bluuebunny/crossref_metadata_2025 huggingface dataset:
Social and economic impact analysis of solar mini-grids in rural Africa: a cohort study from Kenya and Nigeria
Authors: Carabajal A T , Orsot A , Moudio M P E , Haggai T , Okonkwo C J , Jarrard III G T , Selby N S
Published: May 2024

This study presents the first comprehensive analysis of the social and economic effects of solar mini-grids in rural African settings, specifically in Kenya and Nigeria. A group of 2658 household heads and business owners connected to mini-grids over the last five years were interviewed both before and one year after their connection. These interviews focused on changes in gender equality, productivity, health, safety, and economic activity. The results show notable improvements in all areas. Economic activities and productivity increased significantly among the connected households and businesses. The median income of rural Kenyan community members quadrupled. Gender equality also improved, with women gaining more opportunities in decision making and business. Health and safety enhancements were linked to reduced use of hazardous energy sources like kerosene lamps. The introduction of solar mini-grids not only transformed the energy landscape but also led to broad socioeconomic benefits in these rural areas. The research highlights the substantial impact of decentralized renewable energy on the social and economic development of rural African communities. Its findings are crucial for policymakers, development agencies, and stakeholders focused on promoting sustainable energy and development in Africa.
A Jordan-like decomposition for linear relations in finite-dimensional spaces
Authors: Berger Thomas , de Snoo Henk , Trunk Carsten , Winkler Henrik
Published: May 2024

A square matrix

A
A

has the usual Jordan canonical form that describes the structure of

A
A

via eigenvalues and the corresponding Jordan blocks. If

A
A

is a linear relation in a finite-dimensional linear space

H

\mathfrak {H}

(i.e.,

A
A

is a linear subspace of

H

×

H

\mathfrak {H} \times \mathfrak {H}

and can be considered as a multivalued linear operator), then there is a richer structure. In addition to the classical Jordan chains (interpreted in the Cartesian product

H

×

H

\mathfrak {H} \times \mathfrak {H}

), there occur three more classes of chains: chains starting at zero (the chains for the eigenvalue infinity), chains starting at zero and also ending at zero (the singular chains), and chains with linearly independent entries (the shift chains). These four types of chains give rise to a direct sum decomposition (a Jordan-like decomposition) of the linear relation

A
A

. In this decomposition there is a completely singular part that has the extended complex plane as eigenvalues; a usual Jordan part that corresponds to the finite proper eigenvalues; a Jordan part that corresponds to the eigenvalue

∞
\infty

; and a multishift, i.e., a part that has no eigenvalues at all. Furthermore, the Jordan-like decomposition exhibits a certain uniqueness, closing a gap in earlier results. The presentation is purely algebraic, only the structure of linear spaces is used. Moreover, the presentation has a uniform character: each of the above types is constructed via an appropriately chosen sequence of quotient spaces. The dimensions of the spaces are the Weyr characteristics, which uniquely determine the Jordan-like decomposition of the linear relation.
Order Statistics
Authors: Majumdar Satya N , Schehr Grégory
Published: May 2024

We go beyond the global maximum and discuss the statistics of the second, third etc. maxima. This is known as order statistics. We also discuss the statistics of the gaps between two ordered maxima for the two models (IID and random walk). Furthermore, we discuss the universality of the order and gap statistics.
Conclusion and Perspectives
Authors: Majumdar Satya N , Schehr Grégory
Published: May 2024

demonstrated
Freedom of Expression and the Constitutional Canon
Authors: Stone Adrienne
Published: May 2024

This chapter nominates three cases as canonical texts on freedom of expression: Lüth (Bundesverfassungsgericht); New York Times v. Sullivan (United States Supreme Court); and R v. Keegstra (Supreme Court of Canada). The selection of this ‘canon’ is advanced in a pedagogical spirit. The cases served to identify important lines of thought about the protection of freedom of expression. As well as core constitutional ideals and foundational values of constitutionalism, these cases illustrate the ‘background commitments’ of the constitutional order in which they sit. The objective order of values established in Lüth identifies the transformative nature of German constitutionalism, whereas New York Times with its strongly negative and vertical orientation is emblematic of the strongly liberal nature of US constitutionalism. Keegstra complexifies the picture, while still placing Canada firmly within the realm of liberal constitutionalism—albeit a form of liberal constitutionalism that is more attentive to the significance of communal life and more permissive of governmental intervention.
The Canon of Nature Rights
Authors: Huneeus Alexandra
Published: May 2024

Rights of nature have quickly have become part of the transnational lexicon of rights. Though a recent and still liminal trend, they have begun to inform approaches to environmental protection as well as to relations with indigenous peoples, and in particular to the connection between the two. This chapter explores foundational texts in the rights of nature corpus juris, and argues that they point to three distinct strands of argumentation for the importance and meaning of rights of nature. Those who advocate for rights of nature tend to draw on all three strands of justificatory argument at once without distinguishing between them. Ultimately, however, whether rights of nature will be viewed as participating in the liberal democratic canon or challenging it may turn on which strand predominates.
Canonizing the Corporation
Authors: Riegner Michael
Published: May 2024

If the ‘canon’ of constitutional democracy comprises those texts which comparatists consider ‘foundational’ for their discipline, then the role of the corporation has been overshadowed by other protagonists that populate the constitutional canon, such as individuals, states, and peoples. Yet, while some canonical texts are silent on corporations, others explicitly address their formation, rights, or responsibilities, and corporate litigants have shaped constitutional practice at critical junctions of constitutional development. Hence, this chapter argues that uncovering the role of the corporation as a constitutional protagonist enables us to pluralize the canon of comparative constitutionalism, and to theorize its implicit assumptions about constitutional agency, economic organization, and political economy. To illustrate this argument, the chapter analyses three constitutional cases that exemplify three distinct constitutional types, or canons: the US Supreme Court’s 2010 decision in Citizens United as part of the liberal (anti-)canon; the German Federal Constitutional Court’s judgment in the 1979 co-determination case as an element of a social-democratic constitutional canon; and the 2018 decision by the Constitutional Court of Ecuador in the case against Chevron as an instance of transformative constitutionalism.
Emergence and Development of Generativity in Early Adulthood
Authors: Lawford Heather L , Shulman Shmuel
Published: May 2024

While generativity has long been established as a central milestone in midlife, research over the last twenty years has investigated how generativity manifests earlier in the life course, including young adulthood and adolescence. This chapter outlines the current state of research on early generativity using a framework of positive youth development. It examines the role of generativity in the contexts of community, family, careers, and identity. It presents two narrative studies investigating generative themes in personal stories told by young adults, with the two studies arriving at somewhat different conclusions. The first examines narratives of 29-year-olds with a focus on career and romantic development, and found themes of generativity were present in family contexts but not beyond. The second study discusses the potentially unique pressure to be generative found in youth who have already made a significant impact on their community. Finally, the chapter offers suggestions for both future research and practical applications of early generativity.
Friendships, Peer Relations, and Generativity
Authors: Ramey Heather L , Lawford Heather L
Published: May 2024

This chapter discusses research on friendships and peer relationships in the development of generativity, particularly in late adolescence and early adulthood. Friendships are highly salient at these ages and research suggests that caring for others in the context of a close friendship, combined with concrete caretaking actions, the belief that care has the potential to matter, and opportunities to contribute to others, might be key mechanisms linking friendships to greater generativity. It also discuss how conversations with friends might play a role. Beyond friendships, peer groups foster prosocial behaviors and may similarly reinforce or limit generative development. Future research is needed, but current findings and theory point to the importance of friendships in which youth provide and receive care and see the potential and reason for care beyond the friendship, and toward the larger world. In addition, exposure to opportunities where young people might be exposed to a diversity of peers, and can collaboratively engage in generative practice, might be critical.
Romantic Relationships, Intimacy, and Generativity
Authors: Mackinnon Sean P , Hill Taylor G
Published: May 2024

This chapter presents a scoping review of the evidence on how generativity is expressed within romantic relationships and how expressing generativity may enhance or transform romantic relationships. Both quantitative and qualitative research were reviewed. Of the twenty-three papers reviewed, four thematic groups emerged: (1) marital status and generativity; (2) romantic relationship quality and generativity; (3) generative partnerships, where generativity is conceptualized as a mutual, dyadic activity; and (4) queer generativity, where the emphasis is on how generativity is expressed in LGBTQ+ populations. Considerable research remains to be done on the topic of generativity and romantic relationships, and an increased focus on quantitative research using romantic dyads is a particularly fertile ground for future studies.
Volunteering, Civic Engagement, and Generativity
Authors: Euh Hyun , Snyder Mark
Published: May 2024

Volunteering and civic engagement function as important antecedents and consequences of generativity across many stages of the lifespan. This chapter reviews and discusses theorizing and research on the various roles of generativity in community engagement and volunteering. It investigates the intertwined relations of volunteerism, civic engagement, and generativity from the perspectives of three key roles of generativity. First, generative concern as an individual propensity predicts volunteering and community-oriented actions (i.e., civic prosocial behavior). Second, generative commitment (setting generative goals and striving to achieve them) can serve as the linking mechanism between individual traits and civic prosocial behavior. Third, it examines a burgeoning area of research on how the experience of engaging in civic prosocial behavior can increase generativity. Lastly, it discusses types of motivation that may underlie generativity and the ways that these motivations can contribute to developing interventions to promote prosocial behavior and civic engagement.
Education and the Promotion of Generativity throughout Adulthood
Authors: Villar Feliciano , Lawford Heather L
Published: May 2024

This chapter explores the role of education as an activity promoting generativity across adulthood. The first section deals with the significance of generativity in higher education, where the participants primarily consist of young adults, and the setting aligns with the formal structure of education within society. The second section shifts the focus toward generativity and education in the second half of life, utilizing the concept of lifelong learning and distinguishing between education before and after retirement. Throughout both sections, the chapter examines what kind of educational practices are relevant to promote generativity in each life stage, as well as proposing potential avenues to enhance the generative potential of educational environments across adulthood.
States of Nature
Authors: Brett Mark G
Published: May 2024

The chapter examines the various contrasts that were developed in Western traditions between “civil” societies and “pre-civilized” societies in the state of nature. The rights of Indigenous peoples were drawn into early modern debates concerning property, often with reference to biblical arguments. Thomas Hobbes (1588–1679) argued that no property rights could be securely established without the support of a unified civil society under a single sovereign. Among the alternatives to this Hobbesian view, the legal theorist Samuel Pufendorf (1632–1694) argued that a single state could embrace multiple societies, each with their own norms and values. When it came to the reiteration of the common law tradition in the newly minted United States, Chief Justice John Marshall ostensibly adopted the more pluralist line in the 1820s and ’30s when he entrenched the idea of “domestic” Indian nations. In the years leading up to the American War of Independence, there had been a growing conviction among the patriots that some fundamental rights stemmed from the state of nature, rather than from civil society. On this view, Indian lands could then be legitimately transferred to colonists via purchase, treaty or conquest, rather than being claimed by right of discovery. The protection of fragile Indigenous rights became a commonplace trope in public and legal discourses.
Humans and Other Creatures
Authors: Brett Mark G
Published: May 2024

The chapter discusses the modern sciences of ethnography and anthropology, and their impact on the history of biblical interpretation. According to Edward B. Tylor, for example, the narratives in Genesis contained indications of “animism,” as he famously framed the concept in the nineteenth century. Eschewing Tylor’s own imperial pretensions, this chapter takes up the more recent notions of animism in anthropological studies and applies them to the Bible. The peculiarities of the biblical traditions can also be brought into dialogue with sixteenth century Kabbalistic discussions of tsimtsum—an idea of divine withdrawal that leaves traces of God throughout creation but also allows for intensifications of divine presence at particular places. This Jewish reinterpretation of the Priestly traditions offers its own critique of colonial biblical interpretation already in the sixteenth century, while also playing a later role in the formation of German idealist philosophy.
The detecting child TKKG and adapting fair play for young audiences
Authors: Veldhuizen Vera N
Published: May 2024

A key rule of the classic detective genre is the doctrine of fair play, according to which readers should have access to the same information as the detective in order to have the opportunity to solve the mystery as the detective does, or to even beat them to it. Through presenting the reader with a mystery, suspects, and clues, the narrative invites the reader to participate with the in-text detectives to solve the crime depicted. It is this ludic nature that makes the whodunit genre particularly appealing to child-readers. Additionally, through playful approaches to form, ‘children’s texts tend to stress interactivity in ways that other texts do not’: children’s texts are frequently as ‘physical and kinetic’ as they are ‘cognitive and emotional’. Children’s detective fiction not only makes visible the genre’s inherent interactivity, which challenges the reader to engage in detective behaviour, but may intensify the genre’s immersive potential through children’s literature’s own unique affordances. When these detective stories are translated to a different medium, the narrative elements of stories which invite interactivity must also be changed in order to maintain fair play, which is fundamental to the functioning of detective stories. Therefore, this article focuses on the ways through which different media adapt the inherent interactive and ludic nature of children’s detective fiction through an analysis of the audio dramas and board game adaptations of the popular TKKG series, both underserved by adaptation studies and children’s and media studies.
Plant growth-promoting rhizobacteria modulate induced corn defense against Spodoptera litura (Lepidoptera: Noctuidae)
Authors: Cortez Amado O , Yoshinaga Naoko , Mori Naoki , Hwang Shaw-Yhi
Published: May 2024

Common cutworm, Spodoptera litura is an important pest of corn causing significant crop yield loss. Synthetic insecticides have mostly been used to combat this pest, raising human and environmental health concerns. Plant growth-promoting rhizobacteria (PGPR) could compensate for or augment the harmful effects of agrochemicals. Herein, we aimed to assess whether PGPR-induced defenses in corn plants impact the host-plant selection behavior of S. litura. Headspace volatile organic compounds were analyzed using gas chromatography–mass spectrometry. Larvae fed inoculated corn exhibited lower weights and relative growth rate than noninoculated plants. Under choice experiments, PGPR-treated plants significantly reduced percentage leaf damage area and oviposition rate compared to untreated plants. Volatile organic compound ratio emission varied significantly between control and PGPR treatments, which, in part, explains feeding and oviposition deterrence in PGPR-treated plants. The results demonstrate that PGPR inoculation can enhance corn resistance to S. litura, making it a promising candidate for crop protection strategies.
THE ENIGMA OF INCISIONAL HERNIA PREDICTION UNRAVELLED: EXTERNAL VALIDATION OF A PROGNOSTIC MODEL IN COLORECTAL CANCER PATIENTS
Authors: Amro C , Smith L , Shulkin J , Reed McGraw J , Hill N , Broach R B , Torkington J , Fischer J P
Published: May 2024

Aim

Incisional hernia is the most common complication of abdominal surgery. Mesh-augmented closure appears to reduce incisional hernia rates in targeted patients, but identifying high-risk patients remains challenging. This study aims to validate the existing “Penn Hernia Calculator” on an external dataset of patients who underwent colorectal surgery, evaluating its performance and potential for generalisability.

Methods

External validation of the model was achieved using data from the Hughes Abdominal Repair Trial (HART), a prospective randomized control trial comparing closure methods in colorectal cancer patients undergoing abdominal surgery. The previously developed hernia prediction model was applied to the external dataset. Model performance was assessed using key metrics, including area under the curve (AUC-ROC and AUC-PR) and Brier score. Reporting was done in line with TRIPOD consensus.

Results

802 patients who underwent colorectal surgery was identified, of which 674 patients with up to two years follow up were included. The average BMI was 28.1. Prevalence of diabetes, hypertension, and smoking were 15.7%, 16.3%, and 36.5%, respectively. Hernia occurrence rate up to a two-year follow-up was 24%. The external validation revealed an AUC-ROC of 0.66, AUC-PR of 0.72, and a Brier score of 0.2.

Conclusion

The hernia prediction model demonstrated moderate performance in the external validation, suggesting its potential for generalizability in diverse patient populations, specifically those undergoing colorectal surgery. The model may assist clinicians in identifying high-risk patients and implementing preventive measures to reduce hernia incidence.
INITIAL EXPERIENCE IN THE APPROACH TATHIR (TRANS-ABDOMINAL THORACIC HIATUS HERNIA REPAIR)
Authors: Balongo-García R , Pérez-Quintero R , Tejada-Gómez A , Licardie E
Published: May 2024

Aims

Comparative unicentric study of patients who underwent hiatal hernia surgery by Nissen fundoplication with and without placement of titanized mesh ('Butterfly'). We present the results obtained including the GER-Q questionnaire evaluating the postoperative clinical situation, as well as the analysis of complications and/or recurrence.

Methods

Retrospective observational study of patients operated on during 2022. Exclusion criteria were age less than 18 years. Usual variables and a GERD-Q questionnaire and esophagogastroduodenal transit were analyzed. A 180-day follow-up was performed. For this analysis we divided the sample into two groups: group 1 (Nissen fundoplication) and group 2 (fundoplication with mesh).

Results

Eight patients with hiatal hernia, four in each group. Two type III and two type IV hernias in each group. Laparoscopic approach for 100% of group 1; group 2: 25% was laparoscopic approach and 75%, robotic. No patient presented complications. One patient in group 1 had recurrence, while none in group 2. In the GER-Q the median in group 1 was 4 points, while in group 2 it was 2.5, with the possibility of GERD in the first group being 52% and 18.6% in the second group, p = 0.028.

Conclusions

Further patient recruitment and studies are needed, but based on these initial results, we believe that the use of butterfly mesh in addition to fundoplication may be a safe and effective alternative.
EARLY OUTCOMES OF ROBOTIC PAULI FOR PARASTOMAL HERNIA REPAIR
Authors: Barranquero A G , Maestre González Y , Gas Ruiz C , García-González L , Raich M S , Codina-Corrons L , Olsina Kissler J J , Villalobos Mori R
Published: May 2024

Background

The Pauli technique for parastomal hernia repair involves the dissection of the retromuscular space, transversus abdominis release and lateralization of the stoma with the placement of a retromuscular mesh. Limited evidence exists regarding the robotic approach to this technique. The objective was to assess the outcomes at our centre.

Method

Observational retrospective study. Patients included underwent an elective robotic Pauli technique for the repair of a parastomal hernia associated with an end colostomy. All patients underwent surgery in a tertiary referral centre from September 2020 to December 2022.

Results

A total of 21 patients underwent a robotic Pauli in our study. The parastomal hernias intervened according to the European Hernia Society classification were 9.5% (2/21) type I, 52.4% (11/21) type II, 23.8% (5/21) type III, 14.3% (3/21) type IV.

Early complications observed included 14.3% (3/21) seroma, 9.5% (2/21) surgical site infection, 19% (4/21) postoperative ileus, and one case of large bowel obstruction due to colitis (4.8%), which was managed conservatively. No Clavien-Dindo grade III complications were reported.

The overall recurrence rate was 9.5% (2/21) with a median follow-up of 12.5 months (IQR: 3.9–21.3). Only 28.6% (6/21) of the sample achieved a 2-year follow-up. Both recurrences occurred during the early phases of the learning curve and were likely attributed to insufficient lateralization of the stoma.

Conclusions

Robotic Pauli for parastomal hernia repair is a challenging procedure with promising results in terms of recurrence.
PROGRESSIVE PREOPERATIVE PNEUMOPERITONEUM: A SAFE TECHNIQUE IN A HOME CARE HOSPITALIZATION SETTING
Authors: Crusellas O , Subirana H , Comas J , Borlado C
Published: May 2024

Background

In patients with incisional or inguinal hernias with loss of domain, it is necessary to plan an appropriate surgical repair adapted to their comorbidities, potential risks and postoperative complications. One of the techniques to achieve this goal is progressive preoperative pneumoperitoneum (PPP) to prevent postoperative abdominal hypertension syndrome. PPP involves a long preoperative hospital stay. In our centre we have started to use this technique in our Home Care Hospitalisation Unit (HCHU). We analyse the results of the implementation of PPP in our HCHU to prepare patients with hernia with loss of domain for elective surgery.

Method

Unit observational study between April 2016 and October 2023. 18 patients were included (14 incisional and 4 inguinal hernias). All were admitted to hospital and a CT scan guided catheter was inserted into the abdominal cavity. Daily insufﬂation with 1000 cc of ambient air was performed for 48 h. If no complications were observed, patients were admitted to HCHU to continue insufﬂation.

Results

The median length of stay in the HCHU was 12.47 days (SD 3.14 days). Median insufflation volume was 10751 cc (6060–16000 cc). There was only 1 complication, a urinary tract infection, not related to the procedure. None of the patients required conventional hospital readmission during this period, but one of them refused to continue treatment at HCHU after admission.

Conclusion

The PPP technique is a safe technique to develop in a HCHU. It reduces the length of hospital stay, reducing the economic costs and complications associated with conventional hospitalisation.
PRELIMINARY EXPERIENCE WITH WIRELESS SURGICAL HEAD SET DISPLAY IMPLEMENTATION IN LAPAROSCOPIC INGUINAL HERNIA SURGERY
Authors: Gidaro S , Vita L , Pozzi G
Published: May 2024

Background

One wireless surgical Head Set Display (HSD) surgical viewer has been evaluated. This device brings the endoscopic surgical field of view in front of the operator eyes, allowing him for free positioning and orientation regardless the standard tower or satellite monitor position. We have introduced the HSD in abdominal wall minimal invasive reconstructive surgery, to describe its use exploring how this HDS can reduce the need of surgical monitors in operative room.

Methods

In this preliminary experience, laparoscopic Inguinal hernia repair procedures were used by the authors. The head set was installed and adopted throughout different roles in the surgical team: first operator, assistant and scrub nurse. Set up, utilization time, type of surgery and surgical team set up were recorded. Surgical experience questionnaire was then delivered.

Results

Ten implementations were performed. Two surgeons and one nurse were enrolled. Monolateral Inguinal hernia repair was performed in laparoscopic sessions. The HSD was used by the first operator, the surgical assistant and scrub nurse 4, 3 and 3 times respectively. The mean set up time was 4 min, mean HDS utilization time was 29 min. All the surgical sessions were completed with the HSD; surgical questionnaires showed high score in usability patterns for all users.

Conclusions

HSD can reduces the dependence on the surgical monitors in operative room working easily in different rules in the surgical team.
CHATGPT, MD: A PILOT STUDY UTILIZING LARGE LANGUAGE MODELS TO WRITE MEDICAL ABSTRACTS
Authors: Holland A , Lorenz W , Cavanaugh J , Ayuso S , Scarola G , Jorgensen L , Kercher K , Smart N , Fischer J , Janis J , Heniford B T
Published: May 2024

Background

Artificial intelligence (AI) has permeated academia, especially with the inception of Chat Generative Pretrained Transformer (ChatGPT), a large language model chatbot. The goal of this study was to evaluate ChatGPT’s ability to write and grade surgical research abstracts.

Methods

ChatGPT models 3.5 and 4.0 were trained to write ten different abstracts by providing it with ten previous abstracts presented at national meetings as models, background literature, and data with statistics. ChatGPT3.5’s and ChatGPT4.0’s versions were compared with junior resident’s and the senior author’s edited, submitted version for each data set. The 40 abstract versions were judged by experienced, blinded surgeon-reviewers, who graded them on a 10- and 20-point scale and ranked them 1st–4th. ChatGPT3.5 and ChatGPT4.0 also graded/ranked the abstracts. Standard statistics were performed. Results are reported in the order of resident, senior author, ChatGPT3.5, and ChatGPT4.0, respectively.

Results

The surgeon-reviewers could not differentiate between abstract authors; every reviewer ranked an AI-generated version 1st at least once. There was no difference in the surgeon-reviewers’ average 10-point scores (6.8 ± 1.5 vs. 6.9 ± 1.5 vs. 6.6 ± 1.4 vs. 6.9 ± 1.3; P = 0.611), 20-point scores (14.3 ± 3.0 vs. 14.6 ± 2.8 vs. 13.8 ± 2.7 vs. 14.3 ± 2.5; P = 0.500), or rank (2.5 ± 1.2 vs. 2.4 ± 1.1 vs. 2.8 ± 1.1 vs. 2.3 ± 1.1; P= 0.138).

ChatGPT3.5’s grades were similar to those of the reviewers, but ChatGPT4.0 graded all four abstract versions higher on the 20-point scale than both the surgeon-reviewers (P = 0.023, P = 0.032, P = 0.002, P = 0.037) and ChatGPT3.5 (P = 0.003, P = 0.004, P = 0.003, P = 0.012).

Conclusions

When appropriately trained with background knowledge, data, and statistics, ChatGPT can write convincing medical research abstracts that are undifferentiable from resident’s or senior author’s drafts. ChatGPT3.5 graded abstracts similar to the surgeon-reviewers, while ChatGPT4.0 was more generous.
ACUTE TRANSHIATAL WRAP MIGRATION FOLLOWING LAPAROSCOPIC FUNDOPLICATION: OUR EXPERIENCE AT A TERTIARY CARE CENTER
Authors: Kalikar V , Patankar R
Published: May 2024

Introduction

GERD is a very common disease affecting millions of people worldwide with prevalence of 30% in western countries and 10% in Asia. Although laparoscopic Nissen fundoplication is the current gold standard for surgical treatment of GERD, it is associated with complications. One such complication is acute trans hiatal wrap migration which is a surgical emergency. There is risk of strangulation or perforation of the wrap if there is delay in recognition.

Materials and Methods

We discuss our experience with 9 such wrap migrations following a Nissen fundoplication. Laparoscopic Nissen fundoplication was performed in 920 patients in our hospital with 3 wrap migrations and 6 wrap migrations post Nissen were referred. All these patients were managed laparoscopically with excellent post-operative outcomes. 934 patients underwent Laparoscopic Nissen fundoplication from March 2013 to February 2023. All patients underwent crural closure of the diaphragmatic hiatus. Those patients with intercrural hiatal distance more than 5 cm underwent composite mesh placement in the initial years with later use of falciform ligament between the mesh and wrap to avoid mesh complications.

3 patients primarily operated at our hospital and 6 patients referred from other hospitals, all being operated for fundoplication presented within a week with migration of wrap into mediastinum with crural closure dehiscence. All the patients underwent a CECT of the abdomen and lower chest and were classified as per the Hinder’s classification for wrap migration. All patients underwent redo surgery, laparoscopically in terms of either a gastropexy or a redo Toupet’s fundoplication.

Conclusion

Acute trans hiatal wrap migration can be managed laparoscopically in a tertiary and high volume centre.
CAN WE PREDICT THE NEED OF PERFORMING A COMPONENT SEPARATION TECHNIQUE?
Authors: Le Ruyet A , Passot G
Published: May 2024

Introduction

Components separation is a surgical technique (CST) used in abdominal wall (AW) reconstruction. It facilitates the reapproximation of the linea alba and provides soft tissue coverage over the mesh, as well as AW restoration. However, employing this technique may be associated with a higher risk of post-operative complications. Currently, there is no consensus on the method for identifying patients who would benefit from a CST. In this work, we developed a numerical framework based on pre-operative CT-scan images assessing the force required to reapproximate the defect before and after a posterior CST.

Methods

The myofascial structure in 10 pre-operative CT-scans were manually segmented. Once the geometry reconstructed, a computational model based on the finite-element method was developed. Material properties such as elasticity and anisotropy were assigned to each component of the model, while the abdominal cavity was assumed to be incompressible. The reapproximation of the defect was then simulated both before and after a posterior CST.

Results

Depending on the side where the CST was simulated, there was a significant variation in the force required to reapproximate the defect. Simulating a posterior CST resulted in up to a 50% decrease in the necessary force (as shown in the Figure) and a reduction of up to 25% in the resulting intra-abdominal pressure.

Conclusion

Although the credibility of this framework has yet to be validated through comparison of the model’s predictions with experimental data, this approach presents a promising new patient-specific method for assessing the clinical benefits of posterior CST.
PRIMARY FASCIAL CLOSURE IN LAPAROSCOPIC VENTRAL HERNIA REPAIR. THE PROSECO-TRIAL A RANDOMISED DOUBLE-BLINDED MULTICENTRE TRIAL
Authors: Lindmark M , Tall J , Darkhahi B , Österberg J , Strigård K , Thorell A , Gunnarsson U
Published: May 2024

Background and Objective

Laparoscopic ventral hernia repair was introduced in the 1990s as a bridging repair where the mesh overlaps the hernia aperture with no attempt at closure. In recent years, interest in closing the defect has grown, and several fascial defect closure methods have been reported. Trials evaluating the effectiveness of fascial closure, however, have failed to come to a conclusion. This was a double-blinded randomised controlled multicentre trial to see if fascial closure prior to mesh placement decreases hernia site complication rate.

Methods

Adults with a midline hernia aperture measuring 2–8 cm were randomised to either primary fascial closure prior to mesh placement or the classic bridging procedure. Clinical assessment and Ventral Hernia Pain Questionnaires (VHPQ) were answered at three and twelve months after surgery. CT scan was performed after 12 months. To reach a power of 80% and 95% significance level, 180 patients were required in this randomised study.

Results

A total of 192 patients were operated: 97 with primary fascial closure (PFC) and 95 with the classic technique. Of the 192 patients, 79% had completed the one-year follow-up and 92% the three-month follow-up. No differences in hernia site complications between groups were seen at three (p = 0.38) and twelve months (p = 0.73).

Discussion

Primary fascial closure does not reduce hernia site complications after laparoscopic ventral hernia repair at twelve months. There is a significantly increased risk of recurrence and psuedohernia at twelve months if the defect is not closed.
GROIN LUMPS DURING PREGNANCY: EXPLORING THE KNOWLEDGE GAP AMONG SURGEONS AND OBSTETRICIANS REGARDING ROUND LIGAMENT VARICOSITIES
Authors: Malaibari Z , Alrahil R , Alrahil R , Alghabban A , Alshamrani S , Alshehri S , Alzubaidi S , Aldemyati R
Published: May 2024

Background

This cross-sectional pilot study aimed to evaluate awareness and management strategies for Round Ligament Varicosities (RLV) during pregnancy among obstetricians and surgeons in the Kingdom of Saudi Arabia.

Methods

An online questionnaire was distributed through convenience sampling to surgeons and obstetricians across the Kingdom of Saudi Arabia. It assessed demographics, clinical knowledge, experience in diagnosing and managing groin lumps during pregnancy, and engagement in continuing medical education.

Results

Of the 39 participants, 56.41% (n = 22) were obstetricians, and 43.59% (n = 17) were surgeons, with the majority having 5–10 years of practice (35.90%, n = 14). Groin hernia was reported as the most frequent diagnosis for groin lumps during pregnancy (43.59%, n = 17), while only 7.69% (n = 3) identified RLV, indicating a significant gap in recognizing RLV. Furthermore, 35.90% (n = 14) recognized RLV as a differential diagnosis, but only 25.64% (n = 10) were aware of its management.

Conclusion

RLV, which is more common than hernias during pregnancy, is often misdiagnosed due to its similar presentation. Accurate differentiation, often achieved through ultrasound, is crucial as management strategies significantly differ. This study underscores the need for enhanced awareness and training among obstetricians and surgeons to accurately diagnose and manage RLV. The observed knowledge gaps highlight the critical role of continuous medical education in improving patient care. These findings will guide a larger study to assess practices across the Kingdom and develop national recommendations for the management of RLV and groin hernias during pregnancy.
MINIMALLY INVASIVE SURGERY FOR INGUINAL HERNIA: FROM IMPLEMENTATION IN A SERVICE TO RESIDENTS' FORMATION
Authors: Marques-Antunes J , Rodrigues E , Magalhães J , Guimarães M , Nora M , Pereira A
Published: May 2024

Background

Inguinal hernia surgery is one of the most commonly performed procedures by surgeons and is a crucial part of a surgeon's training process. Implementing minimally invasive hernia surgery in the training of surgical residents can be a challenging process. Our aim is to retrospective review and analyze the evolution and results of minimally invasive surgery for inguinal hernia performed by both residents and more experienced surgeons.

Method

Retrospective analysis of patients operated using the TAPP and TEP techniques for inguinal hernias. Descriptive analysis of the evolution over the years and a comparison of outcomes.

Results

An average of 655 inguinal hernias were operated on per year. The percentage of minimally invasive surgeries grew from 0.9% in 2018 to 25% in 2022. The rate of any morbidity was 8.9%, with a slight predominance in the first two years, and the overall recurrence rate was 2.1%. A total of 12 surgeons and 14 residents performed TEP and/or TAPP at least once. 10.7% of the minimally invasive hernia surgeries were performed by residents, 14.2% were performed by both residents and more experienced surgeons. There were no statistically significant differences between the groups in terms of morbidity or recurrence, although the average surgery time was longer in the resident group (p < 0.05).

Conclusions

It is important for residents to collaborate closely with experienced surgeons, seek feedback, and gradually gain proficiency in performing these procedures. With correct patient selection, residents can achieve good outcomes.
MESH REMOVAL DUE TO FOREIGN BODY REACTION AND MESH INFECTION IN GROIN HERNIA SURGERY: A LONG-TERM NATIONWIDE POPULATION-BASED REGISTER STUDY
Authors: Melkemichel M , Nordenson M , De la Croix H , Nordin P
Published: May 2024

Background

Groin hernia repairs (GHRs) with mesh is today gold standard procedure in western countries. Yet, foreign body reaction and mesh infection are feared complications. This study aimed to investigate the incidence and risk factors for mesh removal due to foreign body reaction and mesh infection following GHR.

Method

This is an observational nationwide populations-based register-study with the use of prospectively collected data from the Swedish Hernia Register (SHR). All patients ≥15 years old with a GHR registered in SHR between 1992 and 2022 were eligible. Primary outcome was the incidence of re-surgery for mesh removal. Secondary outcome was risk factors for re-surgery with mesh removal.

Results

Out of 364 012 GHRs during this 30-years long study-period, 216 (0.059%) had a re-surgery with mesh removal. Mesh removals were more frequently performed in men (85.2%). Median age was 56 years old. 91.2% had earlier been performed electively and 73.1% with a previous open anterior mesh repair. In the adjusted multivariate Cox regression analysis for the risk of re-surgery with mesh removal, significantly increased hazard ratios were estimated for women (2.62, CI 1.61–4.27), emergency GHR (3.88, CI 2.20–6.85), postoperative complications (3.45, CI 2.34–5.08), high ASA class (2.12, CI 1.16–3.88) and age below median (1.59, CI 1.09–2.32).

Conclusion

The groin tissue tolerance for implanted mesh following GHR is considered high where re-surgery for mesh removal due to foreign body reaction and mesh infection is rare. Women, younger patients, comorbidity, emergency repairs and presence of postoperative complications were associated risk factors for such re-surgery.
CAN SURGEONS ACCURATELY IDENTIFY MESH TYPE WHEN INTERPRETING COMPUTED TOMOGRAPHY SCANS AFTER VENTRAL HERNIA REPAIR?
Authors: Messer N , Melland M S , Miller B T , Krpata D M , Beffa L R A , Tu C , Petro C C , Maskal S M , Ellis R C , Rosen M J , Prabhu A S
Published: May 2024

Background

Recurrent ventral hernia repair can be a challenging procedure. Given the challenges of acquiring complete and accurate prior operative reports, surgeons often rely on CT scans to obtain information and plan for re-operation. Still, the contribution of CT scans and the ability of surgeons to interpret them is controversial. Here, we assessed the accuracy of expert abdominal wall reconstruction (AWR) surgeons in identifying the type of prior mesh using CT imaging.

Methods

Twenty-two highly experienced AWR surgeons were asked to evaluate 21 CT scans of patients who had undergone open AWR with bilateral transversus abdominis release utilizing mesh. The surgeons were required to identify the mesh type from a multiple-choice selection. Additionally, negative controls (patients without a history of prior laparotomy) and positive controls (patients with laparotomy but no ventral hernia repair) were incorporated.

Results

The accuracy rate in correctly identifying mesh type was 46%, with heavy-weight synthetic mesh (HWSM) being identified only 35.4% of the time, Strattice mesh and medium-weight synthetic mesh (MWSM) were identified at 46.3%, and 51.8% respectively. The interrater reliability analysis found a moderate level of agreement 0.428, and the Repeatability measure was poor – 0.053 (95% CI 0–0.119); this indicates that surgeons cannot reliably replicate the identification process.

Conclusions

Surgeons’ ability to accurately identify the type of previous mesh using CT scans is poor. This study underscores the importance of documenting the type of mesh used in the operative report and the need for standardized operative notes to improve the accuracy and consistency of documentation.
LAPAROSCOPIC PARASTOMAL HERNIA REPAIR WITH A FUNNEL INTRAPERITONEAL MESH DEVICE
Authors: Pietsch A P
Published: May 2024

Aim

Parastomal hernias (PSH) are an underestimated and sometimes undertreated complication after permanent stoma formation. Surgical treatment can be challenging and the optimal treatment options are not determined yet. Laparoscopic parastomal hernia repair using 3D funnel intraperitoneal mesh appears to be a promising approach.

Material and Methods

11 patients (7 females, age 71.7 ± 15.4, range 42–86 y.) could be included in this analysis. Elective surgery due to parastomal hernia had been performed in 5 patients following formation of an ileum conduit and in the remaining patients following formation of a colostomy. In addition, concomitant incisional hernia could be treated in 4 patients. All PSH repairs used a laparoscopic approach.

Results

Mean operations duration was 100 ± 27.6 min. All procedures could be completed laparoscopically. No major postoperative complications requiring redo surgery have been observed. Recurrence rate was 9.1 % (1/11) after a mean follow-up time of 17.7 ± 9.4 (range 6–30) month.

Conclusions

The laparoscopic approach to PSH repair with 3D funnel mesh in IPOM technique is safe and efficient, provides probably advantageous results compared to other techniques and allows the simultaneous repair of additional incisional hernias, with a low rate of recurrence and no major complications. Since the follow up peroid is still not really long, the recurrence rate and other stoma related complications have to be evaluated in the long term and studied more comprehensively.
LAP-T® (LAPAROSCOPIC ABDOMINOPLASTY POZZI TECHNIQUE) IN WOMEN WITH POST-PARTUM RECTUS MUSCLE DIASTASIS AND HERNIA. 1.305 PATIENTS TREATED, MONITORING AND FOLLOW-UP ON 53 WOMEN WITH SUBSEQUENT PREGNANCY. SINGLE SURGEON SETTING
Authors: Pozzi G
Published: May 2024

Background

Aim of this retrospective review on 1.305 female patients undergoing LAP-T® Repair for Diastasis Recti (DR) and Abdominal Wall Hernia (AWH) developed after pregnancy, is evaluating the safety and efficacy of LAP-T® technique, in terms of intra and post operative complications. Secondary aim, proving the feasibility of subsequent pregnancies in 53 women who received the LAP-T® Repair, evaluating complications and recurrence during the pregnancy and after delivery.

Methods

1,305 cases from January 2007 to January 2022, minimum follow-up 24 months. Elected patients, BMI < 30, 3 < IRD > 13 cm. According to LAP-T® Technique rectus muscles are re-approximated from xiphoid to pubis using tailored double row, laparoscopic, running Musculo-fascial suture and intra-peritoneal mesh when needed. After receiving the LAP-T repair, 53 women came back pregnant. Follow-up with clinical examination and ultrasound during pregnancy a 4, 6 and 8 months, and 3, 6 and 12 months after delivery.

Results

In all 1.305 cases, full abdominal physiologic functioning and anatomy were successfully restored. No intra operative bleeding, no seroma formation, nor mesh infection or chronic pain reported. All 53 women coming back pregnant carried out subsequent pregnancy after LAP-T repair with no complications related to repair, no parietal pain recorded. No midline pathologic relapse, DR or AWH recurrence observed.

Conclusions

LAP-T® allowed for DR and AWH sound reconstruction, with restitutio ad integrum of anatomy and physiologic functioning of AW, reduced trauma, fast recovery and no intra or post operative complications. LAP-T® proved to be compatible with carrying out further pregnancies without complications or recurrence.
SURGICAL TECHNIQUE AND CHRONIC POSTOPERATIVE INGUINAL PAIN IN PATIENTS UNDERGOING OPEN INGUINAL HERNIOPLASTY IN PORTUGAL – A PROSPECTIVE MULTICENTRIC COHORT STUDY
Authors: Santos I , Peyroteo M , Simões J F F , Camila Cláudia , Sampaio Alves M , Azevedo J , Cunha M , Alagoa João A , Guilherme Nobre J , Picciochi M , Sampaio Soares A , Vieira B
Published: May 2024

Background

Evidence about the advantage of Lichtenstein’s repair, the guidelines’ recommended technique, is scarce regarding postoperative chronic inguinal pain (CPIP). The primary aim of this study was to compare CPIP in patients undergoing Lichtenstein versus Other techniques.

Methods

Prospective multicentric cohort study including consecutive adults undergoing elective inguinal hernia repair in Portuguese hospitals (October–December 2019). Laparoscopic and mesh-free hernia repairs were excluded.

The primary outcome was postoperative pain at three months, defined as a score of ≥3/10 in the EuraHS-QoL score pain domain. The secondary outcome was 30-day postoperative complications.

Results

869 patients were included from 33 hospitals. The majority were men (90.4%) and had unilateral hernias (88.6%).

Overall, 53.6% (466/869) underwent Lichtenstein’s repair and 46.4% (403/869) other Techniques, of which 83.9% (338/403) Plug and Patch.

The overall rate of CPIP was 16.6% and 12.2% of patients had surgical complications. The unadjusted risk was similar for CPIP (OR 0.76, p = 0.166, CI 0.51–1.12) and postoperative complications (OR 1.06, p = 0.801, CI 0.69–1.60) between Lichtenstein and other techniques. After adjustment, the risk was also similar for CPIP (OR 0.83, p = 0.455, CI 0.51–1.34) and postoperative complications (OR 1.14, p = 0.584, CI 0.71–1.84).

Conclusion

The Lichtenstein technique was not associated with lower CPIP and showed comparable surgical complications.

Further investigation assessing long term outcomes is necessary to fully assess the benefits of the Lichtenstein technique regarding CPIP.