bluuebunny/crossref_metadata_2025 huggingface dataset:
Fractal simulation of surface topography and prediction of its lubrication characteristics
Authors: Zhao Jiang , Wang Zekun , Zhengminqing Li , Zhu Rupeng
Published: December 2021

A machined surface has observable fractal characteristics, with infinite local and overall self-similar consistency. Therefore, the fractal theory is considered to provide a better description of the morphological characteristics of rough surfaces, which accurately reflects the randomness and multi-scale characteristics of rough surfaces and it is not comparable with the surface characteristics obtained based on statistical parameters limited by sampling length and device resolution. In this study, the Weierstrass-Mandelbrot (W-M) function was applied to construct a fractal reconstruction surface, and the mixed elastohydrodynamic lubrication model was used to investigate the lubrication characteristics of real and reconstructed surfaces under the same fractal parameters. The effects of the fractal parameters on the fractal surface lubrication characteristics were further analyzed. The results demonstrate that the lateral roughness fractal surface provides greater resistance to the entrained flow of lubricant, which leads to a larger average film thickness, than the longitudinal roughness and isotropic fractal surface. With the increase in fractal dimension, the surface roughness peak density increases, which reduces the surface film thickness by 47%, and the friction coefficient increases by 46%. The lubrication parameter fluctuates slightly with the change in the number of overlapping ridges M of the fractal surface. Generally, M has little effect on the surface lubrication characteristics.
Preparation of Ta2O5 nanoparticles by using cathode glow discharge electrolysis
Authors: Lu Quan-Fang , Li Juan-Long , Yu Jie , Cui Li-Juan , Wang Bo , Ma Xiao-Juan , Feng Yan
Published: December 2021

Tantalum pentoxide nanoparticles (Ta2O5 NPs) were fabricated by cathode glow discharge electrolysis (CGDE) generated between a needle-like platinum wire cathode and a tantalum foil anode in 6 g L−1 Na2SO4 electrolyte solution containing 5 ml hydrofluoric acid (HF) and 0.075 g cetyltrimethyl ammonium bromide (CTAB). The chemical structure, composition and morphology of the obtained powder were analyzed by using XRD, FT-IR, SEM/EDS, XPS and UV–vis DRS. The results found that Ta2O5 NPs with orthorhombic structure and wide band gap (3.6 eV) are successfully fabricated at 500 V discharge voltage in about 3 h. CTAB as a stabilizing agent can reduce the agglomeration due to forming CTA+ and attaching the surface of the synthetic products. A possible preparation mechanism of Ta2O5 NPs is proposed. Firstly, the tantalum foil anode is oxidized to form a compact Ta2O5 layer. Then, Ta2O5 surface is etched to form soluble [TaF7]2− complexes in the presence of HF. After that, soluble [TaF7]2− complexes can react with H2O to form Ta(OH)5. Finally, Ta(OH)5 is further converted to Ta2O5 from plasma-liquid interface into solution.
The metadynamic recrystallization behavior of ultrahigh-strength stainless steel: effects of precipitates and shear bands
Authors: Wang Xiao-Hui , Liu Zhen-Bao , Liang Jian-Xiong , Yang Zhi-Yong , Qi Yue
Published: December 2021

The metadynamic recrystallization behavior of Cr-Co-Ni-Mo ultrahigh-strength martensitic stainless steel was studied in a double-pass isothermal compression test, and a metadynamic recrystallization kinetics model for softening was established. The results showed that the metadynamic recrystallization softening rate of the steel not only depended on the deformation temperature and strain rate but was also related to the dynamic precipitation and the local shear bands in the steel. When the deformation temperature was below 1050 °C, the dynamically precipitated M6C carbides pinned the grain boundaries and hindered metadynamic recrystallization. When the steel was deformed at a deformation temperature of 1000∼1050 °C and a strain rate of 1.0∼5.0 s−1, a large number of local shear bands were generated. The local shear bands increased the number of nucleation sites for dynamic recrystallization and enhanced the softening rate of metadynamic recrystallization.
Substrate critical effect on the structural and H2Gas sensing characteristics of solution-processed Zn0.075Cu0.025O films
Authors: Sarf Fatma , Karaduman Er Irmak , Yakar Emin , Acar Selim
Published: December 2021

In this study, we report the synthesis of Zn0.075Cu0.025O films by chemical bath deposition to determine the effect of substrate (glass slide or ZnO seed layer) on the structural and H2gas sensing properties of the produced films. The crystal phase, structural topography, surface morphology, and functional groups of the as-synthesized films as well as H2gas sensing properties were investigated. Although both films have a hexagonal wurtzite structure, ZnO seed layer-based Zn0.075Cu0.025O film is more crystalline than glass slide-based Zn0.075Cu0.025O films. ZnO seed layer-based Zn0.075Cu0.025O films exhibited much more nanorod and fewer nanosphere forms compared to glass slide-based Zn0.075Cu0.025O films. EDX analysis and Raman spectra of both samples confirmed the presence of defects in Cu: ZnO samples. ZnO seed layer-based sensors showed higher response (140%) and lower operating temperature (80 °C) compared to glass slide-based sensors (87% response and 140 °C operating temperature). The most important thing to note here is that the fabricated sensors exhibited a high response at room temperature. The responses at room temperature were found as 46% and 23% for the ZnO seed layer-based and glass slide-based sensors, respectively. Sensors operating at room temperature are especially important for commercial applications.
The NMIJ air kerma primary standard for high energy x-ray beams in 300–450 kV
Authors: Ishii Junya , Kurosawa Tadahiro , Masahiro Kato
Published: December 2021

Accurate radiation dosimetry is required for radiation protection in various environments. Therefore, dosemeters and dose-rate meters must be calibrated in standard radiation fields. The National Metrology Institute of Japan (NMIJ) expands the energy range of x-ray reference field measurement up to 450 kV using a cylindrical graphite-walled cavity ionization chamber. Departure from the condition of the Spencer-Attix cavity theory was evaluated by comparing the measurement results obtained using the cavity ionization and the free-air ionization chambers, which are used as the primary standard up to a tube voltage of 250 kV. The calibration coefficients found using the spherical ionization chamber were in good agreement with those obtained by the free-air ionization chamber within relative standard uncertainties (k = 1) for N-200 and N-250 x-ray fields. Consistent calibration coefficients were obtained in the energy range 300–450 kV.
259 IDENTIFYING THE TOP 10 RESEARCH PRIORITIES FOR FAMILY CARERS: THE INTERFACE PROJECT
Authors: Donegan O , Hartigan I , Cowan K , Dunne N , Hally R , O'Connor C D , Fitzgerald S
Published: December 2021

Background

In assessing the global impact of the COVID-19 pandemic on society, it is important to understand the communities most affected and develop methods of support. Family carers provide a vital, yet often invisible role in our society and healthcare system. Identifying research priorities for carers helps establish overall gaps in the research agenda and increases awareness of the role of carers in the community.

Methods

A priority setting partnership methodology was engaged and through collaboration with carers, healthcare professionals and researchers, a participatory process was conducted to identify gaps in the current literature and prioritise research questions and uncertainties. Focus group discussions followed, the first consisted of family carers (n = 5). The second (n = 3) interviewed stakeholders namely healthcare professionals, researchers and policy makers. After collating the data, researchable questions were developed through an iterative process with a Multi Stakeholder Advisory Committee to identify the top 10 research priorities for Family Carers Ireland.

Results

The top 10 researchable questions were distilled from a list of 16 and fit into 7 broad categories. 1) economic impact and financial strain 2) Systemic issues, education, resources and policy 3) technology 4) support services and infrastructure 5) mental health and wellbeing of the carer 6) carers in society 7) Recognition and acknowledgment of the family carer.

Conclusion

The partnership focus of this project allowed the ‘ground-up’ development of research priorities for carers by carers. The COVID-19 pandemic served to magnify systemic issues already present in society, as well as highlight new burdens. As a result, the subsequent development of 10 researchable questions will guide further investigation to improve the support and wellbeing of family carers.
Delays Expected but Duration of Delays Unpredictable: Causes, Types, and Symptoms of Procedural Applications in Investment Arbitration
Authors: Chaisse Julien
Published: December 2021

Delays are becoming a common phenomenon in international investment arbitration and challenging the conventional belief that it is a time-effective mode of dispute resolution. These delays, majorly stemming from interim procedural applications, are known to arise due to the different interests and types of stakeholders involved in the process. This article provides an empirical analysis of such arbitration proceedings to cull out the types, nature, and effects of delay tactics in such proceedings. This article identifies three types of applications that play an increasing role in investment arbitration, namely, applications for ‘security for costs’, applications for disclosure of third-party funding, and the objections of manifest lack of legal merit of claims. Such delays can particularly become a cause of concern for investment arbitration as they have impacts beyond those which are on the parties involved.
Post-traumatic Stress Disorder after Severe Traumatic Brain Injury: A Systematic Review
Authors: Villalobos Dolores , Bivona Umberto
Published: December 2021

Objective

The review aimed to summarize the existing knowledge base regarding post-traumatic stress disorder after severe traumatic brain injury (TBI) and try to guide future research.

Method

Web of Science, Scopus, and PubMed databases were used to identify original studies that explored the relationship between severe TBI and post-traumatic stress disorder.

Results

A total of 13 studies were included in the review. They have been examined in terms of potentially compatible and incompatible mechanisms, as well as of possible confounding factors in relation to the diagnosis of post-traumatic stress disorder after severe TBI.

Conclusion

Only a few studies in the literature have addressed the present topic; therefore, the prevalence of post-traumatic stress disorder in patients with severe TBI still needs to be further investigated. In particular, future studies should be conducted only in severe TBI populations, considering their premorbid personality characteristics and their reactivity alteration. They should also obtain an accurate and appropriate assessment of post-traumatic stress disorder with clinical interviews as well as clarifying the role of post-traumatic amnesia in this population by incorporating control groups of patients.
Current and Future Photography Techniques in Aesthetic Surgery
Authors: Parsa Shyon , Basagaoglu Berkay , Mackley Kate , Aitson Patricia , Kenkel Jeffrey , Amirlak Bardia
Published: December 2021

Background

The rapidly increasing modalities and mediums of clinical photography, use of 3-dimensional (3D) and 4-dimensional (4D) patient modeling, and widening implementation of cloud-based storage and artificial intelligence (AI) call for an overview of various methods currently in use as well as future considerations in the field.

Objectives

Through a close look at the methods used in aesthetic surgery photography, clinicians will be able to select the modality best suited to their practice and goals.

Methods

Review and discussion of current data pertaining to: 2-dimensional (2D) and 3D clinical photography, current photography software, augmented reality reconstruction, AI photography, and cloud-based storage.

Results

Important considerations for current image capture include a device with a gridded viewing screen and high megapixel resolution, a tripod with leveling base, studio lighting with dual-sourced light, standardized matte finish background, and consistency in patient orientation. Currently, 3D and 4D photography devices offer advantages such as improved communication to the patient on outcome expectation and better quality of patient service and safety. AI may contribute to post-capture processing and 3D printing of postoperative outcomes. Current smartphones distort patient perceptions about their appearance and should be used cautiously in an aesthetic surgery setting. Cloud-based storage provides flexibility, cost, and ease of service while remaining vulnerable to data breaches.

Conclusions

While there are advancements to be made in the physical equipment and preparation for the photograph, the future of clinical photography will be heavily influenced by innovations in software and 3D and 4D modeling of outcomes.
P006 MICROBIOLOGY OF CHRONIC MESH INFECTION
Authors: Birolini Claudio , Paulo Faro Mario , Tanaka Eduardo , Miranda Jocielle , Utiyama Edivaldo
Published: December 2021

Aim

Mesh infection represents a significant concern due to its terrible consequences. Mesh sinus, infected seromas, mesh extrusion, and mesh-related enteric fistulas are common complications associated with synthetic mesh. This study aimed to review the microbiota of mesh infection in a series of 100 patients submitted to mesh explantation.

Material and Methods

We reviewed the charts of patients presenting with a history of mesh infection lasting six months or more after mesh placement. All patients submitted to further abdominal wall repair with complete removal of the infected mesh and presenting a positive culture were included. The microbiota analysis was based on positive cultures obtained from the fluids and tissues surrounding the mesh or a positive culture of the mesh itself. Microorganisms were divided into gram-positive or gram-negative, aerobic or anaerobic, and fungi.

Results

Pure aerobic gram-positive cultures were encountered in 50% of the patients, followed by a combination of aerobic gram-positive/gram-negative (9%) and pure gram-negative cultures (6%). Anaerobes were recovered from 31% of patients. Fungi were recovered from 6%. Staphylococcus aureus was identified in 64% of cultures, with methicillin-resistant Staphylococcus aureus present in 42% and methicillin-sensitive Staphylococcus aureus in 22%. Among aerobic gram-negative infections, six (17%) were caused by multi-resistant bacteria, including Pseudomonas aeruginosa, Proteus mirabilis, Acinetobacter baumanii, Klebsiella pneumoniae complex, and Enterobacter cloacae complex.

Conclusions

Pure Staphylococcus aureus infections, occurring in 29%, accounted for most single bacterial infections. Gram-negative infections and anaerobes were commonly encountered in polymicrobial infections. Most fungi cultures occurred in patients with enteric fistulas.
P013 HOW TO IMPROVE TREATMENT OF COMPLEX INCISIONAL HERNIAS IN OBESE PATIENTS: A SINGLE-CENTRE STUDY, AN EVALUATION OF LESS-OPEN TECHNIQUE AND FREE-FIXATION TECHNIQUE
Authors: Bystřický Petr , Šuhájek Stanislav , Pták Petr
Published: December 2021

Aim

Surgery of a complex incisional hernia in an obese patient is a challenging procedure for hernia surgeons. The aim of a new approach is to reduce complications such as pain and wound events, without increasing the number of recurrences.

Material and Methods

Adults with BMI more than 35 who underwent open, elective operation of a complex incisional hernia (with horizontal diameter more than 12cm) including posterior component separation technique with TAR (transversus abdominis muscle release) and retromuscular synthetic large-pore mesh placement, were identified. Patients were divided into 2 groups: The first group was treated with standard open technique with fixation using interrupted stitches, and the second group was treated with a technique using light hook and no or reduced fixation in the upper and lower pole of the mesh. For post-operative complication evaluation, the Clavien-Dindo classification was used. We have also evaluated an average operation time, length of stay, duration of opioid need. The long-term follow-up was 6 – 48 months.

Results

There was no significant difference in length of stay, the need of analgetic treatment, and hernia recurrence. Shorter operation time, and lower occurrence of surgical-site infections were reported in the second group, but it was not significant.

Conclusions

Open posterior component separation technique with TAR using large-pore mesh and no/minimal fixation seems to be a safe and sufficient method of treatment for complex incisional hernias in obese patients. Alternative methods may reduce early complications and pain and do not increase number of recurrences. A larger group of patients and longer follow-up should be needed to improve these findings.
P021 OUTCOME AFTER USE OF THE STAPLED MIDLINE CLOSURE TECHNIQUE AND SELF-FIXATING MESH FOR ABDOMINAL WALL RECONSTRUCTION
Authors: Rapoport Arkadi , Ashatkin Dina , Bukin Alexey , Biswas Seema , Waksman Igor
Published: December 2021

Aim

To evaluate surgical outcomes after introduction to our unit of the stapled opening and closure of the linea alba in reconstruction of the abdominal wall using the GIA linear stapler (linea alba stapling – LAS) and self-fixating mesh for medium and large defects.

Material and Methods

Since 2018, we have transitioned from the Rives – Stoppa (with or without component separation) (R-S) to the LAS technique for abdominal wall reconstruction. We compared our outcomes with the LAS technique with matched historic R-S controls (in terms of defect size, duration of surgery and skin related complications).

Results

Thirty-three cases of LAS reconstruction have been performed in our unit: 15 with defects larger than 10 cm. After exclusion of patients who underwent additional procedures such as adhesiolysis and bowel resection, the mean duration of surgery was 165 min. There were no skin related complications. Comparable cases who underwent R-S reconstruction took 213 min; and, wound infection developed in one patient and skin necrosis in two.

Conclusions

Provisional results indicate significantly lower operative times and incidence of wound complications (including infections and fluid collections). Notable advantages include a shorter skin incision, a small incision in the anterior rectus sheath to introduce the linear stapler rather than the standard laparotomy and lateral abdominal wall dissection (with ligation of perforators) necessary in the R-S method. Self-fixating mesh eliminates the requirement of sutured mesh fixation which may also be associated with more extensive dissection and longer operative times.
P023 MANAGEMENT OF MASSIVE INCISIONAL HERNIA WITH LOSS OF DOMAIN
Authors: Peinado Paula Pastor , Oto Diego , Porrero Belen , Villar José Manuel Molina , Hernando Luis Alberto Blazquez
Published: December 2021

Aim

Large incisional hernia treatment is challenging for surgeons especially when there is loss of domain. Its management require an appropiate preoperative optimization of the patient.

We present a complex case that provides an exhaustive review of different measures in order to treat this type of hernias.

Material and Methods

A 61-year-old, smoker and diabetic patient consulted because of a large ventral hernia. He underwent an umbilical hernia surgery which recurred three more times.

The patient had a M1-M5 W3 hernia with active suppuration through fistulous orifices. The abdominal wall planning CT scan showed a large eventration with 23 cm of transverse defect diameter and a Tanaka index of 92%.

Results

The patient received support to quit smoking and he lost weight due to an intragastric balloon. Botulinum toxin was administered six weeks before surgical intervention. An andominal pneumeperitoneum catheter was placed, reaching 12.400 liters of ambient air insufflated during 13 days.

Finally, surgery was performed, finding a 27 x 35 cm wall defect that required the performance of:

After these maneuvers, the posterior abdominal wall could be completely closed. A double preperitoneal mesh (BioA and polypropylene) was placed.

After 16 days, he was discharged without mayor complications.

Conclusions

Loss of domain hernias are a complex entity which requires a multidisciplinary approach and abdominal wall experienced surgeons since it may require extreme measures.
P026 PREOPERATIVE ABDOMINAL WALL RELAXATION WITH BOLULINUM TOXIN A INJECTION CAN FACILITATE SURGICAL REPAIR OF INCISIONAL HERNIAS: LONG-TERM SINGLE CENTER FOLLOW-UP OF 12 PATIENTS
Authors: Hönes Felix , Kokkalis Marios Konstantinos
Published: December 2021

Aim

It was investigated how preoperative botox injection in the abdominal musculature both facilitates the surgical repair of incisional hernias and reduce the rate of hernia recurrence.

Material and Methods

Botulinum toxin A injections was given to 12 patients (7 female and 5 male) suffering from complex incisional wall hernia, 4 to 6 weeks preoperatively. Mean age was 54 years. 9 patients were treated by anterior and/or posterior component separation repair and 3 by Rives-Stoppa repair. By all patients the mesh could be placed in the retromuscular position. No bridging was necessary.

Results

After a follow-up of 3 to 4 years we examined the patients clinically and by sonography. The rate of incisional hernia recurrence was low as well as the rate of side effects like chronic pain, persisting paresthesia and mobility disorders of the abdomen.

Conclusions

Preoperative injection of botulinum toxin A can help to reduce the risk of further hernia recurrence after surgical repair of complex incisional hernias of the abdominal wall.
P027 CHRONIC MESH INFECTION AFTER TRANSVERSUS ABDOMINIS RELEASE FOR A MULTIRECURRENT COMPLEX VENTRAL HERNIA IN HIGH RISK PATIENT: CRITICAL ISSUES OF A LONG LASTING MANAGEMENT
Authors: Bertoglio Camillo Leonardo , Alampi Bruno , Morini Lorenzo , Maspero Marianna , Grimaldi Simona , Magistro Carmelo , Quagli Oscar , Mastroianni Sara , Ferrari Giovanni
Published: December 2021

Aim

to point out the critical issues of the management of a challenging case of complex ventral hernia (CVH) in high risk patient

Material and methods

A 58-year-old female was referred to our Institution with a history of alcohol and smoking abuse, COPD and class I obesity. Four years before she underwent liver transplantation. In the next two years she had 2 VH repairs with polypropilene (PP) meshes. The postoperative course was complicated by a deep surgical site infection (SSI) and dehiscence. The wound resulted in a large R2 M3-L2 CWH with distorted anatomy. The patient experienced VH incarcerations and bowel obstructions. Clinical examination revealed no signs of infection and the CT scan showed partial loss of substance of the abdominal wall.

Results

The patient underwent posterior component separation with transversus abdominis release (PCS-TAR) and large PVDF mesh on top of a biosynthetic mesh implantation. The postoperative course was complicated after 14 days by a SSI causing a large wound dehiscence with underlying mesh exposure. The patient was readmitted and negative pressure wound therapy (NPWT) with topical wound solution instillation was initiated. After 1 month was followed up as an out-patient to continue traditional NPWT and removal of former PP remnants. NPWT was interrupted after 6 months and no signs of infection nor VH recurrence were recorded at 1 year.

Conclusions

the indication to PCS-TAR for such comorbid patient should be carefully evaluated. The use of a biosyntetic mesh could be debatable. The conservative management of a chronic infection could be the first-line option in case of macroporous mesh implantations.
P030 OPEN VERSUS LAPAROSCOPIC UMBILICAL AND EPIGASTRIC HERNIA REPAIR: NATIONWIDE DATA ON SHORT- AND LONG-TERM OUTCOMES
Authors: Henriksen Nadia , Jorgensen Lars Nannestad , Andersen Hans Friis , Helgstrand Frederik
Published: December 2021

Aim

The aim of the study was to evaluate the rates of 90-day readmission and reoperation for complication, together with rate of operation for recurrence after either open or laparoscopic mesh repair for primary umbilical or epigastric hernias with defect widths above 1 cm.

Material and Methods

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

Results

A total of 6,855 patients were included, of whom 4,106 (59.9%) and 2,749 (40.1%) patients had an open or laparoscopic repair, respectively. There were significantly more patients readmitted with a superficial surgical site infection 2.5% (102/4,106) after open repair compared with laparoscopic repair (0.5% (15/2,749), P < 0.001. The 90-day reoperation rate for complications was significantly higher for open repairs 5.0% (205/4,106) compared with laparoscopic repairs 2.7% (75/2,749), P < 0.001. The incidence of a reoperation for a severe condition was significantly increased after laparoscopic repair 1.5% (41/2,749) compared with open repair 0.8% (34/4,106), P = 0.010. The 4-year cumulative incidence of operation for recurrence was 3.5% after open and 4.2% after laparoscopic repairs, P = 0.302.

Conclusions

Recurrence rates were comparable between open and laparoscopic repair of umbilical and epigastric hernias. Open repair was associated with a significantly higher rate of readmission and reoperation due to surgical site infection, whereas the rate of reoperation due to a severe complication was significantly higher after laparoscopic repair.
P032 SURGICAL SITE INFECTIONS FOLLOWING EMERGENCY HERNIA REPAIR: A SUB-STUDY FROM THE MASH PROJECT
Authors: Proctor Victoria , Spence Olivia , Burns Flora , Green Susanna , Sayers Adele , Smart Neil , Lee Matthew
Published: December 2021

Aim

Acutely symptomatic hernia (ASH) of the abdominal wall and groin are common presentations. Decisions related to repair technique can be driven by contamination and surgical site infection (SSI) risk. The aim of this study is to report rates of SSI following ASH repair, and assess the performance of the Bluebelle wound health questionnaire in this population.

Material and Methods

This study reports on the operated sub-group of the MASH study. This was a 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Hernia site, repair type, wound complications, and Bluebelle questionnaire at 30 & 90 days were captured. Performance of this score was assessed using ROC curves, and regression modelling.

Results

223 patients were operated on, and 21 (9.4%) developed SSI within 90 days. Infections were most common in umbilical hernia (16.2%). No infections were seen in ‘simple’ symptomatic hernia. There was no association with either repair type. Bluebelle scores for 109 patients had an area under the curve of 0.807, showing good performance in this population. Regression modelling showed that SSI was most strongly associated with increased Bluebelle score (OR 8.54 (4.27 to 12.80, p < 0.001)). Use of a sutured repair was associated with a lower score (OR -3.79 (-7.19 to -0.39, p = 0.029)).

Conclusions

SSI is common after surgical treatment of ASH. Strategies to reduce this are needed. The Bluebelle score appears valid for this population; mesh repair might affect scores independent of SSI.
P036 IMPACT OF THE COVID-19 PANDEMIC ON HERNIA SURGERY IN A SWEDISH HEALTH-CARE REGION WITHOUT LOCKDOWN: A RETROSPECTIVE COHORT STUDY
Authors: Kollatos Christos , Alhussain Ali , Hanna Sarmad
Published: December 2021

Aim

During the COVID-19 pandemic, Swedish health care centers were restructured. This was accompanied by changes in the surgical programme. The aim of this study was to determine the effects of COVID-19 on emergency and elective hernia surgeries in a Swedish health-care region.

Material and Methods

This was a retrospective, observational cohort study. Data from inguinal and ventral hernia surgeries were retrieved from a medical database using procedure codes from all three hospitals in Region Jönköping County from March 1, 2019 to January 31, 2021. The participants were divided into two groups: COVID-19 group (March 1, 2020 - January 31, 2021) and reference group (March 1, 2019 - January 31, 2020). The incidence rate (IR) and relative risk (RR) of operations over different time frames were analyzed.

Results

A total 1351 participants met the inclusion criteria. 590 were operated during the COVID-19 period and 761 during the reference period. The IR of elective operations was decreased during the COVID-19 pandemic; 146 operations/100.000 population vs 192 operations/100.000 population during the reference period. RR was 0,76 (95% CI 0.6813-0.8545, p < 0.0001). Moreover, IR of emergency operations decreased insignificantly during the COVID-19 pandemic; 17,5 operations/100.000 population vs 19,4 operations/100.000 population during the reference period. RR was 0,9 (95% CI 0.6404- 1.2649, p 0.5441). No significant variations in the emergency operations have identified when different time frames were compared.

Conclusions

There is no evidence to support that COVID-19 pandemic has increased emergency hernia operations during the studied period despite the significant reduction of elective operations.
P061 ANALYSIS OF THE IMPACT DERIVED FROM MORBIDITY IN THE INCISIONAL HERNIA SURGERY
Authors: Olona Carles , Mancilla Alba Varona , Bargalló Jordi Vadillo , Bernal Marc Vallvé , Serafini Joan Ferreres , Marqués Raquel Casanova , Jorba Rosa
Published: December 2021

Aim

To analyse the repercussion derived from the morbidity that appeared after the repair of incisional hernias.

Material and Methods

Descriptive, retrospective and longitudinal study based on a prospective database of all incisional hernia operated patients of a university-level hospital in the period between 2013 and 2019. Anthropometric parameters, classification of the hernia according to the European Hernia Society guides and characteristics of the intervention performed were registered. Complications observed until the end of the follow-up and the final evolution are analysed.

Results

The sample is composed by 244 patients with a mean follow-up of 11 months. In 50% of the surgeries anterior separation of components was performed. In 240 patients, the mesh was placed in the following positions: 68.5% onlay, 13.5% retromuscular, 13% preperitoneal, 3.6% intraperitoneal and 1.3% inlay. During the first postoperative month, 63 patients (25.8%) presented some type of complication: seroma (47.6%), surgical wound infection (20.6%) and dehiscence (17.5%). 31 complications (49.2%) were classified as Clavien-Dindo III or greater severity. In 60% of patients with seroma the mesh was placed onlay. Of the 30 patients with seroma, 9 recurred over a mean of 16 months of follow-up (30%).

Conclusions

In our sample, the main cause of postoperative seroma is onlay placement of the mesh, and this complication may cause recurrence. We consider that it’s important to register our results to obtain a correct analysis and to prevent morbidity in the future.
P062 IMPLEMENTATION OF ETEP (EXTENDED TOTALLY EXTRAPERITONEAL REPAIR) AS A NEW METHOD OF INCISIONAL HERNIA REPAIR
Authors: Nowakowski Krzysztof , Elkalash Ayman Waly , lahaye thomas
Published: December 2021

Aim

To assess the outcomes of implementation of extended Totally Extraperitoneal Repair (eTEP) for incisional hernia in our clinic.

Material and Methods

In our clinic abdominal wall hernias are predominantly repaired in eMILOS (endoscopic Mini or Less Open Sublay)-technique. However, we hoped for advantages in repairing incisional hernias in eTEP-technique.

From 19.09.2019 till 28.04.2021 there were 13 patients with incisional hernias included to be operated in eTEP-technique.

Results

Among 13 patients, mean age was 64,6 years (range 47 – 78 years), 7 females (54%) and 6 males (46%). Average diameter of the hernia was 6,46 cm (range 2 – 14 cm). The mean Body Mass Index of the patients was 29,41 kg/m² (range 18,4 – 48,76 kg/m²). The mean duration of the operation was 162,38 minutes (range 106 – 237 minutes). The mean surface of the mesh was 612 cm² (range 225 – 1200 cm²). Hospital stay lasted mean of 5,8 days (range 2 – 28 days). We observed one postoperative complication as a lung artery embolism occurred in one patient with preperitoneal heamatoma due to needed anticoagulation. Till today we have not observed any recurrence.

Conclusions

Our study shows that a new method of incisional hernia repair with mesh placement can be a safely implemented and may have advantages compering with other laparoscopic methods. It has low complication rate, shows good cosmetic results and is cost effective.
P068 ROBOTIC REPAIR OF VENTRAL AND INCISIONAL HERNIAS: A STUDY ON 118 PATIENTS OPERATED BY RV-TAPP AND R-RIVES
Authors: Dietz Ulrich
Published: December 2021

Aim

The purpose of this study is to compare the results of robotic ventral TAPP and robotic retrorectus repair for ventral and incisional hernias.

Material and Methods

The results of 118 consecutive rv-TAPP (88) and r-Rives (30) surgeries are presented. The study was approved by the ethics committee (Ref. No. 2019-02046). Primary ventral hernias were treated mainly by rv-TAPP approach, incisional hernias by r-Rives Technique. Patients were followed up six weeks postoperatively.

Results

In every third patient, an additional finding at the linea alba was found. Patients in the r-Rives group were significantly older (p = 0.001). Hernia gaps were significantly larger and meshes were significantly larger in the r-Rives group (p < 0.001). The ratio of mesh area to hernia gap area was comparable in both groups (p = 0.142). OR time was significantly shorter for rv-TAPP (82min) than r-Rives (109min). Hospital stay was shorter in the rv-TAPP group than in the r-Rives group (1.5 vs. 2.7 days, respectively) (p < 0.001). There was a significant clustering of type II seromas in the r-Rives group (p < 0.001), however, the total number of seromas was comparable.

Conclusions

rv-TAPP and r-Rives have the advantages of minimally invasive procedures (low complication rate) and most of the advantages of open procedures (morphological reconstruction). Both techniques allow consistent extraperitonealization of meshes. Umbilical and epigastric hernias (<4cm) are treated as rv-TAPP; incisional hernias, large hernia gaps (4-7cm), as well as in case of planned suturing of the linea alba, the r-Rives is indicated. Concomitant hernia gaps of the linea alba are also treated. Both procedures have few complications and are suitable for residents training.
P075 IS INTER-RECTI DISTANCE (IRD) A RELIABLE PROXY FOR EVALUATION OF FUNCTIONAL IMPAIRMENTS ASSOCIATED WITH DIASTASIS RECTI ABDOMINIS (DRA)?
Authors: Bixo Liv , Sandblom Gabriel , Stackelberg Otto , Olsson Anders
Published: December 2021

Aim

Diastasis recti abdominis (DRA) following pregnancy is associated with functional impairment such as back pain, abdominal core instability, urinary incontinence, and abdominal bulging. Several studies have reported functional improvements after surgical repair of the DRA. The aim of this study was to investigate the association between the inter-recti distance (IRD) and self-reported functional disabilities measured with the Disability Rating Index questionnaire (DRI), with the hypothesis that inter-recti distance could serve as a proxy for core instability symptoms.

Material and Methods

A retrospective study based on a consecutive cohort of patients with core instability symptoms combined with DRA. The IRD was measured with ultrasonography among women with symptomatic post-partum DRA and functional impairments were registered with the self-report DRI questionnaire that covers twelve unspecific daily activities. IRD results were analysed against the DRI score with uni- and multivariable regression analyses.

Results

A total of 222 women were included in this study. Univariable regression analyses showed a significant positive correlation between the heavier activities running, heavy work, lifting heavy objects and exercise/sports and IRD, which failed to reach significance in the multivariable regression analysis with adjustments for length, weight, and BMI.

Conclusions

This study could not show any significant correlation between self-reported functional impairments and DRA isolated in the multivariable analysis, even though there is a tendency towards an association between DRA and heavy activities. The post-partum core instability situation is complex and probably origins from more components than solely the inter-recti distance.
P086 A NOVEL CALIBRATION ALGORITHM FOR COMPARISON ACROSS PATIENT REPORTED OUTCOMES (PROS) IN VENTRAL HERNIA
Authors: Patel Viren , Hsu Jesse Y. , Broach Robyn , Christopher Adrienne , Morris Martin , Fischer John
Published: December 2021

Aim

While there are many patient-reported outcome measures (PROMs) used for ventral hernia (VH), disease-specific instruments, like the Hernia-related Quality-of-Life (QoL) Survey (HerQLes) and Abdominal Hernia-Q (AHQ), have greater accuracy in capturing broad VH-related QoL. We present a novel calibration that allows providers to convert scores between the AHQ and HerQLes, enabling unification of QoL data.

Material and Methods

VH patients were prospectively identified and simultaneously administered the AHQ and HerQLes pre-and post-operatively. To ensure validity of the calibration, responses were excluded if patients answered instruments on different dates or if responses were discordant on corresponding questions on each instrument. The calibration was estimated using a linear mixed-effects model, including linear and quadratic scores, timing of survey relative to surgery and their interactions as fixed effects, and patients as random effects to account for multiple surveys from the same patient.

Results

In total, 109 patients were included, responding to 300 pairs of surveys (112 pre-operative and 188 post-operative). Seventeen (5.6%) were statistically excluded due to discordant responses. Conversion of the HerQLes to AHQ was most accurate when including whether the survey was completed pre-or post-operatively, with a mean square error (MSE) of 0.0091. Similarly, converting the AHQ to HerQLes was most accurate when factoring in the timing of survey administration, with a MSE of 0.016.

Conclusions

We present a novel and accurate method to convert scores between the AHQ and HerQLes. Portability of PROMs will be crucial in efforts to more broadly integrate PROMs into routine care in VH.
P087 LONG TERM SURGICAL RESULTS AND QUALITY OF LIFE AFTER LAPAROSCOPIC INGUINAL HERNIA REPAIR (TAPP): A PROSPECTIVE, CASE CONTROL STUDY COMPARING STANDARD HEAVYWEIGHT AND SELFGRIPPING (PROGRIP) MESH
Authors: Giovannini Sara Capoccia , Frascio Marco , Rossi Lisa , Stabilini Cesare
Published: December 2021

Aim

Aim of this study is to compare long term results of efficacy, recurrence and quality of life in patients submitted to TAPP for inguinal hernia repair with standard Heavyweight or Selfgripping mesh.

Material and Methods

A prospective case control study was conducted at single third referral center. The study included adult patients submitted to TAPP, of both sex, with primary and recurrent, unilateral and bilateral inguinal hernia. Patients received non-fixated standard heavyweight meshes (HW) or PROGRIP self gripping mesh (PG), their data were entered in EuraHS platform and the EuraHS Quality of life (QOL) questionnaire was administered before and 1 year after surgery. Primary outcome of the study is to compare long term QOL before and after surgery in HW vs PG group. Secondary outcome is perioperative morbidity and 12 months recurrence assessed with PINQ questionnaire.

Results

Between 2016 and 2020, 100 patients of both sexes (10 female) were enrolled, 50 in HW group and 50 in PG group. The two groups were comparable preoperatively. After 12 months no cases of CPIP were observed and there wasn’t differences in QOL reported by patients, although in both groups there was an improvement of pain, movement limitations and esthetical discomfort after surgery. None recurrence and overall only 4 cases of complications (1 hematoma and 1 seroma for each group) were registered.

Conclusions

Selfgripping Mesh for laparoscopic hernia repair has produced results equal to standard of care meshes in term of recurrence rate, early morbidity and postoperative quality of life of patients.
P098 DO POSTOPERATIVE COMPLICATIONS CORRELATE TO CHRONIC PAIN FOLLOWING INGUINAL HERNIA REPAIR? A PROSPECTIVE STUDY FROM THE SWEDISH HERNIA REGISTER
Authors: Olsson Anders , Sandblom Gabriel , Franneby Ulf , Sondén Anders , Gunnarsson Ulf , Dahlstrand Ursula
Published: December 2021

Aim

To analyse if postoperative complications constitute a predictor for the risk of developing long-term groin pain.

Material and Methods

Population-based prospective cohort study of 30,659 patients operated for inguinal hernia 2015-2017 included in the Swedish Hernia Register. Registered post-operative complications were categorised into hematomas, surgical site infections, seromas, urinary tract complications, and acute post-operative pain. A questionnaire enquiring about groin pain was distributed to all patients one year after surgery. Reported level of pain one year after surgery was analysed against postoperative complications using multivariable logistic regression analyses.

Results

The response rate was 64.5%. In total 19,773 eligible participants responded to the questionnaire whereof 73.4% had undergone open anterior mesh repair and 26.6% had undergone endo-laparoscopic mesh repair.

Registered postoperative complications were: 750 hematomas (2.3%), 516 surgical site infections (1.6%), 395 seromas (1.2%), 1,216 urinary tract complications (3.7%), and 520 hernia repairs with acute post-operative pain (1.6%).

Among patients who had undergone open anterior mesh repair, analyses showed an association between persistent pain and hematomas (OR 2.03, CI 1.30-3.18), surgical site infections (OR 2.18, CI 1.27-3.73) and acute post-operative pain (OR 7.46, CI 4.02-13.87). Analysis of patients with endo-laparoscopic repair showed an association between persistent pain and acute post-operative pain (OR 9.35, CI 3.18-27.48).

Conclusions

Acute postoperative pain was a strong predictor for persistent pain following both open anterior and endo-laparoscopic hernia repair. Surgical site infections and hematomas were predictors for persistent pain following open anterior hernia repair, although the rate of reported postoperative complications was low.
P103 IS BOTULINUM TOXIN PRE-CONDITIONING & 3D PLANNING USEFUL IN A BILATERAL SUBCOSTAL EVENTRATION WITH LAPAROSTOME AND COLOSTOMY?
Authors: Farré Roser , Gobbo Rafael Gerardo Díaz Del , Sanchon Lorena , Osorio Alexander , Guariglia Claudio Antonio , Pardo Sara , Güell Mercè , Collera Pablo
Published: December 2021

Aim

To assess the usefulness of 3D Planning and preconditioning with botulinum toxin in a complex abdominal wall hernia.

Material and Methods

A 54-year-old man with sever alcoholic pancreatitis required surgery due to poor evolution, performing subtotal colectomy with a right colon colostomy and necrosectomy by bilateral subcostal laparotomy. After several operations and not being able to close the wall, the use of negative pressure therapy and subsequently skin grafting was required.

Abdominal wall 3D Planning was performed and botulinum toxin injection was administered before definite surgery.

During surgery, after digestive reconstruction, it was observed that wound’s edges did not approximate due to retraction of rectus in the cranial and caudal pole. Posterior layer was closed with running suture and double polypropylene mesh was placed.

One year after surgery, patient remains without recurrences with a firm abdominal wall and recovery of life’s quality with radiologic confirmation images.

Results

Intestinal and Wall reconstruction in one step was feasible, although botulinum toxin injection did not provide benefits due a bilateral subcostal incision with significant muscle retraction.

The 3D Planning allowed us to assess the degree of retraction of the musculature, much greater than what was appreciated in the physical examination.

Conclusions

The subcostal incision should be avoided in severe pancreatitis.

Surgical planning with 3D technology is developing, allowing the entire anatomy to be assessed globally.

3D, useful tool for teaching, suggests that in subcostal laparotomies, it could help predicting that botulinum toxin would not be useful due to muscular retraction.
P105 PREVENTION OF INCISIONAL HERNIA WITH A REINFORCED TENSION LINE (RTL) VS PRIMARY SUTURE ONLY IN MIDLINE LAPAROTOMIES: 3 YEARS FOLLOW UP
Authors: Hernandez Edgard Efren Lozada , Chavez Elizabeth Escamilla , Villegas Leticia Hernandez
Published: December 2021

Aim

“Incisional hernia (IH) has an incidence of 10–23%, which can increase to 38% in specific risk groups. The objective of this study is to report the results at 3 years of follow-up of the use of the reinforced tension line (RTL) technique compared with primary suture only (PSO) closure in the prevention of IH in high-risk patients undergoing laparotomy.”

Material and Methods

“Open randomized controlled clinical trial. Included were patients older than 18 years who underwent midline laparotomy, emergency or scheduled, who were considered high risk, and who completed 3-year follow-up. The patients were randomized 1:1 to the RTL technique or to PSO. The objective was to report the incidence of IH and the complications associated with the closure method. Intention-to-treat analysis and Cox regression were performed.”

Results

“A total of 124 patients were randomized; 51 patients from the RTL group and 53 patients from the PSO group finished the 3-year follow-up. The incidence of IH was higher in the PSO group (15/53, 28.3%) than the RTL group (5/51, 9.8%) (p = 0.016, OR 0.35, 95% CI 0.14–0.88, number needed to treat 5.4, log-rank test p = 0.017). The groups were similar in the rates of surgical site infection, hematoma, seroma, and postoperative pain during follow-up.”

Conclusions

“The RTL technique is useful in the prevention of IH when compared with PSO in high-risk midline laparotomy patients, and it is not associated with a higher percentage of complications. Clinical trials NCT02136628, retrospectively registered”