the median follow-up of 44 months, 8 (1,5%) hematomas, 2 (0,4%) seromas, 2 (0,4%), superfitial wound infections, 8 (1,5%) mesh infections and 24 (4,6%) recurrences occurred.

Conclusion

Management of epigastric, umbilical, spigelian and small incisional hernia with OPFMT under local anesthesia as a day case procedure is a safe and associated with favorable long-term outcome.
OC-065 PEEKABOO WITH MESHES AND MACHINES: DEEP LEARNING TO IDENTIFY TACKS AND MESHES ON CT SCANS
Authors: Rengan V , Meenashi Sundaram P , Arora E , Bawa A
Published: October 2022

Aim

To identify the presence of tacks and meshes in CT scans of patients who have previously undergone hernia repairs

Materials & Methods

We annotated data from >100 anonymised Hernia CT scans of patients who had undergone previous ventral hernia repairs and used machine learning(ML)/ deep learning(DL) techniques to identify the presence of meshes and tacks.Annotation of CT scans was performed using computer vision tools. A combination of image processing, feature extraction and artificial intelligence(AI) techniques were used to create models that could identify tacks and meshes on CT scans.

Results

We were able to identify the presence of meshes and tacks with >55% accuracy. The AI model under construction is continuing to improve performance.

Conclusions

Identification of the mesh is a challenge for surgeons and radiologists alike. The presence of machine learning techniques has revolutionised radiology and made the identification of obscure structures possible. Meshes present a unique challenge as they constitute a foreign tissue which integrates into native tissue. We believe that identification of hernia meshes and tacks can help surgeons identify the right planes for planning re-surgeries while operating in patients with previous hernia repairs or while tackling recurrences.
OC-066 LIRA TECHNIQUE, A NEW PROCEDURE. WHERE ARE WE NOW?. OUR RESULTS IN A MEDIUM FOLLOW-UP
Authors: Gómez Menchero J , Guerrero J L , Lara Fernandez Y , Navarro L , De La Herranz P , Gila Bohorquez A , Garcia Moreno J , Morales Conde S
Published: October 2022

Background

LIRA technique (Laparoscopic Intracorporeal Rectus Aponeuroplasty) was described in 2018 in order to reduce the tension in the midline as an alternative to defect closure (CD) in Laparoscopic Ventral Hernia Repair. We present our results in LIRA series in patients with a medium follow up

Methods

A prospective controlled study from January 2015 to December 2020 to evaluate (LIRA) performed on patients with midline w2 hernias (EHS Classification). Data analyzed included patient demographics, operative parameters and complications.

Tomography was performed preoperatively and postoperatively (1 month and 1 year) to evaluate recurrence, distance between rectus and seroma. Clinical examination were performed yearly.

Results

49 patients. Mean Age was 58± 10.59 years old and BMI 33.11± 6.61 kg/m2. Mean width of the defect was 6.19± 1.49 cm. Average VAS (24 h) was 5.09 ± 5, 0.38(1 month) and 0 (1 year). Mean preoperative distance between rectus was 5.55± 1.61 cm; postoperative was 2.15 ± 0.79 cm (1 month) and 2.20±0.68 cm (1 year). Radiological seroma at first month was detected in 40%. Seroma after 1 year was 4,08% Mean follow-up was 24 months. Bulging detected only in 1 case (2.04%) after 1 year follow up. No recurrence is data.

Conclusion

LIRA technique could be considered as an alternative to CD for w2 defects with a low rate of complication, and could be related to a low rate of postoperative pain with no recurrence and a low rate of bulging compared to CD, being a safe, feasible and reproducible technique.
OC-089 STANDARDIZED SUTURING OF MEDIAN INCISIONS AND DEFECTS CAN REDUCE SUTURE SLACKENING AND BURST RATES
Authors: Lesch C , Kallinowski F , Katharina U , Vollmer M , Raschidi R , Nessel R
Published: October 2022

Aim

Has standardization of criteria of a small-stitch-small-bite suture (SSSB) a significant influence on its durability?

Material and Methods

Porcine abdominal walls and bovine flanks were used as model tissues. We cut a median 15 cm long incision into the tissues. Then we punched an additional round (5–10 cm wide) or rhomboid (5×15 cm) defect in the middle of the incision. Monomax® and Maxon® USP 1 and 2–0 sutures were used in a running technique with a suture to incison lengths above 4:1. The mesh-tissue compounds were investigated on our self-built hydraulic bench test simulating coughs. Cyclic pressure impacts were repeatedly delivered peaking around 210 mmHg. In each of twenty experimental series, ten preparations were loaded 425 times.

Results

Standardized SSSB sutures using 2–0 Monomax® with a suture-incision-ratio of 4.5 : 1 can give a durable closure of a large defect in thin, elastic tissues. Under other conditions, suture lines can reopen. Standardization of the suturing technique significantly increased the durability (p = 0.00008). Defect shape is important since the larger rhomboid defects were easier to close compared to the smaller, 5 cm wide, round defects (SSSB: p = 0.00018; LSLB: p = 0.00906).

Discussion

After standardization, insignificant influences on the durability were exerted by the suture material and diameter, the bite and stitch size (small versus large), the surgeon, the tissue elasticity and tension and the defect size.

Conclusions

A standardized suturing technique was developed. The standardization improved the durability of a suture repair significantly.
P-007 CYANOACRYLATE IS A USEFUL TOOL TO PREVENT SEROMAS IN INCISIONAL HERNIA SURGERY
Authors: Jezieniecki Fernández C , Trujillo Díaz J , Ruiz Soriano M , Gomez Sanz T , Cabezudo Molleda G , Montes Manrique M , Rodriguez Lopez M , Herreros Rodríguez J , Beltrán De Heredia Renteria J
Published: October 2022

Aim

To demonstrate that the use of cyanoacrylate (Glubran®) can decrease the incidence of postoperative surgical site occurrences (SSO) in incisional hernia (IH) surgery.

Methods

Retrospective cohort analysis of SSO after elective IH repairs (November 2018 to October 2020). Group 1: mesh fixation by interrupted stitches associating cyanoacrylate (as well as spreading it in subcutaneous tissue). Group 2: without cyanoacrylate.

Results

113 patients were analyzed included (females: 50.4%, age: 70 (IQR: 59–75years)). Length of stay: 3 (IQR: 2–6days). Comorbidities: diabetes (7.1%), hypertension(29.2%), dyslipidemia(41%), smoking(38.1%), alcohol consumption(22.1%), cardiovascular disease(15.9%). ASA: I(5.3%), II(62.8%), III(31.9%). BMI: 29.14±3.63kg/m2. Hernia location: midline (89.4%), others (10.6%). Cyanoacrylate group:54.9%. Surgical technique: onlay (61.1%), sublay (38.9%).

Postoperative complications: global (29.2%), clinical seroma (25.7%), ultrasound seroma (32.7%). Surgical site infection-SSI (8.8%). Recurrence: 3.5%.

Patients with cyanoacrylate had lower overall complications, clinical and ultrasound seroma and SSI rates (17.7% vs 43.1% p=0.003; 16.1% vs 37.3% p=0.011; 27.4% vs 39.2% p=0.1; 3.2% vs 15.7% p=0.02 respectively). These findings are even more statistically significant after selecting onlay procedures (23.3% vs 51.3% p=0.018; 16.7% vs 46.2% p=0.01; 30% vs 46.2% p=0.1; 6.7% vs 20.5% p=0.04 respectively). These differences were maintained in the multivariate analysis (p <0.05).

Conclusion

The cyanoacrylate (Glubran®) is a good tool in preventing postoperative seromas in patients with IH (particularly in onlay procedures), without increasing the incidence of other complications.
P-013 RESULTS OF ANATOMICAL RECONSTRUCTION OF RECTUS ABDOMINIS SHEATH AS A VARIANT OF RIVES TECHNIQUE
Authors: Díaz Pedrero R , López González L , Aguado Henche S , Hernandez Fernández M , Córdova García D , Ratia Giménez T , Bru Aparicio M , San Román Romanillos R , Allaoua Y , Gutierrez Calvo A
Published: October 2022

Aim

To describe our results of the anatomical reconstruction of the midline as a variant of the Rives technique.

Material and Methods

53 cases of midline incisional hernia M2, M3, M4 according to the EHS classification were treated between Jan 2016 and Jan 2022 in our Unit by the same surgeon using a modified Rives technique (reconstruct the midline by continuous sutures to create a new linea alba, where the polypropylene mesh will be fixed; the lateral region is not fixed with suture, only a tissue adhesive -Tisseel®- is used)

Results

Average duration of surgery: 132 min (113–215 min), Mean Age 57 years (32–72), 21 females and 32 males, mean BMI 29 (23–34), . The average stay was 3.7 days, the immediate postoperative pain was 3.8 according to the EVA scale, drainage was used in 7 cases (13.2%). There were 2 infectious complications in surgical site without requiring mesh explantation (3,8%), 3 seromas occurred (5,6%).

Discussion

Hernia recurrence has decreased in recent years due to the incorporation of mesh. There are other important factors when we evaluate the results of hernia repair technique. Anatomical reconstruction offers adequate results.

Conclusion

Anatomical reconstruction of rectus sheath offers good results as an option to the repair of midline hernias
P-017 A FRAMEWORK FOR MULTIDISCIPLINARY TEAM MANAGEMENT OF ABDOMINAL WALL RECONSTRUCTION
Authors: Wei R , Gilmore K , Findlay J , Sanders D , Pawlak M , Bunting D , Arain A
Published: October 2022

Aim

Incisional hernias are common and can significantly impact a patient's quality of life. Traditionally, abdominal wall reconstruction (AWR) has been performed by general surgeons, or those with special interest, often working in isolation. However, there is increasing awareness of pre-optimisation, risk stratification, enhanced training, and personalising treatment using a wide range of techniques.

Methods & Results

For complex and higher-risk procedures, Multidisciplinary team (MDT) management is considered the standard of care for optimising outcomes. The lack of standardised protocols and clear evidence in AWR means that surgical management can vary greatly. This makes the MDT process even more important due to the complexity of the decision-making involved. We describe a successful MDT process for complex abdominal wall reconstruction at a tertiary referral centre. Patients are reviewed at weekly AWR meetings with a multidisciplinary team, which includes consultants, advanced clinical practitioners and trainees. This is an opportunity for objective risk stratification, radiological review and assessment of the patient's goals before preoptimization and operative planning. Prospective data is collected on all patients to allow for quality improvement and service development.

Conclusion

MDT management of abdominal wall hernia is gaining popularity but remains poorly established in most regions. The involvement of surgical colleagues and other specialists is crucial in developing this growing field of surgery. We hope to expand our team to include Radiologists and Nutritionists, with the possibility of extending to regional networks, as we continue to explore new techniques and methods in managing complex abdominal wall hernias.
P-020 PERFORMANCE OF AN ATRAUMATIC AND VERSATILE LIGHT-ACTIVATED ADHESIVE FOR HERNIA MESH FIXATION
Authors: Lopes M , Bitton E , Pereira M , Dufresne A , Guilbot M
Published: October 2022

Aim

This study evaluates the versatility and performance of a novel adhesive for atraumatic hernia mesh fixation. The TISSIUM adhesive is a biodegradable and biocompatible viscous liquid that can be precisely applied to different tissue and mesh.1 Once in place, the surgeon utilizes a light probe to polymerize the adhesive, creating a flexible elastomeric connection that provides strong, durable and atraumatic mesh fixation.

Materials and Methods

The performance of the TISSIUM adhesive when used with a range of marketed mesh and against peritoneum (n=7) and muscle (n=3) was evaluated using a standardized lap-shear bench method using porcine tissues. The shear strength was compared to resorbable tacks (n=8) (against peritoneum as standard of care in IPOM) and self-adhesive meshes (n=4) and fibrin glue (n=3) (against muscle as classically used in the retromuscular approach).

Results

Lap-shear data revealed that the TISSIUM adhesive performance was equivalent to resorbable tacks when fixing meshes to the peritoneum. Similar testing protocol demonstrated that the TISSIUM adhesive shear strength was 6 to 13 times superior to non- penetrating fixation devices such as fibrin glue or self-adhesive mesh.

Conclusions

The use of the TISSIUM Adhesive for hernia mesh fixation is compatible with various mesh materials used in hernia repair and, in a bench model, outperforms existing non-penetrating methods in diverse tissue planes demonstrating the potential to help the surgeon achieve more effective and efficient atraumatic repair in a range of hernia procedures.
P-025 USE OF PREOPERATORY PNEUMOPERITONEUM FOR GIANT INGUINOESCROTAL HERNIA TREATMENT WITH LOSS OF DOMAIN. A GREAT RESOURSE
Authors: Gómez Torres I , Menor P D , Alcobilla E , Llorca S , Artero R , Gómez S , Tamayo A , Laguna M
Published: October 2022

Introduction

Recently, the use of neoadjuvant therapies such as preoperative progressive pneumoperitoneum has favored the treatment of large ventral hernias with loss of domain. Despite this, there are only few cases described in the literature.

Materials & Methods

We present a case of a 69-year-old male affected by giant inguinoescrotal hernia of years of evolution with loss of domain.

A preoperative CT scan with volumetric quantification is performed where giant left inguinal hernia with mesenteric fat content, small intestine, sigma, descending colon, as well as splenic angle of the colon, with a relationship between the volumes greater than 0.67. (VSH of 11,502cc and VABD of 17,061cc).

We decided to perform preoperative progressive pneumoperitoneum.

In the following 15 days up to 8L are administered without complications.

Results

Surgical repair of the inguinal hernia is performed according to the Lichtenstein technique modified by the size of the hernial sac with evidence of unstructured but intact structures of the inguinal canal. Placement of self-adhesive ProGrip TM retroaponeurotic mesh is performed with attachment of this to the inguinal ligament and pubis.

After surgery, the patient presented a good postoperative recovery without complications, without evidence of recurrence more than 6 months after surgery.

Discussion

The use of prehabilitating techniques in patients affected by large hernias can reduce the morbidity and mortality of patients, with the less aggression. In our case it allowed us to completely reduce all the hernia contents without visceral injury and perform an anatomical repair, which would not have been possible without this resource.
P-032 FASCIOTENS: FIRST CASE IN THE HOSPITAL OF MéRIDA
Authors: Lindo Canchado J J , Hernández Sánchez A , Marco Continente C , Lima Teixeira De Abreu P M , Moreno Ballesteros M , López Farias A , Rubio Capote L , Nieto Soler A A
Published: October 2022

Aim

Anterior abdominal wall incisional hernias are a problem present in approximately 11–20% of patients undergoing laparotomy. Incisional hernias with loss of right of abode are associated with many physical, physiological and psychological problems.

In order to surgically repair these incisional hernias with loss of right of abode, we need to perform a prehabilitation of the incisional hernias. Effective prehabilitation is required in order to close the aponeurotic defect without tension and to return the hernial contents to the abdominal cavity.

Material and methods

A 59-year-old female patient with a history of open cholecystectomy and incisional hernia repaired on three occasions, presenting with multisaccular midline incisional hernia (M1-M4 W3) containing colon and greater omentum.

Results

After application of botulinum toxin and Fasciotens, it is possible to perform Rives-Stoppa retrorectus repair, being able to reduce the hernial content without tension and without increasing intra-abdominal pressure.

Conclusions

Prehabilitation in complex abdominal wall surgery is essential to repair large aponeurotic defects without tension. In addition, the application of Fasciotens after administration of botulinum toxin allows closure of the aponeurotic defect using standard abdominal wall closure techniques.
P-042 POSTTRAUMATIC HERNIAS: AN UNKNOWN PATHOLOGY
Authors: Flores Flores C , García Galocha J L , Peña Soria M J , Del Campo Martín M , López Antoñanzas L , Sánchez Del Pueblo C , Pérez Jiménez A E , Ruano Campos A , Torres García A J
Published: October 2022

Introduction

Posttraumatic hernias are a rare pathology. The mechanism is due to increased abdominal pressure during trauma causing disruption muscle planes.

Case description

We report three cases of this patology:

One of them is a women who suffered a sigmoid perforation due to a traffic accident. After sigmoidectomy and primary abdominal wall closure the patient presented bilateral abdominal. hernias.

The second case is about an elderly woman who fell down a subway staircase. The patient presented with a fracture of the left clavicle, fractures of four ribs and left lumbar haematoma. Two months after the trauma she had a left lumbar hernia.

The latest case is about a young man who was involved in an accident while riding a motorbike, pinning the handlebars. Physical examination revealed an oedema of the abdominal wall. He had an abdominal hernia with omentum inside.

Bilateral hernioplasty was performed on the first one. Biosynthetic mesh on the second one. Laparoscopic correction of the defect with polypropylene mesh fixed with tackers in the third case.

Discussion

Traumatic abdominal hernias have a estimated incidence of 0.07 to 0.2% of all abdominal trauma. We use two diagnostic criteria: suffering a trauma and the absence of a previous hernia in the same location. In this context, it is important to confirm the presence or absence of a hernia by CT scan.

Conclusion

The treatment of choice in these cases is the use of mesh because it decreases the rate of recurrence.
P-046 LAPAROSCOPIC E-TEP APPROACH FOR VENTRAL HERNIA ASSOCIATED WITH INGUINAL HERNIA AND RECTUS DIASTASIS: IS IT A GOOD OPTION?
Authors: Trujillo Díaz J , Jezieniecki Fernandez C , Acosta Rodriguez A , Rodriguez Valenzuela N , Montes Manrique M , Saldarriaga Ospino L , Sánchez Gonzalez J , Perez Saborido B
Published: October 2022

Aims

Ventral hernias are a common pathology in general surgery and its association with rectus abdominis diastasis and inguinal hernias is frequent.The surgical technique for the repair of this type of hernias is ideally a retromuscular technique associated or not with a posterior separation of components (transversus abdominis muscle release-TAR).We present the utility of the e-TEP-approach to treat different types of hernias associated with rectus abdominis diastasis in the same surgical procedure.

Methods

71-year-old-man,surgical-histories:open right-hernioplasty and laparoscopic-radical prostatectomy.Physical examination:midline ventral-hernia (M3W2:6cm),left-inguinal-hernia and diastasis(5cm).We decided to perform a laparoscopic-eTEP-approach.

Results

We use 5ports(3×12mm,2×5mm).1°step is to dissect the left retromuscular-space using a dissector balloon,and continuous with the supraumbilical cross-over transecting the left posterior-sheath and then the right posterior-sheath completing the dissection of the other retromuscular-space.The dissection continues down to the pubis dissecting the midline hernial-sac and then dissecting the left-inguinal-space.Due to the tension to close the posterior-sheath,we decided to perform a right-TAR.We begin the right-TAR up-to-down using the monopolar-electrocautery, at this area we observe adhesion due to the ports of the previous surgery.Next, we continue with the closure of the posterior and anterior-sheaths using 2–0 V-lock suture.We placed a 3D-PVDF-mesh for the left-inguinal-hernia and another 30×30cm polypropylene-mesh in the retromuscular-preperitoneal space.The patient presented a satisfactory evolution,was discharged 1°POD.

Conclusions

The minimally invasive e-TEP approach is an effective and good option in cases of ventral-hernias associate with inguinal-hernias and diastasis without increasing the incidence of postoperative complications and with better postoperative recovery,less postoperative pain, shorter LOS,lower rates of recurrence and lower healthcare costs.
P-048 DOES BILATERAL REPAIR INCREASE COMPLICATION RATES COMPARED TO UNILATERAL REPAIR IN PATIENTS UNDERGOING LAPAROSCOPIC TOTALLY EXTRAPERITONEAL INGUINAL HERNIA SURGERY?
Authors: Hayward R , Smith J J , Kontovounisios C , Qiu Mbbchir S , Warren O J
Published: October 2022

Introduction

There is ongoing debate over whether to fix asymptomatic contralateral inguinal hernias during repair of the presenting hernia. This study reviewed the practice of one high-volume hernia surgeon, comparing unilateral and bilateral laparoscopic repairs, to establish if bilateral repair is associated with an increased risk of post-operative complications compared to unilateral repair.

Material & Methods

All patients operated on within a 5-year period were audited and subcategorised depending on whether they underwent unilateral or bilateral repair. Data was collected on complication rates, rates of recurrence, readmission within 30 days and duration of operation.

Results

186 patients underwent repair of 265 hernias. 79 patients underwent bilateral repair. 25 patients suffered a complication (13.4%). Complication rates were 11.2% and 16.5% in the unilateral group and bilateral group respectively (p=0.50). These included superficial infection (1.9% vs 1.3%, p=0.75), haematoma (5.6% vs 7.6%, p=0.59), seroma (2.8 vs 7.6%, p=0.13), and chronic pain (0% vs 2.5%, p=0.01). There were no mesh infections, persisting numbness or explantation in either arm. In both groups, median nights stayed was 0. At median length of follow-up of 1.8 years, recurrence rates were 1.9% vs 0% in the unilateral and bilateral arms respectively (p=0.22).

Conclusions

There was no significant difference in rates of complications between the bilateral and unilateral arms. Opportunistic repair may reduce risk of future surgeries and morbidity and does not appear to be associated with increased complications. Surgeons may wish to consider this when consenting patients.