bluuebunny/crossref_metadata_2025_split huggingface dataset:
P037 TOTALLY ENDOSCOPIC SUBLAY REPAIR FOR DIASTASIS RECTI AND CONCOMITANT MIDLINE HERNIA: FIRST CASE VIDEO-REPORT
Authors: Bertoglio Camillo Leonardo , Morini Lorenzo , Grimaldi Simona , Carnevali Pietro , Ferrari Giovanni 
Published: December 2021

Abstract

Aim
We describe in detail the step by step technique of the first case of TES repair at our institution.

Methods
We selected the case of a M2W3L3 hernia associated to xipho-umbilical diastasis recti in a young woman symptomatic for a progressively worsening back pain and local bulky sensation.

Results
The intervention is started directly with a suprapubic transverse incision of 2.5 cm and a circumferential, atraumatic retraction is inserted after a small incision of the anterior rectus sheath. Blunt dissection is further continued through this access by luxating the underlying rectus muscles to separate the preperitoneal space below the arcuate line. The pneumo-preperitoneum is then inducted through this port. Laparoscopic dissection allows for enlargement of the avascular space laterally and then two 5-mm trocars are placed on the bilateral aspects of rectus muscles. By means of a lap bipolar dissector the edge of posterior rectus sheath are incised from the arcuate line following the diastasis laterally up to the subxiphoid space. The Rives plane is recovered without opening of the linea alba. After reduction of the M2 hernia both the posterior sheath and the diastatic anterior fascia are sutured with a running long-resorbable 2/0 barbed suture. Polyvinylidene fluoride (PVDF) mesh fixed with the use of an hystoacrilic glue.

Conclusion
Minimally invasive extraperitoneal repair of small/medium hernia defects of the linea alba is gaining wide acceptance. Concomitant presence of rectum diastasis recti seems to be the ideal indication to approach the learning curve of such a technically demanding procedure
P042 CHARACTERIZATION OF INNATE AND ADAPTIVE IMMUNE CELLS INVOLVED IN THE FOREIGN BODY REACTION TO POLYPROPYLENE MESHES IN THE HUMAN ABDOMEN
Authors: Dievernich Axel , Achenbach Pascal , Davies Luke , Klinge Uwe 
Published: December 2021

Abstract

Aim
Polypropylene (PP) mesh is widely used to reinforce tissues. The foreign body reaction (FBR) to the implant is dominated by innate immune cells, especially macrophages. However, considerable numbers of adaptive immune cells have also been regularly observed, which appear to play a crucial role in the long-term host response. This study investigated the FBR to seven human PP meshes, which were removed from the abdomen for recurrence after a median of one year.

Material and Methods
Using immunofluorescence microscopy and distance maps, the FBR was spatially analyzed for various innate (e.g., CD68+ macrophages, CD56+ NK) and adaptive immune cells (CD3+ T, CD4+ T-helper, CD8+ cytotoxic, FoxP3+ T-regulatory, CD20+ B) as well as “conventional” immune cells (defined as cells expressing their specific immune cell marker without co-expressing CD68).

Results
T-helper cells (19%) and regulatory T-cells (25%) were present at comparable rates to macrophages, and clustered significantly toward the mesh fibers. For all cell types the lowest proportions of “conventional” cells (&lt; 60%) were observed at the mesh–tissue interface, but increased considerably at about 50–100 µm, indicating reduced stimulation with rising distance to the mesh fibers.

Conclusions
Both innate and adaptive immune cells participate in the chronic FBR to PP meshes with T cells and macrophages being the predominant cell types, respectively. Furthermore, many cells present a “hybrid” pattern near the mesh fibers. The complexity of the local immune reaction may explain why approaches focusing on specific cell types have not been very successful in reducing the chronic FBR.
P095 ARE POLYPROPYLENE MESH IMPLANTS ASSOCIATED WITH SYSTEMIC AUTOIMMUNE/INFLAMMATORY SYNDROMES?
Authors: Kowalik Claudia , Zwolsman Sandra , Malekzadeh Arjan , Roumen Rudi , Zwaans Willem , Roovers Jan-Paul 
Published: December 2021

Abstract

Aim
Worldwide there is a lot of commotion about the effects and complications of mesh implants. The surgical implantation of polypropylene (PP) meshes has been linked to the occurrence of systemic autoimmune disorders (SAIS). We performed a systematic review to determine whether PP implants for inguinal, ventral hernia or pelvic floor surgery are associated with the development of SAIS.

Material and Methods
We searched Embase, Medline, Web of Science, Scopus, Cochrane library, clinicaltrialsregister.eu, clinicaltrails.gov and WHO-ICTR platform. Forward and backward reference searching was performed to avoid missing relevant papers. All types of studies, except case studies, reporting SAIS in patients having a PP implant for either pelvic floor surgery, ventral or inguinal hernia repair were included. Animal studies were excluded. We intended to perform a meta-analysis. The quality of evidence was assessed with the Newcastle-Ottawa Scale. This study was registered at Prospero (CRD42020220705).

Results
Of 1938 records identified, 3 were eligible. Two studies involving retrospective matched cohorts focused on mesh surgery for vaginal prolapse or inguinal hernia compared to hysterectomy and colonoscopy, respectively. These reports had a low risk of bias. The third study was a case-series with a high risk of bias, with a sample of 714 patients with systemic disease, 40 of them had PP mesh implanted. A meta-analysis showed no association when comparing systemic disease between mesh and control groups. Calculated Risk Ratio was 0.9 (95%CI 0.78-1.04).

Conclusions
To date, there is no evidence to suggest a causal relationship between being implanted with a PP mesh and the occurrence of SAIS.
P122 LAPAROSCOPIC APPROACH TO THE ABDOMINAL WALL WITH CLOSURE OF THE DEFECT, OUR INITIAL RESULTS
Authors: Otegi Ibai , Blazquez Lucas , Rico Aida , Marzo Rocío Ruiz , Sebastian Jose Luis , Uribazo Mauricio , Novo Igor , Aramendia Irene 
Published: December 2021

Abstract

Aim
The aim of the study is to evaluate the closure of the defect in postoperative pain, seroma and recurrence.

Material and Methods
Inclusion criteria were; defect width of 2 - 4 cm and body mass index ≤ 35 kg / m2, or previous intraperitoneal surgery. A prospective database of perioperative variables have been collected. We consider postoperative pain as a value ≥5 on the Visual Analogue Scale, seroma types III and IV of the Morales-Conde classification.

Results
32 patients were operated with laparoscopic closure of the defect (LCD) between 2018 and 2020. The mean age was 59 years and body mass index was 31 kg / m2. 14 patients had incisional hernia. 90% of the cases were M2-3 with a mean defect diameter of 2.7 cm. In 5 cases, a preperitoneal mesh was placed without takers, the mean size of the mesh was 15 cm. The mean duration of the procedures was 96.1 min. Seven (22%) patients presented postoperative pain, of which 5 had 24 h limited and in two cases it lasted up to 48 h. No patient presented pain at the 30-day evaluation. The mean length of stay was 1.8 days. The mean follow-up was 23 months, one seroma (3.1%) and three (9.4%) recurrences were diagnosed.

Conclusions
In our initial experience, we considered LCD a safe technique with benefits for selected patients.
P127 ROBOTIC TRANSABDOMINAL RETRO-RECTUS HERNIA REPAIR VS. LAPAROSCOPIC INTRAPERITONEAL ONLAY MESH REPAIR: IMPROVING POSTOPERATIVE OUTCOMES
Authors: Willaume Mette , Jorgensen Lars Nannestad , Jensen Kristian Kiim 
Published: December 2021

Abstract

Aim
“The optimal repair technique for small and medium-sized ventral hernias in obese patients remains unknown. We aimed to evaluate results after robotic-assisted laparoscopic transabdominal repair with retro-rectus mesh placement (rTARUP) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM).”

Material and Methods
“Retrospective cohort study of consecutive patients undergoing rTARUP or IPOM repair for small or medium-sized primary ventral and incisional hernias. The primary outcome was postoperative need for transverse abdominis plane (TAP) block or epidural catheter, and secondary outcomes were 30-day complications, and length of stay. All patients underwent elective surgery and were followed for 30 days postoperatively.”

Results
“A total of 27 patients (rTARUP) and 32 (IPOM) were included. Patients in the two groups were comparable in terms of age, sex, comorbidities, smoking status, body mass index (BMI), and type of hernia. The median BMI was 32.4 kg/m2 and the fascial defect area was comparable (rTARUP median 16.8 cm2 vs. IPOM 11.7 cm2, P = 0.303). The duration of surgery was longer in the rTARUP group (median 117.2 min. vs. 84.4, P = 0.003), whereas the postoperative need for TAP block or epidural analgesics was less in the rTARUP group compared with IPOM (n = 14 vs. n = 1, P = 0.002). There were no severe complications or reoperations in the two groups. The length of stay was shorter in the rTARUP group (median 0 vs. 1 days, P &lt; 0.001).”

Conclusions
“rTARUP was associated with reduced postoperative analgesic requirement and shorter length of stay compared with laparoscopic IPOM.”
P159 PARTIAL VS COMPLETE MESH REMOVAL AFTER CROHNIC MESH INFECTION: COMPARISON OF OUTCOMES
Authors: Anguiano-Diaz Gregorio , Tallon-Aguilar Luis , González Jose Tinoco , Arteaga Alejandro Sánchez , Gómez Daniel Díaz , Padillo Javier 
Published: December 2021

Abstract

Aim
“The purpose of this study is to compare the postoperative outcomes between partial mesh removal (PM) and complete mesh removal (CM) due to chronic mesh infection.”

Material and Methods
“Patients with mesh removal due to chronic mesh infection were included from February 2010 to May 2020. The patients were consequently assigned depending on the surgical technique to either partial or complete mesh removal. The demographic, operative and follow-up data of the two groups were analyzed and compared in terms of surgical site occurrence (SSO), surgical site infection (SSI), overall complications following Clavien-Dindo classification and relapse of mesh infection at 1 year follow-up.”

Results
“The study included 65 patients (44.61% males) intervened of mesh explantation. MThe patients were assigned to PM 56.92% (n = 37) and CM 43.08% (n = 28). 27% of the patient in the CM group needed a new mesh vs. 7.1 % of PM p = 0,039 (4.38 OR 1.02-24.1). There were no statistically significant differences with respect to length of hospital stay CM 5.46 (DS 6.1) vs 5.82 (DS 10.09) days, p = 0.409. SSO were 84.4%, p = 0.631, while SSI was 61.2%. There were no differences in terms of Clavien-Dindo (p = 0.617). The appearance of new chronic mesh infection after surgery were: CM 29.7% vs PM 39.3%, p = 0.420.”

Conclusions
“Postoperative morbidity after mesh explants is comparable between partial and total explants. Those cases in which a total explant is performed are more likely to require the placement of a new mesh, while in partial explant there is a higher percentage of recurrence of chronic infection.”
P160 ENDOSCOPIC ANTERIOR COMPONENT SEPARATION OR OPEN TRANSVERSUS ABDOMINUS RELEASE ARE NOT ASSOCIATED WITH INCREASED WOUND MORBIDITY FOLLOWING INCISIONAL HERNIA REPAIR
Authors: Gaspar Freia , Midtgaard Helle , Jorgensen Lars Nannestad , Jensen Kristian Kiim 
Published: December 2021

Abstract

Aim
Traditional anterior component separation during incisional hernia repair is associated with a high rate of postoperative wound morbidity. Because extensive subcutaneous dissection is avoided by endoscopic anterior component separation (eACS) or open transversus abdominis release (TAR), we hypothesized that these techniques did not increase the incidence of surgical site occurrence compared to incisional hernia repair without component separation.

Material and Methods
This was a retrospective cohort study of patients undergoing open, retro-rectus incisional hernia repair. Component separation during retro-rectus repair was performed using eACS or TAR. The primary outcome was 30-day incidence of postoperative surgical site occurrence. Secondary outcomes included length of stay, 30-day readmission, 30-day reoperation rate and 3-year recurrence rate.

Results
A total of 322 patients underwent retro-rectus repair, 168 (52%) of whom received either eACS or TAR. Addition of eACS or TAR was neither associated with surgical site occurrence, (odds ratio: 0.82, confidence interval: 0.40-1.68, P = 0.596) nor with hernia recurrence (hazard ratio 0.80, CI 0.27-2.40, P = 0.693). There was no significant difference between the groups regarding the frequencies of 30 day-readmission or 30-day reoperation.

Conclusions
The addition of eACS or TAR to a retro-rectus incisional hernia repair was not associated with increased wound morbidity or hernia recurrence.
O01 PROPHYLACTIC MESH PLACEMENT DURING FORMATION OF AN END-COLOSTOMY LONG TERM RCT ON EFFECTIVENESS AND SAFETY
Authors: Brandsma Thijs , Hansson Bibi , De Jong Nienke , Aufenacker Theo , van Westreenen Erik , van Lammeren Felix , Mahabier Chander , Donders Rogier , Steenvoorde Pascal , de Vries Reilingh Tammo , Wiezer Rene , de Wilt Hans , Rovers Maroeska , Rosman Camiel 
Published: December 2021

Abstract

Aim
To determine if prophylactic mesh placement is an effective, safe, and cost-effective procedure to prevent parastomal hernia (PSH) formation in the long term.

Material and Methods
In this multicenter superiority trial patients undergoing formation of a permanent colostomy were randomly assigned to either retromuscular mesh reinforcement or conventional colostomy formation. The primary endpoint was the incidence of a PSH after 5 years. Secondary endpoints were morbidity, mortality, quality of life and cost-effectiveness.

Results
A total of 150 patients were randomly assigned to the mesh group (n = 72) or non-mesh group (n = 78). For the long term follow up, we could analyse 113 patients since 37 patients were lost to follow-up. After a median follow-up of 60 months (IQR 48.6 – 64.4), 49 patients developed a PSH, 20 (27.8%) in the mesh group and 29 (37.2%) in the non-mesh group (p = 0.22; 95% CI -24 – 5.5). A total of 25 patients developed an incisional hernia, seven in the mesh group (10.4%) versus 18 in the non-mesh group (27.2%) (p = 0.013, 95% CI 3.5 – 30.0). No relevant differences were found in quality of life or cost-effectiveness between both study group.

Conclusions
Use of a prophylactic retromuscular mesh at the ostomy site delays but not reduces the incidence of PSH after 5 years of follow-up. It leads to less severe PSH according to the EHS and MM classification with fewer repairs needed. Furthermore it causes patients to have fewer stoma related complications necessitating change of appliances and it is safe without any adverse events or increase in morbidity.
O14 SHORT STITCH TRIAL 6:1 WITH 4-OH-BUTYRATE (MONOMAX) - FINAL RESULTS
Authors: Golling Markus , Zielska Zofia , Maurer Katalyn , Baumann Petra 
Published: December 2021

Abstract

Aim
Surgical technique and material used to close an abdominal wall incision are considered to be important determinants for the risk of developing surgical site occurences (SSOs). Aim of our prospective, non-randomized, monocentric study was a comparative analysis of the perioperative performance (6:1 suture/wound length (SL/WL)-ratio) and SSOs (surgical site infections [SSI] & 2°wound dehiscence/burst abdomen) following midline & transverse incisions.

Material and Methods
The trial is completed. It included 351 patients between 1/2013-10/2018 in a prospective database. The surgeons aimed at performing a 6:1 SL/WL-ratio in all laparotomies. Patient specific data (risk factors, intra- & postop parameters & SSI/SSO) were entered into the registry database. Satistics involved the Chi2-/ANOVA and Mann-Whitney Test.

Results
Overall, 82,3% (289/351) were operated electively, 17,7% (62/351) had an emergency laparotomy, 55% (n = 194) had a midline, 29% (n = 103) a transverse and 15% (n = 54) a combined L-shaped laparotomy (liver resection). A learning curve with respect to the bite width was encountered. While SL/WL ratio all laparotomies were similar, bite width varied but improved with experience. SSI was higher in transverse vs. median laparotomies and overall higher in emergency operations. The rate of 2°wound dehiscence (surgical site occurrence [SSO]) stayed at 1/351.

Conclusions
A learning curve is required to sufficiently perform a short stitch 6:1 suture. Median and transverse laparotomies can be closed safely by a 6:1 SL/WL ratio. SSO could be reduced compared to our historic patient cohort but did not differ within the &gt; and &lt; 6:1 ratio. Emergency laparotomies can also be safely performed with the short stitch technique.
O15 LESS PAIN AFTER TACK FIXATION OF MESH THAN WITH SELF-GRIPPING MESH FOLLOWING LAPAROSCOPIC INGUINAL HERNIA REPAIR: A RANDOMIZED CLINICAL TRIAL
Authors: Christensen Marie Kirk , Dinesen Malene Ørberg , Pedersen Andreas , Rosenberg Jacob , Brandenburger Nils , Hebo Ole , Hassenkam Hasse , Ghani Mohamad , Nielsen Michael 
Published: December 2021

Abstract

Aim
Acute pain following transabdominal preperitoneal inguinal hernia repair (TAPP) may be attributed to mesh fixation. The aim of the present study was to determine short and long-term complications following laparoscopic TAPP repair using either a self-gripping mesh or a tacked mesh.

Material and Methods
Healthy male subjects referred for unilateral inguinal hernia repair were randomized to a TAPP procedure using either a tacked mesh (Parietix, Medtronic; AbsorbaTack, Medtronic) or a self-gripping mesh (ProGripTM, Medtronic). Acute postoperative pain and short and long-term complications were recorded using an e-mail generated questionnaire preoperatively and at days 1 and 7 and at 1, 3, 6 and 12 months postoperatively. Acute pain was assessed using the visual analogue scale (VAS).

Results
A total of 333 male subjects underwent elective repair of a medial (n = 107, 32%) or a lateral (n = 226, 68%) inguinal hernia. Patients were randomized to either a tacked (T = 178) or non-tacked procedure (N = 155). Mean follow-up time was 141 days. Mean number of tacks applied was 2.7 per operation. Mean preoperative VAS score was 2.21 (T) vs 1.78 (N) (P = 0.06). Postoperatively, the mean VAS-score (average within the observation period) was 2.80 (T) vs 3.12 (N) (P &lt; 0.01), resulting in a 10% lower VAS-score following the tacked repair compared to the self-gripping mesh (P &lt; 0.01). Patient-reported signs of recurrence at 12 months was 4.7% (T) vs 7.5% (N) (P = 0.35).

Conclusions
Postoperative acute pain after laparoscopic inguinal hernia repair is lower following a tacked than a non-tacked (self-adhesive mesh) procedure. Patient-reported recurrence did not differ between groups
O47 MESH-RELATED COMPLICATIONS, CHRONIC PAIN, AND ECONOMIC CLAIM COMPENSATION AFTER UMBILICAL HERNIA REPAIR
Authors: Rønnow Martin Frimand , Hoffner Mattias , Schulze Svend , Helgstrand Frederik , Hjalmarsson Claes , Bisgaard Thue 
Published: December 2021

Abstract

Aim
The risk of mesh-related surgical complications after umbilical hernia repair is not known and chronic pain has only sparsely been analysed. Economic claims may represent a surrogate for poor postoperative surgical outcomes. Thus, the present study used mesh-related complications and chronic pain as primary and secondary outcomes, respectively.

Material and Methods
Blinded assessment of Swedish and Danish nationwide consecutive economic claim data from 2007 –2019. The study variables and outcomes were pre-study defined. Major complications were defined as acutely life-threatening complications requiring emergency surgery, clinically important complications were defined as all complications requiring surgical intervention but not emergency surgery.

Results
During the 13-years study period 181 patients were eligible for analysis. There were 96 patients with a surgical complication. In 52 (54%) and 44 (46%) patients the complication was mesh- or non-mesh-related, respectively. In the group of mesh- and non-mesh-related complications, major complications were found in 14 (14,6%) vs 21 (21,9%) patients and clinically important complications were found in 38 (39,5%) vs 23 (23,9%) patients respectively (P &lt; 0.05). Chronic pain was reported in 18%, followed by wound complications (14%) and cosmetic claim reasons (11%). After open repair, claim because of chronic pain was significantly more common after mesh repair (48%) compared with non-mesh repairs (32%), P = 0.05. The economic compensation after a mesh- and non-mesh complication was 3,488€ (291 – 188,186€) and 2,342€ (507€ - 58,437€) (P = 0.55), respectively.

Conclusions
Mesh-repair was related to postoperative complications and chronic pain after umbilical hernia repair
OV03 TEP IN COLORS: ANATOMICAL VIEW USING ARTICULATED FORCEPS
Authors: Guariglia Claudio Antonio , Gobbo Rafael Diaz del , Sanchez Raquel , Sanchon Lorena , Osorio Alexander , Pardo Sara , Farre Roser , Guell Merce , Collera Pablo 
Published: December 2021

Abstract

Aim
Present through an illustrative and educational video, an anatomical and colorful vision of the totally extraperitoneal laparoscopic approach (TEP) of inguinofemoral hernias, with the aim of favoring the learning process of this technique, facilitating the identification of the main anatomical structures, ensuring a safe and effective approach.

Material and Methods
In this video we show the laparoscopic approach to inguinofemoral hernias via TEP, highlighting the most important anatomical structures with different colors.
Additionally, the surgical technique of this approach using articulated forceps is shown, which we consider to be a good resource for dissection in a space as small as the preperitoneal one.

Results
The anatomical study of the inguinofemoral area constitutes the basis of a correct preperitoneal approach, especially in PET, where the most difficult is probably the space location and the identification of the structures.

Conclusions
The preperitoneal PET route is a relatively novel approach for inguinofemoral hernia repair. Its benefits are based on the ability to identify all the anatomical structures of the myopectineal orifice from a preperitoneal view without the need to access the peritoneal cavity.
The knowledge of preperitoneal anatomy is the cornerstone for learning the TEP approach, and we consider that anatomical videos of real surgeries are good strategies to shorten the learning curve.
Mastering the preperitoneal anatomy ensures obtaining the benefits inherent to the TEP approach, such as bilateral exploration of the myopectineal orifice, direct visualization of the pain and doom triangles, tension-free repair with mesh of all possible defects and faster postoperative recovery.