bluuebunny/crossref_metadata_2025_split huggingface dataset:
P020 ESTABLISHING PEER-CONSENSUS ABOUT THE USE OF LONG-TERM BIOSYNTHETIC ABSORBABLE MESH FOR VENTRAL HERNIA (GRADE 2-3) AS THE STANDARD OF CARE
Authors: Morales-Conde Salvador , Berrevoet Frederik , Jorgensen Lars Nannestad , Marchi Domenico , Ortega-Deballon Pablo , Windsor Al 
Published: December 2021

Abstract

Aim
“This consensus project was initiated to provide insight into those situations where a long-term biosynthetic absorbable mesh (LTBA) might be considered the standard of care in repair of ventral hernia grades 2 and 3 (original Ventral Hernia Working Group Classification, 2010).”

Material and Methods
“A steering group of surgical experts developed 35 initial statements formed from six domains. These statements were used to develop an online survey which was sent to surgeons involved in hernia repair surgery within Europe. Agreement (consensus) with the statements was defined as high if ≥ 70% and very high if ≥ 90% of respondents agreed with a statement. After the initial survey round, some statements were revised and these were then reissued, 34 statements were included in the final analysis”

Results
“A total of 255 responses were received over the two rounds of survey. Respondents (n = 255) were all surgeons involved in hernia repair in Europe. Fourteen statements (41%) achieved very high consensus (≥ 90%), 24 statements achieved consensus (≥70% to &lt; 90%) while one statement (3%) fell short of consensus with an agreement score of 69%.”

Conclusions
“Expert consensus opinion about the use of LTBA for hernia (Grades 2-3) as the standard of care was achieved. Based on the consensus scores, the steering group derived eleven key recommendations which, if implemented, should result in a clearer understanding of how and when a LTBA might be used in hernia repair, aiming for improvement in surgical and patient related outcomes”
P031 OPEN VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: A NATIONWIDE DATABASE STUDY
Authors: Henriksen Nadia , Andersen Hans Friis , Jorgensen Lars Nannestad , Helgstrand Frederik 
Published: December 2021

Abstract

Aim
Although laparoscopic repair of incisional hernias decreases the incidence of wound complications as compared with open repair, there has been a rising concern related to intraperitoneal mesh placement. The aim of this study was to examine outcomes after open or laparoscopic elective incisional hernia mesh repair on a nationwide basis.

Material and Methods
A merge of data between the Danish Hernia Database and the National Patient Registry provided data on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence from 2007-2018.

Results
A total of 3,090 (57.5%) and 2,288 (42.5%) patients were operated by laparoscopic and open approach, respectively. The defect was closed in 27.9% (865/3,090) of the laparoscopic cases. The median follow-up time was 4.0 (1.8-6.8) years. Rates of readmission (16.2%, 502/3,090) and re-operation for complication (7.0%, 216/3,090) were significantly lower for laparoscopic compared to open repairs (19.3%, 442/2,288, P = 0.003 and 12.5%, 288/2,288, P &lt; 0.001). Re-operation for bowel obstruction or bowel resection was twice as high after laparoscopic repair (0.6%, 20/3,090) compared with open repair (0.3%, 6/2,288, P = 0.044). Patients were significantly less prone to undergo repair of recurrence following laparoscopic compared with open repair of defect widths 2-6 cm (P = 0.002).

Conclusions
Laparoscopic intraperitoneal mesh repair for incisional hernia should still be considered for fascial defects between 2 and 6 cm, because of decreased incidences of early complications and repair of hernia recurrence compared with open repair.
P044 ATRAUMATIC AND CONSISTENT HERNIA MESH FIXATION: PERFORMANCE AND SAFETY IN A LAPAROSCOPIC IPOM PORCINE MODEL
Authors: Lopes Miguel , Bitton Elisa , Devries Elise , Pereira Maria 
Published: December 2021

Abstract

Aim
Demonstrate the performance and safety of TISSIUM on-demand activated adhesive for atraumatic hernia mesh fixation in a laparoscopic IPOM porcine model.

Material and Methods
Full thickness 4 cm in diameter excisional abdominal defects (n = 14) were created in pig (n = 8). The defects were repaired through laparoscopic intraperitoneal mesh placement using commercial composite meshes fixed with TISSIUM adhesive (n = 8) or resorbable tacks (n = 6). The animals were sacrificed after 28 and 90 days. An independent pathologist evaluated abdominal adhesion, mesh shrinkage, local tissue tolerance and tissue ingrowth through histological analysis (H&E and Movat Pentacrome) at sacrifice. Fixation strength of the explanted abdominal walls was also assessed via burst-ball.

Results
No adverse events were observed at implantation or during the survival period. All the meshes were in place at sacrifice. Mesh shrinkage and abdominal adhesion scores were similar between the two groups. Histological analysis of the mesh demonstrated equivalent quality of tissue ingrowth and excellent local tissue tolerance with minimal/mild foreign body response and mononuclear cells inflammation. The repair strength, evaluated through a burst ball method 90 days after implantation, showed no significant difference between the TISSIUM adhesive and tacks. Usability is currently being evaluated in clinically relevant models.

Conclusions
In this preclinical study the TISSIUM adhesive demonstrated similar fixation strength and quality of repair when compared to commercial tacks. This technology has the potential to impact hernia procedures standardization and reduce pain often associated with current fixation technologies.
P046 ATRAUMATIC AND CONSISTENT HERNIA MESH FIXATION: PERFORMANCE AND SAFETY IN A LAPAROSCOPIC IPOM PORCINE MODEL
Authors: Lopes Miguel , Bitton Elisa , Devries Elise , Pereira Maria 
Published: December 2021

Abstract

Aim
Demonstrate the performance and safety of TISSIUM on-demand activated adhesive for atraumatic hernia mesh fixation in a laparoscopic IPOM porcine model.

Material and Methods
Full thickness 4 cm in diameter excisional abdominal defects (n = 14) were created in pig (n = 8). The defects were repaired through laparoscopic intraperitoneal mesh placement using commercial composite meshes fixed with TISSIUM adhesive (n = 8) or resorbable tacks (n = 6). The animals were sacrificed after 28 and 90 days. An independent pathologist evaluated abdominal adhesion, mesh shrinkage, local tissue tolerance and tissue ingrowth through histological analysis (H&E and Movat Pentacrome) at sacrifice. Fixation strength of the explanted abdominal walls was also assessed via burst-ball.

Results
No adverse events were observed at implantation or during the survival period. All the meshes were in place at sacrifice. Mesh shrinkage and abdominal adhesion scores were similar between the two groups. Histological analysis of the mesh demonstrated equivalent quality of tissue ingrowth and excellent local tissue tolerance with minimal/mild foreign body response and mononuclear cells inflammation. The repair strength, evaluated through a burst ball method 90 days after implantation, showed no significant difference between the TISSIUM adhesive and tacks. Usability is currently being evaluated in clinically relevant models.

Conclusions
In this preclinical study the TISSIUM adhesive demonstrated similar fixation strength and quality of repair when compared to commercial tacks. This technology has the potential to impact hernia procedures standardization and reduce pain often associated with current fixation technologies.
P064 DURABLE REPAIR OF PRIMARY AND RECURRENT INCISIONAL HERNIA BASED ON BIOMECHANICAL PRINCIPLES
Authors: Nessel Regine , Löffler Thorsten , Rinn Johannes , Philipp Lösel , Voss Samuel , Heuveline Vincent , Vollmer Matthias , Görich Johannes , Al-Hileh Liung , Kallinowski Friedrich 
Published: December 2021

Abstract

Aim
Durable composite constructions of polymers follow specific mechanical principles. Can incisional hernia can be repaired durably based on biomechanical principles considering the abdominal wall a polymer composite?

Material and Methods
Biomechanical principles of the reconstruction of the abdominal wall were analyzed ex vivo with cyclic loading common in material sciences. The resulting GRIP concept was clinically applied. The tissue quality of the individual patient was assessed with computed tomography at rest and during Valsalva’s maneuver. Hernia meshes with high GRIP factors (Progrip®, Dahlhausen® Cicat) were used. All patients recieved single-shot antibiosis. Patients were discharged after full ambulation was achieved.

Results
A total of 163 patients (82 males and 81 females) were treated for incisional hernia. Primary hernia was repaired in 119, recurrence in 44 patients. Recurrent hernia was significantly larger (median 161 cm² versus 78 cm²; u-test: p = 0.00714) resulting in a 30 % lower mesh defect area ratio. Redo-surgery took significantly longer (median 229 min versus 150 min; p &lt; 0.00001) as recurrent disease is more likely to require transversus abdominis release (70 % versus 47 %). GRIP tended to be higher in recurrent repair (p = 0.01828). Complication rates (15 %) and duration of hospitalization were the same (6 days; p = 0.28462). After one year, no recurrence was detected in either group. Pain levels were equally low in both groups (median NAS = 0 at rest and under load, p = 0.88866).

Conclusions
Incisional hernia can be repaired safely and durably based on biomechanical principles.
P065 LONG TERM OUTCOMES AFTER LAPAROSCOPIC REPAIR OF VENTRAL HERNIAS LOCATED ON THE ABDOMINAL BORDERS
Authors: Bertoglio Camillo Leonardo , Maspero Marianna , Morini Lorenzo , Alampi Bruno , Grimaldi Simona , Quagli Oscar , Ferrari Giovanni 
Published: December 2021

Abstract

Aim
To assess the long-term outcomes after laparoscopic repair (LR) of ventral hernias located on the abdominal borders.

Material and methods
Out of our prospectively collected LR database, all cases of ventral hernias were reviewed. Defects located near the abdominal borders were identified (M1, M5, L1 and L4 according to the EHS classification). All patients received intraperitoneal implantation of an e-PTFE mesh. The primary aim of this study was to assess long-term outcomes.

Results
Out of 175 LR, 105 (60%) had a M1 component, 61 (35%) an M5, 24 (14%) an L1 and 5 (3%) an L4. The median defect width was 9 cm (range 2.5 - 30), the median length 13 (range 2 - 30), with a median defect area of 92 cm2 (range 5 - 471). Two (1%) cases required conversion to open approach. After a median follow up of 55 months, there were 7 recurrences: 4/105 in M1 patients, 1/61 M5 patients, 1/24 L1 patients and 1/4 L4 patients. 41 patients (23%) experienced chronic seroma, while 24 (14%) had chronic pain. 6 patients (3%) required a reoperation with mesh removal. At univariate analysis, only previous hernia repair was associated with recurrence; COPD, hypertension and M5 defect were associated with seroma development; seroma development and chronic pain were mutually associated.

Conclusions
Laparoscopic repair for ventral hernias is safe and feasible, with good long term outcomes.
P067 HUMANITARIAN HERNIA SURGERY - 10 YEARS OF PERSONAL EXPERIENCE AND THE SAFETY OF LDPE MOSQUITO MESH
Authors: Bystřický Petr 
Published: December 2021

Abstract

Aim
Many people from low-income countries suffer from late or no treatment of incarcerated hernias. That can cause permanent consequences or even death. Hernia International is a 100% volunteer organisation, delivering humanitarian hernia surgery in the countries of the third world. A LDPE mosquito mesh is widely used. Its safety and full functionality was described.

Material and Methods
A LDPE Mosquito mesh was a subject of testing for a heavy metal content; the same-size piece of a mosquito mesh, and a standard commercial mesh, were tested by spectral photometry.
I have had the chance to join 11 international voluntary teams in the years of 2011-2019. More than 1000 procedures were performed, including large inguinoscrotal, incisional, and pediatric hernias. The conditions were often very basic, and a LDPE mosquito mesh and local anaeshesia were used in most adult cases.

Results
The test shows comparable or less presence of heavy metals in the LDPE mosquito mesh, in comparison with a standard polypropylene mesh.
A very low number of early post-op complications, such as haematoma and wound infection, were recorded (less than 1%) in a group of patients operated during voluntary missions. 1-2 local young surgeons were trained in basic hernia procedures.

Conclusions
Hernia International provides a high-quality surgical care to the patients from the developing countries. Using a mosquito mesh is a safe and effective method with a comparable low complication rate but with minimal costs.
P074 PARASTOMAL AND INCISIONAL HERNIAS FOLLOWING EMERGENCY SURGERY FOR HINCHEY III-IV DIVERTICULITIS: A SYSTEMATIC REVIEW
Authors: Mäkäräinen Elisa , Rautio Tero , Muysoms Filip , Kauppila Joonas 
Published: December 2021

Abstract

Aim
The aim of this systematic review was to report the risk of parastomal and incisional hernias after emergency surgery for Hinchey III–IV diverticulitis.

Material and Methods
The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. All randomized controlled trials (RCTs) and cohort studies comparing HP with other surgical treatment options for perforated diverticulitis classified as purulent or faecal (Hinchey III–IV) were considered for inclusion. Exclusion criteria were case series and reports, letters, editorials, reviews and conference abstracts. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence. Seven studies (six randomized controlled trials and one retrospective cohort) with a total of 831 patients were eligible for inclusion.

Results
The parastomal hernia incidence was 15.2–46.0% for Hartmann procedure, 0–85.2% for primary anastomosis, 4.3% for resection and 1.6 % for laparoscopic lavage. The incisional hernia incidences were 7.8–38.1% for Hartmann procedure, 4.5–27.2% for primary anastomosis, 3.2–25.5% for primary resection, 2.7–11.1% for laparoscopic lavage and 16.1–45.8% for secondary resection. Due to heterogeneity of follow-up methods, follow-up time and lack of both parastomal and incisional hernia as outcome, no meta-analysis was conducted.

Conclusions
The hernia incidences reported after surgical treatment for complicated diverticulitis may be biased and underestimated. For future RCTs, researchers are encouraged to pay attention to hernia diagnosis, symptoms and prevention.
P078 SURGICAL PLANNING WITH 3D TECHNOLOGY UN PATIENT WITH MORGAGNI HERNIA AND INGUINAL HERNIA
Authors: Sanchon Lorena , Gobbo Rafael Diaz del , Sanchez Raquel , Osorio Alexander , Guariglia Claudio , Pardo Sara , Collera Pablo 
Published: December 2021

Abstract

Aim
The use of 3D technology is increasingly used for surgical planning in cases of complex surgery. In the case of the abdominal wall, its use is not very widespread. In this video we present the case of a patient with inguinal hernia and Morgagni hernia in which 3D planning provided us with multiple benefits

Material and Methods
71-year-old patient awaiting intervention for right inguinal hernia, presenting progressive dyspnea, abdominal pain and vomiting. A thoraco-abdominal CT scan was performed, which reported a Morgagni hernia containing the transverse colon and omentum.
Due to 3D planning, we were able to obtain the abdominal and hernial sac volumes, evaluate the hernial orifice and its relationship with the adjacent structures.

Results
Laparoscopic repair of the Morgagni hernia was performed by reducing the hernial content, placement of visceral contact mesh fixed with resorbable tackers. In the same surgical act, an inguinal hernioplasty was performed via TAPP.
The postoperative period was correct, without complications, and the patient was discharged after 3 days. Two years after the intervention, the patient remains asymptomatic.

Conclusions
The use of 3D technology for surgical planning facilitates the repair of complex hernias, helping us to assess the surgical indication, hernial volumes and hernial content. Good surgical planning facilitates the performance of the intervention through minimally invasive surgery, in this case two hernias were repaired in the same surgical procedure and with the same incisions, which facilitated the recovery of the patient.
P102 FEMORAL NERVE PALSY POST OPEN INGUINAL HERNIA REPAIR - CASE REPORT AND LITERATURE REVIEW
Authors: Salama Mohamed , Salama Mahmoud , shabaz c. , Yadav Himanshu 
Published: December 2021

Abstract

Aim and Introduction
“Inguinal hernia repair is one of the most common surgical procedures performed worldwide. Postoperative pain control is very important and recently nerve block has gained popularity as an alternative to opioid use. Transient femoral nerve palsy (TNFP) is a potential complication of ilioinguinal nerve block, but it is extremely rare with only a few cases reported. We discuss a case of TNFP post-left inguinal hernia repair to highlight this rare complication.”

Material and Methods
“Case Report: A 17-year-old male with clinically and radiologically confirmed left inguinal hernia underwent open mesh repair (Lichtenstein repair). At the end of the procedure, he had ilioinguinal and iliohypogastric nerve block (10ml, 0.5% bupivacaine). In the recovery room, he developed numbness of his anteromedial aspect of his left thigh with weakness of hip flexion and paralysis of quadriceps with an inability to extend his knee. He was reviewed by the anaesthetic team and was admitted overnight. His symptoms resolved spontaneously within 18 hours. He was subsequently discharged and followed up in the surgical OPD 2 weeks, 6 weeks and 6 months later and there were no residual neurological symptoms.”

Results and Conclusion
“TNFP post open hernia repair is very rare. Mechanisms of femoral nerve injury include suturing, stapling, scar tissue entrapment or direct compression. Careful attention is needed to the technique of local anaesthesia post-operatively (avoid deep infiltration, lowest volume and concentration used, ultrasound use) to avoid potential morbidity if this complication is not recognised.”
P121 ONLAY MESH FOR TREATMENT OF SMALL UMBILICAL HERNIAS IN ADULTS - A SINGE CENTER INVESTIGATION
Authors: Stjärne Ludvig , Melkemichel Maria , Bringman Sven , Widhe Björn 
Published: December 2021

Abstract

Aim
Previous studies on the repair of small umbilical hernias have suggested a lower recurrence rate with mesh compared to suture repair. A remaining important question is in what anatomical position the mesh should be placed. The purpose of this study was to investigate the outcome of using a standardized 4x4 cm onlay-mesh for umbilical hernias ≤2cm.

Material and Methods
A retrospective study was conducted at a single institution in Sweden on all umbilical hernia repairs during 2015-2019. The follow up time was at least four months. Patients were identified using the hospital medical record database. Repairs performed with suture, sublay, ventral patch or laparoscopic mesh positioning were excluded. Patient’s demographics, comorbidities, intra – and postoperative details were considered. Primary outcome was surgical site complications within 30 days. Secondary outcome was recurrence.

Results
80 patients were repaired with a small onlay-mesh for an umbilical hernia ≤ 2 cm and were included for statistical analysis. Median (range) follow-up time was 29.0 (4.3-50.1) months. Median age was 46 (26-76) years old. Median body mass index was 28 (19-38) kg/m2. Men to female ratio was 2.1. 4 patients were identified with a surgical site postoperative complication; 3 with seroma and 1 with superficial wound infection. 3 of these were given antibiotics. 2 patients were treated with wound opening bedside. There were no registered cases of a recurrence.

Conclusions
Repairing small umbilical hernias with a small onlay-mesh was safe with a low surgical site complication rate. Randomized trials are needed to assess weather mesh reduce recurrences in umbilical hernia repairs ≤2cm.
P128 BOTULINUM TOXIN A IN CONJUNCTION WITH NEGATIVE PRESSURE WOUND THERAPY AND MESH-MEDIATED FASCIAL TRACTION PROVIDES HIGH RATE OF FASCIAL CLOSURE IN PATIENTS WITH OPEN ABDOMEN
Authors: Schmidt Irene , Andersen Hans Friis , Zinther Nellie 
Published: December 2021

Abstract

Aim
Presentation of our data on Vacuum-Assisted Wound Closure and Permanent Onlay Mesh-Mediated Fascial Traction (VAWCPOM) in combination with Botulinum Toxin A (BTX-A) injection in the lateral abdominal wall as a treatment of the open abdomen (OA).

Material and Methods
This is a retrospective case series including patients treated for OA from January 2017 till March 2021 with VAWCPOM and BTX-A. Patient records were collected from medical charts, incl. age, sex, body mass index (BMI), comorbidity, initial fascial defect size, time until fascial closure, complications and, when available, outpatient follow-up.

Results
A total of 33 patients with OA were included. The mean age was 62,5 years, male/female ratio was 15:18, with a mean BMI of 35,4 kg/m2. The mean width of the fascial defect was 13,5 cm (5 - 25cm). The rate of fascial closure was 96,9%, achieved within a mean of 22,7 days. Fascial closure was not attainable in one patient who developed enterocutaneous fistula under treatment. 22 patients experienced in-hospital complications. Short-term follow-up was conducted in 22 patients, with hernia recurrences in three.

Conclusions
Treatment of OA remains a surgical challenge. This case series shows promising results with a high rate of fascial closure using a combination of VAWCPOM and BTX-A and an acceptable rate of postoperative complications in this severely challenging patient group. The rate of primary closure indicates that this may be the future management of open abdomen.
P132 TRANSABDOMINAL PREPERITONEAL REPAIR (TAPP) FOR DE NOVO TYPE INGUINAL HERNIAS
Authors: Hirukawa Hiroshi 
Published: December 2021

Abstract

Aim
In Japan, the de novo type inguinal hernia is defined as a hernia that develops without being related to the vaginal process of peritoneum. The pathological condition of a de novo type hernia is considered similar to that of a sliding hernia. the aim of this study is to discuss about the operative procedure for de novo type inguinal hernia, with a particular focus on lipomas.

Material and Methods
We examined surgical procedures, rate of combined lipoma, postoperative complications, and recurrence rates of de novo cases among TAPP cases performed in our department from 2018 to 2020.

Results
We performed 230 TAPP repairs during the period, included 56 de novo type hernia. 19 cord lipomas were found in de novo type hernias but none in non de novo type hernias. The lipomas prolapsed from the lateral side of the internal inguinal ring in 6 cases, medial side in 9 cases, In 4 cases, lipoma or lipomatous tissue were embedded in the spermatic cord and they could not be extracted. There were no postoperative complications. The average postoperative hospital stay was 1.2 days. There were no chronic pain nor recurrence.

Conclusions
It is important to note that the de novo hernia is associated with a high incidence of lipoma. Since lipomas are often attached to the peritoneum, dissecting the peritoneum at the internal inguinal ring has the risk of missing the presence of lipomas, and in de novo hernias, the peritoneum must be pulled out.