bluuebunny/crossref_metadata_2025_split huggingface dataset:
P045 MEDIALIZATION AFTER COMBINED ANTERIOR AND POSTERIOR COMPONENT SEPARATION IN GIANT INCISIONAL HERNIA SURGERY, AN ANATOMICAL STUDY
Authors: Sneiders Dimitri , Smet Gijs de , Hartog Floris den , Verstoep Laura , Menon Anand , Muysoms Filip , Kleinrensink Gert-Jan , Lange Johan 
Published: December 2021

Abstract

Aim
To obtain tension-free closure for giant incisional hernia repair, anterior or posterior component separation (ACS, PCS) is often performed. In extreme patients, ACS and PCS may be combined. The aim of this study was to assess the additional medialization after simultaneous ACS and PCS.

Material and Methods
Fresh-frozen post mortem human specimens were used. Both sides of the abdominal wall were subjected to retro-rectus dissection (Rives-Stoppa), ACS and PCS, the order in which the component separation techniques (CST) were performed was reversed for the contralateral side. Medialization was measured at three reference points.

Results
ACS provided most medialization for the anterior rectus sheath, PCS provided most medialization for the posterior rectus sheath. After combined CST total median medialization ranged between 5.8 and 9.2 cm for the anterior rectus sheath, and between 10.1 and 14.2 cm for the posterior rectus sheath (depending on the level on the abdomen). For the anterior rectus sheath, additional PCS after ACS provided 15% to 16%, and additional ACS after PCS provided 32% to 38% of the total medialization after combined CST. For the posterior rectus sheath, additional PCS after ACS provided 50% to 59%, and additional ACS after PCS provided 11% to 17% of the total medialization after combined CST. Retro-rectus dissection alone contributed up to 41% of maximum obtainable medialization.

Conclusions
ACS provided most medialization of the anterior rectus sheath and PCS provided most medialization of the posterior rectus sheath. Combined CST provides marginal additional medialization, clinical use of this technique should be carefully balanced against additional risks.
P049 SAFETY AND EFFICACY OF ABSORBABLE AND NON-ABSORBABLE FIXATION SYSTEMS FOR INTRAPERITONEAL MESH FIXATION: AN EXPERIMENTAL STUDY IN SWINE
Authors: Kapoulas Spyridon , Papalois Apostolos , Papadakis Georgios , Tsoulfas Georgios , Christoforidis Emmanouil , Papaziogas Basileios , Schizas Dimitrios , Chatzimavroudis Grigorios 
Published: December 2021

Abstract

Aim
Choice of the best fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of this study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation.

Material and Methods
Fourteen Landrace swine were utilized and the experiment included two stages. Initially, four pieces of polypropylene mesh with hydrogel barrier coating1 were fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. Each mesh was anchored with a different tack device between titanium2, steel3 or absorbable (4,5) fasteners. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy. The primary endpoint was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks.

Results
Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Steel tacks had higher peel strength when compared to titanium and absorbable fasteners. No significant differences were noted regarding the secondary endpoints.

Conclusions
Steel fasteners provided higher peel strength that the other devices in this swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.
P053 COMPARISON OF CLINICAL OUTCOMES BETWEEN INTRAPERITONEAL ONLAY MESH REPAIR (IPOM PLUS) AND ENHANCED-VIEW TOTALLY EXTRAPERITONEAL REPAIR (ETEP) FOR VENTRAL HERNIAS
Authors: Hirukawa Hiroshi 
Published: December 2021

Abstract

Aim
We have been performing intraperitoneal on lay mesh repair (IPOM plus) as the standard laparoscopic procedure for ventral hernia in our department. We introduced enhanced-view totally extraperitoneal repair (eTEP) for ventral hernia repair in 2018, and have performed 31 cases so far. We compared the outcomes of IPOM Plus and eTEP at our institution.

Material and Methods
Ventral hernia cases who underwent surgery at our department between 2018 and 2020 were included in the study. The postoperative outcomes and complications of the IPOM Plus and eTEP groups were evaluated retrospectively.

Results
There were 12 cases of IPOM plus, and all were incisional hernias. There were 31 cases of eTEP, including 7 cases of primary hernias and 24 cases of incisional hernias. Transversus abdominis muscle release (TAR) was added in 24 cases. The mean hernia size was 6.6 x 7.9 cm with IPOM Plus and 8.0 x 10.1 cm with eTEP, and the average meshes size was 15.5 x 22.0 cm and 20.3 x 23.6 cm, respectively. The mean postoperative hospital stay was 7.8 days and 5 days. Postoperative complications included 1 case of mesh bulging and 1 case of recurrence in the IPOM Plus group, 1 case of seroma and 1 case of intestinal obstruction in the eTEP.

Conclusions
The surgical outcomes for ventral hernias up to 8 cm wide were similar for IPOM Plus and eTEP. The eTEP can insert a larger mesh and may be useful for wider hernias (&gt;8cm).
P072 ARTICULATED LAPAROSCOPIC INSTRUMENTS. BENEFITS ON LAPAROSCOPIC HERNIOPLASTY
Authors: Santilli Osvaldo , Santilli Hernán , Scaravonati Rodolfo , Nardelli Nicolás , Etchepare Hernán 
Published: December 2021

Abstract

Aim
To present initial experience using 5 mm articulated laparoscopic instruments in tapp laparoscopic hernioplasty that emulated the benefits attributed to robotic surgery.

Material and Methods
We report data from the first 42 procedures using 5 mm articulating instruments.
A retrospective analysis was performed in patients who underwent tapp laparoscopic hernioplasty using novel articulated graspers, needle holders, and scissors. The surgeons and surgical nurses were trained in the handling and operation of the articulating instruments, before the first surgical procedure. In all cases, articulating instruments were inserted through 5 mm trocars. Data collected included patient demographics, details related to the surgical procedure, postoperative outcomes, and complications.

Results
Over a period of one month, were repaired 78 inguinal hernias. 36 patients had a bilateral hernia, and the mean age was 45 years (SD 15.1), with a mean BMI of 28.6 (SD 6.1). 32 male and 4 female patients. The mean operative time was 90 min. The articulated head of the clamp allowed traction, dissection, and suture in different directions. In addition, was not detected a significant learning curve due to its intuitive applicability. Surgical complications included two serohematomas. All patients discharge during operation day. The procedures performing without intraoperative complications nor conversion to open surgery occurred.

Conclusions
The use of an articulated instrument has a promising future. It would meet some benefits of robotics without increasing costs. We need randomized comparative studies for a better conclusion.
P089 THE IMPACT OF VENTRAL HERNIA REPAIR ON PATIENT-REPORTED QUALITY OF LIFE: IDENTIFYING FACTORS ASSOCIATED WITH IMPROVEMENT
Authors: Morris Martin , Patel Viren , Christopher Adrienne , Broach Robyn , Fischer John 
Published: December 2021

Abstract

Aim
Assessing pre- and postoperative quality of life (QoL) is essential to quantify the magnitude of improvement in disease burden after ventral hernia repair (VHR). Here, we identify patient and operative factors associated with QoL improvement after VHR.

Material and Methods
Patients that underwent VHR by a single surgeon were retrospectively identified and included if they had minimum 1 year of follow-up, and completed pre- and postoperative Abdominal Hernia-Q (AHQ) questionnaires. Patients were divided into quintiles based on absolute pre- to postoperative improvement in AHQ score. Chi-squared and fisher’s exact tests were used for categorical data, and Student’s t-test for continuous data, as appropriate.

Results
Compared to the lowest quintile (n = 27, follow-up 32.6 months, mean improvement 3.24 [SD 10.4]), patients in the highest quintile (n = 26, follow up 23.9 months, mean improvement 66.3 [SD 12.1]) were female (76.9% vs 37.0%, p = 0.005) with a greater number of previous hernia repairs (mean 2.12 vs. 0.78, p &lt; 0.005) and previous abdominal surgeries (mean 4.0 vs 2.0, p &lt; 0.001). Patients with greater improvement also had higher incidences of delayed healing (42.3% vs 7.41%), required more office visits (5.54 vs 3.89), and had higher inpatient costs ($30,084 USD vs. $16,886, all p &lt; 0.05). No significant differences were seen in terms of race, ethnicity, body mass index, age, length of stay, Clavien-Dindo scores, hernia recurrence, or other postoperative complications.

Conclusions
Despite increased preoperative risk and healthcare burden, some of the most significant QoL improvement after VHR is demonstrated in patients with complex repairs and recoveries. This indicates the global utility of VHR regardless of patient demographics and complicating perioperative factors.
P090 LONG-TERM OUTCOMES FOLLOWING HYBRID BIOMATERIAL REPAIR OF VENTRAL HERNIAS: A MULTICENTER, RETROSPECTIVE STUDY
Authors: Doerhoff Carl , Grantham David , Mallico Eric , Washington Raymond , Linn John 
Published: December 2021

Abstract

Aim
To analyze device safety and clinical outcomes of ventral hernia repair with a hybrid composite mesh

Material and Methods
This retrospective, multicenter, case review analyzed device/procedure endpoints and patient-reported outcomes in patients treated for hernia repair ≥ 1 year from study enrollment.

Results
There were 459 patients with 469 ventral hernias with a mean age of 58 ±15 years and 77% Ventral Hernia Working Group 2 (VHWG2). Mean hernia size was 18.9 cm2. Laparoscopic or robotic approach were utilized in 95% of patients, incisional hernias accounted for 57%. Mesh location was 75% intraperitoneal and bridging repair was performed in 57%. Procedure related adverse events within 30-days occurred in 5%, including: surgical site infection (SSI), surgical site occurrence (SSO), ileus, readmission, and re-operation. Procedure-related SSI or SSO events were 3.75% through 12-months. SSO events requiring procedural intervention (SSOPI) were 2.57% through 24-months. An estimated 7% of subjects had hernia recurrence through the study with a mean follow-up of 32-months (14-53 months) using a patient-reported outcome measure. Subgroup comparison of fixation type (permanent vs absorbable, p = 0.93) and repair (bridging vs reinforcement, p = 0.99) were conducted for recurrence and were not statistically significant.

Conclusions
In this analysis, ventral hernia repair with hybrid, composite mesh results in successful outcomes in the majority of patients. This study represents a heterogeneous patient population undergoing repair using various approaches, mesh fixation, and mesh placement locations. These data appear to confirm long-term acceptable safety and device performance with a low rate of recurrence in a predominantly VHWG2 population.
P108 SARCOPENIA INCREASES THE RISK OF BURST ABDOMEN AFTER EMERGENCY MIDLINE LAPAROTOMY: A MATCHED CASE-CONTROL STUDY
Authors: Jensen Thomas Korgaard , Nielsen Yousef Jesper Wirenfeldt , Tolstrup Mai-Britt , Gögenur Ismail 
Published: December 2021

Abstract

Aim
The aim of this study was to investigate the association of sarcopenia with the risk of burst abdomen after midline laparotomy.

Material and Methods
A single-center, retrospective, 1:4 matched case-control study of patients suffering from burst abdomen (cases) and controls. Sarcopenia was defined as lowest sex-dependent quartile of total cross-sectional psoas area adjusted for body surface area. Primary outcome was to evaluate the rate of sarcopenic patients among cases and controls. Secondary, risk-factors for burst abdomen and postoperative death, were evaluated by multivariate regression analysis.

Results
67 patients suffering from burst abdomen were matched to 268 controls. Sarcopenia was associated with burst abdomen (OR 2.3, p = 0.006). Unadjusted analysis identified a higher 90-day mortality among sarcopenic patients compared to the non-sarcopenia group (32.9% vs. 21.1%, p = 0.029) but this association was not verified by the adjusted analysis.

Conclusions
Sarcopenia is an isolated risk-factor for burst abdomen after midline laparotomy.
P118 MORBIDITY, MORTALITY AND RECURRENCE FACTORS OF INCARCERATED FEMORAL HERNIA
Authors: Kalayci Tolga , Iliklerden Umit Haluk , Kotan Mehmet Çetin 
Published: December 2021

Abstract

Aim
Aimed to search the factors affecting morbidity, mortality, and recurrence in incarcerated femoral hernia cases.

Material and Methods
After ethical committee approval, patients operated due to incarcerated femoral hernia between 2010 and 2020 were included in the study. Patients in the pediatric age group (0-18 years), and pregnant patients were excluded from the study. Preoperative, intraoperative, and postoperative factors of the patients were gathered. Morbidity, mortality, and recurrence factors were evaluated with Mann-Whitney U test, χ² test, and Likelihood ratio test, p value lower than 0.05 as significant.

Results
The mean age of 50 patients was 54.56±19.34 years (19-91) and the female to male ratio was 33/17. Right-sided hernia was present in 27 (54%) patients and recurrent hernia in 5 (10%) patients. The most common surgery type was Mc Vay repair in 33 (66%) patients. Other surgery types were as follows: Lichtenstein procedure in 9 (18%) patients and Rutkow plug procedure in 8 (16%) patients. The morbidity and mortality rates of the study were 14% and 4%, respectively. Postoperative recurrence was seen in only 3 (6%) patients. Patients with preoperative nausea (p = 0.003), vomiting (p &lt; 0.001), and tachycardia (p &lt; 0.001), presence of recurrent hernia (p &lt; 0.001), surgery under general anesthesia (p &lt; 0.001), performing both laparotomy (p = 0.007) and organ resection during surgery (p &lt; 0.001) had more morbidity. Also, patients with preoperative tachycardia (p = 0.005) and organ resection during surgery (p = 0.029) had more mortality. However, no factors affecting recurrence were found in the study.

Conclusions
Morbidity and mortality probability are higher in patients with preoperative septic and obstructive symptoms.
P124 RECURRENCE OF SPIEGEL'S HERNIA POST-IPOM IN AN ELDERLY PATIENT, HOW TO DEAL WITH IT?
Authors: Farré Roser , Gobbo Rafael Gerardo Díaz Del , Fructuoso Lorena Sanchon , Ramos Alexander Osorio , Guariglia Claudio Antonio , López Sara Pardo , Ormazabal Pablo Collera 
Published: December 2021

Abstract

Aim
To demonstrate how minimally invasive surgery of the abdominal wall allows us to rescue patients with recurrent hernias previously treated with other laparoscopic techniques.

Material and Methods
An 83-year-old woman with moderate comorbidities, ASA III and obese was operated for bilateral Spiegel’s hernia by laparoscopic IPOM. 21 months later, a symptomatic recurrence of the right hernia was diagnosed.
The physical examination was difficult due to obesity and the CT scan showed a right hernia recurrence. This CT scan was used for 3D Planning of the surgery, showing the right Spiegel’s hernia with 5-6 cm of diameter with a bowel loop inside.

Results
Given the age of the patient and comorbidities, it was decided to perform a laparoscopic repair using the IPOM + technique, closing the defect with barbed suture and placing a wide visceral contact mesh fixed with absorbable tackers.
She was discharged 24 hours after surgery without complications, providing the patient with the benefits of minimally invasive surgery.

Conclusions
Laparoscopic surgery allows us to treat hernia recurrences even in cases previously treated by minimally invasive approach.
An individualized treatment adjusted to the age and characteristics of each patient should be carried out.
3D Technology and reconstruction is very useful for pre-surgical Planning, allowing a personalized pre-operative assessment of each patient.
The use of 3D Technology is a great teaching tool with great potential for surgical planning.
P146 ROBOTIC REPAIR OF COMPLICATED INGUINAL HERNIAS
Authors: Avery Michael , Augenstein Vedra , Katzen Michael 
Published: December 2021

Abstract

Aim
In this video, the authors provide an educational demonstration on the use of robotic surgery in management of two patients with complicated and recurrent inguinal hernias. The two patients demonstrated in these videos show the benefits of use of robotics in the approach to a patient with a recurrent hernia after previous open repair with plug and patch method as well as repair in a very obese patient with large hernias causing obstruction of the left ureter.

Material and Methods
N/a

Results
N/a

Conclusions
Robotic surgery is an emerging technology in surgery and can be a useful modality in treating patients with complex and recurrent inguinal hernias. Furthermore, the visualization in these complex cases can be helpful in identifying the important structures during dissection. Regardless of technique, the two videos presented demonstrate a complex dissection which may be needed when repairing recurrent or very large inguinal hernias.
P148 LIRA TECHNIQUE AFTER MEDIUM FOLLOW UP. RESULTS OF A NEW MINIMAL INVASIVE PROCEDURE IN VENTRAL HERNIA REPAIR
Authors: Gómez-Menchero Julio , Bohorquez Antonio Gila , Herranz Pablo de la , Ramirez Jose Luis Guerrero 
Published: December 2021

Abstract

Aim
LIRA technique (Laparoscopic Intracorporeal Rectus Aponeuroplasty) was described in 2018 in order to reduce the tension in the midline as an alternative to defect closure (CD) in Laparoscopic Ventral Hernia Repair. We present our results in LIRA series in patients over 1-year follow-up.

Material and Methods
A prospective controlled study was conducted from January 2015 to December 2020 to evaluate an elective new procedure (LIRA) performed on patients with midline ventral hernias w2 (EHS Classification). Data analyzed included patient demographics, operative parameters and complications.
A Tomography was performed preoperatively and postoperatively (1 month and 1 year) to evaluate recurrence, distance between rectus and seroma

Results
49 patients were included. Mean Age was 58± 10.59 years old and BMI 33.11± 6.61 kg/m2. Mean width of the defect was 6.19± 1.49 cm. Average VAS (24 h) was 5.09 ± 5, 0.38(1 month) and 0 (1 year). Mean preoperative distance between rectus was 5.55± 1.61 cm; postoperative was 2.15 ± 0.79 cm (1 month) and 2.20±0.68 cm (1 year). Radiological seroma at first month was detected in 40%. Seroma after 1 year was 4,08% Mean follow-up was 24 months. Bulging was detected only in 1 case (2.04%) of our series after 1 year follow up. No recurrence is data.

Conclusions
LIRA technique could be considered as an alternative to CD for w2 defects with a low rate of complication, and could be related to a low rate of postoperative pain with no recurrence and a low rate of bulging compared to CD, being a safe, feasible and reproducible technique.
P153 CHALLENGES IN MINIMALLY INVASIVE REPAIR OF ILEAL CONDUIT PARASTOMAL HERNIAS
Authors: Dewulf Maxime , Pletinckx Pieter , Nachtergaele Femke , Muysoms Filip 
Published: December 2021

Abstract

Aim
Parastomal hernia after radical cystectomy and ileal conduit urinary diversion is an underestimated and probably undertreated condition with significant impact on quality of life. However, its surgical treatment is challenging and prone to recurrence and complications. Literature on the subject is scarce and of poor quality, and the optimal surgical treatment of this condition remains to be determined.

Material and Methods
In this retrospective patient series, a prospectively maintained database was screened. Data from all patients undergoing surgical treatment for a parastomal hernia after cystectomy and ileal conduit urinary diversion in our center were collected. The incidence of local recurrence was defined as primary endpoint. The rate of in-hospital complications was defined as secondary endpoint.

Results
Between May 2016 and June 2020, 15 patients underwent minimally invasive repair of a parastomal hernia of an ileal conduit at our center. Almost half of the patients had a concomitant midline incisional hernia (7/15; 46,7%). The majority of patients were treated with robotic-assisted laparoscopic surgery (10/15; 66,7%). Median follow-up was 366 days. One patient developed a local recurrence of her parastomal hernia on day 66 postoperatively, this recurrence was treated with intraperitoneal mesh.

Conclusions
The minimally invasive surgical treatment of a parastomal hernia after ileal conduit urinary diversion poses specific perioperative challenges that require a broad surgical armamentarium and a tailored approach. This paper confirms the significant morbidity after this type of surgery and proposes a flow chart to standardize the choice of surgical technique, depending on the presence of a concomitant midline incisional hernia and perioperative findings.
P156 INTERNET USE OF THE HERNIA PATIENTS BEFORE SURGERY: SEARCHING ABOUT THE DISEASE, AND FINDING A PROPER SURGEON
Authors: Ugurlu Celil , Bayar Bahattin , Celasin Haydar , Kulacoglu Hakan 
Published: December 2021

Abstract

Aim
To find out the current status of the internet use of the patients who undergo hernia repair.

Material and Methods
The patients who were diagnosed with abdominal wall hernia and scheduled for elective hernia repair were requested to answer a questionnaire. The age, gender, education status, place of living, health insurance, access to the Internet, the person who did the search, and the hernia type were the recorded parameters at the first stage. Then the answers for three main questions were taken: “Did you make a search about your hernia?”, “Did you make a search about your surgeon?”, “Would you prefer another surgeon if you could?”.

Results
139 patients were included. 86% of all participants were Internet users. 62% of the patients made an Internet search about their hernias. 57% made a search in order to find a proper surgeon. 10% of the patients stated that they would like to go to another surgeon for the hernia repair if it was possible. Internet search rate was significantly higher in younger patients (16-40 y) in comparison with older patients. The higher the education level of the patients the higher the rate of making Internet searches. Patients who live in the cities more frequently made Internet searches than those in towns or villages.

Conclusions
Less than two thirds of the hernia patients make Internet search about their disease. Higher education level, younger age and living in a city positively affect Internet search rates.