bluuebunny/crossref_metadata_2025_split huggingface dataset:
P133 ROBOTIC ASSISTED REINFORCED BIOLOGIC AUGMENTED REPAIR (REBAR) IN INGUINAL HERNIA: TWO-YEAR OUTCOMES
Authors: Banaschak Cory , Szotek Paul , Sowers Briana 
Published: December 2021

Abstract

Aim
The objective of this study is to identify two-year recurrence and complication rates using robotic assisted reinforced biologic augmented repair (ReBAR) in inguinal hernia repair.

Material and Methods
A retrospective review identified all robotic inguinal hernia repairs utilizing a reinforced biologic mesh performed by a single surgeon from May 2018 through May 2019. All repairs employed the robotic transabdominal preperitoneal (rTAPP) approach combined with the ReBAR technique. Patients with prior repairs and bilateral hernias were included. All patients were followed post-operatively using secure messaging to assess outcomes, including hernia recurrence and other complications.

Results
A total of 57 patients undergoing the rTAPP ReBAR were identified. Of these patients, there were 18 bilateral hernias repaired for a total of 75 inguinal hernia repairs. In addition, 5 of the hernias had previously been repaired. Two-year outcomes identified 1 recurrence (1.3%) at 345 days post-operatively and one complication of small bowel obstruction requiring takeback unrelated to the ReBAR. There were no complications of chronic groin pain or seromas in this cohort.

Conclusions
In conclusion, the two-year recurrence rate in this population of 75 inguinal hernias repaired using the robotic assisted ReBAR was 1.3%. With low recurrence and complication rates, the robotic assisted ReBAR technique appears to be a safe and durable option for inguinal hernia repairs.
P144 SPERMATIC CORD LIPOSARCOMA - A VERY RARE FINDING DURING INGUINAL HERNIA SURGERY
Authors: Gröger Christian , Kundel Lena , Riediger Hardwig 
Published: December 2021

Abstract

Aim
Repair of inguinal hernia is one of the most common operations in general surgery in industrialized countries. Isolated spermatic cord liposarcoma is a very rare soft tissue tumor. Despite standardized diagnostic algorithms for inguinal hernia, it could be difficult to predict such a rare finding.

Material and Methods
We report a case of inadvertent inguinal liposarcoma excision during hernia surgery in a 72-year-old male patient. Except for polyposis coli there were no further illnesses.

Results
After a minimal invasive transabdominal preperitoneal (TAPP) repair of a symptomatic inguinal hernia last year a persistent scrotal swelling developed. Computed tomography (CT) showed a protrusion of fatty tissue into the scrotal sac. Diagnosis of scrotal hernia was made. We performed an open Lichtenstein procedure. The final pathologic examination revealed a highly differentiated liposarcoma. Staging was completed and the case was presented to a multidisciplinary sarcoma tumor board at our institution. As recommended, a inguinal reoperation was performed with wide excision.

Conclusions
Although a very rare condition, spermatic cord liposarcoma should be considered as a possible differential diagnosis for inguinal hernia surgery.
P162 POLY-4-HYDROXYBUTYRATE MESH (PHASIX MESH) FOR VENTRAL HERNIA REPAIRS: A SINGLE SURGEON RETROSPECTIVE SERIES
Authors: Klifto Kevin , Othman Sammy , Weiss Eric , Kovach Stephen 
Published: December 2021

Abstract

Aim
To compare a single-surgeon experience using poly-4-hydroxybutyrate mesh (Phasix™ Mesh) for ventral hernia repairs (VHR).

Material and Methods
A retrospective series was performed from 2014-2020. Inclusion criteria were patients ≥18 years of age with open VHR using poly-4-hydroxybutyrate mesh, with a minimum follow-up of 12-months. Comparisons were performed between no prior VHR versus prior VHR; no mesh infections versus mesh infections; onlay versus retrorectus; no recurrences versus recurrences; no readmissions versus readmissions; no reoperations versus reoperations.

Results
Poly-4-hydroxybutyrate mesh was used for VHR in 179 patients. Compared to 90 patients with no prior VHR, 89 patients with prior VHR had higher BMIs (31.1kg/m2versus33.3 kg/m2; p = 0.042). Compared to 146 patients with no mesh infections, 33 patients with mesh infections had more prior VHR (97%versus39%; p &lt; 0.001). Compared to 101 patients with onlay approaches, 79 patients with retrorectus approaches had more component separations (89%versus31%; p &lt; 0.001). Compared to 168 patients with no recurrences, 11 patients with recurrences had more complications (55%versus23%; p = 0.031), reoperations (82%versus16%; p &lt; 0.001), and readmissions (91%versus20%; p &lt; 0.001). Compared to 136 patients with no readmissions, 43 patients with readmissions had more hypertension (81%versus56%; p = 0.004), COPD (28%versus10%; p = 0.011), complications (79%versus8%; p &lt; 0.001), and recurrences (23%versus0.7%; p &lt; 0.001). Compared to 142 patients with no reoperations, 37 patients with reoperations had more hypertension (89%versus55%; p &lt; 0.008), diabetes (43%versus25%; p = 0.042), COPD (30%versus11%; p = 0.007), hyperlipidemia (57%versus32%; p = 0.008), larger defect sizes (300cm2versus200cm2; p = 0.032), complications (78%versus11%; p &lt; 0.001), readmissions (92%versus6%; p &lt; 0.001), and recurrences (24%versus1%; p &lt; 0.001).

Conclusions
VHR with poly-4-hydroxybutyrate mesh can include prior VHR, different anatomical locations, mesh infections, recurrences, readmissions and reoperations.
VP010 INTRA-ABDOMINAL HERNIA AS A CAUSE OF ACUTE SMALL INTESTINE OBSTRUCTION. LAPAROSCOPIC EMERGENCY TREATMENT - SMALL INTESTINE OBSTRUCTION DUE TO INTERNAL HERNIA WITH CONCOMITANT ACALCULOUS CHOLECYSTITIS
Authors: Świątkiewicz Janusz , Kabala Przemysław , Tomaszewski Dariusz , Jasiński Szymon 
Published: December 2021

Abstract

Aim
Nowadays, in vast majority of emergency patients with gastrointestinal obstruction laparoscopy is not the treatment of choice. In our department laparoscopy is routinely used in emergency admitted patients, also those with abovementioned condition, sometimes yielding unexpected and thrilling results. The aim of this work is to present a laparoscopic internal hernia repair with simultaneous “Phrygian-cap-type” gallbladder excision, performed on a patient with small intestine obstruction and chronic acalculous cholecystitis.

Material and Methods
A 57-year-old patient was admitted to our department as an emergency, with a one week history of symptomatic cholecystitis accompanied by gastrointestinal obstruction. CT revealed atypical suprahepatic displacement of the small intestine. An attempt of conservative treatment failed after the re-initiation of oral nutrition. The patient was qualified for laparoscopy.

Results
An anatomical variant of the liver ligaments was visualized with two defects in the anteriorly displaced coronary ligament and shortening of the falciform ligament. Those defects formed the hernia ring entrapping a small intestine of a total length of about 1.5 m. The falciform ligament was dissected. To avoid re-entrapment of the intestine, most of the coronary ligament was severed. Consecutively the inflamed gallbladder was removed. The unusual anatomical variation of its structure, the so-called “Phrygian cap”, was an additional difficulty.
The postoperative course was uneventful.

Conclusions
The presented material demonstrates the possibility of immediate treatment of intestinal obstruction, even in a complicated cases, with laparoscopic manner, without the need of conversion to the open method.
O13 BIOLOGIC VERSUS SYNTHETIC MESH IN VENTRAL HERNIA REPAIR: PARTICIPANT-LEVEL ANALYSIS OF TWO RANDOMIZED CONTROLLED TRIALS AT ONE YEAR
Authors: Dhanani Naila , Olavarria Oscar , Lee Kyung Hyun , Young Charlotte , Primus Frank , Mukhtar Rita , Holihan Julie , Liang Mike , Harris Hobart 
Published: December 2021

Abstract

Aim
Biologic mesh has been increasingly utilized in complex ventral hernia repair despite limited evidence at low risk of bias supporting its growth. We hypothesized biologic mesh when compared to synthetic mesh would have fewer major complications at one year.

Material and Methods
We performed a participant-level meta-analysis of published randomized controlled trials (RCTs) comparing biologic to synthetic mesh at one year. Primary outcome was major complication (composite of mesh infection, recurrence, reoperation, or death) at one year post-operative. Secondary outcomes included length of index hospital stay, surgical site occurrence, and surgical site infection. Outcomes were assessed using frequentist generalized linear models.

Results
A total of 252 patients from two RCTs were included, 126 patients randomized to the intervention arm of biologic mesh and 126 patients randomized to the control of synthetic mesh. Median follow-up was 15 (12, 27) months. Major complication occurred in 41 (33%) patients randomized to biologic mesh, and 44 (35%) patients randomized to synthetic mesh, (relative risk [RR] 0.91, 95% confidence interval [CI] 0.54-1.55, p-value 0.740). There were 36 total recurrences, 23 (18%) in the biologic arm, and 13 (10%) in the synthetic arm (RR 1.83, 95% CI 0.84-3.99, p-value 0.130). The remainder of outcomes demonstrated no statistically significant differences.

Conclusions
The risk of major complication did not differ between biologic versus synthetic mesh. In patients undergoing ventral hernia repair, there was no clinical benefit with biologic mesh as opposed to synthetic mesh at one year post-operative.
O21 EVALUATION OF THE TREATMENT OF PARASTOMAL HERNIA IN THE NETHERLANDS: A NATIONAL SURVEY
Authors: van Egmond Sarah , Poelman Marijn , Wegdam Johannes , Bloemendaal Bob 
Published: December 2021

Abstract

Aim
The incidence of a parastomal hernia (PSH) is approximately 40% two years after stoma construction and can even increase to 50% after a longer period. The European Hernia Society (EHS) published a guideline showing that the evidence for treatment of a PSH is of low quality. Due to the lack of evidence, a survey was conducted to provide insight into the Dutch approach.

Material and Methods
A survey was sent to 104 surgeons in the Netherlands representing their surgical department. The survey was developed by three hernia surgeons and a physiotherapist specialized in abdominal wall pathology.

Results
The survey was completed by 103 surgeons (99%) from 75 hospitals. 75% of the respondents perform a laparoscopic Sugarbaker for the treatment of PSH after colostomy, ileostomy or Bricker deviation. Most respondents (75%) replied that they never use a prophylactic mesh to prevent for the occurrence of PSH, although more than half of them do wish to introduce this.

Conclusions
Authors believe that the implementation of minimally invasive surgery and the systematic review performed by Hansson et al. in 2012, shifted the treatment strategy for PSH towards the use of a laparoscopic Sugarbaker. Nevertheless, little is known about the results of this treatment. Although there is a high level of evidence for the use of prophylactic mesh placement in reducing the incidence of PSH development, this has not been implemented in daily practice for colorectal and/or hernia surgeons. Authors aim for registration of PSH repair to evaluate the outcomes in terms of recurrence, pain and quality of life.
O32 TREATMENT OF FASCIAL DEHISCENCE IS IMPROVED BY MESH REINFORCEMENT
Authors: Pettersson Patrik Kjärsgård , Petersson Ulf 
Published: December 2021

Abstract

Aim
In 2014 fascial dehiscence (FD) was treated with re-suturing the fascia as the only measure in half of the cases at our institution, with discouraging re-rupture and incisional hernia (IH) rates. A changing path away from fascia closure (FC) by re-suturing solely towards reinforcement of the closed fascia is now evaluated.

Material and Methods
Retrospective chart review of consecutive patients operated for FD 2016-2020. Available CT scans were scrutinized for IH.

Results
58 patients (14 women) with a mean age of 71 years and a mean BMI of 27.3 were treated with: FC by re-suturing as the only measure (n = 1, 1.7%); FC preceded by a reinforced tension line (RTL) suture (n = 9, 15.5%); FC and on-lay mesh reinforcement (n = 23, 39.7%); retromuscular mesh closure (n = 10, 17.2%); open abdomen treatment with retromuscular mesh reconstruction (n = 1, 1.7%); and, open abdomen treatment with vacuum assisted wound closure and permanent on-lay mesh-mediated fascial traction (VAWCPOM) (n = 14, 24.1%). One patient in the RTL-group suffered a re-rupture (1.7%). The in-hospital mortality was 5%. Wound healing problems were seen in 29 (51.9%) patients. IH was evaluable in 49 patients with a total incidence of 22.4% at mean follow-up of 21 months. The hernia incidence for mesh reinforced or reconstructed patients was 17.5% compared to 44.4% in re-sutured or RTL patients.

Conclusions
FD treatment with mesh reinforced FC prevented re-rupture and resulted in a lower rate of IH. Additional standardization and refining the mesh techniques may further improve results.
OV14 POSTERIOR COMPONENT SEPARATION FOR A GIANT LUMBAR HERNIA IN A KIDNEY TRANSPLANT PATIENT
Authors: Maspero Marianna , Bertoglio Camillo Leonardo , Morini Lorenzo , Alampi Bruno , Ferrari Giovanni 
Published: December 2021

Abstract

Aim
Posterior component separation with transversus abdominis release (PCS-TAR) represents a good option for challenging complex ventral hernia repairs. We present a case of PCS-TAR for a giant lumbar hernia in a patient with a transplanted kidney.

Material and Methods
The patient is a 46 years old man with a Charlson Comorbidity Index of 2 and a BMI of 27.5 kg/m2 who underwent a kidney transplant in 2005 and a subsequent open repair with mesh implantation for an incisional hernia in 2007. Two years later, he experienced a hernia recurrence, but chose conservative management. In 2019, the patient complained of progressively worsening pain and bulky sensation. Due to the size and location of the defect and the massive relaxation of the muscle fibers, open repair with PCS-TAR was indicated.

Results
In 2019, the patient underwent right-sided PCS-TAR with retromuscular placement of one polyvinylidene fluoride (PVDF) mesh and one biosynthetic mesh. Duration of the procedure was 295 minutes. Two drains were placed, respectively in the subfascial and in the subcutaneous plane. Postoperative course required non-invasive ventilation for respiratory distress, but was otherwise uneventful and he was discharged on postoperative day 8. After 12 months, the patient showed no signs of recurrence.

Conclusions
PCS-TAR is a versatile technique for the repair of complex ventral hernias, with an acceptable rate of postoperative complications and good long-term outcomes.
Severity grading of unexpected events in paediatric surgery: evaluation of five classification systems and the Comprehensive Complication Index (CCI®)
Authors: Madadi-Sanjani Omid , Zoeller Christoph , Kuebler Joachim F , Hofmann Alejandro D , Dingemann Jens , Wiesner Soeren , Brendel Julia , Ure Benno M 
Published: December 2021

Abstract

Background
Postoperative adverse events may be associated with substantial morbidity and mortality. Numerous severity grading systems for these events have been introduced and validated but have not yet been systematically applied in paediatric surgery. This study aimed to analyse the advantages and disadvantages of these classifications in a paediatric cohort.

Methods
Unexpected events associated with interventional or organizational problems in the department of paediatric surgery during 2017–2020 were prospectively documented daily for all children. Events were classified according to the Clavien–Dindo grading system during monthly morbidity and mortality conferences. All events were also classified according to five additional grading systems: T92, contracted Accordion, expanded Accordion, Memorial Sloan Kettering Cancer Center, and Comprehensive Complication Index (CCI)®.

Results
Of 6296 patients, 673 (10.7 per cent) developed adverse events and 240 (35.7 per cent) had multiple events. Overall, 1253 adverse events were identified; of these, 574 (45.2 per cent) were associated with surgical or medical interventions and 679 (54.8 per cent) included organizational problems. The grading systems demonstrated high overall correlation (rpears = 0.9), with minor differences in sentinel events. The Clavien–Dindo classification offered the most detailed assessment. However, these details had only limited additional value. The CCI® scores were correlated with other grading systems (rpears = 0.9) and were useful in analysing multiple events within individual patients.

Conclusion
Grading systems demonstrated similar scoring patterns for minor and sentinel events, with none being superior for unexpected events in children. However, the CCI® can be a major improvement in assessing morbidity in patients with multiple events. Its use is therefore recommended in prospective studies on paediatric surgery.
Nanomaterials for the delivery of bioactive factors to enhance angiogenesis of dermal substitutes during wound healing
Authors: Weng Tingting , Wang Jialiang , Yang Min , Zhang Wei , Wu Pan , You Chuangang , Han Chunmao , Wang Xingang 
Published: November 2021

Abstract
Dermal substitutes provide a template for dermal regeneration and reconstruction. They constitutes an ideal clinical treatment for deep skin defects. However, rapid vascularization remains as a major hurdle to the development and application of dermal substitutes. Several bioactive factors play an important regulatory role in the process of angiogenesis and an understanding of the mechanism of achieving their effective delivery and sustained function is vital. Nanomaterials have great potential for tissue engineering. Effective delivery of bioactive factors (including growth factors, peptides and nucleic acids) by nanomaterials is of increasing research interest. This paper discusses the process of dermal substitute angiogenesis and the roles of related bioactive factors in this process. The application of nanomaterials for the delivery of bioactive factors to enhance angiogenesis and accelerate wound healing is also reviewed. We focus on new systems and approaches for delivering bioactive factors for enhancing angiogenesis in dermal substitutes.
A case report of pulmonary vein isolation performed in a patient with polysplenia and interrupted inferior vena cava
Authors: Kupics Kaspars , Jubele Kristine , Nesterovics Georgijs , Erglis Andrejs 
Published: December 2021

Abstract

Background
Pulmonary vein isolation (PVI) has entrenched itself as one of the main approaches for the treatment of paroxysmal symptomatic atrial fibrillation (AF). Pulmonary vein isolation prevents focal triggers from pulmonary veins from initiating AF paroxysms. As standard—PVI is performed through the inferior vena cava (IVC) approach, through the femoral vein. However, there are conditions when this approach is not appropriate or is not available.

Case summary
We report a case of a 53-year-old male who was referred to Pauls Stradins Clinical University Hospital for PVI due to worsening AF. Due to the rare anatomical variant of the venous system, the standard approach to PVI could not be applied. Interrupted cava inferior did not allow for femoral vein and IVC access. We had to figure out a different path—a combination of internal jugular and subclavian veins was used. Transseptal puncture was performed under transoesophageal echocardiography (TOE) control with a puncture needle stiletto. Pulmonary veins were isolated successfully, no complications were observed, and the patient was discharged in sinus rhythm.

Discussion
In some patients, PVI cannot be done through the standard IVC approach. In such cases, a different venous access must be chosen. Our patient had a rare variant of interrupted IVC and we had to use superior vena cava approach for the procedure. The difficulty of this approach is that procedure instruments are not designed for non-standard venous access; however, a combined use of TOE, general anaesthesia, and contact force-guided ablation has succeeded in isolating patients’ pulmonary veins.
Old stuff still trending: use of propafenone as a safety net until catheter ablation in a patient with documented pre-excited atrial fibrillation and Wolff–Parkinson–White syndrome – a classic case report
Authors: Karelas Dimitrios , Papanikolaou John , Kossyvakis Charalampos , Platogiannis Dimitrios 
Published: December 2021

Abstract

Background
Atrial fibrillation in Wolff–Parkinson–White syndrome may result in life-threateningly rapid antegrade conduction over a bypass tract, manifested by an irregular broad-complex (pre-excited) tachycardia that can degenerate to ventricular fibrillation. The shortest pre-excited RR interval below 250 ms during atrial fibrillation (AF) predicts increased risk of sudden cardiac death.

Case summary
We report a case of a 43-year-old man with unremarkable cardiac history who presented due to sudden-onset feeling of palpitations and pre-syncope after strenuous lifting. Electrocardiography depicted fast pre-excited AF. The shortest pre-excited RR interval was estimated at 160 ms, indicating an accessory pathway (AP) with short antegrade refractory period at risk for mediating sudden cardiac death. Direct current cardioversion restored sinus rhythm unravelling delta waves. The patient was put on propafenone 450 mg/day having an uneventful clinical course. On Day 10 post-admission, electrophysiological study induced rapid AF but the shortest pre-excited RR interval was substantially increased to 264 ms. A left anterolateral AP was ablated. The patient remained symptom free until his latest follow-up in the 3rd-month post-ablation without manifest pre-excitation on the surface electrocardiogram.

Discussion
Treatment options of pre-excited AF include anti-arrhythmic agents but mainly electrical cardioversion. Cardioversion can safely restore sinus rhythm, while use of anti-arrhythmics often requires intensive care unit monitoring due to the risk of QT prolongation. Catheter ablation is the mainstay of therapy for symptomatic patients. Our rare report highlights the direct impact of propafenone on prolonging the refractoriness of the AP, effectively and safely, and reappraises propafenone’s worthiness as a protective measure following pre-excited AF episode until ablation.