bluuebunny/crossref_metadata_2025 huggingface dataset:
OC-018 Elective recurrent inguinal hernia repair. Value of an Abdominal Wall Surgery Unit
Authors: Martinez Lopez M , Rodrigues Gonçalves V , Verdaguer Tremolosa M , Martinez Lopez P , Bergamini S , Lopez Cano M
Published: May 2023

Purpose

The aim of this study is to analyze the influence of an abdominal wall surgery unit in postoperative complications (within postoperative 90 days), hernia recurrence and chronic postoperative inguinal pain after elective recurrent inguinal hernia repair.

Methods

This retrospective cohort study included patients who underwent elective recurrent inguinal hernia repair between January 2010 and October 2021. The short- and long-term outcomes between the groups of patients operated on by the Abdominal Wall Surgery Unit and groups operated on by surgeons outside of the specialized abdominal wall group were compared. A logistic regression model was performed for hernia recurrence.

Results

A total of 250 patients underwent elective surgery for recurrent inguinal hernia during the study period. Patients in the abdominal wall surgery group were younger (P= <0.001) and had less comorbidities (P= <0.001). Complications were similar in both groups. Patients in the abdominal wall surgery group presented fewer recurrences (15% vs 3%; P= 0.001). In the multivariate analysis, surgery performed by the abdominal wall surgery unit was related to fewer recurrences (HR= 0.164; 95% CI= 0.44–0.613; P=0.007).

Conclusions

Recurrent inguinal hernia repair is associated with better results in terms of recurrence when it is performed by a specialized abdominal wall unit.
OC-020 QUANTITATIVE EVALUATION OF THE ABDOMINAL WALL MECHANICAL BEHAVIOR BY A NEW CONNECTED ABDOMINAL BINDER: A PRELIMINARY STUDY
Authors: Bege T , Joppin V , Gueroult P , Masson C
Published: May 2023

Aim

Abdominal wall hernias result from a mechanical conflict between forces acting on the wall (mainly intra-abdominal pressure (IAP)) and its ability to deform. An abdominal binder instrumented with sensors has been developed to non-invasively quantify the deformation during straining.

Methods

A prospective study was conducted on eight healthy subjects. External deformations were evaluated by a patented connected binder instrumented with resistive sensors covering anterolateral area. IAP was evaluated by intragastric ingested sensor (SmartPill™, Medtronic), and wall muscles deformation by dynamic MRI (semi-automated segmentation method applied to rectus abdominis (RA) and lateral muscle (LM)). The relationship between these signals has been investigated during Valsalva maneuver.

Results

The binder provided time-related mapping of the abdominal deformation. Two different patterns were individualized corresponding to RA and LM areas. Deformation rate (mean 1.21mV/s for RA and 1.66mV/s for LM) and maximum signal (mean 3.03mV for RA and 4.24mV for LM) were recorded. These binder patterns were both correlated with the deep deformation in abdominal muscles observed in MRI (Pearson R=0.89 for RA, and R=0.94 for LM; p<0.005). The binder patterns were also significantly correlated with the IAP variation (Pearson R=0.98 for RA and R=0.99 for LM; p<0.005).

Conclusion

This non-invasive connected and instrumented abdominal binder simply and quickly reflects the abdominal wall muscles deformation and IAP variation during Valsalva maneuver. A larger study is needed to investigate inter-individual variability, and to evaluate the links between quantitative mechanical behavior and surgical outcomes during hernia surgery.
OC-021 TRANSVERSUS ABDOMINIS MUSCLE RELEASE FOR THE TREATMENT OF COMPLEX BILATERAL SUBCOSTAL INCISIONAL HERNIAS
Authors: Medina Pedrique M , Avilés Oliveros A , Morejon Ruiz S , San Miguel Méndez C , Muñoz Rodriguez J , López Monclus J , De Robin Valle De Lersundi A , García-Ureña M Á
Published: May 2023

Aim

To assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. We present our results of posterior component separation through the previous incision as a safe and reproducible technique for complex cases.

Material & Methods

A multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020 was gathered. The outcomes reported were short and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score.

Results

A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 (15%) requiring procedural intervention. During a mean follow-up of 18 months (range, 6–62 months), 1 (2%) case of clinical recurrence was registered. Also, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 variables (pain, restriction, and cosmetic) of the postoperative scores compared with the preoperative score.

Conclusion

Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patient's reported outcomes.
OC-022 Quality and Quantity Matter - Incidence of Incisional Hernia Following Common Abdominal Surgeries by Abdominal Surgical History: A United States Population-based Analysis of 945,262 Patients
Authors: Habarth-Morales T , Rios-Diaz A , Davis H , Broach R , Serletti J , Fischer J
Published: May 2023

Objective

Patients with prior abdominal surgery (prior-AS) may have increased risk of developing incisional hernia (IH) at the time of subsequent abdominal surgery (AS). We hypothesized that prior-AS history is associated with increased incisional hernia (IH) formation and that the risk is higher for prior IH repair (prior-IHR).

Methods

Patients undergoing common AS operations (bariatric, cholecystectomy, small/large bowel resection, prostatectomy, and gynecologic) were identified and followed-up for 1-year using Statewide Inpatient/Ambulatory Databases (2009–2016; FL, IA, NE, NY, UT). Prior-AS history was ascertained within 3-year period preceding the index operation. Risk-adjusted Cox regression examined the association of surgical history with IH.

Results

Of 945,262 patients, 8.55% had prior-AS. Median age was 49 years, most patients were female (68.95%), undergoing open (80.5%) elective (74.5%) AS. Risk-adjusted revealed increased IH risk by surgical history: prior-AS (HR 1.36 [95%CI 1.25–1.48]), multiple prior-AS (2.0 [1.67–2.46]), prior-IHR (3.4 [2.99–3.66]), and multiple prior-IHR (3.56 [2.5–4.28]; Figure). For every additional prior-AS and prior-IHR there was an increase in IH by 9.7% (95%CI 1%-18.6%) and 22.5% (15.6%-29.9%), respectively.

Conclusion

Both the type and number of previous AS are associated with increased risk for IH, particularly in patients with prior-IHR, and multiple prior operations. These findings demonstrate that reoperation through a previously-disrupted abdominal wall poses technical challenges that impact long-term morbidity, and underscore the need to consider preventive measures at the time of subsequent AS.
OC-024 THE IMPACT OF THE INTRODUCTION OF ROBOT-ASSISTED SURGERY ON A DEDICATED VENTRAL HERNIA PROGRAM
Authors: Marckmann M , Willaume M , Jensen K K
Published: May 2023

Aim

The role of a robot-assisted approach in hernia surgery remains controversial due to the high costs associated with robotic surgery and the proposed equal outcomes compared to open surgery. In the current study, we report the 30-day results of the introduction of robot-assisted approach in a dedicated regional ventral hernia repair center.

Material & Methods

This was a retrospective single-center cohort study, including consecutive patients undergoing ventral hernia repair from 2017 to 2022. To reduce the risk of bias, patients undergoing robotic and open repair were matched by propensity scores in a 1:2 ratio on the variables age, type of hernia (primary/ventral) and horizontal fascial defect size. Multivariable logistic regression was performed.

Results

A total of 109 patients undergoing robotic repair were compared to 231 undergoing open repair, of which 61.2% were incisional and 38.8% primary hernias. Mean hernia defect size was 4.9×6.5 cm (horizontal x vertical). The mean length of stay was lower after robotic repair (0.1 vs. 1.9 days, P < 0.001) as was the incidence of readmission (3.7% vs. 15.2%, P < 0.001). The incidence of reoperation was insignificantly lower after robotic repair (0.9% vs. 4.8%, P = 0.139), however after adjusting for confounders there was a significantly reduced risk of reoperation after robotic compared to open repair (OR 0.08, CI 0.01–0.92, P = 0.043).

Conclusions

The introduction of a robotic approach was associated with significantly improved postoperative outcomes.
OC-025 PROSPECTIVE STUDY OF THE ANALGESIC EFFICACY OF A CYCLOMESH™ PARIETAL REINFORCEMENT IMPLANT SOAKED IN ROPIVACAINE IN THE TREATMENT FOR UNCOMPLICATED INGUINAL HERNIA
Authors: Regimbeau J M , Study Group H
Published: May 2023

Background

The objective of this study was to evaluate the interest of a parietal prosthesis (Cyclomesh ™) soaked with ropivacaine in the management of early postoperative pain.

Materials and Methods

This is a randomized, phase III, comparative superiority, double-blind, international multicentre study. 290 patients (October 2019 February 2022) underwent surgery for inguinal hernia, by Liechtenstein technique, under general anaesthesia, and with placement of a ropivacaine or saline soaked parietal prosthesis. The primary endpoint was the coughing pain assessment (EVA) at H6. The secondary endpoints were the overall pain assessment at H2, H4 and H6 and the evaluation of the painkillers consumption.

Results

The prosthesis type had no significant effect on the coughing pain at H6, either for the ITT population (3.3 vs 3.2, p=0.12) or for the PP population (3.3 vs 3.7, p=0.15). The ropivaciane soaked prosthesis resulted in a decrease in the overall pain at H2 (2.3 vs 3.2, p<0.0001), H4 (2.3 vs 3.1, p<0.0001) and H6 (2.3 vs 2.7, p=0.0039). Regarding the painkillers consumption, the postoperative complications and the number of ambulatory conversions, there was no difference between the two groups.

Conclusion

The placement of a parietal prosthesis (Cyclomesh ™) soaked with ropivacaine did not reduce the coughing pain at H6 but allowed a decrease in the overall pain over the first 6 hours after the surgery and could simplify the management of patients.
OC-027 RANDOMISED CONTROLLED TRIAL OF THE DESARDA TECHNIQUE AND SUTURE REPAIR FOR OBSTRUCTED INGUINAL HERNIA
Authors: Awan Z N , Hanif M
Published: May 2023

Aim

Open inguinal hernia repair remains one of the most commonly performed operations worldwide. For elective surgery, mesh implantation is an established global ‘gold standard’. However, for emergency repair of obstructed hernia, non-mesh techniques may be utilised. We designed a randomised controlled trial to compare the open, non-mesh ‘Desarda’ against non-mesh suture darn repair in the treatment of obstructed inguinal hernias.

Materials & Methods

A prospective randomized controlled trial was undertaken between Feb and Aug 2020 at the Emergency Unit, of a busy hospital in a resource-constrained setting. To identify a true difference in operating time, a sample size of 100 patients was calculated using WHO calculator. Exclusion criteria were patients ASA 3+ or with recurrent or strangulated intestine; ethical approval was obtained from the hospital Ethics’ Committee and informed consent obtained from all participants. Randomisation was by the sealed opaque envelope method. Data analysis by SPSS version 25 using Student t-test; p-value ≤0.05 was considered significant.

Results

Total 100 patients were included (71 male and 29 female). Mean age of patients: 39.1 years±6.1SD. Mean operative time was significantly lower in Desarda group (50.5±1.7) compared to sutured repair (58.8±2.1SD) p=0.000. Intra-operative and immediately postoperative complications were not identified in any of the patients. Patient reported outcomes will be reviewed at the 2-year point.

Conclusion

In this RCT of emergency repair of obstructed inguinal hernia, Desarda's repair was safe and effective and took significantly less surgical time compared to a standard sutured darn repair. Longer term, patient reported outcomes are awaited.
OC-029 E- MILOS EXTRAPERITONEAL MESH REPAIR OF UMBILICAL HERNIAS WITH COMBINED RECTUSDIASTASIS
Authors: Pokorny H , Koo P S , Hofmann M , Schlögl M , Reznicek K
Published: May 2023

Aim

Umbilical hernias with combined rectusdiastasis have a higher risk für recurrence after single repair of the umbilical hernia. The E- MILOS concept enables the minimal invasive sublay mesh repair realizing the benefits of minimally invasive surgery and placing the mesh in the retromuscular position.

Materials & Methods

All E- MILOS operations were documented prospectively. For 1 year follow-up all patients received a questionnaire.

Results

From January 2019 to December 2022, 89 patients (24 female/65 male) with umbilical hernia and a coexisting rectus diastasis (median hernia size 2 cm/diastasis recti 5,5 cm) and median age of 61 yrs were operated by 3 experienced surgeons. In all cases a polypropylene mesh (median size 40×12 cm) was implanted in the retromuscular space without any fixation and continuous suture (V-Loc 2–0) of the anterior and posterior rectus sheet was achieved for reconstructing the midline. The average skin incision was 4,5 cm; median operation time was 125 min. The median hospital stay was 5 days, the postoperative median pain score (VAS) was 2. Two patients needed reoperation due to a retromuscular haematoma. Chronic pain was reported by 13 patients, no postoperative infection and 4 recurrences were observed. Not satisfied with the cosmetic result (subcutaneous bulging) were 4 female patients.

Conclusions

The E- MILOS technique allows minimally invasive transhernial repair of umbilical hernias with combined rectusdiastasis using large retromuscular meshes with low morbidity. The technique is reliable and easy to standardize and shows mostly good cosmetic results.
OC-030 COMPARISON OF OUTCOMES OF THE EXTENDED-VIEW TOTALLY EXTRAPERITONEAL RIVES-STOPPA (ETEP-RS) AND THE INTRAPERITONEAL ONLAY MESH WITH DEFECT CLOSURE (IPOM-PLUS) FOR W1-W2 MIDLINE INCISIONAL HERNIA REPAIR
Authors: Taşdelen H A
Published: May 2023

Aim

This study aimed to compare the outcomes of the eTEP-RS and IPOM-plus procedures in W1 and W2 midline incisional abdominal wall hernia (IAWH) repairs performed by the same surgeon.

Material and Methods

Prospectively collected data of laparoscopic abdominal wall repairs performed on 61 patients with eTEP between November 2018 and April 2022 and on 67 patients with IPOM-plus between January 2016 and April 2022 were retrospectively analyzed. A total of 74 out of 128 patients, 30 in the eTEP-RS group and 44 in the IPOM-plus group, who underwent W1-W2 midline incisional hernia repair were included in the study. The mean follow-up was 24 months in the eTEP-RS group and 45 months in the IPOM-plus group.

Results

There was no statistically significant difference between the groups regarding age, sex, BMI, ASA score, or active smoking. The mean mesh area (MMA) and mesh/defect (M/D) ratio were higher in the eTEP-RS group (p <0.001 and p =0.004). In the eTEP-RS group, the hospital length of stay (LOS) (1.48 days vs. 2.58 days, p <0.001) and pain on the first and 10th postoperative days were significantly lower (p <0.001), while the operative time was significantly longer (p <0.001). There was no significant difference in terms of intraoperative complications (p =0.56), seroma formation (p =0.83), or recurrence (p =0.83).

Conclusions

The eTEP-RS technique has advantages over the IPOM-plus approach, such as a shorter LOS and less early postoperative pain with W1-W2 midline IAWH repair. However, the eTEP technique has a longer operative time.
OC-033 SHORT-TERM OUTCOMES OF MINIMALLY INVASIVE RETROMUSCULAR VENTRAL HERNIA REPAIR USING AN ENHANCED VIEW TOTALLY EXTRAPERITONEAL (ETEP) APPROACH: SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Aliseda D , Sanchez-Justicia C , Zozaya G , Almeida A , Blanco N , Sabatella L , Uriz A , Martí-Cruchaga P , Rotellar F
Published: May 2023

Background

The enhanced view totally extraperitoneal (eTEP) approach is becoming increasingly more widely accepted as a promising technique in the treatment of ventral hernia. However, evidence is still lacking regarding the perioperative, postoperative and long-term outcomes of this technique. The aim of this meta-analysis is to summarize the current available evidence regarding the perioperative and short-term outcomes of ventral hernia repair using eTEP.

Study Design

A systematic search was performed of PubMed, EMBASE, Cochrane Library and Web of Science electronic databases to identify studies on the laparoscopic or robotic enhanced view totally extraperitoneal (eTEP) approach for the treatment of ventral hernia. A pooled meta-analysis was performed. The primary endpoint was focused on short-term outcomes regarding perioperative characteristics and postoperative parameters.

Results

A total of 13 studies were identified involving 918 patients. Minimally invasive eTEP resulted in a rate of surgical site infection of 0% [95% CI 0.0–1.0%], a rate of seroma of 5% [95% CI 2.0–8.0%] and a rate of major complications (Clavien-Dindo III-IV) of 1% [95% CI 0.0–3.0%]. The rate of intraoperative complications was 2% [95% CI 0.0–4.0%] with a conversion rate of 1.0% [95% CI 0.0–3.0%]. The mean hospital length of stay was 1.77 days [95% CI 1.21–2.24]. After a median follow-up of 6.6 months (1–24), the rate of recurrence was of 1% [95% CI 0.0–1.0%].

Conclusion

Minimally invasive eTEP is a safe and effective approach for ventral hernia repair, with low reported intraoperative complications and good outcomes.
OC-035 AUTOMATION OF HERNIA VOLUMES - SAC DETECTION AND HERNIA VOLUMETRY USING COMPUTER VISION AND DEEP LEARNING - PUSHING FRONTIERS
Authors: Rengan V , Sundaram P M , Arora E , Bawa A , Alexander N , Balasubramanian R
Published: May 2023

Aim

To identify the sac and defect using deep learning algorithms and to compute hernial sac volume in an automated fashion.

Materials and methods

70 ventral hernia CT scans were used. Slices with hernia defect and sac were annotated using computer vision tools. 80% of the data was used for training and validation. 20% data was used for testing. We used a combination of 3D reconstruction algorithms and deep learning to train the models. The model output was compared to manual annotation by experts.

Results

The testing data showed that our novel algorithm was able tp estimate the defect with an accuracy of 90%. The mean IOU for detection of hernia sac was 88% and volume estimation accuracy was 85%.

Conclusion

A combination of supervised deep learning and 3D volumetry will increase the accuracy of volumetric indices and shorten the volume estimation time. In most parts of the world, the hernia sac volume is not calculated by the radiologist and the surgeon is left to estimate it using rudimentary means such as visual estimation. Automated hernia volumetry will play a major role in standardising hernia reports. We believe this is a pivotal step in creating actionable radiology reports that will help the surgeon assess the complexity and plan surgery.
OC-036 SİNGLE SURGEON EXPERİENCE WİTH MONOTYPE MESH FOR İNGUİNAL HERNİA REPAİR
Authors: Gumus T , Girgin T , Temel R , Ersin S
Published: May 2023

Complex inguinal anatomy, mesh variety, surgeon's use of mesh, surgical technique preference made it inevitable to examine the recurrence of inguinal hernia. Unlike the literature, we examined the recurrence rates of a single experienced general surgeon using a single type of mesh, separately for laparoscopy and open surgery.

Method

Uniform mesh (ProgripTM self-fixating in open, Polipropilen mesh in laparoscopic) was applied. A total of 314 patients who underwent hernia surgery for the first time performed by a single expert general surgeon between 2013–2022 were included in the study. Demographic data, perioperative data, body mass indexes, co-morbidities and recurrence status were documented.

Results

The mean follow-up period was 75.2 months(3–158). Recurrence developed in a total of 24 patients(7.6%). Recurrence developed in 14 patients(7.3%) who underwent open hernia repair, while recurrence was found in 10(8.2%) of laparoscopic repairs(p=0.77).

Diabetes mellitus was diagnosed in 8 patients(33.3%) in the group with recurrence, while diabetes was diagnosed in 14 patients(4.8%) in the group without recurrence(p<0.001).

While there was cardiovascular disease in 16 patients(66.7%) in the group with recurrence, cardiovascular disease was observed in 99 patients(34.1%) in the group without recurrence(p=0.001).

Discussion

Recurrence rates after inguinal hernia repair were found to be compatible with the literature. We found that all patients with recurrence had high ASA scores, heavy lifting, chronic constipation, diabetes mellitus, and cardiovascular disease problems. Especially if we take into account the early return to work in the post-operative period, it doesn't seem easy to reduce the recurrence rate, which is dependent on many factors.
OC-037 Triclosan-coated sutures decrease the risk of surgical site infection in abdominal surgery. A systematic review and meta-analysis
Authors: Depuyt M , Van Egmond S , Petersen S M , Muysoms F , Henriksen N , Deerenberg E
Published: May 2023

Aim

Surgical site infection (SSI) occurs in 2–10% of the patients after abdominal surgery and has an impact on morbidity, mortality and medical costs. The aim of this systematic review and meta-analysis was to evaluate whether the use of triclosan-coated sutures for fascial closure in adominal surgery decrease the rate of SSI compared to uncoated sutures.

Methods

A systematic review and meta-analysis was conducted using the PRISMA guidelines. A literature search was performed in Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Embase. The latest search was performed on January, 21th, 2023. Risk of bias was assessed using the Cochrane RoB 2 tool. A pooled meta-analysis was performed using RevMan.

Results

Out of 1356 records, ten Randomized Controlled Trials, with a total of 9432 patients were included: 4763 in the Triclosan-coated group and 4660 in the uncoated group. The overall SSI rate was significantly reduced in the Triclosan-coated group with an Odds Ratio (OR) of 0.84 (95% CI [0.76; 0.94] p = 0.002). If PDS was evaluated separately (PDS Plus = 3999, PDS = 3900), triclosan-coating reduced SSI with an OR of 0.86 (95% CI [0.77; 0.96], p = 0.008). When Vicryl was evaluated (Vicryl Plus = 764, Vicryl = 760), the OR was 0.71 (95% CI [0.48; 1.04], p = 0.08) and was not significant.

Conclusions

In this current meta-analysis, it was found that the incidence of SSIs decreases when triclosan-coated sutures are used for fascial closure, compared to the uncoated sutures group.
OC-039 PROPHYLACTIC NEGATIVE PRESSURE WOUND THERAPY FOR COMPLEX VENTRAL HERNIA REPAIR, A CASE SERIES
Authors: Trebol J , Sánchez-Casado A B , García-Plaza A , González-Muñoz I , Muñoz-Bellvís L
Published: May 2023

Aims

Presenting our 1-month results in 20 patients with prophylactic negative pressure (pNPWT) applied in complex ventral hernia repairs.

Material & Methods

pNPWT was applied when high surgical site occurrences (SSO) risk factors and when colorectal procedures, huge panniculectomies, active cutaneous/mesh infections or loss of domain are associated.

Our results are compared with SSO incidence calculated with HW-RAT score.

Results

10 men and 10 women with 67.55 (43–84) year-old. BMI 32.01 kg/m2 (24–55). 55% ASA III, 35% II, 10% I.

Most relevant risk factors: 3 stoma closures, 3 loss of domain, 2 paraestomal, 2 peritonitis, 2 W3, 2 multi-recurrences, 1 infected mesh, 1 synchronic colonic fistula.

HW-RAT SSO score (1-less risk- to 5 -maximum-): 3 II, 3 III, 12 IV and 2 V.

pNPWT was applied to 17 midline wounds, 1 bilateral subcostal, 1 colostomy site and 1 midline+colostomy for 6–10 days (mode 7).

12 patients (60%) had 19 complications, 3 grade IIIB and one IVa.

Only 1 patient (5%) had surgical site infection (SSI): 1 infected seroma presenting at 16th postoperative day requiring readmission, drainage, and negative pressure (grade IIIA). Global HW-RAT estimated SSI incidence: 15.76%.

Two patients had other causes postoperative peritonitis, none of which affected the wound.

At 1 month another 2 seromas (1 grade I, 1 grade III) and one 3cm haematoma appeared.

Conclusions

pNPWT in high-risk patients is safe and can significantly reduce SSI and SSO (in our series from 15% to 5%).

Estimated NNT for preventing 1 SSI in the literature is 9 patients.
OC-040 FULL ENDOSCOPIC MINIMALLY INVASIVE MODIFIED SUGARBAKER APPROACH PARASTOMAL HERNIA REPAIR (E-TEP PAULI). MID-TERM RESULTS
Authors: Bellido-Luque J , Licardie E , Bellido-Luque A , Navarro L , Tejada A , Gomez Menchero J , Suarez Grau J M , Sanchez-Matamoros I , Nogales Muñoz A , Morales Conde S
Published: May 2023

Introduction

In 2016, E. Pauli described a novel technique for PSH using TAR combined with a modified “Sugarbaker” repair.

The present study aimed to assess clinical results of this technique performed by minimally invasive access

Methods

Data from patients requiring minimally invasive PSH repair were collected.

Inclusion criteria: Symptomatic PSH

Exclusion criteria: Recurrences with previous retromuscular/intraperitoneal mesh, Incarcerated/strangulated PSH

Data collected:

Results

Between January 2020 and May 2022, 11 patients were included. 5 patients had a type I PSH, 5 patients a type II and 1 patient a type IV hernia. Mean BMI: 28 kg/m2. Mean width defect: 4.5 cm, length: 4.4 cm. Mean width in cases of midline hernia: 4.3 cm, length: 4 cm. Mean mesh area: 749 cm2.No intraoperative complications were detected. Mean operative time was 180+/-13 minutes.Average stay:2.2 days.

Postoperative complications:

After follow-up of 16 months, no clinical/radiological recurrence were observed.

Conclusions

e-TEP Paulí for PSH is a promising surgical technique with different advantages. No intraperitoneal mesh or traumatic fixation are needed.
OC-045 RECURRENCE AFTER RETROMUSCULAR REPAIR OR POSTERIOR COMPONENTS SEPARATION: HOW TO ADDRESS THEM. A RETROSPECTIVE MULTICENTRE COHORT STUDY
Authors: Robin Valle De Lersundi A , López-Monclús J , Blazquez Hernando L , Muñoz Rodriguez J , Medina Pedrique M , Avilés Oliveros A , Morejón Ruiz S , García-Ureña M A
Published: May 2023

Introduction

Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. The aim of this study is to analyse results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation.

Material and Methods

We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2O14 and December 2021.

Results

Fifty-one patients complied with the criteria to be included in this study. Thirty-three patients had midline defects, 9 patients a combination of midline and lateral defect, 4 lateral defects alone and 5 patients parastomal hernia. We managed those patients with different approaches. We have found 11,5% surgical site infection rate and surgical site ocurrencies rate was 33,3%. We identified 3 patients with hernia recurrence. One patient died during postoperative course.

Conclusions

Treating hernia recurrences after retromuscular or posterior components separation is a challenge. Several reconstructive techniques might be planed and adapted to patients with complex abdominal wall defects. We have widely used components separation procedures to treat this type of recurrences. Although technically challenging, reoperation of hernia recurrence after posterior component separation or retromuscular repair should be considered in experienced centres with promising results, even though we may expect severe complications.
OC-047 ENHANCED RECOVERY AFTER ROBOTIC VENTRAL HERNIA REPAIR
Authors: Marckmann M , Willaume M , Kiim Jensen K
Published: May 2023

Aim

Enhanced recovery after surgery (ERAS) protocols lead to reduced postoperative stay and improved outcomes after most types of abdominal surgery. Little is known about the optimal postoperative protocol after robotic ventral hernia repair (RVHR), including the potential limits of outpatient surgery. We report the results of an ERAS protocol after RVHR aiming to identify predictors of overnight stay in-hospital, as well as patient-reported pain levels in the immediate postoperative period.

Material & Methods

This was a prospective cohort study of consecutive patients undergoing RVHR. Patients were included in a prospective database, registering patient characteristics, operative details, pain and fatigue during the first three postoperative days and pre- and 30-day postoperative hernia-related quality of life, using the EURA-HS questionnaire.

Results

A total of 109 patients were included, of which 66 (61%) underwent incisional hernia repair. The most performed procedure was TARUP (Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair) (60.6%) followed by bilateral roboTAR (robotic Transversus Abdominis Release) (19.3%). The mean horizontal fascial defect was 4.8 cm and the mean duration of surgery was 141 minutes.

In total, 78 (71.6%) patients were discharged on the day of surgery, and confounders associated with overnight stay were increasing fascial defect area, duration of surgery, and addition of TAR. There was no association between postoperative pain and overnight hospital stay. The mean EuraHS score decreased significantly from 38.4 to 6.4 (P < 0.001).

Conclusions

The application of an ERAS protocol after RVHR enabled a high rate of outpatient procedures with low patient-reported pain scores.
OC-051 CAN ETEP APPROACH IMPROVE COMPLEX INCISIONAL HERNIA REPAIR OUTCOMES?
Authors: Salido S , Guevara-Martínez J , Hernández S , Gutiérrez E , Zapata C , Chavarrías N , Arteaga P , Fondevila C
Published: May 2023

Aim

To compare postoperative results of two cohorts of patients with simple and complex incisional hernias, operated using the extended totally extraperitoneal technique (eTEP).

Materials and Methods

Retrospective comparative multicenter study based on prospective database conducted at the Fundación Jiménez Díaz University Hospital and La Paz Hospital in Madrid, including eTEP repairs performed between March 2019 and January 2023. Patients were classified as complex hernias if they met at least one criterion according to the Slater definition (1). If no criteria were met, it was classified as a simple hernia.

Results

159 patients were operated on via eTEP during the study period, and 111 incisional hernias were analyzed according to the EHS classification: 38 complex cases and 73 simple cases. The median defect size was 50mm (40–97) in simple cases and 66mm (24–126) (p<0.01), the median surgical time was 130min (59–360) and 145min (63–240) respectively without significant differences. TAR was required in 26 (35.6%) simple cases versus 23 (60.5%) complex cases (<0.01). One (1.4%) recurrence was observed in simple cases and 2 (5.3%) in complex cases, as well as 7 (9.6%) complications in simple cases and 5 (13.2%) in complex cases, both without statistical significance. The median follow-up was 26 months in simple cases and 11 months in complex cases (p<0.01).

Conclusions

The application of the eTEP approach in selected complex cases can improve postoperative results close to simple hernias.

1. Slater NJ et al. Criteria for definition of a complex abdominal wall hernia. Hernia 2014, 18:7–17.
OC-053 POSTERIOR COMPONENT SEPARATION AND THE USE OF BOTULINUM TOXIN IN ABDOMINAL WALL RECONSTRUCTION: NEED TO LEARN THE TECHNIQUE DURING THEIR RESIDENCY?
Authors: Aguilar C , Quiroz O , Mata C , Montalvo J , Jordan E , Ricarte E , Ruiz A , Sandoval S , Grajeda O , Bustamante L
Published: May 2023

Tittle

Posterior component separation and the use of botulinum toxin in abdominal wall reconstruction: need to learn the technique during their residency?

Aim

We aim to evaluate the transversus abdominis release (TAR) and the use of botulinum toxin A (BTA) in abdominal wall reconstruction learning curve based on proper identification of muscle layers and nervous component in the surgery and by US.

Material and Methods

Prospective study including patients submitted to TAR and preoperative BTA injection (n 15), perform by 3 seniors surgeons and a group of residents (10). Resident's acquisition and development of fundamental skills were evaluated by comparing pre (theorical: identification of muscle layers and by US and in images of the surgeries) and post-course (identification of muscle layers by US, BTA injection, and in surgery) assessment measurements.

Results

Out of 20 captured attempts by novices, 20 successful trials were evaluated. An increase in identification post-course of the abdominal wall components by US was shown in comparison of the attempt´s pre-course (p ≤ 0.023) and application of BAT in the patients was success in all the patients. Components of the abdominal wall (muscles layers and nervous component) improve after theorical course (p ≤ 0.048).

Conclusions

Correct identification by US and images of all the components during training showed to be effective in determining acquisition and development of basic surgical skills. The outcomes indicated that skills in vivo improved and that this training should therefore be part of the regular residency training program.
OC-056 CLOSURE STRENGTH OF SUTURE TECHNIQUES AND SUTURE MATERIALS
Authors: Allaeys M , Visscher L , Den Hartog F P J , Tanis P J , Jeekel J , Lange J F , Berrevoet F , Eker H H
Published: May 2023

Aim

Small bites closure is being implemented as standard of care (SOC) for laparotomy closure, but no consensus on which suture material to use is reached. The aim of our study was to compare biomechanical properties of four different closure techniques to SOC.

Materials & Methods

Fifty porcine abdominal walls were divided into five groups: 1. SOC (2/0 polydioxanone); 2. interlocking 2/0 polydioxanone; 3. size 0 barbed polydioxanone; 4. size 0 barbed glycolic acid and trimethylenecarbonate (GATC); 5. size 0 suturable polypropylene mesh. The small bites technique was used for closure of the linea alba in all groups. The abdominal walls were divided into a supra- and infra-umbilical half, which resulted in 20 specimens per group that were pulled apart in a tensile testing machine. Maximum tensile strength and types of suture failure were registered.

Results

The highest tensile strength was measured in the barbed polydioxanone arm (334.8 N ± 157.0) but did not reach statistical significance compared to the other groups. Infra-umbilical abdominal walls endured a significantly higher maximum tensile force compared to supra-umbilical (397 N vs 271 N, p<0.001). Resorbable GATC barbed suture failed significantly more often (25% vs 0%, p = 0.008).

Conclusion

When using small bites for fascial closure, the highest tensile strength was found using size 0 barbed polydioxanone suture, but results were similar among all groups. Tensile strength in infra-umbilical abdominal walls was significantly higher compared to supra-umbilical. Use of GATC barbed suture should be discouraged, as this suture fails significantly more often.
OC-057 VENTRAL HERNIA REPAIR WITH CONCURRENT INTRA-ABDOMINAL SURGERY: RESULTS FROM AN ELEVEN-YEAR POPULATION-BASED COHORT IN SWEDEN
Authors: Lindmark M , Löwenmark T , Strigård K , Gunnarsson U
Published: May 2023

Aim

One remaining question in ventral hernia repair is whether to perform concurrent abdominal surgery or plan two-stage procedures. The aim was to explore the risk for reoperation and mortality due to surgical complication during index admission.

Method

Eleven-year data were retrieved from the National Patient Register and 68,058 primary surgical admissions were included, divided into minor and major hernia surgery and concurrent abdominal surgery.

Results were evaluated by logistic regression analysis.

Results

The risk for reoperation during index admission was higher for patients with concurrent surgery. Major hernia surgery and major concurrent surgery had an OR 37.9 compared to major hernia surgery only. Mortality rate within 30 days increased, OR 9.32. The combined risk for serious adverse event was accumulative.

Conclusion

These results stress the importance of critically evaluating needs for and planning of concurrent abdominal surgery during ventral hernia repair. Reoperation rate was a valid and useful outcome variable
OC-060 PREDICTING FACTORS OF RECURRENCE AFTER TRANSVERSUS ABDOMINIS MUSCLE RELEASE (TAR) FOR COMPLEX INCISIONAL HERNIAS. RETROSPECTIVE ANALYZE OF A COHORT
Authors: Oprea V , Toma M , Grad O , Bucuri C
Published: May 2023

Background

Transversus Abdominis Muscle Release (TAR) is used to provide adequate coverage for large abdominal wall defects and appears to be more advantageous compared to Anterior Component Separation concerning complications and recurrence rates. The aim of this study was to identify the independent predictors associated with hernia recurrence after TAR in the treatment of complex incisional hernias.

Methods

This is a retrospective observational study of 191 patients who underwent TAR between November 2014 and December 2021. The main inclusion criteria were adults with large complex incisional hernias larger than 10 cm in transverse diameter. The recurrence rate was determined by clinical examination and by abdominal CT scan.

Results

At a median of 49.6 months (range 36–75 months) of postoperative follow-up, we reported 19 cases of recurrence (9.94%). Recurrences occurred after a mean period of 12.4 months (range 10–49 months). On multivariate analysis, the development of postoperative hematoma (OR 2.9; CI 1.55–4.10, p = 0.001), and needing surgery for the hematoma (OR 2.1; CI 1.21–3.29, p = 0.004), obesity and chronic pulmonary disease (COPD) were predictors of recurrence after TAR. The area under Curve (AUC) was highly specific for all these independent factors (AUC = 0.842). There was no significant difference in recurrence rate among obesity, smoking, urgent repair, type of mesh fixation, operative time, type of prosthesis, or concomitant procedures.

Conclusions

In our current study, the development of postoperative hematoma and needing surgery for the hematoma, and obesity were associated with an increased risk of hernia recurrence after RSR.
OC-065 THE USE OF CAROLINAS COMFORT SCALE TO COMPARE MESH-RELATED SENSATION BETWEEN BIOSYNTHETIC AND SYNTHETIC MESH: A PILOT STUDY
Authors: Kulkarni G , Elliott Z , Rajoo J , Barnes D , Hammond T
Published: May 2023

Aim

Bio-synthetic meshes potentially disappear from the body after certain timeframe leaving behind strengthening scaffold matrix when used for Complex Abdominal Wall Reconstruction (CAWR). We used Carolinas comfort scale (CCS) to assess mesh sensation differences between biosynthetic and synthetic mesh at different time points.

Material and Methods

This pilot study focusses on patients having undergone CAWR within the unit in the last 3 years. Patients were categorised into four groups of 10 patients each; those repaired with synthetic mesh or biosynthetic mesh within the last 8 months and beyond 18 months. All 40 patients answered all questions of the Carolinas CCS. Decision of mesh type was governed by patient characteristics.

Results

10 patients were included in each group (total 40 patients) consecutive retrospective enrolment. We excluded those who had further abdominal surgery or clinical recurrence since. 20 patients repaired with biosynthetic and 20 with synthetic were included. Two-way ANOVA and post HOC Turkey's difference test showed significant difference (p<0.05) in scores in favour of less scores for patients repaired with biosynthetic mesh. This was more pronounced in the beyond 18 month group. Component separation did not make a significant difference in mesh sensation. Logistic Regression analysis revealed patients scored higher on questions related to bending, sitting up and exercise and these were linked.

Conclusions

This outcome provides a review of current surgical practises and meshes, helping surgeons & patients make better informed decisions. Bio-synthetic meshes have better comfort outcomes for patients with lower CCS scores in the long term.
OC-070 EVALUATION OF PATIENTS’ QUALITY OF LIFE AFTER OPEN REPAIR OF INGUINAL HERNIAS BASED ON THE WEIGHT OF THE MESHES
Authors: Pepe F , Giaccone M , Gambali E , Turturica D I , Rosati S , Balestra G , Sandrucci S
Published: May 2023

Aim

The aim of this retrospective observational study with prospective follow-up is to evaluate the clinical outcomes and patients’ Quality of Life (QoL) after open repair of inguinal hernias using different meshes (48, 127 or 177–220 g/m2, pre-shaped meshes)(1).

Materials and Methods

382 patients who underwent inguinal hernia repair (Lichtenstein, Trabucco or Plug & Patch) from 2017 to 2018 were included in this analysis. All the patients’ baseline characteristics, peri- and post-operative outcomes were collected from the hospital medical records. A phone interview investigating long-term outcomes and patients’ QoL (EuraHS-QoL) was performed between December 2022 and January 2023. The primary endpoint of this study was the evaluation of patients’ QoL in three meshes’ subgroups: lightweight (nA=69), standard-weight (nB=143) and heavyweight (nC=170).

Results

The three subgroups didn't show significant differences in main baseline characteristics. Patients’ QoL improvement compared to the baseline was statistically significant in all three groups. In addition, all the post-operative QoL scores were significantly worse in group C. No differences in complications rate and recurrence rate were detected among the three groups. On the other hand, the surgical techniques did not affect the outcomes (recurrency and QoL).

Conclusion

This analysis performed at our center did not show any significant differences in outcomes between meshes of different weights except for the patients’ QoL which proved to be better in patients with light and standard-weight meshes. Based on our experience the surgical techniques could be chosen depending on the surgeons’ preferences.

References: 1.Dipromed Srl
OC-073 THE 3-D FUNNEL MESH TECHNIQUE FOR PARASTOMAL HERNIA REPAIR
Authors: Köhler G
Published: May 2023

Background

In previous studies, three-dimensional funnel mesh devices have been used successfully for the repair of PSHs by combining a laparoscopic and ostomy-opening approach

Methods

We performed an analysis of prospectively collected data of patients who underwent a same-sided stoma reposition with 3D funnel-shaped mesh augmentation in intraperitoneal- onlay position at three departments between the years of 2012 and 2021. 56 patients received an implant with 2.5 cm funnel length and 25 patients with 4cm funnel length. Primary outcome parameters were surgical complications and recurrence rate.

Results

81 patients could be included in this analysis. PSH repair was performed in 91% as elective surgery and in 87% in laparoscopic technique. A concomitant incisional hernia (EHS type 2 and 4) was found in 39% and repaired in a single-step procedure with PSH. Major postoperative complications requiring redo surgery were identified in 9.8% (8/81). Overall recurrence rate was 11% (9/81). Only 1 recurrence occurred in the group of 4 cm long implants (1/25= 4%). Median follow-up time was 44 months, and a 1-year follow-up rate of 91.4% was reached.

Conclusion

PSH repair with 3D funnel mesh in IPOM technique is safe, efficient and easy to perform providing advantageous results compared to other techniques. However the origin mesh funnel (2.5cm length) becomes shortened over time and further shrinkage happens eccentric concerning the flat mesh parts widening the funnel. Changing mesh construction according to consequently use the narrowest funnel (2cm) and it`s lengthening to 4cm led to reduction in recurrence without increasing implant-associated complications
OC-079 LAPAROSCOPIC TAPP APPROACH FOR A RECURRENT INGUINAL HERNIA
Authors: Santilli O , Santilli H , Nardelli N
Published: May 2023

Aim

To analyze the safety, feasibility, and effectiveness of a systematized laparoscopic transabdominal preperitoneal approach for a recurrent inguinal hernia.

Material & Methods

A retrospective observational analysis of a database between July 2012 and July 2022. Inclusion: all patients with a standard laparoscopic tapp approach to treat a recurrent inguinal hernia. The variables were compared with our results in primary inguinal hernias: laparoscopic finding (cause and type using the EHS classification) conversion rate, cause of conversion, complications, and quality of life outcomes. Demographic analysis of the population Age, BMI, and a number of recurrences.

Results

In this period, 5452 patients underwent a tapp laparoscopic approach to treat an inguinal hernia. 372 (6.82%) were registered as recurrent hernias. Men (98.4%). BMI: (26). When comparing the patients with a previous anterior approach: 316 patients (90%), there were no differences with the results of the primary hernia. Patients with the antecedents of the posterior approach were 39 patients (10,4%). Reviewed case by case, the effectiveness in diagnosis was (100%), and the conversion rate of 8 patients (20,5%). The cause of conversion was severe mesh adhesions to the vascular triangle and vesical preperitoneal space. There were no significant differences when comparing the results between patients who underwent tapp repair in primary and recurrent hernias. There was also no significant difference according to the number of recurrences.

Conclusions

The laparoscopic systematized approach in recurrent hernias shows effective rates in providing safe diagnosis and treatment while maintaining the quality of life standards.