bluuebunny/crossref_metadata_2025 huggingface dataset:
P018 COLLABORATIVE APPROACH FOR SIMULTANEOUS REPAIR OF COMPLEX INCISIONAL HERNIA AND STOMA REVERSAL
Authors: Olona Carles , Caro Aleidis , Casanova Raquel , Espina Beatriz , Vadillo Jordi , Sales Ricard , Jorba Rosa
Published: December 2021

Aim

The simultaneous repair of incisional hernias (IH) and the reconstruction of the intestinal transit may pose a challenge for many surgeons. Collaboration between units specialized in abdominal wall and colorectal surgery can favor simultaneous treatment.

We present our experience in the collaboration between specialized units for the simultaneous treatment of complex incisional hernias and ostomy closure.

Material and Methods

Descriptive study of patients undergoing simultaneous surgery of complex IH repair and intestinal transit reconstruction in the period 2018.2021.

All interventions were performed electively and with the collaboration of surgeons experts in abdominal wall and colorectal surgery. Demographic variables, hernias characteristics, surgical techniques, postoperative evolution, morbidity and mortality are recorded

Results

16 patients are included. 8 with ileostomy, 3 lateral colostomies and 5 end colostomies . All the patients presented IH of the middle laparotomy and 12 had stomal hernias associated. The mean diameters of the IH were 16.2cm longitudinal and 11cm transverse. Intestinal transit was reconstructed in 15 cases (94%) and incisional hernia repair in 100%. Component separation was required in 75% of cases (8 posterior and 4 anterior).

Morbidity in the first postoperative month was 18%, requiring 2 reoperations (12%). At the end of the mean follow-up of 10.8 months, 81% of the cases did not present complications.

Conclusions

The collaboration between specialist allows the use of advanced techniques in the simultaneous reconstruction of the abdominal wall and intestinal transit, with good clinical results and patient quality of life.
P051 NATIONAL TRENDS IN VOLUME, COSTS, AND PATIENT RISK PROFILE OF INPATIENTS UNDERGOING INCISIONAL HERNIA REPAIR IN RELATION TO ABDOMINAL SURGERY
Authors: Rios-Diaz Arturo , Morris Martin , Christopher Adrienne , Patel Viren , Broach Robyn , Hsu Jesse , Fischer John
Published: December 2021

Aim

We describe trends in inpatient burden by volume, cost, and patient risk profiles of incisional hernia repair (IHR) as compared to other abdominal surgery (AS) procedures in the United States.

Material and Methods

Patients undergoing AS were identified using the National Inpatient Sample (2008-2018) by ICD-9/ICD-10 codes. National weighted procedure rates and hospital costs were ascertained and plotted using sampling weights and normalized per 1,000,000 people. Regression models allowed identification of statistical significance of trends and prediction of mean differences in rates, costs and patient characteristics.

Results

Over 38,000,000 AS discharges were identified, averaging 3.5 million annually, with over 1,200,000 discharges following IHR (3.1% of all AS). The difference between AS and IHR significantly decreased over time from 12,702 procedures per million (PPM) to 9,039 PPM. Open and laparoscopic AS down-trended (46.2% and 20.8%, respectively), whereas robotic AS up-trended (95.2% [all p < 0.01]). Open IHR down-trended (60.9%) and laparoscopic IHR up-trended (83.6%, [both p < 0.01]). Robotic IHR increased by 99.5% (p = 0.17). Average annual national charges for AS and IHR were $183.8 and $6.6 billion, respectively. Costs increased by 20.3% for AS and 25.6% for IHR. Patients undergoing IHR were 45-64 years old (46%), female (63.1%), White (68.1%), publicly insured (55.1%), with moderate loss of function (43.2%) and ≥2 comorbidities (43.3%).

Conclusions

IH continues to carry a significant societal and healthcare burden. With AS decreasing and IHR remaining stable from 2008 to 2018, the percentage of patients developing IH after AS has increased, as well as cost per IHR, critically underscoring the need to adopt and implement risk reduction and hernia prevention.
P063 COMPARATIVE ANALYSIS OF INCISIONAL HERNIA REPAIRS WITH MESH IN SUBLAY AND ONLAY POSITION: PROSPECTIVE SERIES
Authors: Amador Sara , Gómez Montserrat Juvany , Martin Aurora Aldeano , Palomino Arantzazu Rada , Valentini Mauro , Alonso Xavier Mira
Published: December 2021

Aim

Sublay mesh placement in incisional hernia repair (IH) does not seem to show lower surgical site infection (SSI) or recurrence than onlay placement, according to a recent review. Our aim was to analyze both techniques in an abdominal wall department.

Material and Methods

Prospective data collection of all IHs for four years. Results were analyzed at one month and during follow-up. The characteristics of IH, operative time, incidence of SSI and recurrence was compared by groups depending on location of the mesh in sublay (SM) or onlay (OM).

Results

“The surface area of the hernial defect was greater in the SM group (216±338 vs 68±84cm2; P = 0.002), as well as longer surgical time (131±91 vs 70±54 min; P < 0.001). A higher number of hematoma was diagnosed in the SM (OR 1.39; CI95% 1.21-1.60; P = 0.18) in 88 operations. No differences were observed in the incidence of SSI between the groups (27.7 vs 21.7%; P = 0.78). 74 patients completed a mean follow-up of 11.4 months, any difference in IH recurrence appeared (5.8 vs 9.1%; P = 0.63) in SM group vs OM group, respectively.

Conclusions

A SM repair is performed in IHs with large defects, which entails a longer surgical time and the appearance of hematoma, although no statistically significant differences in the rate of SSI or IH recurrence was observed between SM and OM repair.
P080 ROUTINE ELECTIVE ILIOHYPOGASTRIC NEURECTOMY IN LICHTENSTEIN INGUINAL HERNIA REPAIR
Authors: Mitura Kryspin
Published: December 2021

Aim

Chronic postherniorraphy pain occurs in 8-25% of patients undergoing groin hernioplasty with mesh insertion. The most common cause for inguinodynia is neuropathy resulting from nerve damage or entrapment during mesh fixation. With wide mesh insertion there is often a conflict between upper prosthesis margin and an iliohypogastric nerve. The aim of this study is to present a routine elective iliohypogastric neurectomy in Lichtenstein groin hernia repair for prevention of chronic inguinodynia.

Material and Methods

Between 2018 and 2020, 398 patients were admitted for open inguinal hernia repair. 218 patients underwent a Lichtenstein repair with transection of iliohypogastric nerve before implantation of 10x14 polypropylene mesh (IH group). In the control group of 180 patients all nerves were spared (C group). Follow-up was conducted on 1 POD,1 month, and 1 year after surgery.

Results

1 month after a surgery a pain was reported in 24 (11%) patients in IH group (2.9% severe; 8.1% moderate; 89% no pain), and 48 (26.7%) patients in C group (3.9% severe; 22.8% moderate; 73.3% no pain). 1 year after a surgery a persistent pain was reported in 1 (0.4%) patient in IH group, and in 5 (2.8%) patients in C group. An incidence of inguinodynia was significantly lower after iliohypogastric neurectomy (0.5% vs. 2.8%; p < 0.001).

Conclusions

Routine neurectomy of iliohypogastric nerve appears to be an effective technique in chronic inguinodynia after open mech repair for inguinal hernias. Iliohypogastric nerve resection allows to place a flat synthetic mesh with wide coverage of myopectineal orifice with no need for additional mesh trimming.
P081 CHRONIC GROIN PAIN IN SPORTSMEN. EVIDENCE-BASED IN EXPERIENCE
Authors: Santilli Osvaldo , Santilli Hernán , Scaravonati Rodolfo , Nardelli Nicolás , Etchepare Hernán
Published: December 2021

Aim

The main objective of this study is to describe and analyze the assessment and treatment of chronic groin pain (CGP) based on the experience collected in 20 years.

Material and Methods

Descriptive, observational, and retrospective study. It is a multidisciplinary team formed by surgeons, physiotherapists, orthopedists, and imaging specialists. That had developed an assessment, diagnosis, and treatment algorithm for (CGP), which have been implemented for more than 20 years. Follow-up included a record of clinical examination findings, clinical entities diagnosed, ultrasound findings, physiotherapy treatment, operation notes, and postoperative recovery, time to return to sporting activity, and complications.

Results

In the period between August 2000 and August 2020, we assessed 9996 patients with CGP. (91%) men and (9%) women with a mean age of 30 (SD: 11.21).

The most frequently practiced sports were: football (43%), rugby (25%), tennis (12%).

The most frequent clinical entities registered were tendinopathies (69%): iliopsoas-pectineus- related (36%) and adductor-related (33%). Tendinopathy sports rehabilitation treatment: (95.7%) presented total recovery in 45 days; 260 patients (4.3%)intra-tissue percutaneous electrolysis was used with favorable recovery. Only 16 patients required tenotomies

The ultrasound has been used to detect signs of adductor tendinopathy (92%) and sportsman hernia, but has low sensitivity in iliopsoas-pectineus tendinopathy (21%).

Conclusions

The algorithm used has proven to be safe and successful.

Tendinopathies and Sportsman's hernia are the most common causes of chronic groin pain in sportsmen, presenting together in 82% of the cases.

TAPP hernioplasty repair, followed by physical rehabilitation offered excellent results to treat sportsman hernia.
P083 PARASTOMAL HERNIA REPAIR - EXPERIENCES WITH THE MODIFIED RETROMUSCULAR SUGARBAKER TECHNIQUE
Authors: Gröger Christian , Kundel Lena , Adam Ulrich , Riediger Hartwig
Published: December 2021

Aim

Parastomal hernias are complex findings with a high recurrence rate. Various methods were described for surgical repair. A new method for the treatment of parastomal hernias with extraperitoneal mesh placement was published in 2016 (Pauli et al.). Recently, open retromuscular repair has been shown to be safe, effective and durable (Beffa et al. 2017). Still, there are concerns regarding mesh related complications (Tastaldi et al. 2017).

Material and Methods

All patients who underwent an open or laparoscopic modified retromuscular Sugarbaker parastomal hernia repair at our institution were identified. We describe the patient characteristics, operative details, perioperative results and the follow-up.

Results

Between January 2018 to May 2021 14 patients received surgical repair for parastomal hernia at our institution. Eight of these patients received retromuscular extraperitoneal mesh placement (4 open, 4 laparoscopic) in the aforementioned technique. The median age was 72 years (65 – 85) and the median BMI was 31 kg/m² (26 – 34). Six patients had a urostomy and two had a colostomy. One patient had a recurrent parastomal hernia after previous intraabdominal mesh repair. The median operating time was 223 minutes (144 – 425). Median Mesh size was 300 cm² (225 – 750). Two minor complications (Clavien-Dindo Classification Grade II) demanding pharmacological treatment. The median hospital stay was 8 days (4 – 17). Median follow up was 17 month (range 1 – 26). Recurrence rate was 25 %.

Conclusions

The modified retromuscular sugerbaker technique seems to be safe and feasible as shown by our data. Due to the extraperitoneal mesh position, we see fundamental methodological advantages. Further studies are necessary for long-term results.
P084 MESH USE IN THE UNITED STATES: MESH TYPES AND THEIR INDICATIONS
Authors: Fadaee Negin , Khanmohammed Zayan , Tung Robert , Huynh Desmond , Towfigh Shirin
Published: December 2021

Aim

Synthetic non-absorbable mesh repair is considered standard of care for most hernias in the United States (US). The introduction of biologic absorbable mesh in the 2000’s has changed this practice and now novel synthetic absorbable and hybrid meshes are available. We aim to describe US trends of mesh use.

Material and Methods

We surveyed the Abdominal Core Health Quality Collaborative database for all repairs using mesh from 2012 to 2021. Mesh types and indications were analysed.

Results

Among 47,555 patients who underwent hernia repair with mesh, the majority were with synthetic non-absorbable meshes (96%). Absorbable mesh was placed in 2,039 (4%) patients and included biologic absorbable (893, 44%), synthetic absorbable (1,070, 52%), and hybrid (76, 4%) meshes. Synthetic non-absorbable mesh use was significantly predominant in all wound classes, including dirty/contaminated wounds (P < 0.01) [Figure 1]. Over time, we noted a trend toward lower incidence of absorbable and hybrid mesh use, from 18% to 2% (P < 0.01). Interestingly, we noted a relative increase in annual incidence of absorbable and hybrid mesh use in clean wounds, from 20% to 63% (P < 0.01) [Figure 2]. Figure 1Mesh type used in each wound classFigure 2Absorbable mesh use in clean vs. not clean wounds.

Conclusions

In the United States, synthetic non-absorbable meshes are commonly used during hernia repairs in dirty and contaminated fields. At the same time, there is a significant increase in the use of absorbable and hybrid meshes in the repair of hernias with clean wound classification. The costs and long-term outcomes of such surgeon choices have yet to be validated.
P085 CLINICAL AND LONGITUDINAL PATIENT REPORTED OUTCOMES AFTER TRANSVERSUS ABDOMINIS RELEASE: A SINGLE SURGEON EXPERIENCE
Authors: Christopher Adrienne , Morris Martin , Barrette Louis-Xavier , Broach Robyn , Fischer John
Published: December 2021

Aim

Posterior component separation with transversus abdominis release (TAR) is a novel complex abdominal wall repair technique that maximizes medial myofascial flap advancement in a vascularized, pre-peritoneal plane. Here, we add to a growing body of literature on this technique by assessing longitudinal clinical and patient reported outcomes (PROs) after ventral hernia repair (VHR) with TAR.

Material and Methods

Adult patients undergoing VHR with TAR between 10/1/2015 and 01/15/2020 by a single surgeon were retrospectively identified. Patients with parastomal hernias and <12 months of follow-up were excluded. Clinical outcomes and PROs using the Abdominal Hernia Questionnaire (AQH) and Hernia Related Quality of Life Survey (HerQLes) were assessed.

Results

57 patients were included with a median age and body mass index of 60 and 30.6 kg/m2, respectively. The average hernia defect was 384 cm2 [IQR 205-471], and all patients had retro-muscular mesh placed. The most common complications were delayed healing (19.3%) and seroma (14.0%). One patient required return to the OR for management of a complication and there were no cases of mesh infection or explantation. Previous hernia repair and concurrent panniculectomy were risk factors for developing any complication (p < 0.05). One patient (1.8%) recurred at a median follow-up of 25.7 months [IQR 18.2-42.1]. Significant improvement in disease-specific PROs was observed and maintained throughout the follow-up period (pre to post p < 0.05).

Conclusions

Longitudinal clinical and patient-reported outcomes after VHR with TAR are limited. We conclude that TAR is a safe and efficacious adjunct in the repair of complex hernia defects.
P091 POSTOPERATIVE OUTCOMES THAT MATTER TO PATIENTS UNDERGOING INGUINAL HERNIA REPAIR: A QUALITATIVE STUDY
Authors: Gram-Hanssen Anders , Laursen Jannie , Zetner Dennis , Rosenberg Jacob
Published: December 2021

Aim

Explore which postoperative outcomes are important to patients operated for inguinal hernia to gain a better insight into the patient experience going through surgery.

Material and Methods

Qualitative study using semi-structured individual interviews. Based on phenomenology and hermeneutics. Participants were all male, between 44-66 years of age, and had undergone inguinal hernia repair. Patients were interviewed either shortly after surgery (≤ 10 days) or 3-6 months postoperatively. Data were analyzed with directed content analysis based on six domains defined a priori based on the literature. Reported according to the COnsolidated criteria for REporting Qualitative research (COREQ) and Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0).

Results

Ten patients were included and interviewed. Data aligned well with the six predefined domains. Major domains: Function, Sensation, Expectations. Minor domains: Appearance, Social Aspects, Satisfaction with surgeon/staff. Preoperative functional limitations were the main motivation for seeking surgery, and postoperative functional improvement seemed to be the most important factor determining overall patient satisfaction.

Conclusions

Patients consider a wide range of factors when assessing the outcome of their inguinal hernia repair. Our results suggest that the current practice of outcome assessment of inguinal hernia repair may be too narrow and may not adequately reflect the patients’ experience. This study is a part of an ongoing development of a Core Outcome Set for inguinal hernia research.
P099 READMISSIONS AND EMERGENCY ROOM VISITS FOLLOWING OUTPATIENT AND INPATIENT HERNIORRHAPHIES
Authors: Shmelev Artem , Batarseh Laith , Ahad Ahmad
Published: December 2021

Aim

Analysis of all healthcare encounters (readmissions and emergency department visits, EDV) following both inpatient and outpatient abdominal hernia repairs (AHR), with respect to the timeline of such encounters.

Material and Methods

Patients undergoing AHR were identified in Maryland State Inpatient and State Ambulatory Surgery and Services Databases, 2016-2017, and all their hospital and ED encounters were assembled into a comprehensive database, covering almost 95% of all AHR performed in Maryland.

Results

Of the total 26,215 patients who underwent AHR (3,333 inpatient and 22,950 outpatient; 48.7% inguinal and 53.0% ventral/umbilical), 5,802 (22.1%) had at least one postoperative encounter (4,186 EDV, 1,415 readmissions, and 248 encounters for mostly outpatient another AHR). 419 (80.4%) post-operative encounters within the first 48 hours were EDV and 98 (18.8%) were readmissions. Fraction of EDV within later encounters was in 69.6–71.1% range. Most frequent reasons for EDV were urinary complaints (24.1%, 10.6% and 4.0% on POD 0–2, 3–7, and 8–30, respectively), followed by pain control issues (18.1%, 24.9%, 14.4%) and delayed return of bowel function or constipation (10.5%, 9.9%, 3.4%). Readmissions mainly occurred for aforementioned GI complaints (15.3%, 19.9%, 6.9% on POD 0–2, 3–7, and 8–30, respectively), local surgical site infections (5.1%, 15.5%, 26.8%), and respiratory complications (8.2%, 6.6%, 4.1%).

Conclusions

2.3% of all patients had at least one readmission while 6.4% patients had at least one EDV within 30 days following herniorrhaphy. Early postoperative EDV were mainly caused by urinary complaints, inadequately controlled pain, or delayed bowel function. Factors associated with these largely preventable complications require dedicated analysis.
P101 BIOSYNTHETIC MESH LIMITS ADHESION FORMATION FOLLOWING INCISIONAL HERNIA REPAIR
Authors: Manchip Gillian , Shaw Alex , Herrick Sarah
Published: December 2021

Aim

Adhesions are fibrous bands of scar tissue that form following peritoneal injury, commonly intra-abdominal surgery, and are associated with serious morbidity such as small bowel obstruction and pain. Surgical meshes used for incisional hernia repair are associated with increased incidence and severity of adhesions. There is limited consensus on which mesh may induce the least adhesions following incisional hernia repair, and most previous data has come from experimental animal models. We aimed to evaluate existing primary research to investigate whether biological mesh limits adhesion formation compared to synthetic or biosynthetic mesh when used in patients for incisional hernia repair and also to assess whether there is correlation with existing animal model data.

Material and Methods

A systematic search was conducted on PubMed and EMBASE. The number of mesh-related adhesions, character of adhesions and adhesion-related complications were documented. Results were compared to previously published results from animal models.

Results

Thirty-two studies were included, 11 of which did not document whether the adhesions were mesh related. A total of 14,161 participants underwent incisional hernia repair, 8,526 of whom were included in follow-up analysis. Overall, 9.7% developed adhesions. Biological mesh induced a high rate of dense adhesions, whereas biosynthetic mesh induced loose, filmy adhesions suggested to cause fewer complications. These findings were similar to findings from experimental animal models.

Conclusions

Bio-synthetic mesh was superior in causing fewer and less dense adhesions. Further analysis of mesh-induced adhesion formation on a larger scale is required to fully understand the consequences of different mesh types.
P104 POSTOPERATIVE OUTCOME AND COMPLICATIONS AFTER STOMA REVERSAL SURGERY WITH CICATRIAL HERNIA HERNIA PROPHYLAXIS BY MESH AUGMENTATION IN SUBLAY TECHNIQUE USING GORE® BIO A® MESH
Authors: Ceno Marsela , Paul Dietmar NV , Berger Dieter
Published: December 2021

Aim

At the surgery hospital of Klinikum Mittelbaden in Baden-Baden (Prof. Dr. Dieter Berger) stoma reversal surgery was performed on 127 patients in the time from Nov. 15, 2010 to Mar. 11, 2015.

All 127 patients were treated with a resorbable synthetic mesh (GORE® BIO-A® mesh) in sublay technique to close abdominal wall incisions.

Primary wound closure was carried out in all cases.

In order to evaluate the rate of postoperative hernias, which literature reports to be over 30 percent and a common complication, all 127 patients were included in a prospective study.

Material and Methods

In total, 104 of the included patients (n = 127) took part in the follow-up examinations. 72 patients underwent clinical examinations and imaging diagnostics, 21 were surveyed on the telephone whenever their presentation at a follow-up exam was impossible, whereas 11 patients deceased during the follow-up period. These cases were analyzed on the basis of the previous examinations which had been part of the respective health records.

The follow-up examination took place after a median time span of 87 weeks (8 -218 weeks).

Results

The total herniation rate of 7.7 percent (n = 8/104) in the examined patient population was thus much lower than described in the literature.

Conclusions

According to our own prospective analysis, we were able to register a very low herniation rate compared to the literature when the resorbable synthetic mesh (GORE® BIO-A®) was applied in sublay technique for stoma reversal.

One disadvantage could lie in the increased perioperative wound infection rate.

5/8 hernias were observed after the occurrence of perioperative wound infections.
P115 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIA REPAIR IN DECOMPENSATED CIRRHOSIS
Authors: Pisarenco Sergiu , Anghelici Gheorghe , Zugrav Tatiana
Published: December 2021

Aim

To evaluate the possibilities, benefits and safety of laparoscopic treatment of inguinal hernias in patients with cirrhosis of the liver and ascites, in particular to evaluate the TAPP approach for the treatment of inguinal hernias in patients with cirrhosis of the liver and ascites.

Material and Methods

Group I - TAPP repair in 16 patients with liver cirrhosis and ascites. Group II - Lichtenstein type hernioplasty in 15 patients with liver cirrhosis and ascites. All patients underwent planned surgery after dosing preoperative laparocentesis and correction of liver function indices.

Results

In the first group of patients no complications developed, no suppurative complications were observed, no edema, no leakage of ascites fluid. Postoperatively, all patients recovered well, noticed less pain. Only 25 percent of patients required analgesics. Patients were discharged at home 3-5 days postoperatively. In group II - minor complications were observed: 1 local hematoma, 1 seroma. Postoperative pain syndrome was more pronounced. All patients required analgesics. Duration of hospitalization 4-6 days. During a 10-month follow-up, no patients had recurrence and chronic pain.

Conclusions

TAPP repair provided the opportunity to assess macroscopic changes in the liver and possibly to perform liver biopsies, if necessary. TAPP repair reduces days of hospitalization and postoperative recovery by reducing pain syndrome with a low percentage of analgesics. TAPP repair can be a useful treatment option for patients with liver cirrhosis accompanied by ascites.
P134 ROBOTICALLY ASSISTED EXTENDED VIEW TOTALLY EXTRAPERITONEAL VENTRAL HERNIA REPAIR (ETEP) - ESTABLISHMENT OF A NEW SURGICAL TECHNIQUE
Authors: Mück Björn , Heinzelmann Frank , Vogel Robert , Büchler Peter
Published: December 2021

Aim

Even today, operations which include retromuscular mesh placement are usually performed using an open approach. Thanks to advent of robotics, these technically demanding operations can be carried out using minimally invasive techniques. The objective of this investigation is to establish a novel minimally invasive surgical method as part of a feasibility study in a hospital providing specialised care.

Material and Methods

We carried out a retrospective analysis, out of all patients who were operated on a ventral hernia, using a robotically assisted totally extraperitoneal technique, during the period between September 2019 and May 2021. For evaluation we used data from our hospitals information system. All patients had given their consent, to participate in the Herniamed quality assurance study.

Results

From September 2019 to May 2021, 33 patients underwent robotic surgery on a ventral hernia, using a totally extraperitoneal approach. 23 patients had an incisional hernia (69.70%), 10 patients had a primary hernia (30.30%). We did perform a total of 3 unilateral and 2 bilateral Transversus Abdominis Releases (TAR). A lateral approach was chosen in 26 patients and a caudal “bottom-up” approach in 7 patients. There were no intraoperative complications. A conversion was not necessary. Postoperative complications did occur in 3 patients (2 Clavien Dindo 1, 1 Clavien Dindo 3a). Reoperation was not needed.

Conclusions

The eTEP technique is a promising surgical method, that can also be carried out in a hospital providing specialised care, with an acceptable risk of complications. This technique enables us, to combine the advantages of minimally invasive surgery with those of extraperitoneal mesh placement.
P139 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR FOR SMALL AND MEDIUM PRIMARY UMBILICAL AND MIDLINE HERNIAS
Authors: Mitura Kryspin
Published: December 2021

Aim

Complications of open mesh repair for primary umbilical and midline hernias (PUMH) may lead to significant re-admissions and follow-up costs. Although laparoscopic intraperitoneal onlay mesh repair reduces infection rates, especially in overweight patients, it’s controversial in these hernias, mainly due to potential adhesions’ formation. Laparoscopic transabdominal preperitoneal technique (lap-TAPP) may address these issues, as it combines advantages of both open and laparoscopic approaches. The aim of this study is to present the initial results of lap-TAPP for PUMH in regard to its feasibility and complication rates.

Material and Methods

We evaluated 25 consecutive cases of lap-TAPP repair for PUMH. Patients’s characteristics, intraoperative findings, and postoperative complications after 30-days follow-up were analyzed.

Results

21 male and 4 female patients were included in analysis (mean BMI 29.8 kg/m2). Surgery time was 82 minutes (55-120). We found 20 umbilical and 11 epigastric linea alba hernias. Mesh size was 144cm2 (120-225); mean hernia defect width was 25mm (10-40). In 9 patients (36%) the peritoneal rents were created which were easily closed with sutures. All patients were discharged on 1 POD with no complications. After 30-days we found no recurrences or bulging, no pain complaints. We found one subcutaneous small hematoma with no need for intervention.

Conclusions

Laparoscopic TAPP for small and medium PUMH is a safe and feasible technique with low complication rate. However, this method is technically demanding and time consuming while performed with laparoscopic approach as it requires precise and subtle plane dissection, and non-ergonomic closure hernia defect.
P140 OBSERVATIONAL STUDY WITH ONE YEAR FOLLOW-UP ON ROBOTIC ASSISTED RETRO-RECTUS VENTRAL HERNIA REPAIR (RTARUP) WITH A SELF-FIXATING MESH
Authors: Muysoms Filip , Dewulf Maxime , Nachtergaele Femke , Pletinckx Pieter
Published: December 2021

Aim

Laparoscopic retro-rectus ventral hernia repair avoids the need for intra-peritoneal mesh placement and penetrating mesh fixation. The robotic platform facilitates the execution of this technique.

Material and Methods

From a prospective consecutive single center database all patients that underwent a robotic assisted trans-abdominal retro-rectus ventral hernia repair (rTARUP) via lateral single docking using a self-fixating mesh (ProGrip) were identified.

Results

Between September 2016 and December 2019, 203 patients were included. There were 89 (44%) umbilical hernias, 34 (17%) epigastric hernias and 80 (39%) incisional midline hernias. Patients had a mean BMI of 29 kg/m2. The mean hernia diameter was 3.2 cm and mainly located in zone M2-M3-M4 of the EHS classification. The mean operative time was 85 min (SD: 33 min) and all except one were clean operations. The self-fixating mesh was mostly 15 cm wide with a variable length between 15 and 30 cm. No intra-operative complications or conversions to open surgery. Intra-hospital complications were seen in 12 patients (6%) and one patient needed a reoperation for bleeding. The operation was performed in day care in 37% of patients and hospital stay was less than 24 hours in 80%. There were 6 readmissions within 30 days of surgery (3%). At 12 months clinical follow-up 3 patients were documented with a recurrence and 2 underwent an laparoscopic intra-peritoneal hernia repair. Due to COVID-19 restrictions a clinical follow-up was only possible in 73 % of patients and needs updating.

Conclusions

This case series reports favorable early clinical outcome of an innovative retro-rectus repair using the robotic platform.
P145 DERMOID CYST MASQUERADING AS INCARCERATED INGUINAL HERNIA
Authors: Ramadan Moh'd Shafiq , Al-Zuhd Huda , Atari Anas
Published: December 2021

Aim

“For pre operative optimization and educational purposes, rare possibilities should be included in the differential diagnosis””

Material and Methods

“CASE REPORT.

Inguinal hernia is one of the common operations done by surgeons, often diagnosed clinically. Here we present a case of 29 year old male patient presented with inguinal swelling for 3 years. He was admitted for the surgical ward as a case of incarcerated inguinal hernia for elective repair under GA. Intra op the mass was not consistent with inguinal hernia, two other possibilities were a concern that can cause the swelling; 1) testes, which was excluded by examining the scrotum, 2) Dermoid/Epidermoid cyst which was checked by the mass content of hair and pasty fluid”

Results

“DERMOID CYST”

Conclusions

“Most surgeons depend on clinical picture in diagnosing inguinal hernia, thus even other rare possibilities should be included in the differential diagnosis.

Unusual presentations of inguinal hernia should be having radiological evaluated.”
P155 DE GARENGEOT HERNIA: A CASE REPORT
Authors: Ferri Enrico , Fanelli Melania Claudia , Latham Lorenzo , Inversini Davide , Odeh Murad , Ietto Giuseppe , Pappalardo Vincenzo , Carcano Giulio , Morabito Marika
Published: December 2021

Aim

“The De Garengeot’s hernia, from Rene De Garengeot, who was the first to describe the appendix inside a femoral hernia sac in 1731, is a rare type of crural hernia. The diagnosis is challenging and surgery must be performed without delay. The incidence of appendicitis in this type of hernia is about 0.08-0.13%. The aim of this work is to describe our experience in the management of this rare subtype of hernia in a 82-year-old women”

Material and Methods

“A 82-year-old patient with a right groin bulge presented to the Emergency. At the physical examination the abdomen was treatable; there was no sign of bowel obstruction. Blood test values were normal, except for a high PCR value. The US of the groin region demonstrated a right femoral hernia containing a bowel tract, irreducible at the probe’s pressure. The patient underwent surgery, with diagnosis of De Garengeot’s hernia; a direct hernia repair followed by an open appendectomy were performed. The patient did not present any complications and was discharged on the second postoperative day”

Results

“The De Garengeot hernia is a rare entity that requires an early treatment; the preoperative diagnosis is difficult and often clinical features are similar to a common incarcerated hernia. There are many surgical options for the management of the De Garengeot hernia, but there is not a consensus for the best surgical approach”

Conclusions

“De Garengeot's hernia is rare, being indistinguishable from an incarcerated femoral hernia in general. This case report is about a De Garengeot’s hernia patient, who presented a good recovery after surgery.”
VP007 MULTIRECIDIVATED DESMOÍD TUMOR OF THE THORAX-ABDOMINAL WALL
Authors: Hernando Luis Blázquez , Guerrero Belén Porrero , Mena Antonio , Villar Jose Manuel Molina , Saldaña David , Monclús Javier López , Lersundi Alvaro Robín del Valle , Méndez Carlos San Miguel , Rodríguez Joaquin Muñoz , Ureña Miguel Ángel García , Cebrián José María Fernández
Published: December 2021

Aim

Treatment of recurrent desmoid tumors represents a real challenge for the surgeon. The purpose of the video is to show the treatment of a multirecidivated complex desmoid tumor that affects the lateral thoracoabdominal wall.

Material and Methods

24-year-old woman with the diagnosis of recurrent desmoid tumor. She was operated in 2014 for a 10 cm desmoid tumor in the left chest wall with affected margins in the biopsy. In 2016 she underwent surgery for a 5 cm recurrence, which was excised en bloc along with the 6th, 7th, 8th and 9th rib arches. In 2018 she presented a recurrence in the scar treated by radiotherapy. She now presents a recurrence that in the CT scan is seen as an 8 cm tumor that affects the thoraco-abdominal wall.

Results

We perform a complete resection with free margins and “en bloc” resection of the 8th, 9th, 10th and 11th rib arches. We repair the defect using a reverse TAR and rebuild the wall with the Madrid APPROACH technique with BioA and polypropylene meshes.

The patient was discharged 11 days after surgery without any complications. The pathological study showed an 8 cm desmoid tumor with free surgical margins. The patient a year after surgery remains disease free.

Conclusions

The resection of a desmoid tumor that affects the abdominal and/or thoracic wall, especially if it is recurrent, represents a challenge for the surgeon. Component separation techniques and Madrid APPROACH may be very useful to achieve an optimal repair.
O07 SHORT-TERM OUTCOMES OF A MULTICENTRE PROSPECTIVE STUDY USING A “VISIBLE” PVDF ONLAY MESH FOR THE PREVENTION OF MIDLINE INCISIONAL HERNIA
Authors: Rodicio Jose , Miguel Carlos San , Monclús Javier López , Moreno Maria , López Patricia , Amoza Sonia , Díaz Tamara , Lopez Antonio , Bear Isabel García , Alonso Alfredo , Menéndez Rafael , Díez Isabel , Ureña Miguel Ángel García
Published: December 2021

Aim

Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under MRI.

Material and Methods

This is a prospective multicentre observational cohort study. Preliminary results from the first three months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. MRIs were performed six weeks after treatment. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position.

Results

Between July 2016 and December 2020, 178 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with BMI being the only significant risk factor (OR = 1.14, 95% CI = 1.00-1.31, p = 0.048). The formation of a seroma was also associated with BMI (OR = 1.11, 95% CI = 1.02-1.21, p = 0.02).

Conclusions

The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to understand how the mesh behaves during the early process of integration.
O08 BIOMECHANICS OF MANUAL, STAPLED, AND MANUAL-STAPLED SUTURES ON FASCIA LATA. TIPS FOR ABDOMINAL WALL SURGEONS
Authors: Lauro Enrico , Corridori Ilaria , Luciani Lorenzo , Leo Alberto Di , Sartori Alberto , Andreuccetti Jacopo , Scudo Giovanni , Motta Antonella , Pugno Nicola
Published: December 2021

Aim

No data on the biomechanical properties of staplers’ use in the repair of abdominal wall defects are available. Our objective is to study prospectively the biomechanical properties of manual, stapled and mixed manual/stapled fascial sutures.

Material-Methods

Stress/strain tests were performed on 16 human cadaver fascial samples. The data on strength, strain (deformability), Young’s modulus (elasticity), and dissipated energy (toughness modulus) were recorded for each type of suture.

Results

Stapled and mixed suture showed a significantly higher strength (manual 0.83, stapled 2.10, mixed 2.68 MPa), and a trend towards a higher strain as compared to manual sutures (manual 344, stapled 249, mixed 280%). Stapled and mixed suture were four-fold higher as compared to manual sutures (manual 1.779, stapled 7.374, mixed 6.964 MPa). Manual and mixed sutures showed significantly higher dissipated energy (manual 0.99, vs stapled 0.73, vs mixed 1.35 mJ-mm3).

Conclusions

Stapled and mixed sutures have better strength performances than manual sutures. On the other hand, stapled and mixed sutures have significantly higher Young’s modulus and lower ultimate strain, showing less deformability, possibly translating in less efficiency in large midline defects, where manual sutures might display higher elasticity. Also, hand-sewn sutures (in manual or over-sewn stapled) appear to increase the ability to absorb mechanical energy, whereas stapled sutures showed to be less tough. Furthermore, an over-sewn stapled suture, as compared to a stapled suture, gains in term of strength, ultimate strain, Young’s modulus, and dissipated specific energy, suggesting the need of over-sewn stapled sutures in case of larger fascial defects.
O10 REINFORCED TENSION LINE SUTURE RESULTS IN LOW INCISIONAL HERNIA RATE AFTER CRS/HIPEC OPERATIONS
Authors: Wenzelberg Charlotta , Petersson Ulf , Syk Ingvar , Rogmark Peder
Published: December 2021

Aim

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis entails several risk factors for incisional hernia (IH). At our institution fascia closure has been performed in a 4:1 manner with a 2-0 polydiaxanone suture (the PDS-group) or a 2-0 polypropylene preceded by a reinforced tension line (RTL) suture (the RTL-group). Our hypothesis was that reinforcing the suture line results in fewer IH at one year.

Material and Methods

Single-center retrospective study on primary CRS/HIPEC 2004-2019. CT-diagnosed IH one year ±3 months postoperative. Additional data retrieved from clinical records and a prospective CRS/HIPEC database.

Results

Of 193 patients, 63 were not evaluable for IH of which two, both in the PDS-group, were reoperated for fascial dehiscence (FD). 130 patients; 83 (45 women) in the PDS- and 47 (23 women) in the RTL-group, mean age 57 years (19-77) remained. RTL-patients were five years younger (54 vs 59), had a higher Karnofsky index and less bleeding (807 vs 1409 mL). No differences regarding sex, BMI, recent midline incisions, excision of midline scars, peritoneal cancer index score, complications (Clavien-Dindo 3b or higher), neo-adjuvant or adjuvant chemotherapy were found. Twelve IH (9%) were found, 11 (13%) in the PDS- and 1 (2%) in the RTL-group (p = 0.055).

Conclusions

Despite many potential IH risk factors, the overall IH-incidences do not seem higher than after laparotomies in general. The RTL-group showed 2% IH compared to 13% in the PDS-group. The PDS-group were further burdened by two FD. The results are clinically relevant, suggesting an advantage with RTL-closure for these patients.
O20 ASSESSING THE VALIDITY AND COVER RATE OF NATIONAL HERNIA REGISTERS
Authors: Axman Erik
Published: December 2021

Aim

To assess the validity and cover rate of the Swedish hernia register.

Material and Methods

Annual validation of the Swedish Hernia Register has been carried out since the start in 1992 and since 2013 in a more standardized way to allow a systematic data collection and evaluation. 10% of all participating units are randomly selected each year in a specific region of Sweden, ensuring a systematic validation of all regions from North to South. Data from 2013 to 2018 was analyzed regarding data quality and from 2014 to 2018 regarding cover rate. All operations registered at the validated clinics was checked against the Swedish Hernia Register to assess cover rate. 50 operations were randomly selected at each clinic and data in the Swedish Hernia register was compared to the medical records to evaluate data quality.

Results

In total 55 participating units were evaluated and 73764 variables compared to medical records. Cover rate between 2014 to 2018 was 97% and proportion of correct variables was 98%. Most frequent errors where ASA-grade, date at which the patient was put on the waiting list and postoperative complications.

Conclusions

This unique validation of a national hernia register show a high cover rate and good quality of data. Efforts to maintain and improve national registers are of great importance. Research with data from the Swedish hernia register should be evaluated on the basis of the results presented in this study.
O23 SURGICAL REPAIR OF PARASTOMAL BULGING - A REGISTER-BASED STUDY
Authors: Krogsgaard Marianne , Gögenur Ismail , Helgstrand Frederik , Andersen Rune Martens , Danielsen Anne Kjærgaard , Vinther Anders , Klausen Tobias , Hillingsø Jens , Christensen Bo Marcel , Thomsen Thordis
Published: December 2021

Aim

To examine the incidence of primary and recurrent repair and types of repair performed in patients with parastomal bulging.

Material and Methods

We linked prospectively collected data on parastomal bulging from the Danish Stoma Database to surgical data on repair of parastomal bulging from the Danish National Patient Register. Survival statistics provided cumulative incidences and time until primary and recurrent repair

Results

Of 1016 patients, registered from 2010-2017 with a permanent stoma and a parastomal bulge, 180 (18%) underwent surgical repair. The cumulative incidence of a primary repair was 9% (95% CI [8%; 11%]) within 1 year and 19% (95% CI [17%; 22%]) within 5 years after the occurrence of a parastomal bulge. For colostomies and ileostomies, we found similar probability of undergoing primary repair.

For recurrent repair, the 5-year cumulative incidence was 5% (95% CI [3%; 7%]). The probability of undergoing further recurrent repair was 33% (95% CI [21%; 46%]) within 5 years. For primary repair, open or laparoscopic repair with mesh (43%) and stoma revision (39%) were performed almost equally frequent. Stoma revision and repair with mesh could precede and follow one another as primary and recurrent repair. Stoma reversal was performed in 17% of patients.

Conclusions

Our data offered a new and comprehensive view of the course of surgical treatment of parastomal bulging. Five years after the occurrence of a parastomal bulge the estimated probability of undergoing a repair was 19%. The probability of undergoing recurrent repair was high and stoma reversal more common than expected.
O27 THE IMPACT OF NERVE MANAGEMENT ON THE RISK FOR PERSISTING POSTOPERATIVE PAIN FOLLOWING OPEN ANTERIOR MESH REPAIR OF INGUINAL HERNIA
Authors: Westin Linn , Gunnarsson Ulf , Sandblom Gabriel , Dahlstrand Ursula
Published: December 2021

Aim

The impact of peripheral nerve management on post-operative pain is poorly known. The aim was to evaluate how management of the inguinal nerves during anterior mesh hernia repair affects the risk for long-term postoperative pain.

Material and Methods

Cross-sectional study based on the Swedish Hernia Register (SHR). Includes patients over 18 years of age with an open anterior repair during 2012-2018, who responded to a one-year follow-up questionnaire regarding pain. Ordered logistic regression analysis was applied to determine risk factors for pain.

Results

In total 35,720 patients who were operated with anterior mesh repair responded to the PROM questionnaire. Overall, 15.6% reported pain interfering with daily activities. The risk for persisting groin pain one year after surgery was not impacted by transecting the iilioingiounal nerve (0.49), the iliohypogastric nerve (0.17) or the genital branch of the genotiofemoral nerve (0.25) in a multivariable ordinal regression adjusting for anaesthesia, gender, age and emergency surgery.

Conclusions

Intraoperative management of the three main inguinal nerves was not associated with the risk for persisting pain in the operated groin one year after surgery.
O38 PROPHYLACTIC LIQUID MESH - A SMALL ANIMAL EXPERIMENT
Authors: East Barbora , Woleský Jakub , Divin Radek , Otahal Martin , Koblizek Miroslav , Staffa Andrea , Lorenzova Jana , Beaux Andrew de , Amler Evzen
Published: December 2021

Aim

Background: Surgical mesh is widely used not only to treat but also to prevent incisional hernia formation. Despite much effort by material engineers, the ‘ideal' mesh mechanically, biologically and surgically easy to use remains elusive. Advances in tissue engineering and nanomedicine have allowed new concepts to be tested with promising results in both small and large animals. Abandoning the concept of a pre-formed mesh completely for a ‘pour in liquid mesh’ has never been tested before.

Material and Methods

Thirty rabbits underwent midline laparotomy with closure using an absorbable suture and small stitch small bites technique. In addition, their abdominal wall closure was reinforced by a liquid nanofibrous scaffold composed of a fibrin sealant and nanofibers of poly-ε-caprolactone with or without hyaluronic acid or the sealant alone, placed as an ‘onlay’ over the closed abdominal wall. The animals were sacrificed at 6 weeks and their abdominal wall was subjected to histological and biomechanical evaluations.

Results

All the animals survived the study period with no major complication. Histological evaluation showed an eosinophilic infiltration in all groups and foreign body reaction more pronounced in the groups with nanofibers. Biomechanical testing demonstrated that groups treated with nanofibers developed a scar with higher tensile ultimate and yield strength.

Conclusions

The use of nanofibers in a liquid form applied to the closed abdominal wall is easy to use and improves the biomechanical properties of healing fascia at 6 weeks after midline laparotomy in a rabbit model.