bluuebunny/crossref_metadata_2025 huggingface dataset:
P-016 INCISIONAL HERNIA AFTER ABDOMINAL EMERGENCY SURGERY. IMPACT OF PREVENTIVE SELF-ADHESIVE POLYESTER MESH PLACEMENT
Authors: Huerta G , Pellicena A , Garcia M , Aguila R , Sanz M , González D , Navarro B , Torrado Á , Tavira H
Published: May 2023

Objective

Analyze the results of the self-adhesive polyester mesh placement in the prevention of the postoperative evisceration and incisional hernia after median abdominal incision during an emergency digestive surgery.

Material and methods

A prospective observational study was done in those patients who underwent a midline abdominal incision and a self-adhesive polyester mesh was placed in onlay position, for an emergency digestive surgery between December 2020 and December 2022. Analysis was done by means of demographics, body mass index (BMI), blood tests, ASA, P-Possum score, etiology, surgical contamination, abdominal incision closure, postoperative records (≥ 90 days) categorized with Clavien-Dindo (CD) classification and 1 year of follow-up.

Results

Sixty patients were included, mean age 62.86, (57.6% men), 52% were ASA III, BMI>30 12%. Most frequent etiologies were complicated small bowel obstruction (17) and complicated acute sigmoid diverticulitis (12). Postoperative records showed a 26,6% of morbidity, 93.7% were D I- II (minor) and 6.3% CD IIIb. Neither wound evisceration nor incisional hernia was observed during the follow-up. A significative relationship (p<0.05) was observed between BMI, preoperative C-reactive protein and ASA classification with postoperative complications, same relationship was observed between surgical contamination but without statistical significance.

Conclusions

In this series, a preventive self-adhesive polyester mesh placement after abdominal midline incision during emergency digestive surgery, showed an acceptable rate of postoperative complications with a low rate of local morbidity and a good results during the follow-up
P-018 ABDOMINAL WALL REPAIR IN JEHOVA´S WITNESSES. PRE, INTRA AND POSTOPERATIVE MANAGEMENT
Authors: Serrano González J , Díaz Pérez D , Román García De León L , Esteban Agustí E , Hernández Bartolomé M , Gutiérrez Samaniego M , Colao García L , Galindo Jara P
Published: May 2023

Aim

Abdominal Wall Repair (AWR) is a surgical procedure with a risk of bleeding during and after its performance. Patients who reject blood transfusion require strategies to avoid bleeding or to increase the margin of indication for transfusion.

Materials and methods

We analyzed the Jehovah's Witnesses patients who underwent AWR in our hospital and the perioperative management aiming to prevent fatal anemia and allow the performance of the surgery in this group of patients.

Results

We present three Jehovah's Witnesses patients undergoing AWR for multirecurrent midline incisional hernias. All of them attended hematology consultation prior to surgery to improve their situation at the time of surgery. During surgery, hemostatic material was used in areas at risk of subsequent bleeding. All received iron after surgery and, prior to hospital discharge, a dose of erythropoietin if needed. Patient characteristics are presented in the table.

No bleeding requiring blood transfusion or other complications occurred.

Follow-up in outpatient clinics showed a correct evolution.

Conclusions

Multidisciplinary care and particular attention to avoid bleeding and improve the condition of patients with refusal of blood transfusion makes complex abdominal wall surgery feasible and safer.
P-020 REACTIVATION OF SURGICAL CAMPAIGNS AFTER THE COVID PANDEMIC: SURGEONS IN ACTION WITH HERNIA INTERNATIONAL FOUNDATIONS IN 2022
Authors: Butrón T , Ramirez C , Perea E , De La Torre C , Mora J , Murga P , Fdez Luengas D , Bustos M , Moreno J , Revuelta B , Kingsnorth A , Catot L
Published: May 2023

Aim

The Cirujanos en Acción and Hernia International foundations carried out their own and collaborative surgical campaigns in developing countries. In 2020 and 2021 the programme had to be suspended due to Covid. In 2022 we restarted our actions, analysed the difficulties of reactivation and described the campaigns that had been carried out and those that had to be delayed.

Material/ Methods

We describe the 9 campaigns of Surgeons in Action, our own and in collaboration with Hernia International and our own campaign to the region of Naborno Karabakh, planned for September and cancelled 24 hours before departure due to the resurgence of armed conflict. An analysis is made of volunteers, places, type (adults or children or mixed), collaborations with other foundations, patients operated and procedures done according to pathologies, integration with local staff with exchange of knowledge.

Results

Made in 8 countries (Benin, Camerun, Gambia (2), Kenya, Liberia, Mozambique, Tanzania, Sierra Leone) and postponed in one country, the Naborno Karabakh region of Armenia. 85 volunteers (25 general and 10 paediatric surgeons, 19 anaesthetists, 3 intensivists, 23 nurses, 5 audiovisuals); local staff; 1144 patients (473 children, 671 adults), 1325 procedures for various pathologies (hernias, goitres, hydroceles, undescendend testis, soft tissue tumours, etc.)

Conclusion

9 campaigns have been carried out successfully and new locations have been opened with a good projection for the coming years, and we have experienced difficulties with the cancellation of a mega-campaign in an area with geopolitical conflicts - to be taken into account in the future
P-022 A RARE CASE OF APPENDICITIS IN A FEMORAL HERNIA, DE GARENGOUT'S HERNIA- A CASE REPORT AND LITERATURE REVIEW
Authors: Kazi A , Kazi F , Perthiani H K
Published: May 2023

Acute appendicitis within a femoral hernia, also known as a De Garengout's hernia (DGH) is a rare condition, occurring in approximately 0.08–0.15% of all femoral hernia cases. It was first described by Renee in 1731. We present the rare case of a young male with acute uncomplicated appendicitis within a femoral hernia, known as a De Garengout's hernia (DGH). Prompt recognition and diagnosis followed by early surgical intervention in the form of femoral hernia repair followed by laparascopic appendicectomy, allowed for timely and appropriate management for satisfactory post operative outcomes of this condition. Our case is unique due to the rarity of this pathology, along with the lack of international standardised guidelines on current management. This can make diagnosis challenging and may present a management dilemma to the surgeon, while also highlighting the importance of a skilled general surgeon along with early involvement of a senior radiologist to aid in an accurate diagnosis.
P-023 PATIENT SATISFACTION AFTER INGUINAL HERNIA SURGERY: LITERATURE REVIEW OF AN OVERLOOKED PATIENT-REPORTED OUTCOME MEASURE
Authors: Nijs J , Miserez M , Meylemans D , Tollens T
Published: May 2023

Aim

Patient satisfaction after inguinal hernia surgery is currently underappreciated and not as well studied as other patient reported outcome measures (PROMs) on this topic. Our study aims to review the literature and summarize available data.

Materials & Methods

A literature review was conducted using Medline focusing on patient reported satisfaction after elective, inguinal hernia surgery in adults (>18 years old). All inguinal hernia repair techniques were considered, but small sample sizes (<100 patients) and short follow-up periods (<6 months) were excluded. The methodology and results of the remaining articles were reviewed. Due to heterogeneity of reporting between articles, only a descriptive analysis was performed.

Results

The available data from 15 out of 358 articles was withheld for further analysis. Unfortunately it has become apparent patient reported outcome measures regarding satisfaction lack validation and yield considerable heterogeneity, as 53% of all included studies used an asymmetrical response questionnaire. Resulting in an overwhelmingly positive patient satisfaction, be it with wide ranges (78–100% more than averagely satisfied, compared to 0–15% less than averagely satisfied). The number of patients not willing to undergo inguinal hernia repair again ranges from 1–16.

Conclusion

Our study demonstrates patient reported satisfaction is not uniformly surveyed and remains unvalidated. Further research on patient reported satisfaction would benefit from standardization and validation, while using a symmetrical and balanced 5-point Likert or 11-point NRS scale at regular post-operative intervals with addition of open questions to evaluate patient satisfaction after inguinal hernia surgery.
P-025 TREATMENT OF UMBILICAL HERNIA IN A COOPERATION PROJECT IN TANZANIA
Authors: Garcia Garcia L , González Sánchez L , Cordero Rojas A , Kimaro J , Antonini G , Hernández Hernández J R
Published: May 2023

Aim

Adult umbilical hernia accounts for between 3% and 14% of abdominal wall hernias, second only to inguinal hernias in frequency. The current prevalence of umbilical hernias in Africa is currently unknown, but it is estimated that about 50,000 patients die each year in Africa as a result of umbilical hernias. We describe below the number of interventions performed in 2022 by European aid workers in a third level Hospital in Tanzania using local anesthesia and the available material.

Material and Methods

We performed a retrospective observational study of the number of umbilical hernias operated in a Third level Hospital in Tanzania

Results

Throughout 2022, 2818 surgical interventions were performed in men and women by european aid workers: 114 interventions (4.04%) were umbilical hernia repairs. The age range of the operated patients was 12–18 years. No mesh was used in any case. The techniques used consisted of edge-to-edge closure. Patients were discharged after 24–48 hours without complications and no follow-up was obtained due to the fact that it was a rural hospital.

Conclusions

Umbilical hernia repair with mesh is the gold standard of treatment in our environment, however its practice in collaborative projects of this type requires a thorough knowledge of non-prosthetic repair options due to the scarcity of material.
P-028 SHORT-TERM RESULTS OF LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA). OUR FIRST EXPERIENCES
Authors: Marrero Marrero P , Delgado Plasencia L J , Lorenzo Rocha N , Rodríguez Castellano D , Fernández Hernández L , Bravo Gutiérrez A F
Published: May 2023

Aim

Closing the defect (CD) during laparoscopic ventral hernia repair began to be performed in order to decrease seroma, to improve the functionality of the abdominal wall, and to decrease the bulging effect. However, tension at the incision after CD in large defects is related to an increased rate of pain and recurrence. We present our preliminary results of this recent technique for midline hernias as an alternative to conventional CD emphasizing the evaluation of postoperative pain.

Material and Methods

A retrospective study was conducted from March 2021 to July 2022 to evaluate the elective procedure (LIRA) performed on patients with midline ventral hernias (3–4 cm width). The posterior rectus aponeurosis was opened lengthwise around the hernia defect using a laparoscopic approach to create two flaps and was then sutured. An on-lay mesh was placed intraperitoneal overlapping the fascia defect. The data analyzed included postoperative pain and recurrence rate.

Results

Fourteen patients were included. Mean width of the defect was 3,5 cm. Average VAS (24 h) was 7, 2–3 (1 month), and 0 (6 month). Clinical seroma vas detected at first month in 50% (Clavien-Dindos-I). Recurrence rate was 14% at the expense of the first cases (Clavien-Dindos IIIb). Mean follow-up was 6 months.

Conclusions

Despite the fact that this technique obtained a “no tension” effect that could be related to a lower rate of postoperative pain, we have detected an elevated early postoperative VAS which is probably due to the fixing system with tackers which counteracts the beneficial effect.
P-034 ROBOTIC TAPP FOR RE-RECURRENT INGUINAL HERNIA: OUR EARLY EXPERIENCE
Authors: Chatzimavroudis G , Kotoreni G , Pavlidis T , Papaziogas V
Published: May 2023

Aim

Undoubtedly, the use of meshes has dramatically reduced recurrence rates following primary inguinal hernia repair; however, recurrences still occur with an incidence ranging from 0.5 to more than 20%, depending upon various factors that include hernia and patient characteristics, applied surgical technique and mesh characteristics, and surgeon's experience. The repair of a recurrent inguinal hernia sets a challenge for the hernia surgeon to prevent not only new recurrence, but also other complications. The challenge becomes even bigger in cases of re-recurrent inguinal hernias. The aim of this study is to present our early experience with the application of robotic system in the repair of re-recurrent inguinal hernias.

Material and Methods

From January to December 2022, five male patients with re-recurrent inguinal hernias (two patients with two previous repairs, one with three and one with four previous repairs) were operated in our Center using the robotic system Da Vinci X. In all cases robotic TAPP was performed and an extra-large (measuring 12×17cm) heavy-weight polypropylene mesh was implanted.

Results

All patients were discharged from the hospital on the first post-operative day. Their postoperative course has been uneventful, without any evidence of early or late complications, including recurrence.

Conclusion

Robotic-assisted repair of re-recurrent inguinal hernia is safe and feasible. The advantages of the surgical robotic system and more specifically, the magnified and three-dimensional view of the surgical field, as well as the increased maneuverability of the instruments permit the efficient treatment of this demanding subtype of inguinal hernias.
P-036 SUTURING OF THE INTERNAL INGUINAL ORIFICE DURING THE LAPAROSCOPIC TRANSABDOMINAL REPAIR OF A LARGE INDIRECT INGUINAL HERNIA
Authors: Chamzin A , Galyfos G , Theodoropoulos C , Triantafyllou A , Toutouzas K , Theodorou D , Zografos G
Published: May 2023

Aim

To present the rationale and surgical technique of the internal inguinal orifice suturing during transabdominal preperitoneal hernia repair of large inguinal hernias.

Methods

The surgical steps of a laparoscopic transabdominal preperitoneal hernia repair (TAPP) with the addition of the suturing reconstruction of the internal orifice are presented.

Results

A 52-year-old man presented with a large symptomatic right inguinal hernia. A TAPP repair was performed. Due to a significantly widened internal inguinal orifice, reconstruction of the deep ring was performed by suturing the transversalis fascia arc to the iliopubic tract with a self-locking 2-0 stitch in a continuous fashion. Accordingly, a medium-weighted polyester mesh was applied. The patient had an uneventful postoperative period, without symptoms of chronic pain or discomfort at a 6-month follow-up.

Conclusions

During the laparoscopic repair of large indirect inguinal hernias, suturing reconstruction of the internal orifice, similar to the common practice for open inguinal hernia repair, may reduce mesh eventration and recurrence.
P-039 INITIAL EXPERIENCE IN ROBOTIC APPROACH IN ABDOMINAL WALL SURGERY
Authors: Hinojosa Ramírez F , Tallón Aguilar L , Tinoco González J , Moreno Suero F , Alarcón Del Agua I , Morales Conde S
Published: May 2023

Aim

To evaluate the results of our robotic hernia repair case series.

Material and Methods

Prospective and observational study on hernia repair cases operated with a robotic approach. We have performed a descriptive analysis of demographic and surgical variables and short-term complications.

Results

From October 2021 to January 2023, 64 robotic interventions, including 39 men (60.1%) and 25 women (39.1%). Mean age is 60,66 years (+/- 11,72). Mean Body Mass Index (BMI) is 30,70kg/m2 (+/- 5.58).

Interventions: 3 unilateral inguinal hernia (2 recurrents), 16 bilateral inguinal hernia (9 recurrents), 13 primary ventral hernias, 23 incisional hernia, 8 mixed hernias and 1 parastomal hernias. Conversion rate is 1,6% (one case).

Techniques in inguinal hernia: 22 rTAPP (Transabdominal Preperitoneal) (85,91min +/- 31.90). In unilateral hernia the mean of intervention time is 50min +/- 25,98 and in bilateral hernia is 95,31min +/- 28,83.

Techniques in abdominal hernia: 2 iPOM+ (Laparoscopic Intraperitoneal Onlay Mesh) (127.50 min +/- 3.54), 1 rTAPP (90min), 1 rRives (260min), 28 TARUP (Robotic Transabdominal Retromuscular Umbilical Prosthetic) (135.50 min +/- 54.02), 2 eTEP (Enhanced-view Total Extraperitoneal) (165 min +/- 49.48), 4 rTAR (Transversus Abdominis Muscle Release) (122.50 min +/- 51.07), 2 rLIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) (147.50 min +/- 74.25) and 1 Pauli (155 min).

Complications: 21 SSO (surgical site occurrence) (32,81%), 2 SSI (surgical site infection) (3.1%), 1 recurrence (1.6%).

Conclusions

Robotic surgery facilitates the approach of complex incisional hernias and the performance or retromuscular techniques. It doesn`t provide clear benefits in inguinal hernia.
P-043 QUALITY OF LIFE SURVEY IN PATIENTS WITH COMPLEX ABDOMINAL WALL RECONSTRUCTION BY TAR
Authors: López Farias A , Flores Flores G , Lindo Canchado J J , Nieto Soler A
Published: May 2023

Aim

Interest in complex abdominal wall repair has been on the rise in recent times, perhaps motivated by the significant challenge they are despite the number of surgical techniques available. The objective is to verify if the TAR technique fulfills its function in the reconstruction of the complex abdominal wall and improves the quality of life of patients.

Material and methods

We performed a systematized Madrid modification of TAR with double mesh (absorbable synthetic and permanent polypropylene), applying the EuraHS QoL quality of life scale pre and postoperatively as well as an analysis of the results.

Results

Of the first 30 patients with complex incisional hernia submitted to the study, 60% were recurrent cases. After a 22-month follow-up (range 10–32), two recurrences (6.6%) have been reported. The EuraHS QoL analysis shows a statistically significant improvement in quality of life in the 3 spheres: pain (p=0.03), restriction of activities (p=0.05) and aesthetic discomfort (p=0.03).

Conclusions

TAR should be considered a first-line technique in complex abdominal wall reconstruction, demonstrating good postoperative results with low morbidity and mortality and recurrence rates and improving the quality of life of patients.
P-046 NOVEL TECHNIQUE TO DISSECT RETRORECTAL SPACE DURING ETEP APPROACH FOR SUPRAUMBILICAL HERNIAS
Authors: Sabatella L , Marti Cruchaga P , Aliseda Jover D , Almeida Vargas A , Blanco Asensio N , Uriz Pagola A , Zozaya Larequi G N , Sanchez Justicia C , Rotellar Sastre F
Published: May 2023

Aim

Present a modification for the retrorectal dissection during the performance of enhanced view totally extraperitoneal (eTEP) approach for the treatment of supraumbilical hernia associated with rectus diastasis.

Material and methods

During eTEP, a new approach to access both retrorectal spaces was performed through an infraumbilical incision. First, we made a 2 cm section in the anterior fascia spanning both sides of the linea alba. Therefore, both retrorectal spaces were dissected with the assistance of a balloon trocar. After this maneuver, a structural trocar was inserted, and CO2 was inssuflated. Then 3 suprapubic trocars were inserted: one at the midline, and the other two medial to both semilunaris lines. After trocar placement, and prior to the inferior crossover the anterior rectus fascia of the infraumbilical incision was closed. The surgery was then performed according to the technique described by Daes and Belyansky.

Results

We have performed this approach in 2 consecutive patients with supraumbilical hernia (M3W1 and M3W2) associated with rectus diastasis. We achieve a complete dissection of the retro-muscular spaces in only one step and from the same location, facilitating the crossover. There were no associated intraoperative or postoperative complications.

Conclusion

The presented modification of the retrorectal dissection during laparoscopic eTEP for supraumbilical hernias represents a time-saver, safe and feasible alternative for the dissection of retrorectal space during eTEP.
P-048 UTILITY OF PRE-OPERATIVE ELECTROMYOGRAPHY AFTER CHEMICAL SEPARATION OF COMPONENTS WITH BOTULINUM TOXIN
Authors: Domínguez Bastante M , Santidrian Zurbano M , Viclhez Rabelo A , Salmeron Ruiz A , Medina Benitez A , Mansilla Rosello A
Published: May 2023

Aim

To describe and analyze the effectiveness of preconditioning complex abdominal wall with botulinum toxin type A (BTA) demonstrated by a preoperative electromyography.

Material and methods

Descriptive and prospective study from September 2018 to November 2020 of our patients who received neoadjuvant BTA and an electromyographic study prior to complex eventroplasty surgery. The patients signed a specific informed consent and 500 U of BTA were administered on an outpatient regimen at 10 different points under ultrasound control. The BTA was administered ecoguide by the radiologist approximately one month (33.8 days) before surgery. The electromyographic study was performed 35 days after the administration. Demographic, pre-surgical, intra-surgical and post-surgical variables were studied.

Results

57 received neoadjuvant BTA, 24 (42.1%) underwent an electromyographic study. The mean age were 64.8 years. The mean BMI was 29.3. The 24 patients (100%) had a W3 eventration of the EHS classification.

Moderate (grade II) denervation was found in 7 patients (29.2%) and intense (grade III) in 17 patients (70.8%), according to neurophysiology criteria. No significant complications occurred in any patient. No complications were register. Eventroplasty was performed according to the Rives-Stoppa technique in 3 patients (12.5%) and according to the transversus abdominis release (TAR) technique in 21 (87.5%). The mean stay was 7.9 days.

Conclusions

The electromyographic study in patients who have received BTA as neoadjuvant therapy for complex eventroplasties confirms the effectiveness of this therapy (100% presented denervation, >70% intense denervation), which clinically translates into less extensive dissections and better fascial closures with no significant complications.
P-055 COMPLEX ABDOMINAL WALL RECONSTRUCTION AFTER THE RESECTION OF ADVANCED OVARIAN CANCER SPREAD TO ABDOMINAL WALL AND ILIAC VESSELS
Authors: Garcia Garcia L , De La Cruz Cuadrado C , Larrubia Loring J , López-Tomassety E , Caballero Diaz Y , Hernández Hernández J R
Published: May 2023

Aim

We present the case of an advanced ovarian cancer spread to the abdominal wall and iliac vessels where a complete resection was performed with immediatly reconstruction of the abdominal wall to achieve a complete R0 resection.

Material and Methods

A 66-year-old woman with history of hysterectomy, double adnexectomy and adjuvant chemotherapy for ovarian cancer 36 years ago. The CT scan showed an 8×7 cm lesion involving the anterior rectus muscle with compression of the ipsilateral iliac vessels. A biopsy was positive for adenocarcinoma with gynecological origin. She received neoadjuvant treatment with chemotherapy. In the control CT scan persisted a mass the abdominal wall mass with slight reduction in size and compressing the iliac vessels.

Results

Following a karakousys incision, an anterior abdominal wall tumor intimately attached to the pubic symphysis was observed. The tumor measured 6 cm, it infiltrated the femoral vein but there was not invasion of the artery. A completed resection of the anterior abdominal wall musculature up to the pubic symphysis was performed, disconnecting the inguinal ligament and leaving a 10×10 cm wall defect. This defect was repaired with the placement of a preperitoneal biological mesh to provide a reinforcement plane and a polypropylene mesh above the previous one.

Conclusions

Wide abdominal wall resections may be necessary to obtain R0 resections. Numerous studies have shown that morbidity rates associated with these procedures are not high. In fact, in our case, an immediate abdominal wall reconstruction achieved good functional and aesthetic results in a single surgical procedure.
P-057 EFFECTS ON SURGICAL QUALITY, TRAINING, AND RESEARCH ON INGUINAL HERNIA AFTER CENTRALIZATION OF PLANNED INGUINAL HERNIA SURGERY IN A REGION
Authors: Ruiz Jasbon F , Ticehurst K , Ölund M , Kroon L , Ahonen J , Norrby J
Published: May 2023

Aims

Evaluate the effects of centralization of inguinal hernia surgery in Region Halland in Sweden on surgical quality, training and research on inguinal hernia.

Methods

Comparison of outcomes for Region Halland in relation to the national average in the Swedish Hernia Register before and after centralization. Review of how training and research on inguinal hernia changed after centralization.

Results

The percentage of patients operated on by “inguinal hernia specialists” increased from nearly 40% in 2008 to 90% in 2019. 20% of the surgeons operating > 90 hernias/year in Sweden are active in Region Halland, even though Region Halland only performs 4% of all inguinal hernia operations in Sweden.

The risk of reoperation 3 years after inguinal hernia decreased from nearly 100% greater to 30% less than the national average (4% to 1.7%).

The percentage of women that underwent the recommended posterior mesh surgeries increased from 5% (2007) to 90% (2019). The percentage of patients with bilateral hernias operated with TEP-TAPP increased from 5% (2007) to 98% (2020).

After centralization residents’ training was formalized including at least 30 operation/resident. Halland runs one of the two national courses on TEP/TAPP. Peer-review publications on inguinal hernias increased from 2 to 6 articles.

Conclusion

The quality of inguinal hernia surgery and training of residents became better after centralization. The number of region-conducted research projects on inguinal hernia increased after centralization.
P-059 FEASIBILITY OF A SMARTPHONE APPLICATION FOR INGUINAL HERNIA CARE: A PROSPECTIVE PILOT STUDY
Authors: Meuzelaar R , Den Hartog F , Verleisdonk E J , Schiphorst A , Burgmans I
Published: May 2023

Aim

The Inguinal Hernia Application (IHAPP) is designed to overcome current limitations of regular follow-up after inguinal hernia surgery. It has two goals: Minimizing unnecessary healthcare consumption by supplying patient information and facilitating registration of patient reported outcome measures (PROMs) by offering simple questionnaires. In this study we evaluated the usability and validity of the app.

Material & Methods

In this prospective cohort study patients (>=18 years) scheduled for elective hernia repair were assessed for eligibility. Feasibility of the app was evaluated by measuring patient satisfaction about utilization. Validity (internal consistency and convergent validity) was tested by comparing answers in the app to the scores of the standardized EuraHS-Quality of Life instrument. Furthermore, test-retest reliability was analyzed correlating scores obtained at 6 weeks to outcomes after 44 days (6 weeks and 2 days).

Results

During a 3-month period, a total of 100 patients were included. Median age was 56 years and 98% were male. Most respondents (68%) valued the application as a supplementary tool to their treatment. The pre-operative information was reported as useful by 77% and the app was regarded user-friendly by 71%. Patient adherence was mediocre, 47% completed all questionnaires during follow-up. Reliability of the app was considered excellent (α > 0.90) and convergent validity was significant (p = 0.01). The same applies to test-retest reliability (p = 0.01).

Conclusions

The IHAPP is a useful tool for reliable data registration and serves as patient information platform. However, further improvements are necessary to increase patient compliance in recording PROMs.
P-061 Bowel obstruction due to intraluminal migration of intraperitoneal mesh
Authors: López R , Beisani M , Comas J , Subirana H , Crusellas O , Gómez H , Castellví J
Published: May 2023

Aim

Report an unusual late complication after laparoscopic IPOM

Material & Methods

Description of a clinical case

Results

An 84 years old patient who had previously undergone laparoscopic IPOM with ePTFE mesh in 2012 for supraumbilical primary hernia, arrived to the emergency room in March 2022 with a small bowel obstruction due to an intraluminal foreign body impacted at the distal jejunum. In the computerized tomography scan (CT) there was no evidence in the abdominal wall of the intraperitoneal mesh present in a previous CT from 2019.

An exploratory laparotomy was warranted. A resection the affected jejunal loops was performed, without evident perforation and clear palpation of an intraluminal foreign body.

When the piece was opened, the mesh was found intraluminally, causing the patient's bowel obstruction.

Conclusions

Intra-abdominal foreign bodies usually cause a chronic inflammatory process that isolate them from neighboring structures by a fibrous capsule. In this case, however, after detaching it from the abdominal wall, the mesh migrated into the intestinal lumen, probably through slow erosion by decubitus.

Despite it being an unusual complication, its incidence could increase as the use of intra-abdominal mesh has multiplied in recent years. Given the appearance of non-specific abdominal pain in patients with intra-abdominal mesh, it may be advisable to perform a CT scan to rule out this or other complications associated with the mesh, even many years after the initial surgery.
P-064 CORRELATION BETWEEN ABDOMINAL WALL STRENGTH AND DIAMETER OF HERNIA IN PATIENTS WITH INCISIONAL HERNIA
Authors: Garcia Moriana A J , Sanchez Arteaga A , Tallon Aguilar L , Maroto Sanchez R , Gil Delgado J L , Padillo Ruiz J
Published: May 2023

Aim

The goal of the study was to analyse the abdominal wall strength profile in patients with incisional hernia and the relationship between the hernial defect diameter and the abdominal wall strength.

Methods

Observational cohort study of patients with incisional hernia (July-October 2022), classified as W2 according to the European Hernia Society. Collected data was demographic characteristics, clinical characteristics related with the hernia, and measure of the abdominal wall strength using an isokinetic dynamometer and a strain gauge. We analysed the relationship between hernia defect and abdominal wall strength with correlation tests to adjustment by age, sex, BMI, and body composition.

Results

53 patients were enrolled (56,6% female) with a mean age of 57,42 age (SD 10,49). Mean BMI was 30,42 (SD 5,15), mean percentage of fat mass of 36,86% (SD 7,48), mean percentage of lean mass of 60,37% (SD 7,55), and maximum diameter of hernia defect was 6,75cm (SD 2,16). The linear regression model determined age (p = 0,02) and gender (p = 0,01) as predictor variables of the abdominal wall strength measured with isokinetic dynamometer. In terms of the relation between the hernial defect diameter and abdominal wall strength, we did not found statistically signification (p = 0,17), although largest hernia defects (p90) were related with a decrease of rate of force development (p= 0,026).

Conclusions

In our study, the most statistically significant predictor variables of abdominal wall strength were age and sex. Hernia defect diameter showed a tendency to a statistically signification.
P-068 A NOVEL TECHNIQUE TO REDUCE RECURRENCE IN PATIENTS WITH DONOR SITE HERNIAS IN ILIAC CREST BONE GRAFTS
Authors: Mazumdar E , Perera D , Lloyd C , Ramanand B
Published: May 2023

Introduction

Iliac crest bone grafts (ICBG) are commonly used to heal non-union fractures in orthopaedic and maxillofacial surgery. The most common complications are pain, haematoma, neurovascular injury and scarring however one complication that is mentioned less frequently is herniation of abdominal contents. We emphasise the importance of this complication, and describe a technique that can be used to repair this when there is herniation.

Case

A 76 year old gentleman developed squamous cell carcinoma of the right mandible in 2019. The right mandible was resected, followed by an iliac crest free flap from the left side with a prophylactic prolene mesh which was performed in 2020. The patient then received adjuvant chemotherapy. Shortly thereafter, the patient developed a lump which became increasingly painful. The patient was referred onto the general surgical team after a CT scan showed herniation of colon and small bowel loops at the donor site. The patient underwent a hernia repair in November 2022 and is recovering well.

Discussion and conclusion

Herniation of abdominal contents following ICBG are rare and potentially dangerous complication that can lead to significant morbidity and even mortality. Here we present an open repair of a recurrent hernia, using a pre-peritoneal mesh. A pre-peritoneal plane was developed all around to ensure there is good overlap of the mesh and was anchored to a mini-plate that was fixed to the iliac bone. Pre-peritoneal meshes should be preferred to fix hernia defects caused from ICBGs, which otherwise can cause significant morbidity in patients with ICBGs.
P-075 CHRONIC INGUINAL SEROMA AFTER LAPAROSCOPIC SURGERY
Authors: Trindade M , Figueiredo J , Souto R , Branco A , Costa P
Published: May 2023

Aim

Chronic inguinal seroma is rare, with 80% being totally reabsorbed 3 months after surgery. Inguinal seroma after laparoscopic indirect hernia repair is presented in 3,7–70% of cases.

Material and Methods

Description of a clinical case.

Results

Male, 74 years-old. Prior bilateral inguinal herniorrhaphy. Diagnosed with recurrent right inguinal hernia, ultrasound confirmed.

The patient underwent TAPP and a L2R right inguinal hernia was observed (EHS classification). The patient was discharged on day 1.

One month after, the patient presented an irreducible tumefaction on right inguinal zone. Ultrasound describes a hydric collection measuring 5.8×5.4×4.1cm, suggesting a seroma, and excluded hernia relapse. 50mL of pure serous fluid was aspirated with clear reduction of the mass. Negative microbiology. Five months post-operatively, the tumefaction was present and 35mL of a fluid, with the same characteristics, was aspirated again. One month later, seroma was still found, and 35mL of a fluid was aspirated. After that, 100mg of Doxycycline was injected.

Two years after surgery, tumefaction was present. He was proposed for surgical intervention and underwent unroofing and scarification of the seroma. Three-month follow-up without complications.

Conclusions

Chronic seroma that needs intervention is extremely rare. It is estimated that only 0,24% need percutaneous drainage and 0,2% reoperation. Therefore, this case is relevant and should inform us for this infrequent form of presentation of a common complication of inguinal hernia.
P-076 HOW CAN WE REDUCE POSTPERATIVE PAIN IN E-TEP RIVES REPAIR?
Authors: Curado Soriano A , Infantes Ormad M , Valera Sanchez Z , Naranjo Fernandez J R
Published: May 2023

Aim

To show the effect on postoperative pain of direct instillation of ropivacaine into the retromuscular space.

Method

During the E-TEP Rives procedure, after mesh placement, we instilled ropivacaine into the retromuscular space via a working port. In our initial experience we compared only five patients from each group. We measured the decrease in postoperative pain with the visual analog pain scale 24 hours postoperatively.

Results

We achieved a decrease in postoperative pain, which we measured using the visual analog pain scale, with a reduction of 3 vs 5 in the control group, and which translates into a decrease in opioid consumption in the immediate postoperative period.

Conclusion

To decrease postoperative pain we implemented several actions, among the most important for us, was the technique of nerve block of the anterior abdominal wall with ropivacaine. This technique is easier and faster than ultrasound nerve localization and allows selectively blocking the nerve bundles of the rectus, having the same efficacy in our experience.
P-078 IMPLEMENTATION OF THE HOSPITAL-AT-HOME UNIT IN THE POSTOPERATIVE COMPLEX ABDOMINAL WALL
Authors: Martínez Gómez A , Molinete M , Benavent M , Homs E , Català A , Domènech J , Sánchez Marín A
Published: May 2023

Abreviations

EHS: European Hernia Society

Aim

Show the results of the application of a new service in our hospital, Hospital-at-Home, in the postoperative period of incisional hernias and complex abdominal wall.

Material and Methods

Retrospective analysis of operated patients in our center in 30 month period (July 2020 - December 2022) with complex abdominal wall. Patients who accept home follow-up with Hospital-at-Home unit and who corresponded to the geographical area. Patients with incisional midline hernia are included: more than two locations -M- in the classification of the EHS or width greater than 4 cm (W2). Lateral incisional hernias with more than two locations -L- are also included in the EHS classification and complex parastomal hernias.

Results

25 patients, 17 men and 8 women, underwent both elective and urgent incisional hernia surgery. The surgical techniques used were retromuscular mesh repair, posterior component separation and onlay technique (emergency cases). Mean hospital stay was 4.5 days. Later the patients were visited by Hospitalization at Home. There were 2 surgical wound infections treated with intravenous antibiotics and a need for reoperation (Grade II and IIIa of Clavien-Dindo classification of surgical complications. Recurrent incisional hernia was observed in 1 patient.

Conclusions

Benefits of Hospitalization at Home by improving the degree of patient satisfaction, reducing the hospital stay and not worsening the clinical safety of the patient with complications.
P-079 RISK FACTORS FOR BOWEL RESECTION IN PATIENTS WITH INCARCERATED INGUINAL HERNIA. RETROSPECTIVE CLINICAL STUDY
Authors: Donmez T , Karabulut M , Surek A , Ozdemir M , Hocaoglu E , Canoz O
Published: May 2023

Backgraund

Early recognition of the risk of bowel resection of patients with incarcerated groin hernia(IGH) will facilitate the clinical decision making of surgeons and improve the outcomes of patients. This study aimed to reveal the risk factors of bowel resection in patients with incarcerated inguinal hernia.

Materyal methods

We retrospectively collected 312 patients who underwent emergency hernia repair surgery for IGH between January 2017 and October 2022. The patients were categorized into those who received bowel resection and those who did not require bowel resection Data analysis was approved by the local ethics committee. Patient characteristics, laboratory and radiological examinations, surgery data, and postoperative outcomes were compared between patients with and without bowel resection. Risk factors for bowel resection were assessed with univariate and multivariate analysis.

Results

Univariate analysis identified 7 variables that were significantly associated with bowel resection among patients with IGH. On multivariate analysis, Charlson comorbidity index (CCI) odds ratio [OR] = 0.751, 95% confidence interval [CI] 0.592 0.953, P = .018), Gender (OR =  4.071, 95% CI 1.749/9.475, P = 0.001) and C-reactive protein(CRP) (OR =  0.321, 95% CI 0.145–0.708, P = 0.005) were identified as independent risk factors for bowel resection among patients with IGH.

Conclusion

In this study, an elavated CRP, gender and high CCI in patients with bowel obstruction due to IGH are associated with an increased risk of bowel resection. Based on our findings, surgeons should prioritize prompt emergency surgical repair for patients who present with elevated CRP and high CCI concurrent with IGH.
P-080 THE GRIP CONCEPT CONSIDERS BIOMECHANICAL PRINCIPLES FOR A DURABLE REPAIR OF INCISIONAL HERNIA – 3 YEAR FOLLOW UP
Authors: Nessel R , Löffler T , Rinn J , Kallinowski F
Published: May 2023

Aim

Durable hernia repair is based on specific biomechanical principles. How are the results after three years in primary and recurrent hernias?

Material and methods

The biomechanical principles were analyzed ex vivo with cyclic loading using a self-built bench test. The minimal requirements for a biomechanically durable repair were defined. The resulting GRIP concept was clinically applied.

Results

A total of 233 patients (123 males and 110 females) were treated for incisional hernia. Primary hernia was repaired in 170, recurrence in 63 patients with an average of 1.3 risk factors with most patients grouped as ASA III (n= 120). Emergency repairs were necessary in 11 patients. Hernia orifices were mostly median (N= 209) and lateral (89 patients, 59 combined). Hernia sizes were on average 9 + 6 cm wide and 13 ± 8 cm long. The mesh-defect area ratio was 7.8. Fixation was necessary (median of 60 fixation points). Recurrences required more effort for a durable repair (Primary OR duration: 165 ± 75 min; recurrence: 233 ± 89 min). A total of 138 patients were followed for three years so far. Four patients died during follow-up (Follow-up rate 100%). A second hernia in the un-repaired abdominal wall occurred three times (gunshot wound, appendectomy, cholecystectomy). Pain levels were low (median NAS = 0 at rest and under load). One recurrence was detected 8 months after primary repair in a liver transplant recipient reconstructed with a sandwich.

Conclusion

Primary and recurrent incisional hernia can be repaired durably based on biomechanical principles.
P-081 ROBOTIC RECTUS DIASTASIS AND UMBILICAL HERNIA REPAIR - INITIAL EXPERIENCE
Authors: Martins De Oliveira Neto R , Roberto Puglia C , Leal Pereira F , Roberto Corsi P , Kochi F , Derwood Mills Costa De Carvalho B
Published: May 2023

Aim

Rectus diastasis is typically an asymptomatic but cosmetically displeasing condition that is not usually repaired except for cosmetic purposes. However, it is been observed that hernias with a rectus diastasis tend to have a higher recurrence rate and poorer cosmetic outcome if the diastasis is not repaired at the same procedure. The authors presents the first 11 cases of rectus diastasis and umbilical hernia repair with robotic assistance.

Material & Methods

we perform the procedure on 11 patients between january and december 2022. All patients have the diagnosis os rectus diastasis and umbilical hernia. All of then underwent a primary umbilical hernia repair with closure of the rectus diastasis, performed with robotic assistance. All procedures went without complications and the patients were discharged on the day after. We evaluate parameters such as lenght of the procedure, complications, post procedure pain and recurrence.

Conclusions

The repair of a hernia within a rectus diastasis has an higher recurrence rate, as the hernia lays within the thinned weakened linea alba. We believe, if possible, the repair of the diastasis will reduce the rate of hernia recurrence. We recommend considering robotic-assisted hernia repair ans diastasis closure for optimal longer outcome and improved cosmesis.
P-085 LAPAROSCOPIC TAP BLOCK
Authors: López Farias A , Hernández Sánchez A , Lindo Canchado J J , Mateos M , Nieto Soler A
Published: May 2023

Aim

To test the effectiveness of the laparoscopic control-assisted TAP Block technique.

Material and methods

we performed an infiltration with 30 ml of 5% Ropivacaine, 5 ml in 3 punctures on each side of the abdomen. The transverse muscle is identified by laparoscopy, lateral to the semilunar line, 3 points are infiltrated with an intramuscular needle, visualizing the tip without crossing the peritoneum and withdrawing 2–3 mm until it is above the transverse muscle.

Results

TAP Block improves postoperative pain, requiring lower doses of opioids and allowing faster recovery. No significant differences are observed in the VAS scale compared to the ultrasound control technique, but it does take less time and avoids any type of visceral injury due to laparoscopic control.

Conclusions

Laparoscopic Block TAP is equally effective in postoperative pain control as part of multimodal analgesia as performed under ultrasound control, with the advantages of reducing anesthetic time and minimizing the potential risk of visceral injury.
P-086 NERVE IDENTIFICATION DURING OPEN MESH HERNIOPLASTY: A DESCRIPTIVE CROSS-SECTIONAL STUDY
Authors: Shettar A , Sinha M , Tripathy P
Published: May 2023

Background

It is recommended to identify nerves in the surgical field during open inguinal hernioplasty. This ensures proper dissection and reduces the incidence of post-operative inguinodynia. From limited surgical studies, it appears that identifying nerves may not be possible in all cases. Little is known about the factors that affect their identification.

Materials and methods

We conducted a cross-sectional study on thirty-six male patients with primary inguinal hernia. We looked for the nerves during Lichtenstein hernioplasty. We collected data on the identification & preservation of nerves for calculating the nerve identification rates. We observed the course of the nerves and evaluated the effect of BMI, height, anaesthesia type, surgical experience, ASA, type of hernia and sac contents on nerve identification.

Results

Ilioinguinal nerve (IIN), Iliohypogastric Nerve (IHN), and Genital branch of genitofemoral nerve (GBN) were identified in 86.1%, 75%, and 50% of the groin dissections. It was easier to identify the IIN when the omentum was the content of the sac. The IHN was easily identified in patients with BMI ≤ 25 kg/m2.

Conclusion

Nerve identification can be challenging during surgery. The GBN and IHN are more prone to dissection-related injuries. Identification of IHN and IIN is difficult in overweight individuals and cases where hernia contains bowel.
P-089 OBTURATOR HERNIA: A RARE CASE OF INTESTINAL OBSTRUCTION REQUIRING SEVERAL TYPES OF TREATMENT
Authors: Flores Flores C , García Galocha J L , Gómez Latorre L , Talavera Eguizabal P , Lopez Antoñanzas L , Peña Soria M J , Torres García A
Published: May 2023

Background

Obturator hernia is infrequent (incidence 1%). This condition usually occurs in older, multiparous women.

Case Report

We report two cases of this pathology:

The first one deals with a woman that presents insidious abdominal pain, who underwent an abdominal CT scan compatible with mechanical intestinal obstruction secondary to present the ileum trapped in a right obturator hernia. Treatment consisted of a laparoscopic approach creating a peritoneal flap, hernioplasty with polypropylene mesh and closure of the flap with V-lock 3/0.

The last one is about an elderly woman who presents nausea and vomiting accompanied by severe pain in the left lower limb. An abdominal CT scan was performed, which revealed a distal jejunal loop into the left obturator accompanied by intestinal obstruction. Open henioplasty was performed due to significant adhesive syndrome. The hernia sac was reduced, preperitoneal plug was placed and the orifice was closed with vycril suture.

Discussion

Diagnosis is complex due to the characteristics of the patients. There are 3 signs of strangulated hernia: obturator neuralgia, pain in the medial thigh due to obturator nerve compression and the absence of the adductor reflex in the thigh. The most accurate diagnostic test is the CT scan.

Three treatment techniques are described: transabdominal, extraperitoneal and laparoscopic.

Conclusion

Despite of obturator hernia is not a frequent cause of intestinal obstruction, we should consider the laparoscopic approach as an option with fewer postoperative complications, when possible.