bluuebunny/crossref_metadata_2025 huggingface dataset:
OC-032 SAFETY OF PERFORMING CONCOMITANT GASTROINTESTINAL RESECTIONAL SURGERY WITH COMPLEX ABDOMINAL WALL RECONSTRUCTION
Authors: Kulkarni G , King E , Hammond T
Published: May 2023

Aim

The literature regarding combined complex abdominal wall reconstruction (CAWR) and gastrointestinal surgery (GIS) is limited and largely suggests staged procedures due to a reported increased incidence of surgical site occurences (SSO), hernia recurrence and anastomotic leak. However this exposes patients to the risks of two substantial procedures and having general anaesthetic twice. This study aimed to evaluate outcomes of single-stage GIS involving a substantial GI resection with CAWR.

Materials & Methods

Analysis of a 8 years prospectively maintained single surgeon CAWR database of 205 patients identified 14 such patients who had undergone concomitant CAWR GIS cases (5 segmental colonic resections, 2 completion proctectomies, 5 Hartmann's reversals and 2 small bowel resection and anastomoses) but excluding cholecystectomy, gynaecological surgery and adhesiolysis alone.

Results

CAWR-GIS mean operating time was significantly longer (5.8hrs vs 3.8hrs) with an increased incidence of post-operative ileus (40% vs 18%, p<0.05) with increased mean length of stay as expected (7.8 days v/s 5.1 days). There was a slightly higher incidence of SSO but there were no anastomotic leaks. Hernia recurrence rate at 2 years follow up was 10% which is comparable to our cohort (8%). None of the 14 patients required reoperation within 30 days or mesh explantation yet. 11 patients had a synthetic mesh and 3 patients had a bio-synthetic mesh used. Patients informally reported high satisfaction for having undergone combined procedures.

Conclusion

Concomitant intestinal surgery during complex abdominal wall repair can be performed safely without increased risk of hernia recurrence, mesh infections or anastomotic leak.
OC-038 LATERAL INCISIONAL VENTRAL HERNIA: CAN ETEP APPROACH ENHANCE THE OUTCOMES?
Authors: Salido S , Hernández S , Gutiérrez E , Guevara-Martínez J , Zapata C , Chavarrías N , Fondevila C
Published: May 2023

Objective

To present the application of the extended totally extraperitoneal (eTEP) approach in lateral incisional hernias and to analyze the results in our series of cases.

Materials and Methods

Retrospective comparative multicenter study based on a prospective database conducted at Fundacion Jimenez Diaz University Hospital and La Paz Hospital in Madrid that includes eTEP incisional ventral hernia repairs performed between March 2019 and January 2023. The inclusion criteria were lateral incisional hernias W1 and W2 according to the classification of the European Hernia Society (EHS). Preoperative, intraoperative, and postoperative data were collected.

Results

In the study period, 159 ventral hernias were intervened by eTEP access and a total of 49 incisional hernias were analyzed. By location, 3 cases were L1, 25 cases were L2, 15 cases were L3, and 6 cases were L4. The median defect size was 48mm (11–126). The median surgical time was 115 minutes (45–237) and transverse muscle release was applied in 36 cases (73.5%). The median length of stay was 1 day (1–7) and 14 (28.6%) patients were intervened on an outpatient basis. Four (8.2%) postoperative complications and 1 (2%) recurrence were evident. The median follow-up was 21 months (3–46).

Conclusions

The treatment of lateral incisional hernias by eTEP approach is feasible and abdominal transverse muscle release may have to be applied in many cases. It presents excellent results in our series in terms of complication rate, recurrence rate, hospital stay, and proportion of outpatient treatment.
OC-042 LAPAROSCOPIC ETEP APPROACH TO VENTRAL HERNIAS: SHORT-TERM OUTCOMES
Authors: Trujillo Díaz J , Gómez López J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martín Del Olmo J C
Published: May 2023

Aim

Ventral hernias are a pathology with a high incidence within general surgery.Repair techniques have been evolving, and the minimally invasive approach to this type of pathology is currently on the rise due to the advantages of the MIS.

Material & Methods

We analyzed our database of patients with ventral hernias undergoing laparoscopic-eTEP approach,August-2021 to December-2022. We present our short-term outcomes.

Results

A total of 31 patients(men:54.8%,age:64(RIQ:43–73years)). LOS:1.48±0.62days. Pathological history:diabetes mellitus(19.4%),arterial hypertension(45.2%),dyslipidemia(51.6%), smoking(25.8%), alcohol consumption(13.3%), cardiovascular disease(12.9%). ASA Classification:I(32.3%), II(45.2%), III(22.6%). BMI:30.6±4.68kg/m2. Overweight:11(35.5%) and obesity:17(54.8%).

Primary hernias:4(26.7%) and incisional hernias:19(61.3%).Location:midline(100%), supraumbilical:58.1%,umbilical:87.1% and infraumbilical:25.8%.Hernia width (EHS classification): W1:12.9%, W2:80.6% and W3:6.5%, transverse hernia diameter: 5.5±2.1cm, hernia length size:6.1±4.4cm. Associated with diastasis:24(77.4%),diastasis width:4.9±1.7cm. Associated with inguinal hernia:6(19.4%).

Type of laparoscopic surgical technique performed:Rives-Stoppa: 24(77.4%), unilateral TAR:5(16.1%), bilateral TAR:2(6.5%).Number of trocars used by procedure:4(RIQ:4–5). Preoperative botulinum toxin:7(22.6%). Posterior sheath closure:23(74.2%). Mesh fixation type:Glutack 5(16.1%), Tisseel 19(61.3%), no fixation 7(22.6%). Mesh type used: Low density wide-pore polypropylene 11(35.5%),PVDF-Mesh 18(58.1%), PVDF-IPOM mesh 2(6.5%). Mesh size: width 18(RIQ:16–22cm) and length 28(RIQ:25–30cm). Drainage: 3(9.7%). Surgical time:200(RIQ:180–300min). Global and serious complications (CD≥III): 4(12.9%) and 1(3.2%), Re-IQ due to incarcerated hernia due to posterior sheath dehiscence: 1 (3.2%). No intraoperative complications. Clinical seroma:3(9.7%).No cases of hematoma or surgical wound infection.No recurrence.

Conclusions

The laparoscopic eTEP approach of ventral hernias has a low rate of global complications,despite being our first cases performed. It also has low rates of postoperative pain and shorter LOS.We can conclude that in our Hospital the laparoscopic eTEP approach is a safe, efficient and effective technique.
OC-043 SYSTEMATIC REVIEW AND GUIDELINES FOR MANAGEMENT OF SCROTAL INGUINAL HERNIAS
Authors: Tran H , Macqueen I , Chen D , Simons M
Published: May 2023

Introduction

6% of all inguinal hernias are scrotal in high-resource countries rising to 67% in low-resource countries. This represents a heavy disease burden on relatively young men during their most productive period of life. Despite limited evidence these guidelines aim to improve treatment for scrotal hernia patients.

Methods

After developing 19 key questions a systematic literature review was performed Statements and recommendations were formulated. Online Consensus meetings with 25 HerniaSurge members were organised with voting and grading Recommendations as “strong” (recommendations) or “weak” (suggestions) and by consensus, in some cases upgraded.

Results

23 studies were selected. Scrotal hernia is defined as an inguinal hernia which has descended into and causes any scrotal distortion. A new classification for scrotal hernias was proposed based on hernia size, SI=upper third thigh, SII=middle thigh and SIII=lower third thigh or below. IR denotes irreducibility. Despite weak evidence antibiotic prophylaxis and urinary catheterization is recommended (upgraded) in complex cases (S2–3) due to prolonged operative time. Scrotal hernia repairs have higher associated morbidity and mortality compared to non-complex groin hernia repairs. Open anterior (mesh) approach is commonest technique and suture techniques in low resource countries. TAPP resulted in less conversion to open approach compared to TEP.

Conclusions

Although evidence is scarce and often low-quality scrotal hernia management guidelines recommend more tailored approaches for better surgical outcomes based on available resources and appropriate skills and provide an impetus for future research where adoption of proposed classification will enable more meaningful comparison of different techniques for different hernia sizes.
OC-055 Mesh infections – frequency, risk factors and treatment options from a Swedish cohort
Authors: Westin L , Sandblom G , Gunnarsson U , Dahlstrand U
Published: May 2023

Aim

To describe the incidence of mesh infection after inguinal hernia repair and the treatment given as well as to investigate possible risk factors.

Material & Methods

Patients with a groin hernia repair in one of Sweden's health care regions during 2005–2020 were identified in the Swedish Hernia Register (SHR). Data from the SHR was collected for all patients with reported infectious complication and for a matched (1:1) reference group without reported complication. Medical records were studied for risk factors, clinical presentation, lab, imaging, treatment provided and duration of treatment.

Results

8350 groin hernia repairs were performed during the study period. Infectious complications were reported to the SHR in 137 cases. Medical records for cases and controls were reviewed to identify infection and treatment given. Mesh infections, or presumed such, constituted 6.5% of all registered infectious complications. Mesh infection was thus seen after 0.11% of repairs. Deep infection was treated with antibiotics, sometimes accompanied by wound revision for drainage. Cases where bowel ischemia necessitated resection were more prone to infections, as were patients with an ASA class of 2 or higher.

Conclusion

Mesh infection is extremely rare after inguinal hernia repair in Sweden. The majority of these infections can be treated with antibiotics and drainage of infectious fluids and almost never has to result in the removal of the mesh.
OC-058 VENTRAL HERNIA REPAIR (VHR) FOR RECURRENT HERNIAS SIGNIFICANTLY IMPROVES QUALITY OF LIFE
Authors: Wilson H , Ku D , Scarola G , Polcz M , Augenstein V , Colavita P D , Heniford B T
Published: May 2023

Introduction

Quality of life (QOL) has become a key outcome measure in VHR. Although recurrent hernias can be more challenging to repair and often have more postoperative complications compared to primary hernias, QOL outcomes have not been specifically studied between these two groups.

Methods

The International Hernia Mesh Registry was queried for patients who underwent either recurrent or primary VHR. Patients detailed QOL using the Carolinas Comfort Scale (CCS). Patient characteristics and preoperative and 1-year postoperative CCS scores were compared between groups with standard statistical methods.

Results

There were 1,349 patients identified from 2008–2019 who underwent VHR with preoperative and 1-year postoperative CCS data, 227(16.8%) of which had recurrent hernias and 1,122(83.2%) had primary hernias. The recurrent group had a higher BMI(32.5±6.7 vs 30.7±6.5 kg/m2,p<0.001), larger hernia defects(78.9±103.5 vs 39.0±79.9 cm2,p<0.001), and more postoperative hernia recurrence(13.7% vs 5.3%,p<0.001). Recurrent patients had increased(difference=3.1±7.9) mesh sensation and more mesh sensation at 1-year(4.6±7.7 vs 2.7±5.5,p<0.001) compared to the primary group. They had greater preoperative(11.1±9.6 vs 6.7±8.2,p<0.001) and 1-year postoperative(4.1±7.2 vs 2.3±5.6,p<0.001) pain but had greater improvement in their pain after surgery(-6.3±10.2 vs -4.3±8.3,p=0.002). They also had greater preoperative(9.4±9.1 vs 5.2±7.1,p<0.001) and 1-year postoperative(4.1±7.2 vs 1.9±4.8,p<0.001) movement limitation but experienced greater improvement in this category (-5.5±10.0 vs -3.2±7.2,p<0.001).

Conclusion

Patients presenting with recurrent hernias had more hernia-related symptoms than patients presenting with primary hernias but experienced greater improvement with pain and movement limitation. They did have increased mesh sensation postoperatively. These data may help in counseling patients preoperatively.
OC-066 TEMPORAL PATTERN FOR REOPERATION OF INGUINAL HERNIA RECURRENCE AFTER A PRIMARY SHOULDICE REPAIR
Authors: Spencer Netto F , Mainprize M , Ylbas A , Svendrovski A , Degani C , Szasz P
Published: May 2023

Aim

To identify timing patterns associated with reoperation for recurrence of inguinal hernia in patients undergoing Shouldice repair (RIHaSR) for primary inguinal hernias.

Material and methods

Patients undergoing a recurrent inguinal hernia repair from 2013–2017 were initially identified. Subgroup analysis of the first recurrence after a Shouldice repair at this institution were selected. Data collection of this subgroup of patients and data analysis were performed.

Results

From the 138 patients undergoing a re-operation for a first time inguinal hernia recurrence after a Shouldice repair, 125 patients were included in the analysis. The mean age was 50.8±13.9, BMI 24.6+2.6 and 97% were male. Regarding time to surgery for recurrence, the most common interval was in the first 5 years after surgery (37.6% of patients; mode: 1 year; median: 7 years; mean: 13.7±13.8 years). A bimodal pattern of temporal recurrence was noted according to patient age: patients >50 had a peak of reoperation for recurrence in the first 5 years (68% of reoperations for recurrence) with a decrescendo pattern, meanwhile patients <50 demonstrated a stable incidence of reoperation for recurrence in the initial 25 years of follow-up.

Conclusions

Patients undergoing surgery for RIHaSR presented a bimodal temporal pattern according to age at the time of primary surgery. Patients older than 50y.o. presenting a peak of RIHaSR in the first 5 years after primary surgery in comparison to younger patients that present a relatively stable frequency of reoperation for recurrence up to a 25-year follow-up.
OC-067 COST-EFFECTIVENESS AND CLINICAL OUTCOMES ANALYSIS OF LAPAROSCOPIC TOTAL EXTRAPERITONEAL (TEP) AND LAPAROSCOPIC TRANS- ABDOMINAL PREPERITONEAL (TAPP) INGUINAL HERNIA REPAIR
Authors: Ferri V , Vicente E , Quijano Y , Duran H , Diaz E , Fabra I , Caruso R , Malave L , Ruiz P , Naldini C
Published: May 2023

Objective

A cost-effective analysis of the laparoscopic total extraperitoneal (TEP) repair and laparoscopic trans- abdominal preperitoneal (TAPP) laparoscopic versus open inguinal hernia repair is still not well addressed. The aim of this study is to compare the clinical and cost-effective outcomes of TEP repair and TAPP repair for unilateral inguinal hernia.

Methods

This is a clinical and cost-effectiveness analysis within a randomized prospective study conducted at Sanchinarro University Hospital. Cases of primary, reducible unilaterl inguinal hernia were included and randomized using a simple randomization program. The outcome parameters included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio.

Results

Between January 2020 and January 2023, 60 patients were enrolled in this study (30 of them underwent TEP and 30 TAPP). The TEP procedure had less early postoperative pain (p=0.035). The operative time was higher in the TAPP group with respecto to the TEP group (p =0.05). The overall cost of TAPP procedure was higher compared with the TEP cost but without statically significance (883.93s vs 780 p>0,05). The mean QALYs at 1 year for TEP (0.7094) was higher than that associated with TAPP (0.541) (p=0,038). At a willingness-to-pay threshold of 20,000 s and 30,000 s, there was a 85.28% and 91.44% probability that TEP was more cost-effective relative to TAPP.

Conclusions

The TEP procedure for unilateral and bilateral inguinal hernia appears to be more cost-effective compared with TAPP.
OC-072 COMPARATIVE STUDY OF THE TROCAR SITE INCISIONAL HERNIA INCIDENCE ACCORDING TO SLOW VS RAPID ABSORPTION SUTURES
Authors: Ferreres Serafini J , Olona Casas C , Julià Verdaguer E , Vadillo Bargalló J , Varona Mancilla A , Rodrigo Rodrigo M , Diaz Martín Á , Jorba Martín R
Published: May 2023

Aim

Abdominal wall closure guidelines recommend the utilization of slow absorption sutures. However, fast absorption sutures are still used for laparoscopic trocar site closure, mainly due to ease of handling and availability.

We planned a retrospective cohort study, analysing the incidence of trocar site hernia (TSH) depending on the suture used for the fascial closure.

Materials & Methods

A retrospective cohort study is carried out including a sample of 200 patients operated in our centre by any elective laparoscopic procedure, by Hasson access technique at the umbilical trocar site.

Patients were distributed in 2 groups, according to the suture used: Group-1 Polyglactin, Group-2 Polydioxanone. In both groups the needle that was employed had a J-shape.

Patients that had open or robotic surgery, reinterventions, and previous diagnosis of umbilical hernia were excluded.

Results

100 patients were included in Group-1, and 100 patients in Group-2. The average age was 57.34 and 63.39 years respectively. The incidence of TSH in Group-1 was 20% with an average follow up of 22.3 months, compared to an 15% TSH incidence in Group-2, with an average follow-up of 20.3 months. These differences were not statistically significant. 80% of TSH were diagnosed in the first 24 months after the surgery.

Conclusions

Likewise the existing evidence in open surgery wall closure, the use of slow absorption sutures in trocar site closure probably reduces the TSH incidence, without repercussion in comorbidity, however, in our study, the sample was not enough to prove statistical significance.

These results should be contrasted with further randomized Control Trials.
OC-083 THE REACH OF THE HERNIA BASECAMP LEARNING PLATFORM SINCE ITS LAUNCH JUNE 2021
Authors: de Beaux A , Becker S , Temporal G , Parent T , Kummer R , Allouard C , East B
Published: May 2023

Aim

Hernia Basecamp is an online learning platform hosted within the WebSurg website. One of the drivers of its development was to cover the syllabus of the UEMS AWS examination, but it is a learning resource in its own right. There are currently 205 video lectures, with a number of them selected to create 10 modules of 3 hours each with UEMS CME accreditation. The aim of this study was to review the Hernia Basecamp usage since launch in June 2021.

Methods

The Hernia Basecamp WebSurg platform was interrogated using Matomo Analytics in January 2023 (19 month period since launch). Data on the number of visits, pages looked at and time spent on the platform per visit, along with the number of CME modules taken and passed were collected.

Results

Users from 146 countries visited the Hernia Basecamp site 17,171 times (6586 times, 38.4% in first 9 months). The top 5 countries by visitors were the UK, Mexico, Spain, USA and Germany (accounting for 29.4% of the visits). The average time spent per visit was 11 min 37 sec (range: 47 sec to 49 min 4 sec), and the number of pages/videos viewed per visit was 8.1 (range: 2–21). The number of UEMS CME modules taken was 675, and 326 (48%) of these tests were passed.

Conclusions

In the first 19 months from launch, Hernia Basecamp provided over 3,000 hours of hernia education to users around the world. The UEMS approved CME accreditation tests were commonly used.
OC-084 PATIENT-REPORTED OUTCOMES ON INCISIONAL VENTRAL HERNIA: SINGLE CENTER REPORT
Authors: Trindade M , Figueiredo J , Souto R , Branco A , Costa P
Published: May 2023

Aim

The impact of incisional hernia repair on quality of life is poor. Patient-reported outcomes (PROs) self-report one's health status and imply an impact on daily life. This study presents PROs in incisional ventral hernia repair from a single hernia center.

Material and Methods

55 consecutive patients undergoing incisional hernia repair between 2019 and 2022 were selected. Pain and restrictions on daily life were evaluated. They were asked 3 questions by phone call: 1. Compared to how you were before surgery, do you consider yourself better/same/worse?; 2. Do you still have any symptoms? (If so, explain them); 3. If you had to have another ventral hernia surgery, would you do it again?

Results

Study's population median follow-up was 16,5 months. Ventral hernias were mostly W2 or M2, according to EHS classification. 54% underwent laparoscopic surgery. 49 patients (89%) answered they were better than before surgery. 19 patients (34,5%) stated they still have some symptom, pain being the most common. 41 patients (75%) said they would accept surgery again if they had to. 9 patients (16%) would undergo surgery again whether same team and hospital were available. Only 4 patients said they would deny another ventral hernia repair.

Conclusions

This study suggests that the majority of patients improved their self-reported symptoms. Nonetheless there are still patients with persistent postoperative symptoms, especially those with pain and daily life restrictions pre-operatively. Expectation management is therefore determinant to improve decision-making in incisional ventral hernia treatment.
OC-088 NOT ALL SYMPTOMS MAY BE THE HERNIA!
Authors: Wolesky J , East B
Published: May 2023

Introduction

Ventral hernias are common and operations for ventral hernias are some of the most commonly performed procedures in general surgery. These operations are often motivated also by symptoms such as back pain, the bulge growing and abdominal wall pain or inability to exercise.

Material and methods

We have run a retrospective trial looking at our cohort of patients with large ventral hernias that have successfully completed a prehabilitation programme. We have specifically focused at symptoms of back pain, size of their hernias and other general symptoms like ability to exercise.

Results

78 patients have successfully completed the programme and 45 have decided against an operation as the symptoms that have originally motivated them to seek surgical help have diminished. Their abdominal circumference (measured over the hernia) has not increased in any of them.

Conclusion

Individual physiotherapy can lead to improvement in patient symptoms and can prevent a hernia from getting bigger.
OC-089 A CHALLENGING REPAIR OF RECURRENT VENTRAL HERNIA IN A PATIENT WITH A PREVIOUS INTRAPERITONEAL MESH AND ABDOMINOPLASTY
Authors: Prce D , Gaber M , Gerogiannis I
Published: May 2023

Aim

To understand the challenges faced in repair of recurrent ventral hernia in a patient with a previous intraperitoneal mesh and abdominoplasty.

Introduction

Ventral hernias still represent a great challenge for surgeons, especially if they are recurrent.

We present a 54-year-old overweight female with complex surgical history and a recurrent incisional hernia. She had a laparoscopic cholecystectomy and port site hernia which was repaired without a mesh. She later underwent a Roux-en-Y Gastric bypass for obesity and developed another port site hernia in lower epigastrium. The incisional hernia was repaired with an intraperitoneal mesh. Finally, she had an abdominoplasty for cosmetic reasons. She presented to our surgical clinic with a clinically palpable recurrent large incisional hernia.

Methods

The repair was carefully planned with a CT abdomen confirming a 6 cm defect in the upper midline and a large intraperitoneal mesh with multiple metallic tacks.

The surgical procedure was as follows:

Midline incision and careful dissection of the sac. The intraperitoneal mesh was identified and removed carefully keeping the posterior rectus sheath and peritoneum intact. A posterior component separation technique was performed. Posterior rectus sheath was closed with interrupted absorbable sutures. A tailored polypropylene mesh was placed in retro-rectus space. The anterior rectus sheath was closed with non-absorbable interrupted sutures. Patient had an uneventful postoperative period and was discharged on the third postoperative day.

Conclusion

Careful patient selection, detailed preoperative planning and expertise in abdominal wall reconstruction result in a successful repair of complex ventral hernias.
OC-094 LESSONS LEARNT FROM DEVELOPING AN ABDOMINAL WALL RECONSTRUCTION (AWR) MULTIDISCIPLINARY TEAM (MDT) IN A COMPREHENSIVE HERNIA CENTRE
Authors: Gilmore K , Birch A , Cocciolo F , Bunting D , Findlay J , Sanders D , Pawlak M
Published: May 2023

We present our experience of developing a successful AWR MDT in a Tertiary Referral Centre, which aimed to optimise the management of complex AWR patients.

The weekly AWR MDT was established in August 2020. Cases are discussed with a hollistic approach. A comprehensive individualised plan is agreed regarding appropriateness of surgery, pre-operative risk factors requiring optimisation and operative specific decisions.

151 patients have been discussed to date (118 incisional hernias, 33 primary). In 65% of patients, at least one risk factor for adverse surgical outcomes was identified that required pre-optimisation, most commonly the need for weight loss (93%), glycemic control (22%), & smoking cessation (22%). 50 patients have been operated on to date. Retrorectus repair was the most commonly used technique (86%). Adjuvant techniques such as peritoneal flaps were suggested in 36% of patients.

23 patients are currently on waiting list for surgery, 45 remain in their prehabilitation period. 20 patients did not undergo surgery after combined patient and MDT decision. 8 patients await further investigation and 5 patients have been transferred to other centres due to specialist input requirement.

MDT management of abdominal wall hernias remains poorly established in most regions. Our experience highlights how vital it is. We have proven that it is feasible to run MDTs and that it has improved pre-operative planning and focus on modifiable risk factors in our centre. We would encourage other centres to establish this for complex cases, so that the most appropriate decisions can be made for this surgically challenging group.
OC-100 CORRELATION BETWEEN DIASTASIS RECTI AND RECURRENCE AFTER UMBILICAL HERNIA REPAIR
Authors: Ruiz García B D L Á , Sánchez Arteaga A , Hinojosa Ramirez F , Moreno Suero F , Tinoco González J , Tallón Aguilar L
Published: May 2023

Aim

Evaluate whether diastasis recti is an independent risk factor for recurrence after umbilical hernia repair.

Material and Methods

Retrospective cohort study based on patients operated on for primary umbilical hernia between 2015–2017. Inclusion criteria were umbilical hernia repair with previous computed tomography scan, without diastasis repair and follow-up of at least two years.

Rectus diastasis was defined as a separation >2,5 cm.

Different variables were analyzed to assess their influence on hernia recurrence, with diastasis recti being our main factor to evaluate. Demographic characteristics, hernia size, type of hernia repair, postoperative complications and long-term recurrence were recorded.

Results

458 patients underwent umbilical hernia repair during the study period, 70 patients (15,28%) met the inclusion criteria and were selected.

The mean age was 57.08 years and 42.9% were women. The mean diameter of the hernia defect was 2.26 cm. 67.1% of the sample presented diastasis with a mean size of 3.78 cm.

Female sex(p=0.04), diabetes(p=0.16) and diastasis recti(p=0.05) present a statistically significant relationship with the development of recurrence after umbilical hernia repair.

We obtained that female sex(p=0,029) and diabetes(p=0,16) significantly increase the recurrence development. Meanwhile, we cannot affirm that diastasis acts as an independently risk factor(p=0,058),since it has been influenced by these variables.

Conclusions

We obtained that diabetes and female sex independently influence the development of recurrence after umbilical hernia. We have not been able to demonstrate that diastasis is a risk factor by itself for the appearance of recurrence, although we did find a trend towards statistical significance.
OC-106 #SOME4SURGERY
Authors: López Farias A
Published: May 2023

Aim

Digital transformation of society is now a reality, as is the incessant increase in the use of social networks. The aim is to present digital platforms for surgeons, how they are used, what impact they have and their roles in research and communication.

Material and methods

We carried out a narrative review based on bibliographic searches on the use of social networks in health professionals, as well as studies of impact and repercussion in the field of surgical communication and research.

Results

There are different social networks that can be used by surgeons, Twitter being preferred for its easy use and speed of diffusion, with the ability to group specific topics and amplify them through the use of hashtags such as #SoMe4Surgery (Social Media for Surgery). It is possible to spread knowledge in specific areas, facilitate conversation, collaboration and support between professionals with common interests anywhere in the world.

Conclusions

Social networks have been described as a necessary component in the usual practice of surgery and as an obligation for surgeons to know how to recognize their power and potential and to be used in the preparation of guides or expert panels, as well as the dissemination of information and interaction between professionals in the face of the growing difficulty in the resources available to access continuing education programs or attendance at face-to-face events. All this through responsible use (even requiring the publication of a guide for the ethical use of social networks by the American College of Surgeons).
OC-108 THE EFFECT OF COMBINED SPINAL EPIDURAL ANESTHESIA ON SHOULDER PAIN IN LAPAROSCOPIC EXTRAPERITONEAL HERNIA SURGERY
Authors: Donmez T , Cayirci C E , Surek A , Guzey D , Ferahman S , Kones O , Karabulut M
Published: May 2023

Background

Shoulder pain is a condition that seriously discomforts patients which develops due to peritoneal tear in laparoscopic extra peritoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out for the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method in order to prevent shoulder pain in the TEP technique.

Method

The patients which operated with TEP procedure were divided into two groups; SA (Group 1) and CSEA (Group 2). The two patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effect, intra operative and postoperative complications.

Results

The number of patients in group 1 was 42 and the group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2 respectively, which was statistically significantly shorter in group 1 (p<0.001). Postoperative pain was significantly less in group 2 for the 4th hour (p<0.0001) and the 12th hour (p: 0.047). There was no difference between the two groups in terms of peritoneal tear (p:0.860). Intra operative and postoperative shoulder pain was significantly less in group 2 (p: 0.038, p:0015 respectively).

Conclusion

CSEA is an effective and safe anesthesia method in preventing shoulder pain that develops after TEP surgeries.
OC-111 FIVE YEARS OUTCOME OF LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH PHASIX ST
Authors: Altowaijeri A , Aljomah N , Alshammari S , Binjaloud A , Aldohayan N , Aldohayan A
Published: May 2023

Background

Repair of ventral and incisional hernias (VIHR) is a standard procedure; newly introduced resorbable mesh biomaterials provide an attractive option to reduce the use of permanent synthetic mesh in hernia surgery and reduce its complications. Indeed the data of Phasix resorption started to occur post-maturation of the wound tissue. However, data on the use of slowly resorbable mesh materials remain scarce, and this study aims to evaluate the use of Phasix ST in the laparoscopic repair of VIHR.

Methods

This is a retrospective study of a sequential cohort of patients undergoing laparoscopic VIHR utilizing a Phasix ST mesh. Perioperative characteristics and clinical outcomes were collected.

Results

In total, 26 patients, including 19 females and 7 males, underwent laparoscopic VIHR using Phasix ST from April 2016 to January 2023. All surgeries were performed in a single institution by the same surgeon. The average patient age was 52.6, and the mean BMI was 35.5. All patients had a clean wound classification. The average defect size was 136.4 cm2. All patients were seen in the clinic with a median follow-up of 48 months. We observed four wound seromas, no wound infections, and three recurrences during the five years follow-up period. All occurred in the center of the mesh with severe adhesions to the mesh and tacker

Conclusion

Five years of follow-ups showed 11% recurrence in the same site note, which needs to be reviewed. Further, ten years of follow-up results need to be assessed.
OC-129 A new surgical technique for repair of rectus diastasis and associated hernia: description and initial experience
Authors: Rodríguez-González D , Casanova-Ramos R , Tuñón-Féquant C , Guil-Ortiz B , Montes-Montero A , Arteaga-González I J
Published: May 2023

Aim

Rectus diastasis (RD) is a common pathology, usually associated with midline hernias. Preaponeurotic surgical repairs have been described with complications derived from extensive subcutaneous dissection or suprafascial mesh placement. Other techniques place preperitoneal mesh but midline plication is not performed, with aesthetic disadvantages. We describe a new technique for the correction of ventral hernias associated with RD with midline plication and preperitoneal mesh (MPPM) and report our initial experience.

Material and Methods

We reviewed patients with RD and associated hernia surgically treated using the MPPM technique at our hospital from June 2021 to July 2022. The minimum follow-up time was 6 months.

Results

Forteen patients with RD and associated hernia were surgically treated with MPPM technique, with an average age of 64.1 years (range 38–82 years), 71.4% male and 28.6% female. The mean BMI was 28.8 Kg/m2 (range 18.6–40.0 Kg/m2). Three women (21.3%) had a mean of 1,3 previous pregnancies (range 0–2 pregnancies). The most common types of associated hernia with RD were primary midline hernia (50%), incisional hernia (21.4%), and recurrent midline hernia (28.6%). Half of the RD (50%) were M1-3 and the other half M2-3 (50%) as well as W1 (50%) and W2 (50%). The mean diameter of associated hernia was 3,2 cm (range 1–6 cm). Hematoma was observed in one patient (7,1%) in the first 30 postoperative days. No reccurence was recorded in the follow-up time.

Conclusions

The MPPM technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with RD.
P-003 ASSESSMENT OF UROSTOMY PARASTOMAL HERNIATION FORCES
Authors: Kanabolo D , Kumar Y , Maxwell A , Schade G
Published: May 2023

Introduction

Approximately 10,000 patients undergo cystectomy with ileal conduit diversion annually in the USA, of which ∼ 50% will subsequently develop a parastomal hernia (PSH) at 2 years. Due to the knowledge gap between urostomy surgical factors and abdominal wall forces, we developed a silicone and ex-vivo human cadaver fascia-based model for study. Our objective was to measure the relationship between incision size/type/material and axial tension force (ATF) as a surrogate for herniation force.

Methods

Using incisions (linear, cruciate, circular) ranging 1 to 3 cm (0.5cm increments) in clamped 3″x3″x0.020″ silicone or cadaveric sheets, a dynamometer was hooked to a Foley catheter at the drainage aperture and pulled using a motorized positioning system at 20 millimeters/minute. Balloons were hydrated to 125% incision dimension. Upward ATF was recorded until balloon herniation and repeated up to N=5 membranes/size. As limited cadaveric fascia was available, a single incision size was used.

Results

Controlling for silicone incision size, linear incision ATF was highest. With an average 3cm incision herniation force of 18.58, 8.48, and 2.36 Newtons (linear, cruciate, and circular respectively), linear was greater than cruciate herniation force (p<0.0001), and cruciate was greater than circular (p=0.0039). This was true in cadaveric fascia for linear vs cruciate (p=0.0001) and cruciate vs circular (p=0.0024).

Conclusion

This ex-vivo study suggests incision type/size have predictable influences on ATF for herniation. En-bloc human studies are underway to assess these factors in more clinically optimized models. If confirmed, these data can help to standardize urostomy creation, reducing PSH risk.
P-004 APPENDICITIS CAUSING CHRONIC MESH INFECTION: A CASE SERIES OF TWO PATIENTS
Authors: Willis K A , Pawlak M
Published: May 2023

Aim

To discuss appendicitis as a cause of chronic mesh infection.

Methods

This study reports two patients with previous inguinal hernia repair who presented with recurrent groin infections resulting from appendicitis.

Results

Patient 1 had a history of laparoscopic bilateral inguinal hernia repair, followed by an open repair of a unilateral recurrence. He presented twice with groin pain and discharge. Sinugram demonstrated a superficial tract, but intra-operatively the sinus tract extended to the deep ring where the appendix was adherent and inflamed. There was also a meshoma of the preperitoneal mesh. He underwent appendicectomy and excision of meshoma.

Patient 2 presented with perforated appendicitis with a large pelvic collection extending into the anterior abdominal wall. This was treated with percutaneous drainage and antibiotics. Further presentations with recurrent abscesses prompted a laparoscopy where an inflamed appendix was found adherent to the previous mesh through a hole in the peritoneum in a pre-peritoneal abscess cavity. He underwent appendicectomy and washout without mesh removal.

Both patients remain symptom free at 10 months and 1 month respectively.

Conclusion

Literature review found reports of mesh-related appendicitis but no cases of appendicitis causing chronic mesh infection. Whilst rare, appendicitis causing chronic mesh infection should be considered in patients presenting with recurrent groin pain and abscesses having previously undergone inguinal hernia repair. Whilst we do not have long term follow up data, our experience indicates that these patients can be managed with or without mesh removal, providing the appendix is removed and the source of sepsis controlled.
P-005 SINGLE-PORT VS. MULTI-PORT TOTALLY EXTRAPERITONEAL (TEP) INGUINAL HERNIA REPAIR: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Prassas D , Knoefel W T , Krieg A
Published: May 2023

Objective

The value of single-port totally extraperitoneal inguinal hernia repair (STEP) when compared to the conventional multi-port approach (TEP) is still a matter of controversy. We conducted a meta-analysis of randomized controlled trials comparing the feasibility and safety of the above-mentioned techniques.

Materials and Methods

A systematic literature search for randomized controlled trials (RCTs) comparing the outcome STEP and TEP in patients with inguinal hernia was conducted. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The Odds Ratio and Standardized Mean Differences with 95% Confidence Intervals (CI) were calculated.

Results

Six RCTs were identified, involving a total of 636 cases (STEP: n=328, TEP: n=308). There was a statistically significant difference noted between the two groups regarding return to everyday activities favoring the STEP group (SMD=-0.23; 95% CI [-0.41, -0.06]; p=0.009; 4 studies; I2=9). For the remaining primary and secondary endpoints, intra- and postoperative morbidity, conversion rate, peritoneal tears, major intraoperative bleeding, postoperative haematoseroma, operative time, postoperative pain, chronic pain, cosmetic satisfaction, hernia recurrence and in-hospital length of stay no statistically significant difference was noted between the two study groups.

Conclusions

Current evidence suggests that patients who underwent STEP had similar outcomes to the traditional TEP technique with the exception of time to return to everyday activities, which was reported to be shorter in the STEP group.
P-011 OPEN PREPERITONEAL APPROACH IN AN INCARCERATED ABSCESSIFIED GARENGEOT HERNIA
Authors: Fernandes N , Verdaguer M , Rodrigues V , Martínez P , Bergamini S , Cirera A , López P , López Cano M
Published: May 2023

Aim

The Garengeot hernia is a a rare entity (incidence 0.15–5%) that appears more frequently in elderly women and contents the vermiform appendix. Different surgical approaches are available but the most appropriate one is unknown. Association or conversion to laparotomy may be needed in complicated cases entailing higher morbimortality.

Results

82-year-old female with hypertension, dyslipidemia and left inguinal hernioplasty. She presented acute right inguinal pain with a 1 month of evolution mass associated extended to the limb. Blood tests were normal but CT scan was performed reporting a right incarcerated inguinal hernia with acute perforated and abscessified appendicitis. Besides antibiotics, an open preperitoneal approach was performed. An incarcerated crural hernia was found: the sac was opened, the perforated appendix was reduced and the abscess was debrided. Appendicectomy was performed and after aseptic measures and critical view, a 15×15cm gentamicin impregnated large-pore light-weight polypropylene mesh was placed in the preperitoneal space covering the myopectineal orifice. Patient was successfully discharged 4 days after surgery with no complications after two years of follow-up.

Conclusion

The treatment of a complicated crural hernia in a septic environment in the emergency room represents a challenge. In an incarcerated and abscessified Garangeot hernia, an open preperitoneal approach (modified Nyhus technique) can be safely performed to confront both pathologies. Not only it allows access to the abdominal cavity through a small incision, avoiding the need for a laparotomy, but also favours an optimal exploration and repair of the myopectineal orifice.
P-021 DELAYED ENTEROCUTANEOUS FISTULA AND ENCAPSULATING MESH INFECTION AFTER COMPOSITE MESH REPAIR OF AN ABDOMINAL MIDLINE INCISIONAL HERNIA - COMPLICATIONS 12 YEARS LATER
Authors: Rajaretnam N , Christopoulos P , Sinha S
Published: May 2023

Aim

Mesh infection is a well-recognised complication of incisional hernia repair, however, is usually encountered within months after mesh insertion. Only a few cases have been published where an enterocutaneous fistula has presented many years after mesh repair of an incisional hernia. Here we describe a complicated case of enterocutaneous fistula and mesh infection 12 years after the primary surgery.

Material & Methods

A 44 year-old gentleman presented acutely with a worsening 4 month history of an umbilical discharging sinus with associated fever, intermittent abdominal pain and nausea. There was also an associated hard lump and skin erythema. He previously had a laparotomy, small bowel resection for tuberculosis and ileostomy formation 13 years ago, followed by ileostomy reversal and intraperitoneal incisional hernia repair with composite mesh 1 year later.

Results

Cross-sectional imaging showed a large volume of gas within the mesh with underlying small bowel and collection within anterior abdominal wall, suggesting an enterocutaneous fistula. The patient initially underwent ultrasound guided aspiration of the collection followed by nutritional optimisation prior to another laparotomy, mesh excision and small bowel resection. The mesh was found to have a thick biofilm initially thought to be encased in mycobacterium but further testing was negative for this.

Conclusions

Delayed mesh infection over more than a decade after mesh insertion is rare. It is likely that pre-existing risk factors such as previous TB and small bowel resection with adhesions increased the risk of enterocutaneous fistulation.
P-026 FASCIAL TRACTION WITH EPTFE MESH FOR DEFINITIVE CLOSURE OF CATASTROPHIC ADBOMEN
Authors: Esmailli Ramos M , Gómez Ruiz L , Santiago Peña J C , Cruz Romero P , Arriero Ollero L , Cano Pecharromán E M , Martin Paniagua L , Mesa Ruiz M I , Ortiz González M , Balsa Marín T
Published: May 2023

Aim

Show the benefits of temporary closure with expanded polytetrafluoroethylene (ePTFE) mesh associated with negative pressure therapy (NPT) in the management of catastrophic abdomen.

Material & methods

We present the case of a 74-year-old female who underwent emergency surgery for necrotising fasciitis of the abdominal wall and tertiary peritonitis after a vaginal hysterectomy and anterior colpoplasty, where the use of NPT combined with ePTFE mesh allowed gradual fascial traction until its complete closure (after ten days), restoring the functionality of the abdominal wall.

Results

Temporary abdominal wall closure using NPT with ePTFE mesh allows progressive fascial traction and early closure of the abdominal wall in cases of catastrophic abdomen with low complication rate.

Conclusion

Techniques for temporary abdominal wall closure have led to a significant mortality reduction in cases of complex abdomen. There are several techniques with unclear evidence as to which is optimal. The combined use of NPT with ePTFE mesh is a riveting alternative as it does not adhere to bowel serosa and the risk of eventrations and fistulas are less common.
P-027 Enhanced view totally extraperitoneal technique (e-TEP) for laparoscopic retromuscular inguinal hernia repair- our experience
Authors: Prodan A , Matei M , Cancea B , Turculet C , Beuran M
Published: May 2023

The best approaches to repair inguinoscrotal hernias are still debated. Extended totally extraperitoneal repair technique (e-TEP) represents a modification of the traditional TEP method. The role of this technique is to overcome the limitations of the classical technique (limited dissection space), while still keeping the main advantages.

The e-TEP technique allows an additional dissection space, a large surgical field and a very flexible trocarization, adaptable to many clinical situations and also good tolerance to pneumoperitobeum

Our team uses the e-TEP technique to repair most cases of inguinal hernias.

Between May 2017 and January 2023, we performed 102 operations, using the e-TEP technique. I used macroporous polypropylene mesh 15/12, fixed with cyanoacrylate.

For a total of 102 cases, we registered a total of 6 self-limiting seromas, two cases were converted to open surgery, one wound infection and three recurrences. Patients were followed up one week, three months and one year, postoperatively.

One patient presented with chronic pain one year postoperatively. The operating time was about 60–90 minutes.

Conclusions

Our experience with the e-TEP procedure has been satisfactory. We had no major complications, neither intra, or post-operatively, and the functional results were excellent. The operating time was found to be longer than usual at the beginning of the use of this technique, attributed to the novelty of the technique, the longer laryngeal curve and the complexity of the cases.