bluuebunny/crossref_metadata_2025_split huggingface dataset:
P002 POST-PARTUM ABDOMINAL WALL INSUFFICIENCY SYNDROME. LESSON LEARNED FROM THE SINGLE SURGEON'S EXPERIENCE BASED ON 200 CASES
Authors: Smietanski Maciej , Śmietańska Irmina 
Published: December 2021

Abstract

Aim
Post-partum abdominal wall insufficiency with rectus diastasis is present in over 30% of women after pregnancy. Little is known about how PPAWI affects the social, sexual life and self-esteem of patients. This study was designed to evaluate the safety of onlay mesh combined with abdominoplasty and its impact on the well-being of the patients.

Material and Methods
Two hundred patients with PPAWI underwent surgery with onlay mesh and abdominoplasty. The safety of the procedure was assessed by postoperative complications, time of hospitalization and time of drainage. Before the operation and 6 months later, a questionnaire asking about the patient’s sexual and social life and the presence of back pain was completed. The cosmetic effect was assessed separately.

Results
The onlay procedure with abdominoplasty was found to be safe and fast. The mean operation time was 82 min, and the drainage time was 2.1 days. In this group &lt;2% postoperative complications were noted. There were no recurrences within the 6 month.p. Significant improvements in social and sexual life and the level of self-esteem were noted. Back pain was relieved or minimalized in all patients. The cosmetic effect was insufficient for 2 patients (1%).

Conclusions
PPAWI can be treated safely with onlay mesh and abdominoplasty. The patients’ symptoms were strongly correlated with the morphological status of the front abdominal wall and improved after the procedure. The authors are the first to propose PPAWI syndrome as a complex disorder with a disease classification, which can help patients with their choice of proper surgical intervention.
P008 SYNCHRONOUS SURGICAL TREATMENT OF MORBID OBESITY AND COMPLEX VENTRAL HERNIA AFTER PROGRESSIVE PNEUMOPERITONEUM AND BOTULINUM TOXIN A INJECTION
Authors: Bertoglio Camillo Leonardo , Morini Lorenzo , Barone Gisella , Maspero Marianna , Alampi Bruno , Girardi Valerio , Ferrari Giovanni 
Published: December 2021

Abstract

Aim
the worldwide increase in morbidly obese patients with complex hernia raises controversies in the choice of the appropriate treatment timing: synchronous bariatric and abdominal wall surgery versus delayed abdominal wall surgery. We report an innovative tailored surgical treatment carried out at our Institution.

Material and Methods
the approach provided the injection, six weeks before surgery, of 500 international units of botulinum toxin A on either side of the large abdominal wall muscles. Four weeks before surgery pneumoperitoneum was inducted and out-patient daily sessions of progressive insufflation with ambient air were then carried out. Surgery was scheduled 48 days after botulinum injection. Sleeve gastrectomy and simultaneous posterior component separation with transversus abdominis release were performed. Two prosthetic meshes were placed sublay.

Results
Postoperative superficial surgical site infection was successfully treated with negative pressure wound therapy. At one year follow up no hernia recurrence was recorded while total body weight loss was 31%.

Conclusions
a delay in ventral hernia repair could worsen quality of life of morbidly obese patients. In such high risk patients, the choice of the best surgical strategy remains controversial. There is great concern in performing bariatric surgery simultaneously to hernia repair, although there is lack of evidence on which is the ideal treatment modality. Synchronous bariatric surgery and complex ventral hernia repair should be approached in high volume centres where a consolidated experience of multidisciplinary team-work is available. Combined botulinum toxin A and preoperative progressive pneumoperitoneum administration allow for a safe resolution of loss of domain.
P055 THE USE OF ARTIFICIAL NEURAL NETWORK TO PREDICT THE RISK OF INCISIONAL HERNIA AFTER MIDLINE LAPAROTOMY
Authors: Hernandez Edgard Efren Lozada , Real Tania Aglae Ramírez del , Medina Dagoberto Armenta , Rodriguez Jose Francisco Molina , Reynoso Juan ramon Varela 
Published: December 2021

Abstract

Aim
“Incisional Hernia (IH) has an incidence of 10-23%, which can increase to 38% in specific risk groups. The objective of this study was developed and validated an artificial neural network (ANN) model for the prediction of IH after midline laparotomy (ML) and this model can be used by surgeons to help judge a patient’s risk for IH.”

Material and Methods
“A retrospective, single arm, observational cohort trial was conducted from January 2016 to December 2020. Study participants were recruited from patients undergoing ML for elective or urgent surgical indication. Using logistic regression and ANN models, we evaluated surgical treated IH, wound dehiscence, morbidity, readmission, and mortality using the area under the receiver operating characteristic curves, true-positive rate, true-negative rate, false-positive rate, and false-negative rates.”

Results
“There was no significant difference in the power of the ANN and logistic regression for predicting IH, wound dehiscence, mortality, readmission, and all morbidities after ML. The resulting model consisted of 4 variables: surgical site infection, emergency surgery, previous laparotomy, and BMI(Kg/m2) &gt; 26. The patient with the four positive factors has a 73% risk of developing incisional hernia. The area under the curve was 0.82 (95% IC 0.76-0.87).

Conclusions
“ANNs perform comparably to logistic regression models in the prediction of IH. ANNs may be a useful tool in risk factor analysis of IH and clinical applications.”
P069 IMPLEMENTATION OF A TAP BLOCK PROTOCOL IN OUTPATIENT LAPAROSCOPIC HERNIA REPAIR DURING COVID PANDEMIC
Authors: Capinha Mariana , Gonçalves Mário Rui , Pereira Joaquim Costa , Antunes Conceição , Arantes Ana Rita , Almeida Paulo 
Published: December 2021

Abstract

Aim
“COVID has been a great challenge since its beginning. Hospitals had to change/create a lot of clinical pathways and protocols to fight it. As an adaptation to COVID pandemic, our surgical department decided to implement a protocol of Transversus Abdominis Plane Block (TAPB) in laparoscopic incisional ventral hernia repair to allow these patients to be shifted from elective to outpatient regime. This study aimed to analyze the implementation of this protocol during the covid era as a way to have more resources available for COVID patients.”

Material and Methods
“A retrospective observational study was conducted using data since the beginning of the implementation of the protocol, from July 2020 to May 2021. TAPB was performed in all patients, laparoscopically or ultrasound-guided. Patients and hernia variables were identified using the hospital database. Data was recorded in the recovery room, by a phone call 24h post-surgery and in postoperative consultations with the surgeon.”

Results
“A total of 18 patients with incisional ventral hernia was included in the study. All patients had laparoscopic incisional ventral hernia repair surgery with TAPB and in ambulatory regime, discharged before 24h, are very satisfied with the protocol in terms of post-operative pain and there are no complications related to the TAPB.”

Conclusions
“This study found that, despite of COVID Pandemic, implementing a TAP Block procedure during laparoscopic incisional ventral hernia repair, allows to shift these patients from elective to outpatient surgery without compromising the outcomes, pain management and patient security, and, finally, to increase availability of resources for COVID patients.”
P077 LONG-TERM CLINICAL OUTCOMES OF AN ANTIBIOTIC-COATED NON-CROSSLINKED PORCINE ACELLULAR DERMAL GRAFT IN HIGH-RISK ABDOMINAL WALL RECONSTRUCTION
Authors: Robinson Jordan , Sulzer Jesse , Baker Erin , Iannitti David 
Published: December 2021

Abstract

Aim
Abdominal wall reconstruction in high-risk and contaminated cases remains a challenging surgical dilemma. We report long-term clinical outcomes for a rifampin/minocycline-coated acellular dermal graft (XenMatrix™ AB) in complex abdominal wall reconstruction for patients with a prior open abdomen or contaminated wounds.

Material and Methods
Patients undergoing abdominal wall reconstruction at our institution at high risk for surgical site occurrence and reconstructed with XenMatrix™ AB with intent-to-treat between 2014 through 2017 were included. Demographics, operative characteristics, and outcomes were collected. Primary outcome was hernia recurrence. Secondary outcomes included length of stay, surgical site occurrence, readmission, morbidity, and mortality.

Results
Twenty-two patients underwent abdominal wall reconstruction using XenMatrix™ AB during the study period. Two patients died while inpatient from progression of their comorbid diseases and were excluded. Sixty percent of patients had an open abdomen at time of repair. All patients were Modified VHWG class 2 or 3.
There was a total of four 30-day infectious complications including superficial cellulitis/fat necrosis (15%) and one intraperitoneal abscess (5%). No patients required re-operation or graft excision.
Median clinical follow-up was 35.1 months with a mean of 32.2 +/- 16.5 months. Two asymptomatic recurrences and one symptomatic recurrence were noted during this period. Follow-up was extended by phone interview which identified no additional recurrences at a median of 45.5 and mean of 50.5 +/-12.7 months.

Conclusions
We present long-term outcomes for patients with high-risk and contaminated wounds who underwent abdominal wall reconstruction reinforced with XenMatrix™ AB to achieve early, permanent abdominal closure. Acceptable outcomes were noted.
P096 QUALITY OF LIFE FOLLOWING ROBOTIC-ASSISTED RETROMUSCULAR VENTRAL HERNIA REPAIR
Authors: Valsamidis Alexandros , Frederichsen Mathias , Nielsen Kristian Als , Harthimmer Mads , Helligsø Per , Nielsen Michael 
Published: December 2021

Abstract

Aim
Robotic-assisted ventral hernia repair (rVHR) has emerged as an alternative to current open and laparoscopic procedures. The present study aims to determine the effect of rVHR on postoperative quality of life.

Material and Methods
Patients undergoing elective rVHR from 01/01 2017 until 12/6 2020 were identified from the hospitaĺs electronic medical record system. Patient demographic, clinical presentation, location of the hernial defect and postoperative complications were obtained from the case notes. A phone interview was also conducted to assess postoperative life quality using the EuraHS-QoL questionnaire. The pre and postoperative life quality assessment was performed to determine the effect of robotic-assisted ventral hernia repair on 1. Pain at the site of the hernia, 2. Restrictions of activities due to pain or discomfort at the site of the hernia and 3. Esthetical discomfort. Moreover, patients were asked whether they felt their overall quality of life had improved, deteriorated or was unaltered after the procedure. A Wilcoxon signed rank test was conducted to determine the effect of the repair on postoperative life quality.

Results
85 out of 99 patients completed the interview and were included in this case series. The survey revealed a highly significant improvement of life quality in all categories (P &lt; 0. 01). 86% of the participants reported that their overall quality of life had improved, 13% reported no change and 1% felt that it had deteriorated.

Conclusions
Robotic-assisted retromuscular ventral hernia repair is a safe procedure that is associated with a significant improvement of patient quality of life.
P154 DOES A PENO-SCROTAL APPROACH FOR PENILE PROSTHESIS IMPLANTATION INCREASE THE INCIDENCE OF INGUINAL HERNIAS POSTOPERATIVELY?
Authors: Al-Bahri Shadi , Taifour Hazem 
Published: December 2021

Abstract

Aim
The incidence of direct inguinal hernia and reservoir migration post-penile prosthesis implantation is extremely rare. We present a case series of patients presenting with direct inguinal hernia following three-piece penile prosthesis implantation.

Material and Methods
Three patients presented with direct inguinal hernia shortly following penile prosthesis implantation for treatment of refractory erectile dysfunction due to venous leak that was confirmed on ultrasound imaging. All patients underwent standard open Lichtenstein tension free repair.

Results
All patients underwent penile prosthesis Implantation through a peno-scrotal approach in which the reservoir was placed in the space of Retzius. The first patient had reservoir displacement one day post-operatively presenting as an inguinal bulge and discomfort, and repaired the same day. The other two patients presented with symptoms of inguinal swelling and pain at 40 days and 8 months respectively. None of our patients had signs and symptoms of intestinal obstruction. Identifiable risk factors included high BMI and a history of smoking, however dissection and placement of the reservoir may play a role in weakening the floor of the inguinal canal.

Conclusions
Despite the rare incidence of inguinal hernia post-penile prosthesis implantation, identification of patients with risk factors for inguinal hernia development should be done preoperatively. This may be evaluated through preoperative radiologic imaging with an abdominal wall ultrasound or clinical examination by a general surgeon.
O24 10 YEARS PARTICIPATING IN THE HERNIAMED-REGISTRY: REFLECTING ON RESULTS OF THE PAST HELPS US TO SHAPE THE FUTURE
Authors: Mayer Franz , Lechner Michael , Gabersek Ana , Bittner Reinhard , Emmanuel Klaus 
Published: December 2021

Abstract

Aim
Between 01/2011 and 12/2020 5,068 AWR-patients at our department (tertiary referral center) – 884 (17.4%) incisionals. Over this 10-years period considerable changes (patients characteristics, surgical techniques, results) were analyzed.

Material and Methods
Herniamed® offers an internet-based registry-platform to document all kinds of abdominal wall repairs on a voluntary basis since 2009. Demographic data, interventional details and outcomes are documented using the EHS-classification-system. Follow-up is standardized and sheduled for 10 years.

Results
Up to 54.7% of patients (in 2020) show at least one risk factor (diabetes, smoking ….), in contrast to the age pyramid patients &gt;70 years are decreasing (47.2% in 2011 down to 29.3% in 2020), share of ASA III/IV is initially increasing (up to 42.9% in 2017) with a constant decrease after 2017 to 25.3% in 2020. Emergent cases are increasing (6.9% in 2011 up to 10.8% in 2019). Recurrent hernia repairs stays almost constant at median 21.7%. After 2015 we decided – for various reasons - not to routinely apply the laparoscopic IPOM-technique (with an interim ratio of up to 46.2%) – with a post-OP complication rate of median 23.3% anymore. From 2016 onwards we performed an increasing number of „other techniques“ (E-MILOS, E-TEP, ….) up to 36% in 2020 instead.

Conclusions
By analysing trends we recognized that patients show increasing numbers of risk factors and ASA-scores which led us to implement a prehabilitational strategy in clinical routine. However rate of post-OP complication is still high representing AWR as demanding in many aspects. A temporary cessation of MIS did not led to an extensive increase in post-OP wound complications.
O28 APPLICATION OF MICROPOROUS POLYSACCHARIDE HEMOSPHERES DURING TRANSVERSUS ABDOMINAL RELEASE TO REDUCE SEROMAS AND HEMATOMAS
Authors: Johannes Wegdam , de Jong Dite , Nienhuijs Simon , Schipper Ellis , Berkvens Elske , de Vries Reilingh Tammo 
Published: December 2021

Abstract

Aim
Wound complications, like seromas and hematomas, occur in 23% after transversus abdominis release (TAR). Hemostat agents like fibrin glue have potential to reduce this rate, by vessel sealing and tissue bonding. But these are expensive. A topical hemostatic, like microporous polysaccharide hemospheres (MPH), is much cheaper, but its potential to reduce seromas and hematomas has never been analyzed in ventral hernia surgery.

Material and Methods
After the first 25 consecutive TAR patients (Control group, 2016-2018), MPH was introduced as an adjunct in a consecutive group of 25 TAR patients (Intervention group, 2019-2020). MPH was sprinkled in the TAR planes and subcutaneous tissue. Groups were compared.

Results
Pre-operative base-line characteristics and the overall complexity of the hernia patients and operations did not differ between the two groups. Postoperatively, the overall rate of surgical site occurrences (SSO) differed (CG:60%;IG:32%), but not significantly. Seromas (CG:5%;IG: 3%) and hematomas (CG:28%;IG:8%) did not differ significantly between the two groups. Medical complications (CG:13%;IG:10%) and two-year recurrence rate (CG:12%;IG:16%) also did not differ.

Conclusions
This study did not demonstrate a clear effect of MPH on the incidence of SSO, seromas or hematomas after a transversus abdominis release, despite the high incidence of wound complications in the first group of TAR patients (presumably, reflecting the learning curve of TAR). The fact that MPH does not glue tissue layers and minimize dead space, may be causative. MPH is not advised as an adjunct to reduce SSO.
O34 AUTOLOGOUS FENESTRATED CUTIS GRAFTS FOR VENTRAL HERNIA REPAIR IN PATIENTS WITH OBESITY
Authors: Mansour Charles , Leonardi Claudia , McLaren Patrick , Cook Michael , Hodgdon Ian , Paige John 
Published: December 2021

Abstract

Aim
Traditional approaches to ventral hernia repair involve implantation of synthetic mesh (SM), primary suture (PS) repair, and the use of biologic prostheses (BP). A body mass index (BMI) &gt; 30 increases recurrence rates and complications for such repairs. We have begun to use Autologous Fenestrated Cutis Grafts (CG) as an alternative hernia repair. We investigated the impact of obesity on the recurrence and complication rates of CG compared to traditional repairs.

Material and Methods
A five-surgeon, retrospective study included all ventral/incisional, epigastric and umbilical hernia repairs (SM, PS, and BP from 2015-2020; CG repairs from 2018-2020). Patients with a BMI ≥ 30 were stratified according to surgical approach. Outcomes included recurrence and complication rates. Descriptive statistics for demographics and outcomes were compared and logistic regression performed with p &lt; 0.05 considered significant.

Results
A total of 301 hernia repairs were performed (173 CGs, 54 SM, 59 PS, 15 BS). The groups had similar recurrence rates. A significant difference in complications rates did exist (37% CGs, 48.1% SMs, 15.3% PS, 66.7% BP, p &lt; 0.001). Logistic regression revealed PS had fewer total complications than all other repairs. Compared to SM, CG had fewer seromas. Compared to BP, CG had fewer wound infections, systemic infections, renal complications, and additional procedures.

Conclusions
CG for abdominal wall hernia repair in patients with BMI ≥ 30 is an acceptable hernia repair in obese patients with similar recurrence rates and an acceptable complication profile compared to traditional repairs.
O41 PREDICTORS OF LOW QUALITY AFTER OPEN INGUINAL HERNIA REPAIR USING THE EURAHS-QOL SCORE: PROSPECTIVE MULTICENTRIC COHORT STUDY
Authors: Simoes Joana ,   PT Surg (Portuguese Collaborative Research Group)
Published: December 2021

Abstract

Aim
Evidence about factors influencing quality of life after inguinal hernia surgery is scarce. This study aimed to identify predictors of low Quality of Life (QoL) after open inguinal hernia repair, to guide practice and inform patients at high risk.

Material and Methods
Prospective multicentric cohort study including consecutive patients undergoing elective open inguinal hernia repair in Portuguese hospitals (October-December 2019). The primary outcome was Quality of Life at 3 months after surgery, using the EuraHS-QoL score (higher score correlates with lower QoL). Low QoL was defined as the higher EuraHS-QoL score tertile and multivariate logistic regression was used to identify predictors.

Results
893 patients were included from 33 hospitals. The majority were men (89.9% [800/891]), had unilateral hernias 88.7% (774/872) and the most common surgical technique was Lichtenstein’s repair (52.9% [472/893]). The median QoL score was 24 (IQR 10-40) before surgery and 2 (IQR 0-10) at 3 months after surgery, showing significant improvement (p &lt; 0.001). After adjustment, low QoL at 3 months was associated with low preoperative QoL (OR 1.76, 95% CI 1.21-2.57, p = 0.003), non-absorbable mesh fixation (OR 1.64, 95% CI 1.12-2.41, p = 0.011), severe immediate postoperative pain (OR 2.90, 95% CI 1.66-5.11, p &lt; 0.001) and minor postoperative complications (OR 2.23, 95% CI 1.30-3.84, p = 0.004).

Conclusions
This study supports the use of the EuraHS-QoL score preoperatively to inform consent. Although significant improvement in QoL is expected after surgery, high scores before surgery are associated with low postoperative QoL. Caution should be taken with non-absorbable mesh fixation and immediate postoperative pain control should be optimised.
O48 PREOPERATIVE CT IMAGING IN PATIENTS WITH STRANGULATED ABDOMINAL WALL HERNIAS DELAYS SURGERY AND INCREASE RISK OF BOWEL RESECTION: A RETROSPECTIVE RECORD BASED STUDY
Authors: Ibrahim Walid , Magee Conor , Wilson Jeremy 
Published: December 2021

Abstract

Aim
“To investigate whether preoperative CT imaging in acute symptomatic hernia was associated with either surgical delays or increase risks of bowel ischemia and the need for resection.”

Material and Methods
“The data was collected retrospectively for patients who had emergency hernia surgeries in the period between June 2003 till January 2021. We studied the role of preoperative CT scan in delaying surgical intervention and its impaction on intra-operative surgical intervention, postoperative complication, HDU admission and hospital length of stay.”

Results
“Data analysis was performed for 505 patients, 191 had preoperative CT scan. Hernia types included inguinal in 164 patients (32.5%); umbilical in 164 (32.5%); femoral in 69 (13.7%); incisional in 69 (13.7%); epigastric in 30 (5.9%); Spigelian in 9 (1.8%). Preoperative CT scan was associated with surgery delay (22.0 hours vs 13.0 hours, P 9.77e-16). Delayed surgery had an impact on increasing postoperative complications (5.2% vs 3.5%, P 0.4741), longer mean postoperative hospital lengths of stay (9.23 days vs 5.12 days, P 2.2e-16), and increase HDU admission (11.0% vs 4.8%, P 0.01408). Increase bowel resection (12% vs 6.4%, P 0.04032) with surgery delay (20.0 hours vs 12.0 hours, P 0.003448) and also increase omentum resection (7.3% vs 5.4%, P 0.4974) with surgery delay (22.5 hours vs 13.5 hours, P 0.02083) were noted.”

Conclusions
“Pre-operative CT scan for emergent hernias leads to delay in surgical intervention. Surgery delay leads to more aggressive intra-operative intervention and worse postoperative outcomes.”
OV01 A LOW-COST HERNIA MODEL FOR THE TRAINING OF THE SHOULDICE AND THE LICHTENSTEIN INGUINAL HERNIA REPAIR
Authors: Wiggers Theo , Nazari Tahmina 
Published: December 2021

Abstract

Aim
Based on an international European survey, residents prefer to study inguinal hernia repair through lectures or video-demonstrations or want to practice either on simulation or cadaveric models. Simulation models in inguinal hernia are scarce or expensive.

Material and Methods
A low-cost model was developed that can be produced everywhere with the aid of the instruction video: “How to build an inguinal hernia model”. Initially, the model was designed to practice the Lichtenstein technique but after some minor modifications (adding the conjoint tendon, enough slack in the transversalis fascia) it was also possible to practice the Shouldice technique on the same model. It only needs the removal of the stitches of the third and fourth layer before the Lichtenstein can be performed.

Results
The model was used for several studies with students and residents and proved to be realistic and was approved by an international survey among experienced hernia surgeons. It has been used once in a national training session of residents.

Conclusions
The video shows the execution of both procedures on the same model.