bluuebunny/crossref_metadata_2025 huggingface dataset:
P-051 TAPP IN A COMMUNITY HOSPITAL SETTING : AN EXPERIENCE OF OVER 1000 CASES
Authors: Agresta F , Licitra E , Mazzarolo G , Savino G , Pontarolo N , Montori G
Published: October 2022

Aim

We want to share and discuss what we have learned from our 20-year experience in TAPP procedures

Material and Methods

We use only all 5 mm trocars, instruments, and 30-degree optics and we always use low intraabdominal pressure (10mmHg).

The major technical trick is to carefully prepare the peritoneum flap all around, like a cone, just in order to let the mesh perfectly lie down on the inguinal area.

Results

Our TAPP experience is almost more than 1000 cases, elective as an emergency. We use a 10×15 cm LW macroporous monofilament polypropylene mesh. Besides the well known needed physical characteristics of the mesh, on the surgeon's side, a mesh should be smooth, stiff, wide enough to cover all the possible defects, easy to handle, and, especially for its possible use in laparoscopy, with a certain degree of and thickness just what it is needed in order to let it pass through a 5 mm trocar once rolled up. We do not use to fix the mesh anymore because we do believe in the mesh pushed versus the abdominal wall by the intra-abdominal pressure, and in the exact size of the (10×15 cm). Only in case of huge direct hernia we do “lift” without tension the transversalis fascia.

Conclusions

Most of the advantages of laparoscopy rely on the minimal access and therefore the benefits of this technique will be greater as the access becomes smaller, together with a no fixed LW mesh.
P-054 STANDARDIZATION OF HERNIA REGISTRY IN A HIGH-VOLUME LOW-COMPLEXITY CENTRE
Authors: Di Nubila F , Kaul S , Buhain R , Sarwary S , Shatkar V
Published: October 2022

Introduction

Our surgical department performs an average of 350 cases per year, performed by general surgeons of various seniority. These are predominantly in a post-pandemic period, where a backlog of patients are awaiting surgery in the NHS. It is not always possible for the same professional to provide continuity of care. An easy and reproducible classification of hernias is necessary to facilitate universal communication among surgeons.

Methods

We implemented a surgical proforma for the pre-assessment and operation note, based on the European Hernia Society (EHS) for inguinal and ventral hernias. The pre-assessment and operation note proforma were trialled on an elective basis on a week designated for hernia surgery. The proforma was then rolled out to both elective and emergency hernia repair surgery with the collaboration of all surgeons from our department.

Results

The use of designated hernia week was beneficial to learning and led to acceptance of the new proforma amongst all our surgeons. Hence, the reproducibility in non-dedicated elective lists and emergency cases could be achieved.

Conclusion

The adoption of a single classification accepted internationally, as proposed by the EHS, improves the continuity of patients’ care from pre-assessment to post-operative follow-up. The registry will benefit from better planning of theatre lists, improved productivity, understanding of recurrence rates, types of complications, and lead to improved quality of life. Long-term data collection and further studies can be uniformly compared inside the surgical department, and in collaboration with multinational studies with this initiative.
P-065 PROSPECTIVE STUDY OF QUALITY OF LIFE OUTCOMES OF TOTALLY TRANSFASCIAL SUTURE FIXATION OF MESH WITH CLOSURE OF DEFECT IN LAPAROSCOPIC VENTRAL HERNIA REPAIR
Authors: Agrawal M K , Kumar A , Fanai M H , Pal A , Anand A , Pahwa H S , Sonkar A A
Published: October 2022

Aim

To study the Quality of life Outcome in totally transfacial suture fixation of mesh with primary closure of defect in laparoscopic ventral hernia repair with regards to:

Materials & Methods

Patients who visited the OPD of General Surgery, KGMU, Lucknow, UP and was diagnosed as a case of symptomatic ventral and incisional hernia fulfilling the inclusion and exclusion criteria were enrolled.

Results

A total of 40 patients from OPD department of General Surgery were enrolled. Maximum numbers of patients in the study i.e. 14(35%) belong to M4. Mean BMI is 28.6. Mean defect size was 3.25 cm (Range- 2cm to 5 cm). Mean duration of hospital stay was 2.85 days. With this procedure the patients were able to resume his/her daily routines very early and a mean of 4.65 days was recorded among the 40 patients involved in the study. Also a mean of 11.6 days was recorded as the time taken to return to office works which was all within two weeks after the operation. Carolina's comfort scale measure quality of life score in pre-op and post-op period on sensation of mesh,pain sensation and limitation of movement . where the scores were added and the mean sensation of mesh at post-operative period was 0.30.

Conclusion

There was significant improvement in dimensions of body pain, physical function, vitality, emotional role, mental health and sensation of mesh in small and medium size hernia, with totally transfascial suture fixation of mesh.
P-067 FORMATION IN MINIMAL INVASIVE SURGERY IN INGUINAL HERNIA REPAIR IN GENERAL SURGERY RESIDENCY TRAINING: RESULTS OF A NATIONAL SURVEY
Authors: Gonzalez-Prado C , Cabriada García G , Reoyo Pascual J F , Valero Cerrato X , León Miranda R , Muñoz Plaza N , Otero Rondón M , Álvarez Rico M Á , Polanco Perez L , López Rodríguez B , Casaval Cornejo L , Dominguez Arroyo I
Published: October 2022

Aim

To describe and assess how minimal invasive surgery in inguinal hernia repair is in spanish general surgery residency.

Material & Methonds

An anonymus survey with 26 questions was sent to all Surgery Residents in Spain by email by Spanish Surgeons Association. Responses were analysed using both qualitative and quantitative methods.

Results

161 answers were recieved. Residents of each year and each hospital answered that survey. 83.2% performed minimal invasive abdominal wall surgery. But in 78.2% of hospital this surgery was conducted by 1 or 2 senior surgeon. 55.1% performed less than 30 surgeries per year. TEP was preferred than TAPP in most cases. 51.2% of residents did not rotate in an abdominal wall surgery unit. At least 48% of residents did not performed any minimal invasive surgery during their residency training, but 71.4% performed their first open inguinal hernia repair at their first year of residency. Those who performed minimal invasive surgery, just 6% performed more than 20 surgeries. 91.9% of residents percieved gaps in their minimal invasive inguinal hernia repair surgery training.

Conclusion

Abdominal wall surgery is infraestimated. This survey findings highlighted the gaps and the callenges encouterd by Spanish General Surgery residents in acquiring satisfactory minimal invasive inguinal hernia surgery skills during their residency. An improvement in our formation is needed.
P-076 PROSPECTIVE COHORT STUDY ON MESH SHRINKAGE MEASURED WITH MRI AFTER ROBOT ASSISTED MINIMAL INVASIVE RETRORECTUS VENTRAL HERNIA REPAIR USING AN IRON OXIDE LOADED PVDF MESH
Authors: Vierstraete M , Beckers R , Vangeel L , Foriers B , Pletinckx P , Muysoms F
Published: October 2022

Aim

Mesh-reinforced ventral hernia repair is considered the gold standard treatment for all but the smallest of hernias. Human data on mesh shrinkage in the retrorectus mesh position is lacking. A prospective observational cohort study was performed to measure mesh shrinkage in robot assisted minimal invasive retrorectus repair of ventral hernias.

Methods

A cohort of 20 patients underwent a robot assisted minimal invasive retrorectus repair of their ventral hernia. Magnetic resonance imaging (MRI) imaging was performed one month and thirteen months after implantation of an iron-oxide-impregnated polyvinylidene fluoride (PVDF) mesh to assess the decrease in mesh surface area. Inter-rater reliability among three radiologists regarding measurement of the mesh dimensions was analyzed. Quality of Life scoring was evaluated.

Results

The inter-rater reliability between the radiologists reported as the intra-class correlations proved to be excellent for mesh width (ICC 0.95), length (ICC 0.98) and surface area (ICC 0.99). Between MRI measurements at one month and thirteen months postoperatively, there was a significant increase in mesh surface area (+12.0 cm2, p=0.0013) and mesh width (+0.8 cm, p<0.001), while the length of the mesh remained unchanged (-0.1 cm, p=0.754). Quality of Life Scoring showed a significant improvement in Quality of Life after one month and a further improvement at thirteen months (p<0.001).

Conclusion

There was an excellent inter-rater reliability between three radiologists when measuring width, length and surface area of an iron-oxide-impregnated PVDF mesh using MRI visualization. Mesh shrinkage was not observed, instead the effective mesh surface area and width of the mesh increased.
P-087 ANALYSIS OF COMPLICATIONS AND QUALITY OF LIFE IN PATIENTS AFTER 5 YEARS OF ANTERIOR SEPARATION HERNIOPLASTY
Authors: Kulakova A L , Protasov A V , Kuliev S , Evsukova I , Borsuk A
Published: October 2022

Aim

To assess the treatment results, complications and the quality of life of patients after anterior separation hernioplasty.

Material & Methods

comparative analysis of complications and quality of life of 96 patients with giant postoperative ventral hernias after anterior separation plastic by using polypropylene mesh endoprosthesis. Description of method of implant fixation is given, analysis of complications and quality of life of patients is given. The Clavien-Dindo scale and the EuroHS QoL score by EHS were used to investigate complications in the first 30 days.

Results

wound complications were observed in 11.4% (p < 0.01), general complications 4.2% (0.05), hernia recurrence rate1.0% (p < 0.01), death 1.0% (p < 0.05). Most patients (n = 71, 74%) experienced a significant reduction in pain intensity, increased physical activity, and satisfaction with appearance at 3 months post-surgery.

Conclusions

study results showed low percentage of wound complications, relapses, and the significant improvement of the quality of patient's life.
P-100 ANATOMICAL STUDY ON THE PREPERITONEAL FAT DISTRIBUTION IN EXTENDED RETROMUSCULAR PREPERITONEAL DISSECTION: FROM THE FATTY TRIANGLE TO THE FATTY TRIDENT
Authors: Garcia-Urena M A , Lopez-Monclus J , Medina M , Aviles A , Blazquez Hernando L A , Robin Valle De Lersundi A , Munoz-Rodriguez J , Rial X , Minaya A , Sanchez A
Published: October 2022

Aim

Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model.

Material and methods

Thirty frozen cadaver torsos were dissected by posterior component separation. The shape of the preperitoneal fat was identified, and the dimensions and more significant distances were calculated.

Results

The results showed that the preperitoneal fat resembles a trident, exists along the midline under the linea alba, and expands in the epigastric area into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. The mean rhomboid area was 35 cm2. Caudally, the midline preperitoneal fat widened under the arcuate line to reach the Retzius space. Laterally, the Bogros space communicated the root of the trident with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The mean width of the midline prong at the umbilicus was 2.8 cm. It was easier to tear the peritoneum outside the area reinforced by the fatty trident.

Conclusions

The concept of preperitoneal fatty trident may be of practical assistance to perform various hernia procedures, from the simple ventral hernia repair to the more complex preperitoneal ventral repair or posterior component separation techniques. The consistency of this layer allows us to follow our plane between the peritoneum and muscle layers to extend the preperitoneal dissection.
P-105 A UNIQUE AND MULTIDISCIPLINARY APPROACH TO ABDOMINAL DEFECT CORRECTION AFTER TRAM FLAP
Authors: Fonseca T , Andrade Almeida M , Campos E , Barbosa E , Barbosa E
Published: October 2022

Aim

The Transverse Rectus Myocutaneous (TRAM) flap is a valid option in autologous breast reconstruction with acceptable aesthetic results, but the absence of the rectus muscle can be responsible for the discomfort and functional lost caused be the asymmetry of the abdominal wall with a slight bulge. It's also described that incisional hernias can develop following TRAM, and the management is often challenging. We want to present a case of a multidisciplinary surgery with immediate correction of the abdominal defect after the TRAM flap.

Material and Methods

We describe a case of a woman who, at the same surgical time, underwent skin-sparing mastectomy with immediate reconstruction with a TRAM flap and correction of the muscle defect of the abdominal wall with transverse abdominis release (TAR) with placement of a wide, macroporous polypropylene mesh with 48mg/m2 density in a retromuscular position.

Results

The association of the TAR with the placement of a wide mesh retromuscular allows a greater containment of intraabdominal force, with less bulging and better aesthetic results at the muscle donor site.

Conclusion

The correction of the muscle defect should be considered at the same time of the TRAM flap. The multidisciplinary approach in these cases can reduce the patient's surgical morbidity and allow better aesthetic and functional outcomes.

Note: we use a DIPROMED®, BULEVB5050 mesh
P-106 CAN POOR ORAL HYGIENE BE RESPONSIBLE FOR MESH INFECTION FOLLOWING HERNIA REPAIR? A SYSTEMATIC REVIEW AND SUGGESTION FOR NEW PRACTICE
Authors: East B , Podda M , Beznosková-Seydlová M , de Beaux A C
Published: October 2022

Background

There is a reasonable evidence around oral/dental health and implant infection in orthopaedic and cardiovascular surgery. Mesh hernia repair is another area of surgical practice associated with a permanent implant. The aim of this SR was to review the evidence around oral/dental health and mesh infection.

Mehods

The study was registered at Prospero. A systematic review of the literature was undertaken according to the PRISMA2020 statement. The initial search identified 520 publications. After a review by title and abstract, 40 papers were read in full text. A further 4 papers were identified from references and searching.15 publications were included in the final review.

Results

There is no published evidence investigating the state of oral hygiene/health and the risk of mesh infection. Improvement in oral hygiene/health can reduce surgical site infection and implant infection in colorectal, gastric, liver, orthopaedic and cardiovascular surgery. Poor oral hygiene/health is associated with a large increase in oral bacteria and bacteraemia on everyday activities such as when chewing or brushing teeth. Antibiotic prophylaxis does not appear to be necessary before invasive dental care in patients with an implant.

Conclusion

Good oral hygiene and oral health is a strong public health message. The effect of poor oral hygiene on mesh infection and other complications of mesh hernia repair is unknown. While research is clearly needed in this area, extrapolating from evidence in other areas of surgery where implants are used, good oral hygiene/health should be encouraged amongst hernia patients both prior and after their surgery.
P-109 A RETROSPECTIVE AUDIT OF THE DEPARTMENTAL USE OF PROPHYLACTIC ANTIBIOTICS IN ELECTIVE VENTRAL HERNIA SURGERY AS COMPARED TO NATIONAL AND INTERNATIONAL GUIDELINES
Authors: Islam R , Sriskanthanathan A , Maynard O , Abdalla S
Published: October 2022

The routine use of prophylactic antibiotics for the prevention of surgical site infection is no longer recommended in all types of elective ventral hernia repairs, according to national and international guidelines.NICE recommends that prophylactic antibiotics are given only in clean surgeries that involve the use of a prothesis or implant. The British Hernia Society and European Hernia Society state that there is no indication for antibiotic prophylaxis in both open and laparoscopic elective groin hernia repairs with mesh in patients that are healthy and considered low risk for surgical site infection.

This is a retrospective audit of patients who underwent elective ventral hernia repairs at Ealing Hospital between June 2021 and December 2021 to assess the compliance of antibiotic prophylaxis with the current guidelines.

Forty-nine patients underwent elective ventral hernia repair, of which 44 was with the use of a mesh.Thirty-five of these cases (79.5%) received prophylactic antibiotics. All cases that underwent laparoscopic hernia repair received prophylactic antibiotics. Five cases underwent an elective open ventral hernia repair without a mesh.Three cases who were considered low risk received prophylactic antibiotics.

In conclusion, majority of patients along with those who were considered high risk received prophylactic antibiotics, which is compliant with guidelines. However, patients who did not have a mesh repair, or were not considered high risk also received prophylactic antibiotics.It would be useful to improve the awareness of the guidelines by creating clear local guidelines and improving documentation of reasons to give antibiotics against the recommendations.
P-111 TAR (TRANSVERSUS ABDOMINIS MUSCLE RELEASE) AS AN ALTERNATIVE IN PATIENTS WITH INCISIONAL HERNIA AND COMPLEX ABDOMINAL WALL. ANALYSIS OF OUR EXPERIENCE
Authors: Serrano Yébenes E , Diaz Pedrero R , Ovejero Merino E , Córdova García D M , Ratia Gimenez T , Allaoua Moussasi Y , Laguna Hernandez P , Bru Aparicio M , Manes Jimenez F , Jimenez Martín R , Medina Reinoso C , San Román Romanillos M R , Gutierrez Calvo A
Published: October 2022

Aim

To analyze the results of patients with complex abdominal wall surgery using TAR(transversus abdominis muscle release) technique in our center.

Material and Methods

An observational, descriptive, retrospective study of patients operated using TAR technique in a second level hospital in the last three years was carried out. Demographic variables, classification of incisional hernias according to the EHS(European Hernia Society), and complications after the intervention were recorded. Statistical analysis was performed with IBMSPSS-Statistics-25.

Results

13 patients were operated using TAR. Medium age was 56 years. 54% of patients were men and 46% women. Median BMI was 30. According to the EHS classification, the most frequent incisional hernia was M3(84.6%), followed by M4(61.5%) and M2(53.8%). W2(61.5%) and W3(30.8%). Median distance between the rectus in the CT prior the intervention was 85 mm. 100% had median laparotomy. 53.8% subcostal or stomal incision. 46% of the patients suffered some type of complication, 38.5% surgical. The complications were wound dehiscence secondary to skin necrosis(23%), abscess(15%), mesh infection(7%), hematoma(7%). Recurrence(7%).

Subcostal or other laparotomy showed higher risk of complications of any type(p 0,048). Distance between rectums was associated with high risk of skin necrosis and wound dehiscence(p 0,015). No ileus, UTI, pneumonia, stroke or DVT.

Conclusions

TAR is a technique used in complex abdominal wall with good results in relation to closure of hernia defect. However, in our cohort some postoperative complications were observed with a low rate of hernia recurrence. This highlights the effectiveness of TAR as a technique for complex abdominal wall closure.
P-124 UMBILICAL HERNIAS IN ADULTS: WHICH PROCEDURE? A RETROSPECTIVE STUDY OF OUTCOMES
Authors: Oprea V , Buia F , Toma M , Bucuri C , Pavel P , Grad O
Published: October 2022

Goal

To evaluate the outcomes of three procedures for adult umbilical hernias larger than 2.5 cm.

Patients and methods

all adult patients with umbilical hernias larger than 2.5 cm admitted between 01 January 2018 and 30 December 2019 were included in the study. According to the surgeon's preference, three mesh procedures were performed: open Rives-Stoppa (o-RS), IPOM (with composite polypropylene mesh with polypropylene transparent film), and endoscopic Rives-Stoppa (e-RS). Demographics were included. The evaluated outcomes were duration of surgery, postoperative pain (on the VAS scale), local complications (seroma, hematoma, infections), and recurrence.

Results

57 patients fulfilled inclusion criteria and were distributed according to the operative procedure as follows: 28 patients with o-RS, 18 with IPOM, and 11 with e-RS. The mean age was 39.3 ± 8.2 years. Operative time was significantly shorter for o-RS patients compared with the other procedures (28.2 ± 12.7 min versus 41.7 ± 18.3 min for IPOM versus 124.3 ± 43.1 min for e-RS). No infection rate was reported. Equal rates of wound events were described. The pain was slightly increased in o-RS patients but only for the first 24 hours (4.1 ± 0.8) compared to 3.1 ± 0.2 for IPOM and 2.8 ± 0.5 for e-RS. An early recurrence rate was detected for each group of patients.

Conclusions

According to our data o-RS, repair for umbilical hernia in adults is a valid and un-expensive procedure with similar immediate outcomes in terms of pain and wound events.
P-125 INCIDENCE OF DIASTASIS RECTI ABDOMINIS SEEMS TO BE HIGHER IN PATIENTS WITH INGUINAL HERNIAS
Authors: Ugurlu C , Gok H , Sahin A , Bayar B , Olcucuoglu E , Kulacoglu H
Published: October 2022

Aim

To find the incidence of Diastasis Recti Abdominis (DRA) in patients with inguinal hernias.

Materials and Methods

Prospective, multicenter, cross-sectional study. Patients with inguinal hernias constitues the study group (IH), and patients with proctological disorders in the control group (PC). Investigated parameters: age, gender, BMI, family history, systemic comorbidities, alcohol consumption, tobacco use, constipation, malignancies, chemotherapy, number of births, multiple pregnancies, prostate hypertrophy. The measurements were done at 3 cm above the umbilicus. Any separation ≥20 mm was accepted as DRA. The existence of paraumbilical hernia (PUH)was also recorded.

Results

36 female and 212 male patients with a mean age of 51.3± 1.4 in IH, whereas 137 women and 305 men with a mean age of 44.5±15.9 in PC. 48.0% of IH and 21.1% of PC were diagnosed with DRA (p=0.001). Incidences of PU were 16.5% and %5.2 respectively (p=0.01). BMI ≥25, chronic pulmonary disease, multiple pregnancies and prostatic enlargement were associated with DRA. Multivariate analysis revealed that inguinal hernia and multiple pregnancies were independent factors for DRA.

Conclusions

Incidences of DRA and PUH seem to be higher in patients with inguinal hernias in comparison with control subjects.
P-127 E-TEP ASSISTED REVERSE-TAR FOR THE TREATMENT OF LARGE LUMBAR INCISIONAL HERNIAS ASSOCIATED TO MIDLINE DEFECTS
Authors: Lopez-Monclus J , Roman Garcia De Leon L , Muñoz Rodriguez J , Blazquez Hernando L , Robin A , Polaino Moreno V , Rial Justo X , Lucena De La Poza J L , Iglesias Garcia E , Garcia Ureña M A
Published: October 2022

Aim

To describe a new hybrid surgical approach of large lumbar incisional hernias (IH) associated to synchronic midline defects.

Material and Methods

Prospective multicentric study including patients with large lumbar hernias (L4W3) associated to midline abdominal wall defects. Surgical intervention starts with a bilateral retrorectus dissection performed through a minimally invasive extraperitoneal endoscopic approach (eTEP). Once this space has been dissected, the lumbar IH is treated with an overextended centrifugal preperitoneal open approach through the previous lumbar incision. Afterwards the dissected spaces are communicated performing a reverse transversus abdominis release (TAR) from lateral to medial. A prosthetic preperitoneal repair is performed with an absorbable and permantent meshes that cover the space dissected.

Results

Five patients were included in the study. All patients had lumbar hernias L4W3 associated to primary or incisional midline hernias M1–5 W1–2. Eighty percent of the patients were women, with a mean age of 62 years. Mean BMI was 32 (range 30–34), with a 60% of diabetic patients, and 80% of recurrent lumbar hernias (between 1 and 3 previous repair attempts). Mean surgical time was 198 minutes (range 160–250). Mean hospital stay was 5 days (range 4–8 days). Two lumbar hematomas which didn't required any interventional procedure took place as the only surgical site occurrences, without any systemic complications. No recurrence has taken place after 5 months mean follow up (range 2–9 months)

Conclusion

Hybrid eTEP and open approach of large lumbar hernias associated with small midline defects seem to be an efficient and safe approach.
P-129 TRAUMATIC HERNIA, URGENT REPAIR?
Authors: Infantes Ormad M , Curado Soriano A , Montemuiño Chulian N , Valera Sanchez Z , Naranjo Fernandez J R
Published: October 2022

Aim

We present our clinical experience in the urgent repair of traumatic hernias through two clinical cases.

Material and Methods

Case 1: A 45-year-old man suffering thoraco-abdominal trauma due to running over. Thoracoabdominal CT scan and surgical examination shows a meso tear of terminal ileum and traumatic section of the right lateral musculature.

Case 2: A 19-year-old man suffering abdominal trauma due to a traffic accident. CT abdomen is performed which reports large traumatic hernia of the left anterior abdominal wall including intestinal loops, with pneumo and retroneumoperitoneum.

Results

Case 1: We close the mesenteric gap and repair musculature by associating a polypropylene mesh in the preperitoneal space. The patient is discharged after 13 days. During the two-year follow-up, no hernia recurrence was detected.

Case 2: A reconstruction of the wall is performed associating posterior separation of left components, in addition to ileocecal and sigma resection with anastomosis. As a complication presents seroma and chronic sinus, without hernia recurrence during follow-up for 5 years.

Conclusions

The tendency in traumatic hernias is their repair in a second time attending first to injuries that compromise the survival of the patient, but larger defect can lead to irreversible sequelae since enlargement of hernia, atrophy and muscle retraction, resulting in a more complex repair. If the patient requires urgent surgical intervention for visceral injury, some authors defend the simultaneous repair of the hernia in stable patients. Our group thinks that patients requires individualized management and its urgent repair will depend on the clinical situation.
P-131 SHORT TERM RESULTS OF PREOPERATIVE TOXIN BOTULINUM A IN PREPARATION FOR ABDOMINAL WALL RECONSTRUCTION
Authors: Amaral P , Dias E , Carvalho J P , Macret J , Pivetta L , Malheiros C A , Roll S
Published: October 2022

Aim

to report short term outcomes of preoperative toxin botulinum A (TBA) in preparation for abdominal wall reconstruction (AWR).

Material and Methods

Patient with a hernia width>10cm and/or loss of domain who underwent elective AWR from April 2021 through March 2022 were included. All patients received ultrasound-guided administration of 300 units of TBA prior the surgery. Outcomes of interest included: changes in hernia dimensions and CT-Scan volumetric measurements after treatment, rates of complete fascial closure, postoperative intraabdominal hypertension, unplanned readmission and hernia recurrence.

Results

Fifteen patients were included (53% males; mean age 61years, mean body mass index 28.9kg/m2). Median hernia width decreased by 2cm (before 15cm [IQR 14–18.5], after 13cm [IQR 10.3–15]; p=0.002) and median abdominal cavity volume increased by 1.4L (before 4.8L [IQR 3.8–11.1], after 6.2L [4.2–9.2]; p=0.594). Thickness of lateral abdominal wall muscles decreased (before 2cm [IQR 1.6–3], after 1.1cm [IQR 1–1.3]; p=0.008 and the Tanaka Index decreased (12% [IQR 3.6–24.2] and 5% [IQR 1.4–16.8]; p=0.066)

Complete fascial closure was achieved in 13cases(87%). Three patients did not require component separation. Mean endotracheal pressure was 19mmHg. There were no intraabdominal hypertension. At a median 9months follow-up [range 6.2–11.5] wound morbidity rate was 20%(N=3), N=1 recurrence, N=1 unplanned readmission.

Conclusions

TBA promotes changes to the lateral abdominal wall with decrease on defect width and thickness of lateral muscles and increase in cavity volume and Tanaka index. Randomized clinical trials are needed to determine the clinical implication of preoperative TBA in preparation for AWR.
P-136 MANAGEMENT OF DIRTY ABDOMINAL WALL SITUATIONS WITH AN OVINE RUMEN BIOLOGIC MESH WITH POLYPROPYLENE REINFORCEMENT
Authors: Lopez-Monclus J , Muñoz Rodriguez J , Roman García De Leon L , Grillo Marin C , Iglesias García E , Fernandez Rodriguez M , Robin A , Lucena De La Poza J L , Blazquez Hernando L , Garcia Ureña M A
Published: October 2022

Aim

To present our initial results of abdominal wall surgery in dirty situations with an ovine rumen (OR) biologic mesh reinforced with polypropylene.

Patients and Methods

Five patients with elective abdominal wall surgery in a dirty setting were included. Two cases were previous PTFE mesh infections after IPOM repairs, one case of enteroatmospheric fistula through a previous posterior component separation repair, one deep tissue infection after a MILOS retromuscular repair and one definitive closure after a 8 weeks open abdomen in a liver transplantation patient. In the five cases cultures showed polymicrobian infections. Both PTFE meshes were removed and substituted by the OR biologic mesh. In the enteroatmospheric fistula patient the exposed mesh was resected together with the fistula take down, and a re-Rives was performed. In the case of the MILOS deep tissue infection after two weeks with an open abdomen and a temporary abdominal closure the definitive closure was performed with the biologic mesh in the retromuscular space. In the definitive closure of the liver transplantation patient the mesh was placed intraperitoneally as prophylaxis.

Results

In four cases there weren´t any surgical sites ocurrences. In the case of the enteroatmospheric fistula the patient presented a partial fascial dehiscence with mesh exposure, managed with a VAC system. With less than a year follow up no hernia recurrence has taken place.

Conclusión

The use of an OR biologic mesh with polypropylene reinforcement seems to be safe in abdominal wall repair in dirty settings, with good results during early follow up.
V-004 REDO ETEP APPROACH FOR SMALL BOWEL INCARCERATION DUE TO POSTERIOR SHEATH SEPARATION: AN UNUSUAL COMPLICATION
Authors: Trujillo Díaz J , Jezieniecki Fernández C , Gomez Lopez J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C
Published: October 2022

Aims

The retromuscular-preperitoneal approach of primary or incisional hernias is a technique that is being performed more frequently due to the more anatomical position of the mesh, the lower rates of complications and recurrences in the short and long term.However, this technique is not without complications, the most frequent being retromuscular seromas or hematomas, the rarest being incarcerated hernias secondary to dehiscence of the posterior sheath closure,hence the importance of presenting this case.

Methods

Video-case presentation.

Results

40-year-old man with surgical histories:open appendectomy 20years-ago, and endoscopic repair(eTEP-Rives) of umbilical hernia and diastasis of the rectus abdominis. He went to the emergency room 4days after surgery(eTEP) due to sudden, intense abdominal pain, located in the mesogastrium.Abdominal-CT:hernial defect at the umbilical level (posterior-sheath-dehiscence) with incarcerated and dilated small-bowel inside.

We decided to perform urgent surgical intervention.An iterative eTEP-retromuscular-laparoscopic-approach was performed,observing hernial defect due to dehiscence of the posterior-sheath suture at the umbilical level with incarcerated small bowel loops within the retromuscular space.Hernia content revision and reduction is performed, previous mesh is removed and since tension is visualized for the closure of the hernial defect, right Hemi-TAR is performed, after which a tension-free closure of the the posterior sheath, and PVDF-mesh is placed.The patient presented a satisfactory evolution.

Conclusions

The enhanced view totally-extraperitoneal-approach(eTEP) is a valid, effective and safe option in cases of acute complications,such as the one presented,through which more complex separation techniques(TAR) can be associated to achieve a correct and tension-free closure of the abdominal wall, presenting the advantages of MIS.
V-018 PREOPERATIVE OPTIMIZATION AND POSTERIOR COMPONENT SEPARATION WITH INTRAOPERATIVE MONITORING OF RECTUS MUSCLE INERVATION FOR LOSS OF DOMAIN INCISIONAL HERNIA
Authors: Medina M , Garcia-Urena M A , Aviles A , Robin Valle De Lersundi A , Cruz A , Munoz-Rodriguez J , Blazquez Hernando L A , Martinez J , Perez-Flecha M , Lopez-Monclus J
Published: October 2022

Aim

The importance of an appropriate patient optimization (botulin toxin and pneumoperitoneum) and adequate surgical technique is highlighted.The possibility of intraoperative monitoring of the nerves that may be injured during posterior component separation is explained

Material and methods

We present a 74 years old man, past smoker, with history of hypertension, steatohepatitis and chronic bronchopathy

Results

This is a disastrous but unfortunately not so uncommon story of a failed repair of a simple umbilical hernia with 3 previous unsuccessful attempts of repair with and without mesh. After the last surgery the patient developed a giant incisional hernia with loss of domain. Optimization consisted of improving nutritional status, respiratory physiotherapy, botulin toxin and pneumoperitoneum. The surgery was made using previous skin scar. After dissecting the retrorectus space, a posterior component separation was made with the aid of monitoring the nerves that come to innervate the rectus abdominis. An overextended overlapped was obtained. A patch of absorbable mesh was used to completely close the peritoneum. A combination of absorbable and permanent synthetic mesh was used as giant reinforcement of the visceral sac. The only points of fixation were the Cooper Ligaments. The patient had a satisfactory recovery without complications and was discharged on the 8th postoperative day.

Conclusions

Loss of domain incisional hernias is a real surgical challenge. The combination of a good preoperative strategy (preoperative neumoperitoneum) and surgical technique (TAR and pannniculectomy) gives a great opportunity to solve very complex cases of incisional hernia.
V-019 LAPAROSCOPIC CONTROL OF HEMOPERITONEUM AFTER TACKER FIXATION IN TAPP HERNIA REPAIR
Authors: Ramirez A , Bascuas B , Delgado M , Licardie E , Guadalajara J
Published: October 2022

Aim

The use of tackers for peritoneal closure in TAPP (transabdominal preperitoneal approach) is controversial because of the associated risk of vasculo-nerve injury. We present the case of a 56 years old male who came for hypovolemic shock due to hemoperitoneum after TAPP hernia repair in another center 72 hours earlier.

Material & Methods

We opted for an exploratory laparoscopy showing a massive hemoperitoneum due to a bleeding from the left epigastric artery at the site of placement of a tacker. Hemostasis was performed with bipolar energy and peritoneal approximation with glue after washing and aspiration.

Results

The patient was discharged on the third day without any complications.

Conclusions

Peritoneal flap closure in TAPP remains a controversial issue despite finding no significant differences between the different closure methods in the literature. Blind placement may injure vessels and nerves that require subsequent urgent surgery.

In selected patients, if the patient is stable, laparoscopy through the same trocars is a safe and reliable option to resolve hemoperitoneum after epigastric artery injury.
V-021 REPORT OF AN ACQUIRED INTERCOSTAL HERNIA REPAIR USING A BILAYER MESH
Authors: Burns E , Aliar A , Baltatzis M , O'keeffe N , Sheen A J
Published: October 2022

Aim

A 53-year-old male underwent a T10/11 discectomy with partial removal of the right T9 rib. 10 years later, he developed an acquired painful intercostal hernia, worsened by leaning against the defect. CT imaging demonstrated an 8cm hernial defect containing the posterior lobe (segment VII) of the liver with a loss of integrity of the diaphragm.

Methods

Open surgical repair though the original incision was undertaken, with the patient in the left lateral position. The hernia was entirely reducible in this position.

Results

The liver was replaced into the peritoneal cavity, the hernial sac and the weakness at the postero-lateral edge of the diaphragm were then identified. The edges of the hernial sac were dissected off the ribs. An intraperitoneal mesh (SymbotexTM; Medtronic, Lyon) was cut to size, placed, and fixed to the undersurface of the ribs, with a 5cm overlap obtained medially and laterally. Care was taken to avoid damaging the neurovascular bundle and breach of the pleural cavity was not observed.

A bridging mesh was then used to reinforce the repair (VersatexTM; Medtronic, Lyon) with fixation to the ribs using ethibond sutures and cyanoacrylate glue (Glubran®; Viareggio). The repair was checked by Valsalva manoeuver prior to wound closure.

Post operative pain control was achieved using intercostal nerve block and patient-controlled analgesia. A post-operative chest x-ray did not demonstrate a pneumothorax. The patient was discharged on postoperative day 2.

Discussion

The patient experienced no serious postoperative sequelae and was pain free with no hernia at 30 days post-surgery.
V-023 R-TAPP AS A TRAINING MODEL IN ROBOTIC SURGERY
Authors: Esposito S , Pecchini F , Casoni Pattacini G , Trapani V , Gozzo D , Piccoli M
Published: October 2022

Aim

The main aim of the project will be evaluating the effectiveness of an experimental structured didactic program in robotic surgery in filling the training gap caused by the pandemic. We intend to evaluate how establishing a training pathway could improve young surgeons’ robotic skills and implement their participation in robotic procedures during the COVID-19 pandemic. We will also evaluate the learning curve of robotic transabdominal preperitoneal inguinal hernia repair (TAPP) for young surgeons with limited experience as first operators at the dual console.

Matherials and Methods

We designed an experimental stepwise training program in robotic surgery that starts from a first step of theoretical and laboratory lessons, followed by a second phase of bedside assistance training, and finally the completion of low complexity procedures by the trainees proctored at the dual console by senior surgeons. Robotic TAPP was selected as training model. The performance of each trainee will be registered in an evaluation data sheet and Learning scores will be recorded by the tutor with the evaluation of 6 corner steps of the procedure.

Results

Preliminary results showed improved technical skills and increased team spirit and wellbeing.

Conclusions

TAPP is a good training model because involves technical steps useful for more complex procedures. The robotic dual console represent an extraordinary training tool and a structured training program positively impacts technical skills and could help filling the training gap caused by the pandemic.
V-024 LAPAROSCOPIC ENHANCED-VIEW TOTALLY EXTRAPERITONEAL RIVES-STOPPA REPAIR (E-TEP RS). FIRST EXPERIENCE AT HOSPITAL UNIVERSITARIO DE CANARIAS
Authors: Marrero Marrero P , Delgado Plasencia L J
Published: October 2022

We present the case of a 55-years-old female with a personal history: high blood pressure, dyslipidemia, without previous abdominal surgeries. Height: 1,65 m; Weight: 62 Kg. BMI: 22,7. Clinical and ultrasound diagnosis of a painful and partially reducible ventral hernia M2 W1 (EHS Classification). It is programmed for hernia correction using the Laparoscopic Enhanced-View Totally Extraperitoneal Rives-Stoppa Repair (e-TEP RS) technique adapted to the hernia defect. Access is made to the left retrorectal space on the left flank, medial to the semilunar line but lateral to the epigastric vessels; dissection of the retrorectal space with a disector balloon on a 5 cm perimeter around the hernia defect; pneumoperitoneum; cross-over manoeuvre connecting the two retrorectal spaces with the medial preperitoneal space; dissection and reduction of the hernia sac; closure of the hernia defect with bearded reabsorbable suture. Implantation of polyvinylidene fluoride (PVDF) macroporous mesh in retrorectal space without using any type of fixation. A retromuscular closed-suction drain is then placed and the place is then desuflatted. The patient is discharged at 12 hours postoperative with in situ drainage, wich was removed in consultation 48 horas after surgery due to null debit. We present the first published case, in our latitude, of a e-TEP RS adapted to the hernia defect. It is a challenging but safe and effective technique as well as practically painless postoperative technique.
V-034 IPOM PLUS: IS THERE ANY PLACE LEFT? WHY WE (STILL) DO IT
Authors: Agresta F , Licitra E , Mazzarolo G , Savino G , Pontarolo N , Montori G
Published: October 2022

Aim

In this video, we want to share and discuss what we have learned from our 20-year experience in IPOM PLUS, for scheduled as emergencies

Material and Methods

We use only all 5 mm trocars, instruments, and 30-degree optics and we always use low intra-abdominal pressure - 10mmHg.

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

Results

Our experience is almost more than 500 cases, elective as an emergency. In the last years, we normally use a prosthesis, made with a monofilament macroporous mesh and transparent film(with the film versus the intestine), with a 5 cm overlap. Besides the well known needed physical characteristics of the mesh, on the surgeon's side, a mesh should be smooth, stiff, wide enough to cover all the possible defects, easy to handle, and, especially for its possible use in laparoscopy, with a certain degree of and thickness just what it is needed to let it pass through a 5 mm trocar once rolled up. We use to close the defect to avoid serosa and SS - Morbidity and we use to fix the mesh with absorbable tackers. Above all we do believe in the diagnostic value of the technique, cause allows us to better see and judge the intraabdominal context

Conclusions

The advantages of laparoscopy rely on the minimal access and the possibility to manage and examine the abdominal context, especially in emergencies, close the defect, and fix the mesh with tackers.
V-044 ABDOMINAL WALL RECONSTRUCTION OF A POST-HEMIPELVECTOMY INCISIONAL HERNIA: AT THE LIMITS OF WHAT IS POSSIBLE
Authors: Blázquez Hernando L , García Ureña M Á , Molina Villar J M , Oto D , Muñoz Rodriguez J , Lopez Mónclús J , Porrero Guerrero B , Robín Valle De Lersundi A
Published: October 2022

Incisional hernias in patients with bone defects are a real challenge. There is very little evidence of how to repairing them.

Clinical Case

56-year-old patient. He underwent a left external hemipelvectomy for osteosarcoma of the iliac bone in 2012 and a left nephrectomy in 2013. The patient presents an inguinal and right thigh root bulge of progressive growth with severe pain and limited mobility. In the past month, he was unable to walk.

Physical examination: inguinal defect, defect in the right thigh root and a large lateral bulge.

Preoperative CT scan: atrophy of the left abdominal musculature, absence of the left hemipelvis, left hip prosthesis with a pseudocapsule, a large lumbar defect, and a large defect in the inguinal area.

Surgery

Dissection of hernia sacs and retroperitoneal/preperitoneal dissection was performed, cranially to the retrodiaphragmatic area, medially to the linea alba, posteriorly to the spine and caudally to the pelvis. The abdominal wall is reconstructed with a polyglycolic acid and trimethylene carbonate mesh to reinforce the abdominal wall and a large polypropylene mesh that envelops the visceral sac and is fixed to the right pubis and the pseudocapsule of the hip prosthesis.

In the postoperative period, the patient presented pulmonary thromboembolism and surgical wound infection. He was discharged on the 17th postoperative day.

One year after surgery, the patient is asymptomatic, and has a continent wall with discrete lateral bulging.

Preperitoneal dissection makes it possible to solve very complex wall defects, even with very large bone defects.
V-046 LAPAROSCOPIC SURGICAL MANAGEMENT OF AN HUGE DIAPHRAGMATIC HERNIA
Authors: Costa J , Monti E , Latham L , Marzorati A , Odeh M , Colombo E M , Ballabio A , Zanchetta M , Inversini D , Ietto G , Carcano G
Published: October 2022

Introduction

Diaphragmatic hernias (DH) in most cases are the consequence of a diaphragmatic trauma causing a missed injury. Less frequently, DHs are congenital.

Case Presentation

A 52 years old patient came to our attention due to a worsening severe dyspnea. A chest CT scan were performed, showing an extensive left-side DH. We present the video of the surgical procedure.

The patient mentioned a severe left hemithorax trauma occurred almost twenty years before due to a motorbike accident. Possibly, a diaphragmatic injury was not diagnosed at the time. Subsequently, a Covid-19-related chronic cough resulting in a persistently increased intra abdominal pressure may have caused the herniation of abdominal viscera.

The surgical procedure was laparoscopic. The whole greater omentum and most of the transverse colon were herniated and, after a thorough adhesiolysis between the herniated tissues and the left diaphragmatic crus, the DH was reduced. It was confirmed the presence of a 8 cm defect of the left hemidiaphragm, it was repaired with a absorbable continuous suture. A 08×10 cm Bio-A patch was positioned over. The herniated tissues were meticulously examined and showed no signs of damage.

Conclusions

Diaphragm's injuries are unfortunately difficult to diagnose in an acute setting, thus remaining often unbeknownst to the surgeon. Some patients never develop any symptoms because of such missed diaphragmatic injuries. Some others instead, due to an increase in the intra abdominal pressure, may develop symptomatic DHs. In the latter case, surgical management becomes mandatory.