bluuebunny/crossref_metadata_2025 huggingface dataset:
P-012 ESTABLISHING THE NORTH-WEST LONDON MDT FOR COMPLEX ABDOMINAL RECONSTRUCTION: OUR EXPERIENCE
Authors: Grove T , Howell A M , Kontovounisios C , Nicolay C , Mehta A , Warren O
Published: October 2022

Aim

Complex patients have been shown to have favourable outcomes when managed under the care of the multi-disciplinary teams (MDT) 1,2. In 2019 we published our experience of a single centre complex AWH MDT and advocated its use 3 in line with EHS and a collaborative group from AWRE 2020 4,5.

Expansion

Further development has led to the set-up of a regional, tertiary, complex, abdominal wall reconstruction MDT service. This has facilitated identification of patients who will ultimately benefit from management of the regional AWH MDT surgical teams undertaking the most complex of abdominal wall procedures together.

Since 2021 our regional MDT discussed 87 cases including tertiary referrals from within and out with the immediate geographical area. 71 abdominal wall hernias including 15 recurrent, 6 with concurrent parastomal hernias, 9 parastomal hernias and one perineal hernia.

Progression

The development of virtual conferencing services has allowed the MDT improved access for healthcare professionals. With resources for benign cases becoming increasing restricted, having an MDT approved management plan for patients streamlines services and allows costs to be rationalised. Scheduling joint operations between different hospitals facilitates pooling of expertise for difficult cases.

We are developing an online registry for involved abdominal wall units to allow data sharing, service evaluation and improve accountability.

Conclusion

Appreciation of complex abdominal wall surgery as a stand-alone sub-specialty is increasing and there is a consensus among hernia surgeons that these patients should be managed by the MDT in specialist centres by specialist surgeons enhancing learning, proficiency, and accountability.
P-028 POSTOPERATIVE ASSESSMENT OF PAIN AFTER LICHTENSTEIN TENSION-FREE MESH INGUINAL HERNIA REPAIR
Authors: Katsaros I , Vafias E , Athanassiou K , Floros C , Karakeke M , Gkogkos S , Giaga E , Kyriakidis A
Published: October 2022

Background-Aim

Effective postoperative pain management is vital for the well being of the patients after inguinal hernia repair. The aim of this study was to assess the analgesic efficacy and safety of parecoxib sodium versus diclofenac sodium following inguinal hernia repair.

Material & Methods

Patients that underwent from 1/1/2019 to 31/12/2020 an Lichtenstein tension free inguinal hernia repair at General Hospital of Amfissa were included in this study, They were randomly assigned to receive postoperatively parecoxib 40mg twice daily iv (group A), or diclofenac 75mg twice daily im (Group B). Tramadol 50mg iv was used as “rescue” treatment. Pain Rating System (PRS) was utilized for pain assessment.

Results

214 patients (162 males, 52 females) with a mean age of 72 (26–93) years were included in this study. Patients receiving parecoxib sodium experienced significantly lower PRS scores at 6 hours postoperatively (2.2 vs 3.1) and 24hrs postoperatively (1.2 vs 2.0). Fifty-nine patients (27.8%) needed a “rescue” analgesic treatment with the majority of them (43 patients) belonging to the Group B. 96.7% of total patients left the hospital on 1st postoperative day without needing any additional analgesic treatment.

Conclusions

Administration of parecoxib sodium 40mg twice daily is more effective than diclofenac for pain management after inguinal hernia repair.
P-033 RATIONALE FOR BILATERAL TAPP IN INGUINAL HERNIA AND NON-OVERGROWTH OF THE VAGINAL APPENDIX PERITONEUM ON THE CONTRALATERAL SIDE
Authors: Feleshtynsky Y , Shtaier A
Published: October 2022

Introduction

When performing TAPP overgrown vaginal appendage of the peritoneum is diagnosed on the contralateral side quite often. The question remains whether it is necessary to perform bilateral TAPP in unoccupied vaginal appendix.

Aim

To increase the effectiveness of TAPP in inguinal hernias combined with unhealed vaginal appendages contralaterally.

Materials and methods

An analysis of surgical treatment of 22 patients with bilateral TAPP who were diagnosed with vaginal appendix nonunion. All patients were men aged 25–65 years. Prior to surgery, it was agreed with patients that in case of nonunion of the vaginal appendix on the opposite side bilateral TAPP will be performed. For comparison, the efficacy of unilateral TAPP was evaluated in 21 patients with laparoscopically diagnosed non-overgrown vaginal appendix on the contralateral side.

Results

Among 22 patients with bilateral TAPP, the postoperative treatment was uncomplicated, postoperative pain was rated 2–3 points on a visual-analog scale. There was no postoperative wound infection. The duration of hospitalization was 2 + 1.2 days and was comparable to patients underwent unilateral TAPP. Long-term results were assessed by re-examinations and questionnaires, ultrasound examination, in 6–18 months. No complaints or recurrence of hernia were detected. A contralateral hernia developed in 9 (42.9%) patients of the control group at 6 to 12 months, which was scheduled for repeat TAPP.

Conclusion

TAPP requires diagnosis of bilateral inguinal area and bilateral TAPP in case of non-overgrowth of the vaginal peritoneal process, which reduces the likelihood of inguinal hernia on the contralateral side.
P-040 DIFFUSE LARGE CELL B LYMPHOMA TYPE ACTIVATED B CELL (MANTLE LYMPHOMA) AS A DIFFERENTIAL DIAGNOSIS OF INGUINAL HERNIA. A RARE FINDING
Authors: Gómez Torres I , Menor P D , Alcobilla E , Ridaura N , López E , Ponce P , Monzó C , Laguna M
Published: October 2022

Introduction

Mantle cell lymphoma is a rare type of B-cell non-Hodgkin lymphoma. It represents 7% of lymphomas in Europe, with an incidence of between 4 and 8 cases/year per million-hab. More frequent in men with a 4:1 ratio and middle-age.

We present a diagnosed clinical case of MCL with an infrequent presentation.

Material & Methods

A 70-year-old male affected by left inguinal tumor after physical exertion 6 months before the consultation.

Abdominal ultrasound and CT scan describe an extra testicular 3cm lesion with irregular edges without extension to other structures with possible signs of malignancy.

Surgery is performed with the lesion bloc excision including left test and elements of the spermatic cord.

Results

The analysis of Pathological Anatomy shows us as a result a diffuse large cell B Lymphoma type Polymorphic Mantle Cell Lymphoma.

The postoperative extension study (PET) shows no residual tumor or medullary involvement, suggestive of stage I.

Discussion

MCL is a rare type of lymphoma, characterized by translocation (11;14) (q13; q32) leading to overexpression of cyclin D1.

Most common presentation of MCL is B symptoms (up to 40%) fever, night sweats. Others include asthenia, nighttime pruritus, adenopathies, and hepatic or splenic enlargement.

Finally, CML can present with extranodal disease, digestive system, respiratory system, nervous system, endocrine or salivary glands.

It is a highly aggressive type of lymphoma that is usually diagnosed in advanced stages (90% cases), with poor prognosis with a life expectancy of 4 years despite optimal treatment.

Current treatment consists of a combination of chemotherapy and immunotherapy.
P-041 THE IMPACT OF COVID-19 ON ELECTIVE INGUINAL HERNIA REPAIR: A SINGLE-CENTER EXPERIENCE
Authors: Katsaros I , Kyriakidis V , Vafias E , Athanassiou K , Floros C , Karakeke M , Gkogkos S , Kyriakidis A
Published: October 2022

Background – Aim

Inguinal hernia repair is among the most common surgical operations worldwide with over 20 million performed yearly. During the COVID-19 pandemic most elective hernia repairs were canceled, leading to potentially detrimental effects on the patients suffering from them. The aim of this study was to assess the impact of the pandemic on inguinal hernias and elucidate its consequences.

Material & Methods

Patients that underwent inguinal hernia repair at General Hospital of Amfissa from March 2018 to March 2022 were included in this study. Patients were divided into two groups before (Group A) and after (Group B) March 2020, the date on which the first lockdown was implemented in Greece.

Results

Overall, 407 patients (382 males & 25 females) with a mean age of 69 (24–93) were included in this study. A 27.5% decrease in total surgeries was found during the Group B (236 vs 171 patients), but emergency surgeries significantly increased (17.3% vs 43.9%). Furthermore, there was a statistically significant increase in strangulated cases (15.3% vs 40.4%) and cases warranting a bowel resection (13.6% vs 39.2%). Mean length of hospital stay also significantly increased over Group B period (1.69 vs 3.02 days).

Conclusions

Policies leading to cancelation of elective surgeries and reallocation of healthcare facilities in order to confront the COVID-19 pandemic have led to a significant delay in the management of inguinal hernias. Thus, a steep increase in emergency cases was observed, as a greater part of theses hernias are being left untreated and subsequently strangulated.
P-045 LAPAROSCOPIC TAPP APPROACH FOR INGUINO-SCROTAL HERNIAS: IS IT A GOOD OPTION?
Authors: Trujillo Díaz J , Jezieniecki Fernandez C , Gómez López J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C
Published: October 2022

Aim

Hernial defects of the inguinal area have a high incidence, and of them inguino-scrotal defects are less frequent.The classic and most frequently used treatment is the open approach, however, during the last years the endoscopic management of this type of hernias is increasing, obtaining the advantages of MIS.

Material and Method

Retrospective study where we analyzed our database of patients diagnosed with inguino-scrotal hernia undergoing laparoscopic surgery using the TAPP-approach.

Results

8patients with inguino-scrotal hernias were surgically operated on by laparoscopic TAPP approach.Age: 67(RIQ: 39–72.5years)).LOS: 1.

In 75% of patients the duration of surgery was longer than 60minutes.Postoperative complications: scrotal seroma(37.5%), scrotal hematoma(62.5%), Clavien-Dindo≥III: 0%, SSI(0%). Hernia recurrence: 0%. Conversion:0%.Both patients who presented seromas and hematomas in the scrotal region resolved spontaneously after the first and second months.

We performed a comparative analysis between the group of patients operated on for inguino-scrotal hernias versus patients without this type of hernia, both treated by laparoscopic TAPP approach, and observed that patients with inguino-scrotal hernias presented a higher incidence of global complications(50%vs. 4.3% p<0.05),scrotal seroma(37.5% vs.7.2% p=0.008) and hematomas inguino-scrotal(62.5% vs.4.3% p<0.05), all of them with statistically significant differences, however, no differences were found in terms of LOS, serious complications or hernia recurrences.

Conclusions

The laparoscopic TAPP approach to inguino-scrotal hernias is a valid, safe and effective option, and although it presents a high incidence of postoperative scrotal seroma, these are usually resolved conservatively without the need for reoperation.
P-055 LAPAROSCOPIC EXPLANTATION OF GROIN MESH WITH STAPLED EXCISION OF COLO CUTANEOUS FISTULA
Authors: Gandhi J , Chaudhari S
Published: October 2022

Aim

Groin mesh explantation is a challenging situation and a multidisciplinary approach at index explantation surgery can avoid a long term catastrophic situation for the patient .

Material & Method

The history of the patient started a decade back with bilateral laparoscopic TAPP, following which he had swelling in both groin area with high grade fever . He was advised open bilateral groin exploration and explant of the mesh. Post procedure he was kept on antibiotics for few weeks and he was asymptomatic, he developed swelling again and started on anti mycobacterial treatment

He presented four years with foul smelling discharge from the suprapubic area . CT Scan with sinogram revealed a communication with sigmoid colon and tacker from index surgery

We planned laparoscopic approach, stapled excision of sigmoid-cutaneous fistula was performed . Removal of residual mesh and tacker from index under fluoroscopy guidance with skin tract excision .Intra op flexible sigmoidoscopy revealed no lumen compromise .

Histopathology showed granulomatous inflammation for which he was started on atypical mycobacterial treatment for 9 months .He remains uneventful after 2 years of surgery .

Conclusion

Mesh infection should be avoided at index surgery with utmost care to aseptic precautions.

Mesh explantation should be a part of multidisciplinary approach, radiology and colonoscopy were key investigations in this case . One should plan for a complete removal of mesh and tacker/s at index explantation surgery for safe long term outcomes .
P-077 SURGICAL TREATMENT OF LARGE INCISIONAL HERNIA WITH BOTULINUM TOXIN A INJECTION: STUDY PROTOCOL FOR A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL
Authors: Moszkowicz D , Renard Y , Romain B , Gillion J F , Ortega-Deballon P , Passot G
Published: October 2022

Aim

The best strategy for W3 incisional hernia (IH) repair is not known to date and is associated with high risks of recurrence and morbidity. We aim to demonstrate that preoperative Botulinum Toxin A (BTA) injection in the lateral abdominal wall muscles reduces the rate of postoperative morbimortality after large IH (EHS W3) repair with mesh, compared with placebo injection.

Material & Methods

This study will be a prospective, national multi-center, double-blinded, randomized (1:1) superiority phase III trial with two parallel arms: BTA versus placebo injection. Participants will be selected based on an abdomino-pelvic CT-scan without contrast injection performed in the 6 months preceding the patient's surgery. Main inclusion criteria will comprise midline anterior primary or recurrent IH (subxiphoidal to suprapubic), of width ≥ 10 cm, without loss of domain. Patients included will be randomized (1: 1 ratio), by using a computer-generated randomization scheme, and randomization will by stratified on the center and width of the IH (10–15 cm and > 15 cm). Participants will be randomized on the day of the injection, at least 4 weeks before the surgery.

Results

The primary endpoint will be the occurrence of Clavien-Dindo classification grade II or higher post-operative complication during the 90-day postoperative period. Secondary endpoints will include the rates of primary fascial closure, occurrence of component separation techniques, radiological response to injections, consumption of analgesics and pain, and occurrence of clinical and radiological recurrences.

Conclusions

Protocol version 2.0 is currently being assessed for funding by the French Ministry of Health.
P-083 AMYANDS HERNIA WITH RENAL CELL CARCINOMA - A RARE CASE PRESENTATION
Authors: Iqbal A , Kaul A , Sheen A J
Published: October 2022

47 year old gentleman presented to the emergency department with 2 days history of lower abdominal pain and right inguinal swelling which has increased in size during the same duration, he also had one episode of vomiting, bloating and constipation since 2 days. Investigations revealed an inflamed appendix within the right inguinal hernia along with a left renal lesion. The patient underwent emergency open primary repair of inguinal hernia with appendicectomy. Followed up with urology as an outpatient regarding renal lesion and with MDT discussion the patient was subjected for a partial nephrectomy.
P-085 MANAGEMENT OF LATERAL ABDOMINAL WALL HERNIAS
Authors: Köhler G
Published: October 2022

Lateral abdominal wall hernias are rare and inconsistently defined, which is why the use of the EHS classification makes sense, not least for the purpose of comparing the quality of surgical results. A distinction must be made between true fascial defects and denervation atrophy. Based on the available literature, there is generally a low level of evidence with no consensus on the best operative strategy. The proximity to bony structures and the complex anatomy of the three-layer abdominal wall make lateral hernias difficult to care for. The surgical variability include laparo-endoscopic, robotic, minimally- invasive, open or hybrid approaches with different mesh positions in relation to the layers of the abdominal wall. The extensive preperitoneal mesh reinforcement open, transperitoneally laparoscopic (TAPP) or endoscopic extraperitoneally (TEP, TES) has met with the greatest approval. The extent of the required medial mesh- overlap is determined by the distance between the medial defect boundary and the lateral edge of the straight rectus-abdominal muscles. The lateral pre- and retroperitoneal dissection can be extended into the homolateral retrorectus compartment by laterally incising the posterior rectus sheath or can even be expanded by crossing the midline behind the intact linea alba into the contralateral retrorectus compartment. The “intraperitoneal onlay meshplasty” (IPOM) is only a suitable procedure for smaller and closable defects, but it is also important as an “exit strategy” in the case of a defective peritoneum. All procedures are explained using clear illustrations which are protected by copyright and were exclusively published in German in “der Chirurg”.
P-088 HOW TO REPAIR A LATERAL INCISIONAL ABDOMINAL WALL HERNIA?
Authors: Zuvela M , Galun D , Bogdanovic A , Palibrk I , Velickovic J , Djukanovic M , Bogdanovic M , Zivanovic M , Zuvela M , Zuvela M
Published: October 2022

Aim

To present our original method for surgical treatment of patients with lateral incisional hernia (LIH)

Material and Method

Patients with LIH and simultaneous presence of a middle incisional hernia (MIH) were treated by our original technique based on the principles of anterior component separation technique and sublay technique: a) skin and subcutaneous tissue incision along the midline and MIH dissection; b) subcutaneous tissue dissection in the lateral direction to the Spiegel line or the LIH lateral edge on the side of the LIH; c) vertical incision of the external oblique muscle (EOM) lateral to the Spiegel line or the LIH; d) the rectus muscle (RM) dissection from its posterior sheath on the opposite side of the LIH; e) suturing the posterior rectus sheath on the opposite side of the LIH with RM on the side of the LIH; f) suturing of the internal oblique muscle with the lateral edge of the RM on the side of the LIH; g) onlay polypropylene mesh hernioplasty.

Results

Between January 2013 and May 2022, 44 consecutive patients with LIH+MIH underwent surgery. A median (range) LIH defect surface was 90 (20–270) cm2. During mean follow up of 14 months postoperative complications occured in seven (15,9%) patients: seroma in three, hematoma in two, mesh infection and hernia recurrence in one.

Conclusion

Our original method can be one of the good solutions for simultaneous treatment of LIH and MIH.
P-090 EMERGENCY INTRAPERITONEAL ONLAY MESH REPAIR OF INCARCERATED VENTRAL E INCISIONAL HERNIA
Authors: Garbarino S , Latham L , Marzorati A , Gianazza S , Zullo A , Scorza A , Costantini D , Ballabio A , Inversini D , Ietto G , Carcano G
Published: October 2022

Aim

Abdominal wall hernia surgery is the frequent surgical operation. Incarceration and strangulation are the complications for patients going to emergency surgery clinics.Laparoscopic approach in emergency is controversial. IPOM treatment permits safe hernia reduction, accurate abdominal exploration,diagnosis and treatment of unknown hernia.

Material and Methods

in one year,we operated 12 urgent ventral hernia patients with IPOM technique. All patientsshowed hemodynamic stability. We evaluated safety of hernia reduction, conversion rate,operative time,hospital stay, and prosthesis infection.

Results

Nine patients underwent surgery for incarcerated incisional hernia, 3 patients for primary incarcerated ventral hernia. We used a laparoscopic approach. In 10 cases,we placed an intraperitoneal mesh. In two cases, we converted to open surgery, because of small bowel injury. It was never necessary to perform Intestinal resection for strangulated hernia.Contents of hernia sacs were omentum (7 patients), large bowel (1 patients), 4 omentum and small bowel (4 patients). Patients presented signs of small bowel obstruction. Average size of the defect was 6cm.Average operative time was 91 min, the mean post-operative hospital stay was 3.5 days. Post-operative complications weren't recorded. There wasn't mortality. During the follow-up none patients had mesh infection or hernia recurrence.

Conclusion

In emergency the Intraperitoneal Onlay Mesh Repair of Incarcerated Ventral and Incisional Hernia allowed safe adesiolysis, bowel reduction. Laparoscopic approach was associated to low post-operative complications even in emergency setting.
P-092 LAPAROSCOPIC TRANS-PERITONEAL HERNIOPLASTY (TAPP) IN EMERGENCY
Authors: Garbarino S , Latham L , Gianazza S , Colombo E M , Odeh M , Palamara N , Vigezzi A , Costa J , Inversini D , Ietto G , Carcano G
Published: October 2022

The aim efficacy and technical feasibility of TAPP operation by analyzing patients operated on incarcerated inguino-crural hernia in emergency setting.

Materials and methods

In 1 year, we enrolled 8 urgent incarcerated hernia patients operated using laparoscopic trans-peritoneal approach (TAPP) operated on acutely for inguino-crural incarcerated hernia associated with suspected visceral ischemic damage.

Results

We repaired 6 inguinal incarcerated hernia and 2 cases of crural hernia. Among 6 inguinal hernia, only one was recurrent. In one case the laparoscopic approach permitted to exclude an obstructed Spigelian hernia diagnosed through tomography. In another case, TAPP allowed to diagnose omental incarcerated Spigelian hernia. In 3 cases this approach permitted to diagnose concomitant unknown wall defects. All cases presented signs of small bowel obstruction. The content of the sac in three cases was small bowel, in other three cases it was omentum, and in other two cases it contained lipoma. None of the cases were converted to open technique. The operative average time was 95 min; the average hospital stay was 1.5 days. No chronic pain or recurrences were observed after a mean follow up time of 8 months.

Conclusions

The repair of complicated inguino-crural with TAPP in emergency is not a standard treatment. In our experience the laparoscopic approach allowed a safe reduction of hernia, the observation of the feature of hernia content, the diagnosis and repair of unknown wall defect, and a crural defects and contralateral inguinal hernia.
P-095 RECTUS DIASTASIS REPAIR: VARIATIONS OF POSTPARTUM ABDOMINAL WALL ANATOMICAL CHANGES PROPOSE A TAILORED SURGICAL REPAIR. EARLY RESULTS OF THE EXTENDED REPAIR TECHNIQUE STUDY
Authors: Olsson A
Published: October 2022

Aim

A pregnancy can result in permanent anatomical changes such as a persistent rectus diastasis (RD), a widened linea semilunaris and retracted oblique muscles. The diverse anatomical changes contribute to the abdominal deformation and may present in a variety of combinations. A standardized suture repair of the RD may not be sufficient in severe abdominal wall deformation cases. This observational cohort study evaluated an extended repair technique.

Method

A cohort of 44 postpartum women with training resistant core instability symptoms planned for surgical repair were examined with ultrasonography prior to surgery. Participants with severe anatomical changes i.e. diastasis of the linea semilunaris exceeding one cm, were offered an extended repair, re-approximation of both linea alba and linea semilunaris. Results were evaluated with ultrasonography and the Disability Rating Index (DRI), two and twelve months after surgery.

A standardized rectus diastasis suture repair was used in 24 participants with an isolated rectus diastasis. A combined repair with reapproximation of both the linea alba and the linea semilunaris was performed in 20 participants.

Results

Preoperative mean rectus diastasis (widest measurement) was 45 mm (30–75 mm), a mean diastasis of the linea semilunaris (umbilical level) of 15 mm (0–35 mm).

There were no recurrencies at the 12-month follow-up. Early results showed significant improvements of physical function (DRI) but no differences between the two repair technique groups.

Conclusion

The extended repair seems to be a safe and sufficient repair technique in cases with a RD combined with a linea semilunaris diastasis.
P-098 RETHINKING CHRONIC POSTOPERATIVE INGUINAL PAIN (CPIP) DEFINITION
Authors: Kroon L
Published: October 2022

Aim

There is a lack of consensus regarding the definition of chronic postoperative inguinal pain (CPIP). The World Guidelines for Hernia Management (WG) suggests a broader definition of CPIP that does not include pre-operative assessment which decreases comparability between studies. According to the International Association for the Study of Pain (IASP) a clinical assessment of extent and cause of pain is done comparing pre- and postoperative pain, mandating a physical examination at two separate occasions. The aim of this study is to find the real incidence of CPIP with a clinically relevant definition compared to the traditional WG CPIP definition, one year following inguinal hernia repair where both pre- and postoperative clinical evaluation is included.

Material & methods

A prospective observational cohort study performed during one year at a hernia clinic. Patients were clinically assessed and filled out validated questionnaires both pre- and postoperatively. Patients with significant or increased inguinal pain one year after surgery were evaluated for probable causes of chronic pain.

Results

574 patients were included of which 372 were selected for surgical hernia repair. 265 (71%) filled in pre- and postoperative questionnaires. According to WG 9 (3%) patients experienced more pain 1 year after surgery however of those, 5 patients (55%) had non-surgical causes of pain. 3 patients (1.1%) had clinically relevant CPIP one year after surgery (IASP).

Conclusions

Evaluating patient perceived pain both pre- and postoperatively, including a clinical examination of patients with possible CPIP, is imperative to correctly evaluate CPIP following inguinal hernia surgery.
P-099 PERSISTENT POST-SURGICAL PAIN AFTER SURGICAL CORRECTION OF VENTRAL HERNIA REPAIR. PRELIMINARY DATA OF AN OBSERVATIONAL STUDY AT VARESE UNIVERSITY HOSPITAL
Authors: Novazzi C , Guzzetti L , Selmo G , D'onofrio D F , Latham L , Gianazza S , Cannavo' M , Cabrini L , Pappalardo V , Bacuzzi A , Inversini D , Ietto G , Carcano G
Published: October 2022

Aim

Persistent post-surgical pain (PPSP) is one of the most frequent complication after surgery and has important socio-economic consequences.

Materials and methods

We performed an observational analysis of the patients submitted to surgical correction of ventral hernia repair at our University Hospital between 1st February 2021 and 1st January 2022.We registered data about perioperative surgical period. After at least 3 months we proceeded with a phone interview in order to record the incidence of PPSP according to its definition.

Results

We enrolled 61 patients and 26 patients were lost to follow-up. 9 patients (25%) denveloped chronic pain after surgery and 3 cases reported pain that had deteriorated the quality of life (PPSP group).In the PPSP group median age was 53; obesity, COPD, diabetes mellitus, smoking status, were not significant (p > 0,05). Male sex, previous abdominal surgery and open approach showed correlation with PPSP onset. In our cohort demographical and clinical characteristics were not statistically related to PPSP, while the use of locoregional anesthesia could be protective in front of PPSP onset.

Conclusion

At the moment, although there is no shared protocol in the prevention of PPSP, it is possible to implement some interventions to reduce its risk. Our results show that more effective analgesic/anesthetic perioperative measures may help to prevent the adverse consequences of poorly controlled pain, including its transition to PPSP. The main limits of our data is the small cohort analysed and the study protocol without an analysis about immediate postoperative pain and PPSP outbreak.
P-104 A STEP-UP APPROACH FROM IPOM + IN MINIMALLY INVASIVE ABDOMINAL WALL SURGERY
Authors: Arana Iñiguez I , Recreo Baquedano A , Ruiz R , Ariceta López A , Ramírez Cervera J L , Piñera A , Talavera Utrera G , Pérez Otermin I , Otegi Altolagirre I , Blázquez Lautre L
Published: October 2022

Aim

To compare the early outcomes of two different techniques for ventral hernia repair in our abdominal wall surgery unit.

Materials and Methods

A prospective non-randomized review was perfomed including patients who underwent laparoscopic hernia repair from January 2018 to April 2022. All patients were followed-up for 1 month and the hernia orifice was closed in all cases. Patients and hernias characteristics, operative data and early complications were reviewed. Postoperative pain was defined as ≥4 value in Visual Analogue Scale.

We compared 2 laparoscopic techniques: intraperitoneal mesh fixed with a double crown of resorbable tackers (IPOM+) and self gripping sublay positioned mesh (preperitoneal –PREP- or retromuscular –RIVES- position).

Outcomes

During the study period, 44 patients were assigned into 2 groups: 31 (70%) in IPOM+ group and 13 (30%) in Rives/Preperitoneal group. No differences were found in risk factors, population and hernia data between both groups. 6 patients (19%) from IPOM+ group presented postoperative pain and only 1 patient (7,7%) in Rives/Prep group (p: 0,30). There was no differences in other complications, length of stay or operative time.

Conlusion

Early outcomes of sublay techniques (Rives or preperitoneal) do not report more complications during perioperative time, but they could help reducing immediately postoperatorive pain.
P-116 UNUSUAL VISCERAL CONTENT IN PARASTOMAL HERNIAS - A REVIEW OF LITERATURE
Authors: Bandyopadhyay S , Sheen A J , Iqbal A
Published: October 2022

Parastomal hernias remain the most common complication of an ileostomy or colostomy - It is estimated that upto 50 percent of patients with a stoma will develop one. They may be classified as Interstitial, Subcutaneous, Intrastomal or Peristomal. The most common contents of Parastomal Hernias are bowel and omentum.However, other visceras have been reported as a content of a parastomal hernia. This presentation is aimed at a literature review of such surprise surgical situations that are challenging to the surgeons.

Presence of gallbladder in a parastomal hernia has been reported by multiple authors - there is reported incidence of incarceration or acute inflammation of the gallbladder. Cholecystectomy t the time of parastomal hernia repair has been reported though some patients have been treated non-operatively as well.

Similarly, there have been multiple reports of stomach beong the contents of parastomal hernias - there have been patients presenting with gastric outlet obstruction who have been found to have the stomach being a content of their parastomal herniation.

This presentation reviews the available literature and presents the challenges and oprions that a surgeon may face when treating similar patients.
P-118 COMPLEX INCISIONAL HERNIA AFTER BRICKER PROCEDURE. A CASE REPORT
Authors: Laguna-Hernandez P , Serrano Yebenes E , Diaz Pedrero R , Soto Schutte S , Bru Aparicio M , Allaoua Moussaoui Y , Mañes Jimenez F , Jimenez Martin R , Quiroga Valcarcel A , Cordova Garcia D , Alvarado Hurtado R , Jimenez Alvarez L , Ovejero Merino E , Medina Reinoso C , San Roman Romanillos R , Ratia Gimenez T , Gutierrez Calvo A
Published: October 2022

Aim

To analyze the treatment and complications of gigant paraestomal eventration with a case report and literatura review

Material and Methods

a retrospective case report from our hospital and her evolution since her urology surgery in 2011

Results

Female of 59 years old, with personal antecedents of arterial hypertension, simple cistectomy and Bricker's urinary derivation (cutaneus ureteroileostomy) in 2011 due to intersticial cistitis, parastomal incisional hernia repair with intraperitoneal mesh in 2015. The patient was derivated from urology consult for a huge paraestomal incisional hernia and personal history of obstructive uropathy and several infections of urinary tract since 2022. No obstruction clinic was associated. Elective surgery was performed with an Trasversus Abdominis Release (TAR) and moving previous urostoma: hernial sac disection and previous mesh explant. Opening Rives, Retzius spaces and transversus fasciotomy was realized. Middle line was reforzed and hernial defect was closed. Polipopilene mesh was fixed at middle line and pubis with no reabsorbible suture and reforced with haemosthatic sealant. Anterior fascia was closed fixing at middle line. At the end a new urostoma was made in ryght hypocondrium. In postoperative period the patient developed light anaemia. Following months, the patient has not other complications due to incisional hernia repair.

Conclusions

Many factors can contibute to incisional hernia such as obesity, hypertension, number of surgerys, age, sex… TAR technique can be useful with complex eventration but we can not forget the commorbilities association to this surgery (anemia, pulmonar Tromboembolism…)
P-137 DE GARENGEOT`S HERNIA: AN UNUSUAL PRESENTATION OF APPENDICITIS. CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Del Campo Martín M , García Galocha J L , Flores Flores C , López Antoñanzas L , García Alonso M , Díaz González J M , Torres García A J
Published: October 2022

Introduction

The presence of the appendix within a femoral hernia was first described by René De Garengeot in 1731. Less than 200 cases have been reported in the literature with an incidence of 0.5–5% of all the femoral hernias.

Case Description

A 69-year-old woman presented with a 72-hour history of painful right-sided groin swelling. She denied fever or any gastrointestinal symptomatology. Clinical examination revealed a non-reducible right mass. X-ray did not show any bowel obstruction. Laboratory found an increased leukocyte count (14.10 K/μL) with 77% neutrophils. She underwent emergency surgery. An inguinotomy was performed, observing the presence of the appendix incarcerated within the femoral ring. It showed clinical signs of appendicitis with no presence of abscess or perforation. Appendectomy was performed. The hernia was repaired with a polypropylene plug fixed to Cooper's and Gimbernat's ligaments.

Discussion

De Garengeot`s hernia affects women four times more compared to men. The most common symptoms are tenderness and a groin bulge (usually right-sided). The diagnosis is usually performed intraoperatively, although CT-scan is useful as a complementary test. Due to its low incidence, there are still no standardized recommendations on the treatment of this type of hernia. The most common approach in the literature is an open surgery via inguinal incision. Laparoscopic approach has been described too. Mesh use should not be considered in a contaminated field.

Conclusion

The treatment of this entity is the emergency surgery. We should consider this type of hernia to make an early diagnosis in order to prevent complications.
P-138 PREDICTORS OF COMPLICATIONS IN COMPLEX VENTRAL HERNIA REPAIR USING POSTERIOR COMPONENT SEPARATION TECHNIQUE WITH RETRO RECTUS MESH PLACEMENT – AN OBSERVATIONAL STUDY
Authors: Kumar M , Arora A , Kumar M
Published: October 2022

Introduction

Incisional Hernia has an incidence ranging from 2–20%. Large and complex incisional hernias are difficult to treat with standard procedures. PCS-TAR is a relatively novel procedure. There persists a gap in knowledge regarding its outcomes, especially in the Indian population.

Aims & Objective

To identify the pre-operative clinical and radiological factors that predict the risk of re-herniation and wound and mesh-related complications after CVH (Complex Ventral Hernia)

Methodology

In a prospective observational study, patients undergoing open PCS-TAR with retro rectus mesh for Complex Ventral Hernia repair included in the study. The patient demographics, hernia characteristics, radiological details, operative data, post- operative outcomes, and follow-up data were entered in a pre-designed proforma. Data were analyzed with SPSS softwere.

Results

35 patients with CVH were included, of which 30 (85%) women and 5 men. The mean age was 51.8 years and the mean BMI was 29.7 kg/m2. The mean size of defect was 12 cm. 83% hernia were midline primary and 255 were recurrent hernias. We observed zero recurrences at six months of follow-up, but a high wound morbidity rate of up to 49%, of which most common was seroma formation. 23% of patients developed SSI.

Conclusion

In conclusion, PCS-TAR is a promising novel procedure for complex ventral hernias not amenable to primary closure using the traditional retro rectus approach, with excellent short term outcomes. Wound morbidity is a significant concern with this procedure, which can be prevented or reduced by thorough pre-operative optimization on a case-to-case basis.
P-139 THE EFFECTS OF THE INCISION TYPE ON INCISIONAL HERNIA RESULTS OF LIVING DONOR LIVER TRANSPLANT; SINGLE CENTER EXPERIENCE
Authors: Tirnova İ , Karataş C , Kanmaz T
Published: October 2022

Aim

We aimed to assess the effects of the chosen incision type on postoperative hernia rates of liver transplantation in this paper.

Material-Methods

During the period between the 5th September 2018 and 31st March 2022, total 210 liver transplantations were performed in the Liver Transplantation Center of Koç University Hospital. 96 pediatric and 10 deceased donor transplantations were excluded. Living donor liver transplantation (LDLT) cases in only adults were included in the trial. Total 104 patients were included. Patients divided into two groups in the manner of chosen laparotomy incision during the operation. Reverse T incisions (Group A, n=68) and Makuuchi incisions (Group B, n=36) were performed in our center during the trial period. Minimum 3 month-follow up period was performed.

Results

Demographic data (Table 1) was similar in both groups. Operation and warm ischemia durations were longer in Group B (Table 2). Postoperative immunosuppressive regimens were same protocols contains tacrolimus and prednisolone. Surgical site infection rates, relaparotomy rates, postoperative blood transfusion rates, biliar, vascular and pulmonary complication rates were also similar in both groups (Table 3). While 11 patients diagnosed with incisional hernia in Group A (%16,2), 2 patients diagnosed with incisional hernia in Group B (%5,6, p=0,212).

Conclusion

Although Makuuchi incision seems to be safer in manner of hernia rates, this couldn't be proved by statistically significance as a result of this retrospective analysis of a single center. The necessity of prospective designed trials is obvious in order to obtain more reliable results.
P-142 CLINICAL AND ECONOMIC OUTCOMES OF ABSORBABLE KNOTLESS BARBED SUTURE VERSUS OTHER CONVENTIONAL SUTURES FOR ABDOMINAL MIDLINE CLOSURE IN PATIENTS UNDERGOING OPEN HERNIA REPAIRS
Authors: Berrevoet F , Gunja N , Danker W , Schmitz N D , Tomaszewski J , Stern L , Chandak A , Van Cauteren L
Published: October 2022

Aim

We assessed clinical and economic outcomes of patients undergoing open hernia repair using absorbable knotless barbed suture versus conventional absorbable suture for abdominal wall closure.

Methods

This retrospective cohort study identified patients undergoing hernia repair at a single center between 2013 and 2020. Fixed follow-up of 30, 60, and 90 days were used to assess outcomes (peri-operative complications, and resource utilization). Multivariate analyses for outcomes and Cox Proportional Hazards models for time to readmission and complications were conducted.

Results

Of 821 hernia repairs, 446 used absorbable knotless barbed suture and 375 used conventional absorbable suture. Baseline characteristics were largely similar between the groups. Surgical site infections (SSI) were significantly less frequent with absorbable knotless barbed suture (60-day, 5.9% vs. 11.4%; P=0.0083; 90-day, 5.9% vs. 11.7%; P=0.006) and remained consistent after multivariate adjustment (60-day, OR [95% CI]: 0.52 [0.29–0.92]; 90-day, 0.51 [0.28–0.90]). Among patients with SSI, deep SSI were less frequent with absorbable knotless barbed suture (60-day, 9.1% vs. 35.7%; P=0.022; 90-day, 9.1% vs. 34.9%; P=0.0252). Absorbable knotless barbed suture significantly reduced the risk of peri-operative complications over time (HR 0.57 [95% CI 0.36–0.92]; P=0.0203). Hospital length of stay was, on average, 2.74 days longer in conventional absorbable suture patients (mean [95% CI] 8.75 [7.83–9.78] vs. 6.01 [5.16–6.99] days; P<.0001).

Conclusions

Significant differences between sutures were seen with peri-operative infections, which occurred less frequently with absorbable knotless barbed suture and less severe. Peri-operative complications and length of stay were significantly reduced with absorbable knotless barbed suture.
P-155 ROLE OF MDT IN CPIP MANAGEMENT: LITERATURE REVIEW
Authors: Pawlak M , Alabbasi I , Cocciolo F , Wei R
Published: October 2022

Chronic Post-operative Inguinal Pain (CPIP), is recognised as a long term condition and has a significant effect on patients’ quality of life. CPIP affects 18–30% of patients after an open inguinal hernia repair and 6% of patients after a laparoscopic inguinal hernia repair. CPIP result from several causes such as a pre-operative nerve lesion in other area of the body, an intra-operative nerve injury, or due to the intensity of acute post-operative inflammation and healing. a multidisciplinary clinic would be considered the best approach in order to assess patients’ pain and identify an individual management plan. This review allowed the team to choose which literature could be used to support the implementation of the clinical practice change.

Method

Literature searches were performed using PubMed and Embase databases were searched using key terms to include all related articles in the last ten years. three independent reviewers to choose included and excluded articles with two steps.

Results

Out of 25 articles found by the research, 8 articles included in this review including MDT about CPIP, meeting including criteria after the full articles reviewed. it was important to understand the nature and mechanisms of Chronic Post-operative inguinal hernia. several risk factors have been identified, which may be causing CPIP such as young age, recurrent inguinal hernia repair procedure and presence of pain before the procedure. Because of the complexity of CPIP, many authors concluding that a multidisciplinary approach should be considered the more appropriate method to ensure an effective and safe treatment. This include the need of regular follow up after an inguinal hernia repair to identify the chronic pain and establish an appropriate management plan.

Conclusions

Although the literature review enabled the team to gather useful information about the topic of the clinical practice change; it was evident that more researches and studies need to be completed in order to identify the safest and effective treatment for patients presenting with CPIP.
V-001 ROBOTIC ETEP WITH TOP DOCK: STEP BY STEP FOR A SAFE PROCEDURE
Authors: Villalobos R , Maestre Y , González Barranquero A , Olsina J
Published: October 2022

Introduction

Robotic surgery has evolved in the last few years. Extended total extraperitoneal approach (eTEP) has allowed a better location of the mesh avoiding contact with the bowel. The most important step for this technique is the trocars Positioning in the retrorrectal space. It will depend on the defect localization. Docking can be performed in 3 ways: Inferior (down), lateral and superior (top). The last one represents the most complex. We present a video that explains step by step how to do this technique.

Material and methods

We considered patients with M3–5W2 and W3 incisional/ventral hernias with a non-injured supraumbilical area. For the retrorrectal dissection, an optic trocar or an expander balloon were used in the left-up quadrant. Afterwards, a 12mm trocar was introduced and the pneumo initiated. At the left flank a 5mm trocar was placed to initiate the crossover with a hook. Subsequently, an 8mm trocar was place in the top midline and next the third robotic trocar at the right up quadrant. Finally, the docking was made.

Results

Twelve eTEP assisted with robot in a top dock have been performed in a safe way in patients with incisional/ventral hernias.

Conclusions

The eTEP technique assisted with robot in a top dock position allows a safe access following the steps that we learned in our experience.
V-008 ROBOTIC TOTALLY EXTRAPERITONEAL RETROMUSCULAR REPAIR OF A TYPE III PARASTOMAL HERNIA
Authors: Barranquero A G , Villalobos Mori R , Maestre González Y , Gutiérrez E , Olsina Kissler J
Published: October 2022

Aim

The retromuscular repair described by Pauli et al. (2016) dissects the retromuscular space, releases the transversus muscle, and lateralizes the stoma to place a retromuscular mesh. The aim was to show the results of the robotic approach for this intervention.

Material & Methods

Video description of a case report. The patient was a 71-year-old woman that underwent an abdominoperineal resection for rectal cancer in 2017 and presented with a 5.8 cm parastomal hernia without midline defects (type III of the EHS classification).

Results

Three robotic trocars were placed in the lateral of the right rectus sheath, and posteriorly a 12 mm assistance port was inserted in the left hypochondrium. The dissection began in the inferior preperitoneal space, until finding the left transversus muscle. Then, the rectus sheath was dissected superiorly and laterally. A posterior rectus sheath release was performed in a down–to–up direction, initially avoiding the parastomal hernia, which was later reduced. Posteriorly, the peritoneum was incised and then sutured to lateralize the stoma. The parastomal hernia defect and the posterior rectus sheath were equally sutured. Finally, a polyvinylidene difluoride (PVDF) mesh was placed in the retromuscular space, which was fixed with transfascial sutures to the sides of the stoma.

Conclusions

The robotic totally extraperitoneal retromuscular approach for parastomal hernias is safe and feasible, with the advantage of avoiding the intraperitoneal space.
V-013 ETEP - STEP BY STEP
Authors: Pires M , Rosas F , Neves S , Flores A , Magalhães C
Published: October 2022

Minimally invasive approaches are increasingly being used for the correction of abdominal wall hernias. Although laparoscopy presents as a greater technical challenge compared to classical techniques, once the learning curve is overcome, the advantages are multiple: less postoperative pain, shorter hospital stay, faster return to daily/professional activities and lower rate of surgical site infection.

The authors present the case of a 55yo women with a history of type 2 diabetes mellitus and peripheral venous insufficiency. No history of previous surgeries. The patient was referred to an appointment in the Ambulatory Surgery Centre for evaluation of a primary midline hernia. Symptoms were worsening in the last 6 months. No previous episodes of complications. Preoperative evaluation included an abdominopelvic computed tomography, which revealed a hernia sac containing only fatty tissue (no intestinal loops present) and a 19 mm hernial neck with a supra-umbilical median location. No other abdominal wall defects were evident.

The patient was proposed for a laparoscopic approach - extended totally extraperitoneal (eTEP) in ambulatory setting. The surgery and post-operative period (9 months) to date went without intercurrences.

The present video aims to demonstrate the main steps of the surgical technique applied in a tertiary centre with years of experience in laparoscopic abdominal wall surgery.

With this paper the authors pretend to demonstrate that laparoscopy may become the gold-standard in abdominal wall hernia correction as soon as the know-how and respective learning curve are aquired. Until then, these cases should continue to be referred to specialized tertiary centres.