bluuebunny/crossref_metadata_2025 huggingface dataset:
OC-077 OPEN REPAIR OF FLANK AND LUMBAR HERNIAS (FLH): 145 CONSECUTIVE REPAIRS AT A HIGH-VOLUME, TERTIARY HERNIA CENTER
Authors: Wilson H , Ayuso S , Katzen M , Ku D , Scarola G , Colavita P , Kercher K , Augenstein V , Heniford T
Published: October 2022

Aim

FLH present a surgical challenge due to their anatomic location, proximity to boney structures, and lack of elasticity of the surrounding muscle. With less than 1,000 cases reported, there is no uniform operative management. This is the largest study to date evaluating FLH repair (FLHR).

Materials & Methods

A prospective, single-center, hernia specific database was queried for patients who underwent open flank or lumbar hernia repair from 2004–2021. Demographics, operative characteristics, and outcomes were evaluated. Standard statistical methods were used.

Results

145 patients included 109 flank hernias and 36 lumbar hernias. The hernias resulted from prior surgery (73.3%), blunt trauma (19.7%), or primary defects (7.0%). The mean defect size was 125.7±166.8cm2, 46.9% were recurrent, and 11.0% of patients visited a pain specialist preoperatively. Mesh was commonly synthetic (92.4%), a mean of 755.9±373.4 cm2, and placed in the preperitoneal space (92.7%). Component separation technique was utilized in 16.8% of cases and pelvic bone anchor fixation in 13.8%. Preoperative chronic pain was present in 75% of patients receiving bone anchors and only 6.6% postoperatively. Complete defect closure occurred in each case. Wound infection (8.1%) and mesh infection (1.4%) were uncommon. Prolonged, postoperative discomfort was reported in 22%, half of which had chronic pain preoperatively (p<0.01). Hernia recurrence was 3.4% at 29.3±13.2 months follow-up. Recurrences occurred posteriorly in 3 and in 2 mesh infections requiring explantation.

Conclusions

Open preperitoneal repair of FLHs with synthetic mesh results in low rates of postoperative complications and hernia recurrence. Postoperative pain correlated closely with preoperative pain.
OC-080 COMPLETE VERSUS PARTIAL EXCISION OF AN INFECTED MESH FOLLOWING ABDOMINAL WALL HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Patel I , Qayum M K , Kar I , Hajibandeh S , Hajibandeh S
Published: October 2022

Aims

To evaluate comparative outcomes of complete and partial excision of infected mesh following abdominal wall hernia repair.

Methods

A systematic search of electronic databases and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits was conducted. Surgical site infection (SSI), chronic sinus formation, recurrent hernia and need for reoperation were the evaluated outcome measures.

Results

Six comparative observational studies were identified, reporting a total of 317 patients of whom 193 underwent complete mesh excision and the remaining 123 patients underwent partial mesh excision for an infected mesh following abdominal wall hernia repair. The complete mesh excision was associated with significantly lower rates of SSIs (OR: 0.36; 95% CI, 0.16–0.81, p=0.01), chronic sinus formation (OR: 0.11; 95% CI, 0.02–0.71, p=0.02), and reoperation (OR: 0.10; 95% CI, 0.03–0.33, p=0.0001) compared to the partial mesh excision. There was no significant difference in hernia recurrence rate (OR: 3.96.16, 95% CI 0.62–25.44, p=0.15) between two groups.

Conclusions

Our meta-analysis demonstrated that complete mesh excision may be associated with lower SSI, chronic sinus formation and need for reoperation when compared to the partial mesh excision in an infected mesh event. However, the available evidence has failed to report the outcomes with respect to the main confounding factors which, together with other important outcomes such as fistula formation, should be considered by future high quality research.
OC-086 COMPARISON OF MESH-FIXATION TECHNIQUES IN LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA, RELIATACK™ V PROTACK™ (TACKOMESH) NCT 03434301
Authors: Pilkington J , Wilkinson F , Pritchett J , Fullwood C , Sheen A J
Published: October 2022

Background

A study examining post-op pain, comparing permanent versus absorbable tack fixation devices, Protack™ versus Reliatack™, in IPOM plus repair.

Methods

TACKoMesh is a single-centre double-blind RCT conducted from 2017–2020 with 1-year follow up. Patients were randomised to either Protack™ (titanium tacks) or Reliatack™ (an articulating-arm with dissolvable tacks). Primary outcome was reported pain on activity at Day30. Secondary outcomes include recurrence and quality of life measures (SF-36 & Carolina Comfort Score).

Results

67 patients randomised: 36 with Protack™, 27 with Reliatack™, with 4 conversions. No significant difference in reported pain ‘on activity’ (post-operative Day 1, 6, 30 and 365). There was significantly reduced pain ‘at rest’ on Day1 with Reliatack™ (Protack™ 6 [4 to 9] vs Reliatack™ 4 [3 to 5], p = 0.020) and reduced pain at all other points with Reliatack™.

Operation (p = 0.001) & mesh-fixation (p = 0.001) times were longer, with more knots (p = 0.001) & tacks (p = 0.001) used with Reliatack™.

Entire cohort hernia recurrence, seroma formation, SSI & Clavien-Dindo Grade III-V complication were 8/63 (12.7%), 33/63 (52.4%), 7/63 (11.1%), and 12/63 (19.1%) respectively. There were no significant differences in these outcomes between the treatment groups. CCS showed improvement from post-op Day30 to 365. SF36 showed a reduction in baseline scores at post-op Day30.

Conclusion

There is no difference in reported pain ‘on activity’ following elective IPOM plus hernia repair when choosing either Protack™ or Reliatack™. There is a trend towards improved post-op pain ‘at rest’ with Reliatack™.
OC-087 PAIN AND INFLAMMATORY SIGNALLING IN TACKOMESH TRIAL PARTICIPANTS FOLLOWING ELECTIVE LAPAROSCOPIC INCISIONAL HERNIA REPAIR WITH INTRAPERITONEAL ONLAY MESH (IPOM) AND SPIRAL-TACK MESH FIXATION
Authors: Pilkington J , Wilkinson F , Pritchett J , Fullwood C , Sheen A J
Published: October 2022

Background

The aim of this study was to investigate for links between reported pain and inflammation within a sub-cohort of patients undergoing the IPOM plus repair through the measurement of serum/plasma levels of established inflammatory biomarkers in trial participants across 1-year follow up.

Methods

22 patients (12 Protack™ and 10 Reliatack™) within the TACKoMesh randomised controlled trial underwent serial blood sampling as part of their follow up. A panel of pro- and anti-inflammatory biomarkers were assayed using Luminex multiplex assays and ELISAs. Circulating biomarker concentrations were described and compared in the context of clinical and patient reported outcome data that was obtained within the trial.

Results

An increase in the serum concentration of pro- (IL-6 and CRP) and anti- (IL-10) inflammatory biomarkers was seen following IPOM plus repair. Serum IL-6 and CRP were significantly raised compared to baseline at post-operative Days 1, 6 and 30 (p < 0.05). Markers of onward signalling (Cortisol and TNF-alpha) and tissue repair (PDGF-AA and VEGF) showed a trend towards an elevation at similar timepoints (notably at post-op Day 6) but were not significantly different from baseline levels. There were no observed correlations between inflammatory signal and reported pain, treatment allocation within the trial, burden of implanted prosthetic material, or hernia recurrence.

Discussion

This study demonstrates the novel finding of a pro-inflammatory signal at post-operative Day 30 following the IPOM plus repair.
OC-088 CAN PROCOLLAGEN I AND PROCOLLAGEN III SERVE AS PREDICTIVE BIOMARKERS FOR INCISIONAL HERNIA RECURRENCE?
Authors: Pilkington J , Wilkinson F , Pritchett J , Fullwood C , Sheen A J
Published: October 2022

Background

The aim of this study was to determine the temporal evolution of extracellular matrix (ECM) remodelling and collagen biomarkers and their influence on incisional hernia recurrence after the IPOM plus repair.

Methods

A sub-cohort of patients (n=25) undergoing laparoscopic incisional hernia repair within the TACKoMesh randomised controlled trial were bled at serial timepoints up to 1-year following surgery. Serum/plasma concentration of biomarkers (Procollagen I, Procollagen III, Fibronectin, TGF-beta, MMP-2, MMP-9, TIMP-1, and TIMP-2) were quantified using ELISA and Luminex multiplex techniques. Data were described and compared between groups that developed and remained free from recurrence using R statistical software.

Results

Procollagen I was reduced relative to baseline on post-op Day 1 but increased at Days 6 and 30 (p<0.05). Procollagen III showed an elevation at Day 30. Lower levels of Procollagen I were detected at Day 0, Day 1 and Day 6 (p<0.05) and higher levels of Procollagen III at Day 0, Day 1, Day 6 and Day 30 (p<0.05) in patients with a recurrence.

Fibronectin was reduced at Day 1 and 6 (p<0.05) whilst TGF-β was increased at Day 30 (p<0.05). MMP-2 and its inhibitor TIMP-2 were reduced at post-operative Day 1 (p<0.05). MMP-9 was persistently higher than baseline (p<0.05) at all timepoints. TIMP-1 was elevated at post-op Days 6 and 30. No differences were found in the circulating concentrations of these biomarkers to predict a recurrence.

Conclusion

In patients that developed incisional hernia recurrence, low levels of Procollagen I and high levels of Procollagen III were detected.
OC-090 Heterotopic Ossification in a Laparostomy Wound Complicating Reconstruction– a Case Report
Authors: Lumley E , Garner J
Published: October 2022

Introduction

Heterotopic Ossification (HO) is a benign process of osseous matrix deposition in extra-skeletal tissues; it is well recognised in the orthopaedic setting, especially after blast injury, but is a rare phenomenon following abdominal surgery and is likely under reported. The aetiology is unclear but may be due to differentiation of local mesenchymal cells into osteoblasts leading to calcification of the extracellular matrix, or damage to xiphoid or pubis causing liberation of bone-forming cells into the wound.

Case Report

A 46-year-old man, presented with perforated diverticulitis and underwent an emergency Hartmann's procedure with temporary abdominal closure. Sequential returns to theatre failed to achieve fascial closure and he was managed as a laparostomy. Two years later he underwent reversal of Hartmann's with complex abdominal wall reconstruction (CAWR) – the procedure was complicated by an unrecognised ring of HO around the edge of his laparostomy wound, which necessitated additional excision of fascia. Only partial fascial closure could be achieved leaving an 8×4cm bridge over polypropylene mesh. After a complicated post-operative course, he was discharged home with intestinal continuity and healed abdominal wounds.

Discussion

Pre-operative review of the 2-D axial CT images failed to identify the almost complete ring of HO clearly evident on 3-D reconstructions which impacted on the outcome of the CAWR; 3-D reconstructions should be routinely reviewed. It is commoner in males, those with prolonged ICU intubation, hollow viscus injury and non-closure of the fascia. Restoration of intestinal continuity can be safely performed with complex abdominal wall reconstruction.
P-003 LATERAL ABDOMINAL HERNIAS: A REGISTRY-BASED MULTIVARIATE ANALYSIS OF SURGICAL TECHNIQUES AND OUTCOME
Authors: Schaaf S , Willms A , Güsgen C , Köckerling F , Schwab R
Published: October 2022

Aim

Data on lateral incisional hernia (LAH) repair is scarce. The operative therapy is challenging due to complex anatomy and bulging due to previous nerve lesions. Data concerning medial hernias are not necessarily transferable. Therefore, this study evaluates the status-quo of LAH repair, compares different strategies, and identifies risk factors for complications and adverse outcomes.

Materials and Methods

The German Herniamed registry was screened for LAH. Data from patients operated on between 01–05–2009 and 05–31–2020, resulting in 6,306 cases. Data analysis focused on patient-specific, surgery-related factors, complications, and outcome. In addition, a logistic regression analysis of multiple variables was conducted.

Results

Laparoscopic IPOM (27.9%) and open sublay (38.1%) were the most common surgical procedures. Intraoperative complications were more common in laparoscopic IPOM compared to open sublay (1.8% vs. 0.9%; p<0.001), whereas seroma rate was lower (1.8% vs. 3.4%; p<0.001). Open sublay showed a lower risk for intraoperative complications compared to laparoscopic IPOM (OR 0.298 [0.158–0.564]; p<0.001) in the regression analysis. Risk factors for recurrence were large defect size, open onlay/IPOM, and BMI.

Conclusion

LAH repair is especially challenging due to its anatomical complexity, rareness, and weak management evidence. This study adds registry-based data with the largest number of cases yet published. Due to the complexity and the flimsy evidence of treatment options, lateral incisional hernias should be treated in specialized hernia centers. In addition, further evaluation of repair techniques is needed, and particular focus should be put on a proper localization classification and defect size (both according to EHS).
P-004 OUR EXPERIENCE WITH POSTERIOR COMPONENT SEPARATION – TAR (TRANSVERSUS ABDOMINIS RELEASE) IN LARGE COMPLEX INCISIONAL HERNIAS – A SERIES OF 18 PATIENTS
Authors: Ungureanu C , Iordache N
Published: October 2022

Background

Large incisional hernias represent a challenge for parietal surgeon. Thanks to the modification of the Rives-Stoppa technique introduced by Novitsky, a new era in solving complex defects begun. Posterior component separation (PCS) with unilateral/bilateral TAR has promising results in many studies. Our experience is presented in a retrospective study.

Method

We present a study on 18 patients (sex ratio=1:1), operated between 2019–2022, with large complex incisional hernias. Mean body mass index was 37.17 kg/m2 (range 31–42). Mean age – 58 years (range 34–70 years). We used PCS with bilateral TAR in 12 cases (66.66%) and unilateral TAR in 6 cases. One of the hernias was a combined midline-large parastomal hernia operated using Pauli technique. 5 of the hernias (27.78%) were lumbar, of which 2 were operated with hybrid technique (open and laparoscopic), using reverse TAR. Mesh used was polypropylene (61.11%) and ePTFE mesh (38.89%). The prothesis size ranged from 20×25 cm to 34×32 cm. Mean operative time was 3.41 hrs (range 2–4 hrs). Average hospitalization time was 5.44 days (range 2–14 days).

Results

Fascial closure anterior to mesh was achieved in 72.22% of patients. No recurrences were reported in the follow-up (3–12 months). Postoperative morbidity: seromas (33.33%), wound infection (11.11%), hematoma (5.55%).

Conclusions

Rives-Stoppa technique is the gold standard in VHR. Extending this technique with PCS-TAR in complex incisional hernias seems to be the perfect solution in obese patients with great outcome and low postoperative morbidity. Also the hybrid approach has great results and we hence recommend.
P-006 LAPAROSCOPIC ETEP APPROACH TO VENTRAL HERNIAS: INITIAL EXPERIENCE AND SHORT-TERM RESULTS
Authors: Trujillo Díaz J , Jezieniecki Fernandez C , Gomez Lopez J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C
Published: October 2022

Aim

Ventral hernias are a pathology with a high incidence within general surgery.Repair techniques have been evolving,and the minimally invasive approach to this type of pathology is currently on the rise due to the advantages offered by the minimally invasive surgery (laparoscopic or robotic):less postoperative pain, SSI,seromas,length of stay (LOS) and faster return to routine daily activities.We present our initial series of patients with ventral hernias treated by laparoscopic eTEP approach.

Material & Methods

Retrospective-study where we analyzed our database of patients with ventral hernias (primary and secondary)undergoing abdominal wall surgery using laparoscopic-eTEP-approach.

Results

15 patients underwent laparoscopic-eTEP-surgery (men:73.3%, age:64(RIQ:41–74years)). LOS:1.73±0.7days. Pathological history: diabetes mellitus (26.7%), arterial hypertension (46.7%), dyslipidemia (66.7%),smoking (20%), alcohol-consumption(13.3%), cardiovascular disease (13.3%). ASA-Classification: I (26.7%), II(53.3%), III(20%). BMI:29.82±4.78kg/m2. Overweight: 14(93.3%) and obesity: 6(40%).

Primary hernias:4(26.7%) and incisional-hernias:11(73.3%). Location:midline (100%), supraumbilical:60%, umbilical:93.3% and infraumbilical:26.7%.Hernia-width(EHS classification): W1:13.3% and W2:86.7%, transverse hernia-diameter: 6.2±2.1cm, hernia length-size:7.2±4.4cm. Diastasis:10(66.7%), diastasis-width:5.7±1.38cm. Associated with inguinal hernia:5(33.3%).

Type of laparoscopic surgical technique performed: Rives-Stoppa: 10(66.7%), unilateral-TAR: 3(20%), bilateral-TAR: 2(13.3%). #trocars: 4(RIQ:4–5). Preoperative botulinum-toxin: 6(40%). Posterior-sheath-closure: 14(93.3%). Mesh fixation-type:Glutack 5(33.3%), Tisseel 6(40%), non-fixation 4(26.7%). Mesh type: Low density wide-pore polypropylene 6(40%), PVDF-Mesh 8(53.3%), PVDF-IPOM-mesh 1(6.7%). Mesh size: width 20(RIQ:18–25cm) and length 30(RIQ:26–30cm).Drainage:3(20%).Surgical time:240(RIQ:180–300min).

Global and serious complications (CD≥III):1(6.7%) and Re-IQ due to incarcerated hernia due to posterior-sheath-dehiscence:1(6.7%).No intraoperative-complications.Clinical-seroma:0% and ultrasound-seroma:66.7% that resolved completely spontaneously during the first-second postoperative-months.No hematomas or surgical-wound-infection.Until the current follow-up no-recurrence.

Conclusions

The laparoscopic-eTEP-approach of ventral-hernias has a low rate of global-complications,despite being our first cases performed.It also has low rates of postoperative pain and shorter-LOS.We can conclude that in our Hospital the laparoscopic-eTEP-approach is a safe, efficient and effective technique.
P-008 PRELIMINARY RESULTS OF A RANDOMIZED CLINICAL TRIAL COMPARING TWO DIFFERENT MESH FIXATION TECHNIQUES IN OPEN RETROMUSCULAR VENTRAL HERNIA REPAIR
Authors: Chatzimavroudis G , Kotoreni G , Pavlidis T , Beratze N , Kourgiali C , Atmatzidis S , Koutelidakis I , Papaziogas V
Published: October 2022

Aim

Retromuscular ventral hernia repair has become very popular recently due to its very promising results concerning recurrence and other complications. However, controversy exists regarding the optimal mesh fixation method. The aim of this study is to compare the safety and effectiveness of two mesh fixation techniques.

Material & Methods

This is an ongoing randomized, prospective, single-blind study. According to study protocol, patients with midline ventral hernias who meet the inclusion criteria, undergo open retromuscular hernia repair and the mesh is fixed either with transfascial sutures or with n-butyl-2-cyanoacrylate glue. In the three-month follow-up patients answer the EuraHS QoL score to assess postoperative pain and other QoL features and are examined for the identification of postoperative complications. The results of the first 20 patients who have completed the three-month follow-up are presented.

Results

Glue group had an average VAS pain at the site of the hernia of 0.3/10, 0.9/10 and 0.3/10, in rest, during activities, and during last week, respectively, while suture group had 0.3/10, 1.1/10 and 0.6/10, respectively. Concerning the restrictions of daily activities: inside, outside the house, during sports and during heavy labor, glue group had 0.2/10, 0.3/10, 0.6/10 and 1/10 and suture group 0.2/10, 0.4/10, 0.9/10 and 1.1/10, respectively. All differences between groups were not statistically significant. Regarding postoperative complications, only one patient from the suture group presented with seroma.

Conclusions

The preliminary results slightly favor the glue group, without reaching statistical significance. Retromuscular hernia repair leads to very good early results concerning pain and other complications.
P-011 FEASIBILITY OF VENTRAL-TAPP FOR VENTRAL HERNIA REPAIR IN A LOW INCOME COUNTRY LIKE INDIA
Authors: Rodha M S , Gupta D
Published: October 2022

Aim

Minimal invasive repair is now the established procedure for ventral hernia. Surgeons are now validating newer techniques each year to deal with the ventral hernia. It becomes difficult to choose, best fit technique from this large armamentarium. For a low income country like India, ventral- trans abdominal preperitoneal (TAPP) technique is cost effective and uses simple polyester or polypropylene mesh.

Methods

For this article we used our experience with ventral-TAPP performed from July 1, 2021 to May 31, 2022. Patients were followed up for 6 months.

Results

In the above time period, we had performed 10 ventral-TAPP. Out of these, 3 had completed the follow up. Median age was 45.0 years, BMI was 26.56 kg/m2. One patient was male (33.33%). All patients were presented to surgery due to bulge or pain in the anterior abdominal wall.

The median hernia defect measured 80 mm, median mesh diameter was 15 cm and median operative time was 125 min. No intraoperative complications occurred.

Postoperatively, none of the patients developed complications. Length of hospital stay was 3.0 days. Six months after surgery, neither recurrence nor chronic pain were recorded.

Conclusion

We have concluded that mesh used in repair with ventral-TAPP costs one fourth to one-fifth to that of composite mesh used in intraperitoneal onlay mesh (IPOM) repair with the comparable results. So in a low income country like India, ventral TAPP should be a preferred approach.
P-015 POLY-4-HYDROXYBUTYRATE ABSORBABLE BARRIER COMPOSITE MESH AND POLY-PROLINE MESH: DUAL REPAIR FOR HUGE INCISIONAL HERNIA
Authors: Binjaloud A , Alshammari S , Aldohayan A
Published: October 2022

Introduction

A giant incisional hernia is a serious challenge. Along with loss of domain, the ideal surgical management is difficult to identify, with various surgical techniques and meshes. Obesity and comorbidities in patients with diabetes add to difficulties in repairing incisional hernias with loss of domain. Herein, we present a case in which a double-mesh technique was performed for surgical repair of huge incisional hernias.

Presentation of Case

An 80-year-old male patient with multiple comorbidities presented to the clinic with multiple incisional hernias secondary to a missile injury. The huge incisional hernias affected the patient's daily life and limited his activities. Abdominal computed tomography showed multiple central and lateral incisional hernias. Through a midline laparotomy, a 30 × 35-cm poly-4-hydroxybutyrate/absorbable barrier composite (P4HB/ABC) mesh was sutured to the abdominal wall intraperitoneally, and then a 20 × 25-cm lightweight polypropylene (LWPP) mesh was sutured to the edge of the muscular defect.

Discussion

This report described the case of a patient with multiple huge abdominal hernias, which were repaired using the double-mesh technique. The patient had an uneventful postoperative recovery. However, the patient had a seroma during follow-up, which was managed conservatively.

Conclusion

This report described the usefulness and challenges of using the double-mesh technique for successful repair of multiple central and lateral incisional hernias. We used two types of meshes, P4HB/ABC and LWPP meshes, which yielded good outcomes and no hernia recurrence occurred in a 3-year follow-up.
P-016 SMALL BOWEL PERFORATION WITHIN A GIANT INGUINOSCROTAL HERNIA DUE TO AN INGESTED FOREIGN BODY
Authors: García Galocha J L , Del Campo Martín M , Avellana Moreno R , Sotillo Valenzuela L , Flores Flores C , López Antoñanzas L , Talavera Eguizabal P , Torres García A J
Published: October 2022

Introduction

Bowel perforation due to an ingested foreign body is a rare event. Its presentation within an inguinoscrotal hernia, is even more uncommon.

Case Description

We report the case of a 69-year-old indigent man with a chronic alcoholic liver disease history, who presented in the emergency department due to sepsis. He was complaining of nausea, vomiting and mild abdominal pain. Clinical examination revealed a painful, giant right inguinoscrotal hernia, with cutaneous trophic changes and subcutaneous emphysema. Blood test showed leukocytosis and lactic acidosis. CT scan revealed small bowel perforation with peritonitis inside the hernia sac. The patient underwent emergency surgery. Two 5-centimeters long fishbones were found. Ileocecal resection with ileocolic side-to-side anastomosis and Lichtenstein hernioplasty open repair were performed. A polypropylene mesh was placed.

Discussion

Accidental foreign body ingestion followed by gastrointestinal tract perforation is a rare cause of peritonitis. There are few case reports about this event happening inside a hernia. Perforation is more common at points of physiological angulation or narrowing of the passage within the digestive tract, such as lower esophageal sphincter, pylorus or ileocecal valve. Inguinoscrotal hernias present as a pathologic stenotic area where foreign bodies can produce an obstruction or perforation. In these cases, the hernia repair is challenging due to the contaminated scenario.

Conclusion

The diagnosis of perforation within an inguinal hernia should be suspected in cases of acute abdomen and incarcerated hernia, in order to choose the best surgical treatment option.
P-023 ABDOMINAL WALL HERNIA AND MENTAL HEALTH: PATIENTS LIVED EXPERIENCES AND IMPLICATIONS FOR PATIENT CARE
Authors: Smith O , Mierzwinski M , Mcvey J , Chitsabesan P , Chintapatla S
Published: October 2022

Aim

To qualitatively examine how Abdominal Wall Hernia (AWH) affects patients’ mental health.

Methods

Fifteen patients were interviewed from a purposive sample of AWH patients until no new themes emerged. Interviews explored patient thoughts and experiences of AWH and mental healtth. Data were examinted using Interpretative Phenomenological Analysis (IPA).

Results

Three themes pertaining to mental health were identified: “psychological and emotional distress”, “identity disruption” and “coping mechanisms and support systems”.

Conclusions

This is the first study to qualitatively examine how AWH affects patients’ mental health. Our findings illustrate that AWH is a pathology that can have a significant detrimental impact on people's mental health. This impact has implications for patient care and can be treated and managed through better psychological support. This support may positively affect AWH patient's experience and outcomes in terms of quality of life. We provide recommendations for improved AWH patient care in regards to mental health.
P-024 COMPLEX ABDOMINAL WALL RECONSTRUCTION BY RETROMUSCULAR SUBLAY TECHNIQUE: INITIAL EXPERIENCE IN A THIRD-LEVEL HOSPITAL
Authors: Jezieniecki Fernandez C , Trujillo Díaz J , Ruiz Soriano M , Gomez Sanz T , Cabezudo Molleda G , Rodriguez Lopez M , Montes Manrique M , Herreros Rodriguez J , Beltrán De Heredia Rentería J
Published: October 2022

Aim

Large or complex incisional hernias require more than just mesh placement.There are techniques such as component separation, retromuscular techniques (Rives-Stoppa, transversus abdominis muscle release-TAR), which help to repair the hernia and physiologically rebuild the abdominal wall.However, this type of technique can present a higher incidence rate of complications, such as hematomas, seromas, SSI, skin necrosis.We present our initial experience in complex abdominal wall reconstruction using the retromuscular sublay technique (RST).

Methods

Retrospective study analyzing our database of patients with complex incisional hernia undergoing abdominal wall surgery using the RST, during November-2018 to October-2020.In addition, we conducted a comparative analysis with patients undergoing hernia repair using the onlay-technique.

Results

44 patients underwent RST (male:56.8%, age:66(IQR: 52–73years)). Hospital stay:4(IQR: 2–6days).Pathological history: diabetes mellitus (4.5%), arterial hypertension(20.5%), dyslipidemia(36.4%), smoking(34.1%), alcohol consumption(27.3%), cardiovascular disease(9.1%).ASA-classification:I(9.1%), II(59.1%), III(31.8%). BMI: 29.3±2kg/m2.

Hernia location: midline(95.5%), others(4.5%). Preoperative botulinum toxin (PBT): 20.45%. Preoperative progressive pneumoperitoneum (PPP): 9.1%. Type of surgery performed: Rives-Stoppa(68.2%), TAR(31.8%).

Postoperative complications: global(13.6%), Clavien-Dindo≥III:0%, clinical seroma(13.6%) and ultrasound-seroma(22.7%), SSI(0%). Hernia recurrence:0%.

In the bivariate analysis of patients undergoing hernia repair using the RST compared to patients undergoing onlay repair, we observed that the RST presented lower incidence of global complications, both clinical and ultrasound seromas, surgical site infections and recurrences (13.6% vs 39.1% p=0.004; 13.6% vs 33.3% p=0.019; 22.7% vs 39.1% p=0.07; 0% vs 14.5% p=0.008; 0% vs 5.8% p=0.1; respectively).

Conclusions

In our enviroment, the management of complex incisional hernias using RST and the use of PBT and PPP is effective and safe, with a lower incidence of complications and recurrences.
P-026 SMALL BITE CLOSURE IN EMERGENCY LAPAROTOMY; A RETROSPECTIVE COHORT ANALYSIS
Authors: Khan A , Wintrip D , Light D , Light D
Published: October 2022

Aims

To investigate the outcomes of the implementation of small bite closure in emergency laparotomy

Methods

A retrospective comparative cohort analysis was performed from Northumbria NHS Trust (United Kingdon) surgical database from 2017 to 2021. All cases of emergency laparotomy were included. Cases of open appendicectomy were excluded. Small bite closure was performed by a standardised technique with slowly absorbable sutures. A matched cohort of cases who were closed with mass closure were used for comparison.

Results

262 cases of emergency small bites closure were included, and 247 cases of emergency mass closure. There were comparative age, sex and ASA grade in each group. There was no significant variation in the types of procedure performed.

In the small bites closure group, there were 8 cases of superficial dehiscence (3%), 4 cases of deep dehiscence (1.5%) and 16 wound infections (6%). The mean post operative stay was 10 days (2 to 74). The 30 days mortality was 18 cases (7%) and 40 cases overall (15%).

In the mass closure group, there were 6 cases of superficial dehiscence (2%), 6 cases of deep dehiscence (2%) and 23 wound infections (9%). The mean post operative stay was 14 days (3 to 65). The 30 day mortality was 34 cases (14%) and 65 cases overall (26%).

Conclusion

Small bites closure shows comparative results to mass closure in the emergency setting in post operative outcomes. Small bites closure is safe and feasible in the emergency setting.
P-027 REDUCING SURGICAL WAIT TIMES FOR ABDOMINAL WALL HERNIA OPERATIONS POST COVID-19 BY USING DEDICATED CLINICS
Authors: Renna M , Lyon S , Sindhar J , Ebied H
Published: October 2022

Background

Specialization influences the way that surgeons deliver care and has a direct impact on doctors, healthcare systems and patients. Hernias impact around 2% of the population and repairs are among the most common procedures performed globally. The European Hernia Society recognizes a growing need for specialist surgeons as abdominal wall surgery becomes more complex with newer techniques and more challenging cases being encountered. At this trust, a new specialized hernia clinic was implemented in response to COVID backlogs and the growing need and proven benefits of specialization. The project's aim was to review the impact on procedure wait times and outcomes for hernia repairs.

Methods

A retrospective review of patients undergoing hernia repairs between June 2019 to June 2021 was compared to similar patients who attended the hernia clinic between February 2021 to March 2022. Included operations were inguinal, femoral, and umbilical hernia repairs. Data collected included diagnoses, percentage of day case and wait times.

Results

59 patients underwent surgery pre-intervention with average wait times of 191 days. 72 post-intervention patients had an average wait of 59 days. 59 patients were still awaiting surgery post-clinic. Open surgery incidence increased from 66% to 79%. 86% of patients post-intervention were day cases, compared to 78% of pre-intervention patients.

Conclusions

The new hernia clinic has reduced wait times for surgery and improved day-case rates despite more cases being performed as open procedures. Following these results, the clinic system shows great promise and hernia surgery has the potential to evolve as a sub-specialty.
P-031 AN UNUSUAL CASE OF AN INCARCERATED 5MM PORT SITE HERNIA FOLLOWING LAPAROSCOPIC FUNDOPLICATION
Authors: Christopoulos P , Sinha S , Browning M , Bradley A , Andrews S
Published: October 2022

Aim

Port site hernias are a rare, but recognised risk of laparoscopic surgery. Literature supports fascial closure at port sites of 10mm or greater. However, there are few reported cases of herniation through 5mm port sites.

Methods

This case report focuses on a 67-year-old female who underwent an uncomplicated primary laparoscopic Toupet's fundoplication. 11 days post procedure she presented with an incarcerated port site hernia. CT scan demonstrated high grade small bowel obstruction with a transition point at the site of the 5mm right sided port. A laparotomy was performed, the hernia reduced, small bowel was viable, and the port site hernia was closed internally using vicryl sutures.

Results

The incidence of 5mm trocar-site hernias is rare. A recent literature review found only 10 such cases related to general surgery (cholecystectomy:6; appendicectomy: 2; right hemicolectomy: 1; paraesophageal hernia:1). Risk factors for port-site hernias include: high BMI, midline position, size, number and type of trocar tip. The limited current literature identifies excessive trocar manipulation as the major risk factor for developing 5mm port-site hernias, yet routine fascial closure is not supported.

Conclusion

Herniation at 5mm port sites is rare but attention should be paid when patients present with symptoms suggesting its occurrence.
P-034 RECOMMENDATIONS ON POSTOPERATIVE ACTIVITIES AFTER ABDOMINAL OPERATIONS AND INCISIONAL HERNIA REPAIR - A NATIONAL AND INTERNATIONAL SURVEY
Authors: Schaaf S , Willms A , Güsgen C , Schwab R
Published: October 2022

Aim

There is no conclusive data on postoperative recommendations after abdominal and hernia surgery, and substantial variation in the literature. Thus, this study evaluates the status quo of recommendations of postoperative activity restriction after abdominal surgery.

Material and Methods

A national (German) and international survey (at the 41st EHS Annual Meeting) of general surgeons on postoperative recommendations after abdominal and hernia surgery was pooled and analyzed. Results 74.6% recommended postoperative reduced activity for 2 weeks or less after laparoscopy. For midline laparotomy, 48.8% considered a reduced activity of 4 weeks or less to be sufficient. A majority from the national survey recommended more than 4 weeks instead (60.2%), whereas only 31.5% from the international survey did so (p=0.000). In the pooled analysis, 258 of 450 (57.3%) rated 4 weeks or less suitable. However, the recommendations differed significantly between the surveys (4 weeks or less: a national survey, 47.1% vs. international survey, 64.6%; p=0.000).

Conclusion

There was substantial variation in the given recommendations. However, we found no evidence against immediate mobilization, reduced physical activity, and lifting for up to 2 weeks after laparoscopic surgery and for up to 4 weeks after open abdominal surgery and open incisional/ventral hernia repair in uncomplicated and standard cases. There might be individual and socio-economic benefits to allow patients to return to their whole personal level of activity and work without putting them at risk of complications. Due to lack of evidence, both retrospective and prospective, controlled studies are in need to develop reliable recommendations.
P-035 SEPARATION OF COMPONENTS WITH TRANSVERSUS ABDOMINIS MUSCLE RELEASE TRANSVERSE (TAR): OUR SERIES
Authors: Curado Soriano A , Infantes Ormad M , Aguilar Marquez A , Valera Sanchez Z , Naranjo Fernandez J R
Published: October 2022

Aim

In our series we analyze our experience in the subsequent separation of components with release of the transverse (TAR).

Material & Methods

Study of our series of retrospective cases since 2016 to the present. We analyzed 59 patients with large hernias (midline and sides) all with defects greater than 10 cm. We perform the technique accessing the Rossen space through down to up. We used two meshes as prostheses, one biodegradable and the other made of polypropylene low density.

Results

We present 59 patients (38 men/21woman), of mean age of 61 years old and average BMI 32.05 Kg/m2. The mean postoperative stay was 7 days. The technique was carried out bilateral in 39 patients, and 20 it was applied unilaterally. Mesh implant to retromuscular level in 56 of the cases and 4 preperitoneal. Reinterventions in 4 (6.78%) patients. As minor complications, 8 (13.56%) wound infections, 9 (15.25%) wound seromas, 7 (11.86%) patients with pain chronic with preserved management, 1 (1.69%) edge ischemia and 1 (1.69%) wound sinus. Readmissions 4 patients (6.78%). Average follow-up of 24 months, no recurrence has been detected in any of the patients.

Conclusions

TAR is a complex technique that requires a learning curve, and that, even in equipment experienced, is not exent from serious complications. Therefore, the indication must be individualized and in order for it to be definitive, because once the wall is remodeled with this technique, the surgical options that remain are few.
P-036 CLOSURE OF INFECTED LAPAROSTOMY WITH NPWTI (NEGATIVE PRESSURE WOUND THERAPY WITH INSTALLATION) TO ON-LAY POLYPROPYLENE MESH IN A SEVERELY SARCOPENIC PATIENT
Authors: Ewan H , Zanellato A
Published: October 2022

Aim

To demonstrate NPWTi allows using polypropelene mesh in infected wounds in a patient with sarcopenia at high risk of developing incisional hernia.

Methods

This case describes a severely unwell 50 year-old with a gangrenous caecal volvulus and severe sarcopenia and hypoalbuminaemia. He underwent a right hemicolectomy and ileostomy and on ITU intubated. His wound grew yeast and vancomycin-resistant enterococcus, he developed large bilateral flank collections and on day 8 dehisced.

Results

A washout and laparostomy with mesh partial closure plus silicone-coated dressing was performed. At 48 hours Abthera@ fill was applied and the mesh was trimmed and tightened for gradual closure. Subsequent washouts showed mesh was fixated on the posterior rectus sheath with several holes caused by stitches used to fixate it. As such, the anterior rectus sheath was divided, creating a flap bilaterally. The posterior sheath flaps were reapproximated but the anterior sheath couldn't be, but was kept in place without tension by securing a polypropylene mesh and a NPWTi (Veraflo.)

Successive returns to theatre showed the mesh was intimately attached to aponeurosis and rectus muscle and subsequently there was exuberant granulation tissue on top of mesh. Skin was closed, again with NPWT. Despite leakage from his stoma, he now has a clean healed wound.

Conclusion

NPWTi enabled use of polypropylene mesh in a very hostile wound with gross contamination in a sarcopenic patient with high risk of developing incisional hernia. It is still a short follow up but we expect with this technique will avoid hernia formation.
P-037 ABDOMINAL WALL CLOSURE WITH SMALL-BITES TECHNIQUE USING PDS 3–0 SUTURE: EXPERIENCE IN A THIRD-LEVEL HOSPITAL
Authors: Trujillo Díaz J , Jezieniecki Fernández C , Herreros Rodríguez J , Ruiz Soriano M , Cabezudo Molleda G , Montes Manrique M , Rodriguez López M , Beltrán De Heredia Rentería J
Published: October 2022

Aim

Current studies show the correct closure of the abdominal wall must be carried out with a technique of giving many points and separated from each other with very little distance (small-bites technique) and with a suture of slow absorption.We conducted a review of our experience in abdominal wall closure in which we used a 3–0 polydioxanone (PDS®II)-suture using small-bites technique.

Methods

Retrospective study analyzing our database of patients in whom laparotomy and abdominal wall closure were performed using small-bites with PDS 3–0 suture, needle 26mm-½C, during November-2018 to October-2020.Emergency and elective laparotomies were analyzed.

Results

164 patients were analyzed(men:59.8%,age:73(IQR:61–78years)).LOS:6(IQR:5–10days). Pathological history: diabetes mellitus (28%), arterial hypertension (62.2%), dyslipidemia(67.1%), smoking (45.1%), alcohol consumption(19.5%), cardiovascular disease(19, 5%).BMI:27.45±4.2kg/m2(Range:18.31–38.29).Overweight:70.7%. Obesity:28%.

Laparotomy location: midline(47.6%), pfannenstiel(30.5%), transverse or subcostal(22%). Laparotomy was performed as an auxiliary to laparoscopy in 35.4%. Emergency surgery:40.2%. Neoplasms:56.1%. Associated with hernia repair:17.1%. Associated with surgical reoperations:9.8%.

Complications: no evisceration, SSI(11%),no eventration until current follow-up (17.5±4.3months).

Overweight patients and those who underwent emergency surgery had a higher incidence of SSI (13.6% vs. 4.2% p=0.07; 18.2% vs. 6.1% p=0.015).The location of the laparotomy, the association with hernia repair, reoperations, and neoplasms were not associated with a higher incidence of SSI (p>0.05).

Conclusions

The closure of the abdominal wall using small-bites technique with slow resorption suture (PDS®II 3–0) with a small needle, provides a safe and effective closure, both in midline and transverse laparotomies, in emergency surgery and in patients with associated neoplasms, without increasing the number of complications and with no evidence of evisceration or eventrations.
P-044 LEARNING AND DATA FROM OUR TEP LEARNING CURVE
Authors: Ruiz Marzo R , Rico Arrastia A , Otegi Altolaguirre I , Enguita Germán M , Ramírez Cervera J L , Uribazo Rodríguez M , Sebastián Labayen J L , Blázquez Lautre L
Published: October 2022

Aim

Laparoendoscopic techniques for inguinal repair (TEP) offers advantages such as less postoperatory pain, less local complication rates and early comeback to work activities.

We describe the TEP learning curve in our unit and we present a preliminary analysis of our results.

Material and Methods

We present the retrospective analysis of patients who underwent TEP inguinal hernioplasty between 2018 and 2021 in a Wall Surgery Unit of Navarra Hospital. We perform a descriptive analysis of the collected data.

Results

182 patients were analysed, including 91.6% male with an average age of 57.1 years. 11patients required conversion from TEP to another technique (mainly TAPP and open preperitoneal surgery) due to surgical or anesthetic problems, with a conversion rate of 6%.

4 patients (2%) presented early recurrence and 6 patients (3%) late recurrence. 16 patients (8.8%) had moderate pain (VAS < 5) while 7 patients (3.8%) had severe pain (VAS ≥5). All the patients who presented postoperative pain were reviewed and none presented postoperative neuralgia. No patient showed surgical site infection neither epididymitis. 4 patients (2%) presented seroma and 23 (12.6%) hematoma.

Conclusions

Laparoendoscopic techniques, especially TEP, has more demanding learning curve than open repairs. Support and tutoring are imperative in the first cases. An adequate selection of cases at the beginning is important. Mastering open preperitoneal hernioplasty surgery leads to better and faster results in TEP approach.
P-047 PERINEAL HERNIA: RECTUS ABDOMINIS MUSCLE FLAP REPAIR
Authors: Bockova M , Kocián P , Miletin J , Stolz A , Hoch J
Published: October 2022

Aim

Perineal hernia (PH) is a rare complication of pelvic surgeries. We present two cases of male patients with symptomatic PH following abdominoperineal resection (APR), repaired with rectus abdominis muscle flap.

Cases presentation

N1: 66-year male, 1 year after laparoscopic-assisted APR was treated with rectus abdominis muscle flap repair (RAM) by open abdominal approach. In postoperative period, heavy bronchitis leaded to the disruption of the muscle flap and need of reoperation. The patient healed completely two months after the repair. No recurrence of PH within 5 years has been registered. N2: 64-year male, underwent chemoradiotherapy and open APR for rectal carcinoma. 2 years later, CT showed a PH and 2cm wide mass suspicious of cancer recurrence in pelvis. By the open abdominal – perineal approach, the mass of recurrence was excised, and PH was repaired with vertical rectus abdominis muscle flap (VRAM). The postoperative period was uneventful and 1 year after the surgery, the patient is cancer and PH free.

Discussion

Treatment of more advanced carcinomas or wide use of radiotherapy can lead to an increased number of PH. Abdominal, perineal or combined approaches exists. The pelvic floor reconstruction is mostly realized by mesh implantation or flap repair. In our presented cases, we took advantage of long existing cooperation with plastic surgeon team and chose rectus abdominis muscle flap reconstruction. We proved its feasibility and good effect on PH repair.

Conclusion

Perineal hernia repair is challenging. No consensus regarding the ideal method exists. Every case must be assessed individually.
P-056 ELECTIVE OPEN INGUINAL HERNIA REPAIRS- ARE WE DISCLOSING ALL THE RISKS?
Authors: Zhang C , Butnari V , Anber A , Bhargava A
Published: October 2022

Introduction and Aim

Elective open inguinal hernia repairs are one of the most common procedures carried out in the NHS with over 78000 operations per year. There are many risks associated with this procedure and so obtaining informed consent is imperative to patient care and patient choice. The aim of this study is to compare the quality of consent forms for elective open inguinal hernia repairs to the guidance provided by the Royal College of Surgeons (RCS) and the British Hernia Society (BHS).

Method

60 patients (50 male, 10 female) undergoing elective open inguinal hernia repair between 01/09/2021–20/12/2021 were identified retrospectively. Their consent forms were audited against modified guidelines from RCS and BHS. The grade of the consenting surgeon was also noted.

Results

Sepsis (95%), recurrence (85%), and chronic pain (82%) were the most consented risks. Least consented serious risks were persistent numbness (47%), nerve injury (47%), and mesh infection (40%). Notable disparities existed between rates of consent and grade of surgeon: 64% of registrars consented for nerve injury compared to 9% of SHOs and 82% of SHOs consented for haematoma compared to 20% of consultants.

Conclusion

Serious risks such mesh infection and nerve injury were often missed from consent forms. There is inconsistency in consented risks between different grades of surgeon. A standardised consent form would improve consent consistency and potentially reduce rate of litigation for doctors and the trust. Comprehensive pre-made consent forms were therefore designed to better facilitate a standardised approach to the consenting process.