bluuebunny/crossref_metadata_2025_split huggingface dataset:
O03 SMALL BITES AND PROPHYLACTIC MESH TO PREVENT INCISIONAL HERNIA IN HIGH-RISK PATIENTS. A MESH IS THE MOST POWERFUL TOOL
Authors: Amador Sara , Pereira-Rodriguez Jose Antonio , Bravo-Salva Alejandro , Ventura-Montcusí Blanca , Insenser Juan José Sancho , Román Miguel Pera , Cano Manuel López 
Published: December 2021

Abstract

Aim
Small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by guidelines to prevent incisional hernias (IHs) and burst abdomen (BA). Our aim was to implement a protocol combining both and to analyze its outcomes.

Material and Methods
Prospective data collection of all EMLs for one year. Results were analyzed at one month and during follow-up. The incidence of IH and BA was compared by groups depending on the use of a PM (M Group) or not (S Group), and in subgroups related to the closure technique: SB (Subgroups MSB and SSB) or not (Subgroups MLB and MSB).

Results
A lower number of BA was diagnosed in the M group (OR 0.0692; CI95% 0.008-0.56; P = 0.01) in 197 operations. 163 patients completed a mean follow-up of 29.23 months, with a lower frequency of IH in M group patients (OR = 0.769; CI 95% 0.65 - 0.91; P &lt; 0.0001). Same differences persisted after a propensity matching score: BA (OR = 0.355; CI 95% 0.255 - 0.494; P &lt; 0.0001) and IH (OR = 0.394; CI 95% 0.24 - 0.61; P &lt; 0.0001). Comparing suturing techniques by subgroups any difference in IH and BA appeared. PM was the main factor related to reduction of IH (HR 11.794; CI 95% 4.29 - 32.39; P &lt; 0.0001).

Conclusions
A PM is the most powerful tool for prevention both IH and BA after EMLs, regardless of the closure technique in patients at high-risk for IHs.
O05 1-YEAR RESULTS OF AN INTERNATIONAL RANDOMIZED CONTROLLED TRIAL (ESTOIH STUDY) COMPARING THE “SHORT STITCH” VERSUS “LONG STITCH” TECHNIQUE USING AN ULTRA-LONG ABSORBABLE ELASTIC SUTURE MATERIAL
Authors: Fortelny René , Albertsmeier Markus , Hofmann Anna , Riedl Stefan , Kewer Jan Ludolf , Shamiyeh Andreas , Maier Theo David , Schuhmacher Guido , Koeckerling Ferdinand , Pession Ursula 
Published: December 2021

Abstract

Aim
The aim of this multicenter, randomized, double blinded study was to compare the short stitch technique for elective, primary, median laparotomy closure with the long stitch closure using the ultra-long absorbable, elastic monofilament suture made of poly 4-hydroxybutyrate (MonoMax®).

Material and Methods
Eligible patients were randomly allocated to receive either the short or the long stitch suture technique in a 1:1 ratio in 9 centers in Austria and Germany after elective midline laparotomy.

Results
425 patients were randomized to receive either the short stitch (n = 215) or long stitch technique (n = 210). In a cox proportional hazards model, the risk for burst abdomen was reduced by 7-fold (HR 0.183 (0.0427 - 0.7435), p = 0.0179) for the short stitch group. Complications such as seroma, hematoma and other wound healing disorders occurred without significant differences between groups. After one year, the incisional hernia rate was 3.65% in the short stitch group compared to 8.80% in the long stitch group (p = 0.055). The combination of burst abdomen and incisional hernia rate had a significantly lower rate of 5.38% for the short stitch technique compared to 13.17% for the long stitch technique (p = 0.0142).

Conclusions
Both in the short-term results, the short-stitch technique showed substantial advantages in burst abdomen rate, as well as in the 1-year follow-up regarding the incidence of incisional hernias. The low incidence of incisional hernia in the short stitch technique with MonoMax® is promising in comparison to previously published data and should be confirmed in the 3-year follow-up.
O11 SEX DIFFERENCES, SLEEP DISTURBANCE AND RISK OF PERSISTENT PAIN ASSOCIATED WITH GROIN HERNIA SURGERY: A NATIONWIDE REGISTER-BASED COHORT STUDY
Authors: Bjurström Martin F. , Irwin Michael R. , Chen David C. , Smith Michael T. , Montgomery Agneta 
Published: December 2021

Abstract

Aim
Persistent pain after groin hernia repair is a major health problem. Sleep disturbance is associated with heightened pain sensitivity. The main objective of this study was to examine the role of sleep disturbance in the development and long-term maintenance of chronic postherniorrhaphy inguinal pain (CPIP), with exploration of sex differences.

Material and Methods
From 2012-2017, a national cohort of patients with prior groin hernia repair (n = 2084; 45.8% females) were assessed for the development of CPIP 12 months after surgery. Patients then underwent long-term (median 5.0 years) follow-up to evaluate the contribution of sex and sleep disturbance on the maintenance of CPIP. Associations between pre- and postoperative sleep problems (assessed at long-term follow-up) and CPIP were tested using logistic regression.

Results
Females had higher rates of CPIP with negative impact on daily activities 12 months after surgery as compared to males (14.6 vs 9.2%, p&lt;0.0005), and were more likely to have moderate-severe CPIP in the long-term (3.1 vs 1.2%, p=0.003). Preoperative sleep problems predicted development of CPIP 12 months after surgery (adjusted odds ratio (aOR) 1.76 (95%CI 1.26-2.46), p=0.001) and CPIP in the long-term (aOR 2.20 (1.61-3.00), p&lt;0.0001). CPIP was associated with insomnia and depression.

Conclusions
Sleep disturbance may increase the risk for CPIP, and contribute to maintenance of postsurgical pain. Females are at heightened risk for CPIP as compared to males. Given the robust associations between sleep disturbance and CPIP, interventions which consolidate and promote sleep, especially in females, may improve long-term pain control.
O22 ANDROGEN DEPRIVATION THERAPY AND THE RISK FOR INGUINAL HERNIA
Authors: Hermann Maria , Sandblom Gabriel , Gustafsson Ove , Stattin Pär , Styrke Johan , Katawazai Asmatullah , Vikman Hanna 
Published: December 2021

Abstract

Aim
To investigate whether androgen deprivation therapy (ADT) for prostate cancer increases the risk for inguinal hernia.

Material and Methods
A population-based nested case-control study based on data from the Prostate Cancer Database Sweden. The cohort included men with prostate cancer who had not received curative treatment. Men who had been diagnosed with inguinal hernia or had undergone inguinal hernia repair (n = 1324) were cases and controls were men, not diagnosed, nor operated on for inguinal hernia, matched on birth year (n = 13 240). Conditional multivariate logistic regression models were used to assess any temporal association between ADT and inguinal hernia, adjusting for confounders.

Results
Odds Ratio [OR] for repair of inguinal hernia 0-1 years from start of ADT was 0.5 (95% confidence Interval (CI)) 0.38-0.68), between 1 and 3 years after, the OR was 0.35 (95% CI 0.26-0.47), 3-5 years after, the OR was 0.39 (95% CI 0.26-0.56), 5-7 years after, the OR was 0.6, (95% CI: 0.41-0.97), and &gt; 9 years after, the OR was 3.68 (95% CI 2.45-5.53).

Conclusions
The marked increase in OR for inguinal hernia after 9 years of ADT supports the hypothesis that low testosterone levels increase the risk for inguinal hernia. The low risk for inguinal hernia during the first eight years on ADT is likely caused by selection of men with advanced cancer unlikely to be diagnosed or treated for inguinal hernia. This finding may support the hypothesis that sex hormones plays a crucial role in inguinal hernia development.
O26 INFECTIOUS COMPLICATION IN RELATION TO THE PROPHYLACTIC MESH POSITION: THE PRIMA TRIAL REVISITED
Authors: Van den Dop Matthijs , Sneiders Dimitri , Kleinrensink Gert-Jan , Jeekel Hans , Lange Johan , Timmermans Lucas 
Published: December 2021

Abstract

Aim
Prophylactic mesh reinforcement has proven to reduce the incidence of incisional hernia (IH). Fear of infectious complications may withhold the widespread implementation of prophylactic mesh reinforcement, particularly in the onlay position.

Material and Methods
Patients scheduled for elective midline surgery were randomly assigned to a suture closure group, onlay mesh group, or sublay mesh group. The incidence, treatment, and outcomes of patients with infectious complications were assessed through examining the adverse event forms. Data were collected prospectively for 2 years after the index procedure.

Results
Overall, infectious complications occurred in 14/107 (13.3%) patients in the suture group and in 52/373 (13.9%) patients with prophylactic mesh reinforcement (p = 0.821). Infectious complications occurred in 17.6% of the onlay group and 10.3% of the sublay group (p = 0.042). Excluding anastomotic leakage as a cause, these incidences were 16% (onlay) and 9.7% (sublay), p = 0.073. The mesh could remain in-situ in 40/52 (77%) patients with an infectious complication. The 2-year IH incidence after onlay mesh reinforcement was 10 in 33 (30.3%) with infectious complications and 15 in 140 (9.7%) without infectious complications (p = 0.003). This difference was not statistically significant for the sublay group.

Conclusions
Prophylactic mesh placement was not associated with increased incidence, severity, or need for invasive treatment of infectious complications compared with suture closure. Patients with onlay mesh reinforcement and an infectious complication had a significantly higher risk of developing an incisional hernia, compared with those in the sublay group.
O35 WHAT HAPPENS TO PATIENTS WITH ACUTELY SYMPTOMATIC HERNIA IN THE UK? FINDINGS FROM THE MASH STUDY
Authors: Proctor Victoria , Spence Olivia , Burns Flora , Green Susanna , Sayers Adele , Smart Neil , Lee Matthew 
Published: December 2021

Abstract

Aim
Acutely symptomatic abdominal wall and groin hernias (ASH) are a common reason for acute surgical admissions in the UK. There is limited data to guide the treatment of such presentations. This study aimed to assess outcomes of emergency hernia surgery, and identify common management strategies, to improve care for these high-risk patients.

Material and Methods
A 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Data on patient characteristics, inpatient management, quality of life, complications and wound healing was collected. 30 and 90-day follow-up phone calls assessed complications and quality of life. Descriptive analyses were performed to describe population and outcomes.

Results
Twenty-three acute Trusts recruited 268 patients. Inguinal (37.7%) and umbilical (37.7%) were the most common hernia locations. 13.4% were awaiting elective surgery and 13.1% had been previously declined intervention. CT was performed in 48%. 82% underwent surgical management with open repair (94%) under general anaesthesia (93%) being most common. 4/11 laparoscopic procedures were converted to open. 55% of repairs used mesh, typically synthetic non-absorbable (87%). Complications were infrequent with surgical site infection (9.4%), delirium (3.2%) and pneumonia (2.3%) being most common. Mortality was 1.5%. Immediate surgical management was associated with significant improvement in quality of life at 30 days.

Conclusions
There is variation in the investigation, management and surgical strategy to treat acutely symptomatic abdominal wall and groin hernias in the UK. Further large-scale work is needed to establish the optimal management strategy for specific acute presentations given the wide variation at present.
O40 A MODIFIED DELPHI PROCESS TO ESTABLISH RESEARCH PRIORITIES IN HERNIA SURGERY
Authors: Scrimgeour Duncan , Allan Morven , East Barbora , Blackwell Sue , Laidlaw Lynn , Light Duncan , Smart Neil , Horgan Liam , Beaux Andrew de , Wilson Michael 
Published: December 2021

Abstract

Aim
Abdominal wall hernia repair is one of the most commonly performed surgical procedures worldwide, yet there remains a lack of high quality evidence to support best management. The aim of the study was to use a modified Delphi process to determine future research priorities in this field.

Material and Methods
Stakeholders were invited by email, using British Hernia Society membership details or Twitter, to submit individual research questions via an online survey. In addition, questions obtained from a patient focus group (PFG) were collated to form Phase I. Two rounds of prioritisation by stakeholders (phase II and III) were then completed to determine a final list of questions. All questions were analysed on an anonymised basis.

Results
A total of 266 questions, 19 from the PFG, were submitted by 113 stakeholders in Phase I. Of these, 64 questions were taken forward for prioritisation in Phase II, which was completed by 107 stakeholders. Following Phase II analysis, 97 stakeholders prioritised 36 questions in Phase III. This resulted in a final list of 14 research questions, 3 of which were from the PFG. Stakeholders included patients and healthcare professionals (consultant surgeons, trainee surgeons and other multidisciplinary members) from over 27 countries during the 3 phases.

Conclusions
Fourteen key research priorities pertaining to abdominal wall hernia surgery were identified. Many topics focused on pain, mesh and what the optimal outcome measures following hernia surgery should be. Uniquely, these priorities have been determined from participation by both healthcare professionals and patients. These priorities should now be addressed by well-designed, high-quality international collaborative research.
O49 COMPARING OUTCOMES BETWEEN MINIMALLY INVASIVE AND OPEN INGUINAL HERNIA REPAIR
Authors: Katzen Michael , Ayuso Sullivan , Aladegbami Bola , Nayak Raageswari , Colavita Paul , Augenstein Vedra , Kercher Kent , Todd Heniford B 
Published: December 2021

Abstract

Aim
Prospective evaluation comparing outcomes between laparoscopic (LIHR), robotic (RIHR), and open inguinal hernia repair (OIHR).

Material and Methods
Prospective institutional data comparison of patients undergoing inguinal hernia repair from 1999–2020 was performed. Patients with chronic pain or infection were excluded. Standard statistical methods were used and univariate analysis was performed between LIHR, RIHR, and OIHR groups.

Results
3,300 repairs were performed: 1,970 LIHR (597-bilateral), 127 RIHR (25-bilateral), and 538 OIHR (43-bilateral). LIHR and RIHR patients were younger (55.4±14.8vs59.0±13.7vs 65.0±13.7years;p&lt;0.01), with lower BMI (26.6±6.5vs28.9±20.3vs31.8±7.6kg/m2; p&lt;0.01), fewer overall (2.7±1.9 vs 2.7±2.2vs3.7±2.5; p &lt; 0.01) and cardiac (0.2% vs 0% vs 2.6%; p&lt;0.01) comorbidities, and fewer patients had diabetes (5.2%vs4.6%vs10.9%; p&lt;0.01). OIHR had the highest rate of recurrent hernias (21.2%vs11.2%vs30.9%; p&lt;0.01). History of smoking was less in LIHR (13.9%vs30.9%vs19.5%%; p&lt;0.01). Mesh was used in 99.5% of cases; synthetic was used in all minimally invasive cases and 98.4% of OIHR, with biologic mesh in 1.0% of OIHR due to bowel resection during the operation. Operative time was shortest in LIHR followed by open (86.5±39.6vs109.0±56.8vs92.6±55.2 min; p&lt;0.01). Wound complications were more frequent in OIHR (0.8%vs0.7%vs3.8%; p&lt;0.01). Admission was more common after open repair (2.2%vs2.7%vs5.7%; p&lt;0.01) with a trend to less readmission following LIHR (1.0%vs2.0%vs2.3%; p=0.06). There were few recurrences overall (0.7%vs0.7%vs1.3%; p=0.40) with mean follow-up time 21.1±22.4 months.

Conclusions
LIHR, RIHR, and OIHR were performed with low overall morbidity and complications. Recurrent hernias and cardiac patients were most often repaired open, which more frequent admission and had higher wound morbidity. RIHR had longer OR times with no improvement overall outcomes.
OV02 COMPLEX PARASTOMAL HERNIA REPAIR WITH MESH FISTULA AND MESH INFECTION
Authors: Elhage Sharbel , Deerenberg Eva , Ayuso Sullivan , Augenstein Vedra , Kasten Kevin , Todd Heniford B 
Published: December 2021

Abstract

Aim
Parastomal hernias of any size can be difficult to manage and greatly affect a patient’s quality of life, however, they can be even more problematic when associated with loss of domain and infection. The aim of our video was to demonstrate open repair of a massive parastomal hernia complicated by loss of domain, mesh fistula, and mesh infection.

Material and Methods
Images and footage from clinic and the operative procedure were included.

Results
A 51-year-old female with a history of prior APR followed by failed ventral and parastomal hernia repairs presented with a massive parastomal hernia that was significantly impacting her and her family’s quality of life. Due to her hernia, she had become immobile and was bed bound. Furthermore, the hernia had caused significant chronic constipation secondary to colonic dysmotility. The patient also had loss of domain, and her hernia appeared to be complicated by a chronic mesh infection with a draining sinus. She underwent pre-operative bilateral botulinum toxin A injection in the oblique abdominal musculature. She then underwent open preperitoneal parastomal hernia repair with biologic mesh, excision of prior mesh, primary fistula repair, total abdominal colectomy, and end ileostomy. The patient tolerated the procedure well without complications and has continued to do well in follow-up. She has had great improvement in her quality of life.

Conclusions
In this patient with a massive parastomal hernia complicated by loss of domain, mesh fistula, and mesh infection, we demonstrate a successful open preperitoneal repair following pre-operative BTA injection.
OV10 LAPAROSCOPIC-GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK IN HERNIA SURGERY - HOW WE DO IT
Authors: Gonçalves Mário Rui , Antunes Conceição , Capinha Mariana , Arantes Ana Rita , Almeida Paulo , Pereira Joaquim Costa 
Published: December 2021

Abstract

Aim
“COVID has been a great challenge for Hospitals around the world. At our surgical department a new protocol of TAP block was designed and implemented in our laparoscopic incisional ventral hernia repairs, to allow these patients to be operated in ambulatory regime, without compromising pain control and the outcomes. In this video we aim to present the technique for the Laparoscopic-guided TAP Block during a Laparoscopic IPOM Plus ventral hernia repair.”

Material and Methods
“We implemented this protocol in July 2020 and since then, we performed 18 TAP block in laparoscopic incisional hernia repairs, laparoscopic guided by the Surgeon or ultrasound-guided by the Anesthesiologist. In this case, the video reports to a Laparoscopic IPOM Plus incisional hernia repair performed on a 54-year-old patient, male, with obesity, arterial hypertension and dyslipidemia. He had a 6 centimeter incisional hernia post-colorectal surgery in 2013.”

Results
“As detailed in the video, we show all the steps to perform a TAP block under laparoscopic direct visualization”

Conclusions
“TAP block can be performed by the Surgeon, with direct visualization at the beginning of the laparoscopic procedure.”
The Effect of Antiretroviral Therapy for the Treatment of Human Immunodeficiency Virus (HIV)-1 in Pregnancy on Gestational Weight Gain
Authors: Joseph Naima T , Satten Glen A , Williams Rachel E , Haddad Lisa B , Jamieson Denise J , Sheth Anandi N , Badell Martina L 
Published: December 2021

Abstract

Background
Gestational weight gain above Institute of Medicine recommendations is associated with increased risk of pregnancy complications. The goal was to analyze the association between newer HIV antiretroviral regimens (ART) on gestational weight gain.

Methods
A retrospective cohort study of pregnant women with HIV-1 on ART. The primary outcome was incidence of excess gestational weight gain. Treatment effects were estimated by ART regimen type using log-linear models for relative risk (RR), adjusting for prepregnancy BMI and presence of detectable viral load at baseline.

Results
Three hundred three pregnant women were included in the analysis. Baseline characteristics, including prepregnancy BMI, viral load at prenatal care entry, and gestational age at delivery were similar by ART, including 53% of the entire cohort had initiated ART before pregnancy (P = nonsignificant). Excess gestational weight gain occurred in 29% of the cohort. Compared with non–integrase strand transfer inhibitor (-INSTI) or tenofovir alafenamide fumarate (TAF)–exposed persons, receipt of INSTI+TAF showed a 1.7-fold increased RR of excess gestational weight gain (95% CI: 1.18–2.68; P &lt; .01), while women who received tenofovir disoproxil fumarate had a 0.64-fold decreased RR (95% CI: .41–.99; P = .047) of excess gestational weight gain. INSTI alone was not significantly associated with excess weight gain in this population. The effect of TAF without INSTI could not be inferred from our data. There was no difference in neonatal, obstetric, or maternal outcomes between the groups.

Conclusions
Pregnant women receiving ART with a combined regimen of INSTI and TAF have increased risk of excess gestational weight gain.
Nonparametric bounds on treatment effects with imperfect instruments
Authors: Ban Kyunghoon , Kédagni Désiré 
Published: December 2021

Summary
This paper extends the identification results in Nevo and Rosen (2012) to nonparametric models. We derive nonparametric bounds on the average treatment effect when an imperfect instrument is available. As in Nevo and Rosen (2012), we assume that the correlation between the imperfect instrument and the unobserved latent variables has the same sign as the correlation between the endogenous variable and the latent variables. We show that the monotone treatment selection and monotone instrumental variable restrictions, introduced by Manski and Pepper (2000; 2009), jointly imply this assumption. Moreover, we show how the monotone treatment response assumption can help tighten the bounds. The identified set can be written in the form of intersection bounds, which is more conducive to inference. We illustrate our methodology using the National Longitudinal Survey of Young Men data to estimate returns to schooling.