bluuebunny/crossref_metadata_2025_split huggingface dataset:
P027 CHRONIC MESH INFECTION AFTER TRANSVERSUS ABDOMINIS RELEASE FOR A MULTIRECURRENT COMPLEX VENTRAL HERNIA IN HIGH RISK PATIENT: CRITICAL ISSUES OF A LONG LASTING MANAGEMENT
Authors: Bertoglio Camillo Leonardo , Alampi Bruno , Morini Lorenzo , Maspero Marianna , Grimaldi Simona , Magistro Carmelo , Quagli Oscar , Mastroianni Sara , Ferrari Giovanni 
Published: December 2021

Abstract

Aim
to point out the critical issues of the management of a challenging case of complex ventral hernia (CVH) in high risk patient

Material and methods
A 58-year-old female was referred to our Institution with a history of alcohol and smoking abuse, COPD and class I obesity. Four years before she underwent liver transplantation. In the next two years she had 2 VH repairs with polypropilene (PP) meshes. The postoperative course was complicated by a deep surgical site infection (SSI) and dehiscence. The wound resulted in a large R2 M3-L2 CWH with distorted anatomy. The patient experienced VH incarcerations and bowel obstructions. Clinical examination revealed no signs of infection and the CT scan showed partial loss of substance of the abdominal wall.

Results
The patient underwent posterior component separation with transversus abdominis release (PCS-TAR) and large PVDF mesh on top of a biosynthetic mesh implantation. The postoperative course was complicated after 14 days by a SSI causing a large wound dehiscence with underlying mesh exposure. The patient was readmitted and negative pressure wound therapy (NPWT) with topical wound solution instillation was initiated. After 1 month was followed up as an out-patient to continue traditional NPWT and removal of former PP remnants. NPWT was interrupted after 6 months and no signs of infection nor VH recurrence were recorded at 1 year.

Conclusions
the indication to PCS-TAR for such comorbid patient should be carefully evaluated. The use of a biosyntetic mesh could be debatable. The conservative management of a chronic infection could be the first-line option in case of macroporous mesh implantations.
P030 OPEN VERSUS LAPAROSCOPIC UMBILICAL AND EPIGASTRIC HERNIA REPAIR: NATIONWIDE DATA ON SHORT- AND LONG-TERM OUTCOMES
Authors: Henriksen Nadia , Jorgensen Lars Nannestad , Andersen Hans Friis , Helgstrand Frederik 
Published: December 2021

Abstract

Aim
The aim of the study was to evaluate the rates of 90-day readmission and reoperation for complication, together with rate of operation for recurrence after either open or laparoscopic mesh repair for primary umbilical or epigastric hernias with defect widths above 1 cm.

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

Results
A total of 6,855 patients were included, of whom 4,106 (59.9%) and 2,749 (40.1%) patients had an open or laparoscopic repair, respectively. There were significantly more patients readmitted with a superficial surgical site infection 2.5% (102/4,106) after open repair compared with laparoscopic repair (0.5% (15/2,749), P &lt; 0.001. The 90-day reoperation rate for complications was significantly higher for open repairs 5.0% (205/4,106) compared with laparoscopic repairs 2.7% (75/2,749), P &lt; 0.001. The incidence of a reoperation for a severe condition was significantly increased after laparoscopic repair 1.5% (41/2,749) compared with open repair 0.8% (34/4,106), P = 0.010. The 4-year cumulative incidence of operation for recurrence was 3.5% after open and 4.2% after laparoscopic repairs, P = 0.302.

Conclusions
Recurrence rates were comparable between open and laparoscopic repair of umbilical and epigastric hernias. Open repair was associated with a significantly higher rate of readmission and reoperation due to surgical site infection, whereas the rate of reoperation due to a severe complication was significantly higher after laparoscopic repair.
P032 SURGICAL SITE INFECTIONS FOLLOWING EMERGENCY HERNIA REPAIR: A SUB-STUDY FROM THE MASH PROJECT
Authors: Proctor Victoria , Spence Olivia , Burns Flora , Green Susanna , Sayers Adele , Smart Neil , Lee Matthew 
Published: December 2021

Abstract

Aim
Acutely symptomatic hernia (ASH) of the abdominal wall and groin are common presentations. Decisions related to repair technique can be driven by contamination and surgical site infection (SSI) risk. The aim of this study is to report rates of SSI following ASH repair, and assess the performance of the Bluebelle wound health questionnaire in this population.

Material and Methods
This study reports on the operated sub-group of the MASH study. This was a 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Hernia site, repair type, wound complications, and Bluebelle questionnaire at 30 & 90 days were captured. Performance of this score was assessed using ROC curves, and regression modelling.

Results
223 patients were operated on, and 21 (9.4%) developed SSI within 90 days. Infections were most common in umbilical hernia (16.2%). No infections were seen in ‘simple’ symptomatic hernia. There was no association with either repair type. Bluebelle scores for 109 patients had an area under the curve of 0.807, showing good performance in this population. Regression modelling showed that SSI was most strongly associated with increased Bluebelle score (OR 8.54 (4.27 to 12.80, p &lt; 0.001)). Use of a sutured repair was associated with a lower score (OR -3.79 (-7.19 to -0.39, p = 0.029)).

Conclusions
SSI is common after surgical treatment of ASH. Strategies to reduce this are needed. The Bluebelle score appears valid for this population; mesh repair might affect scores independent of SSI.
P036 IMPACT OF THE COVID-19 PANDEMIC ON HERNIA SURGERY IN A SWEDISH HEALTH-CARE REGION WITHOUT LOCKDOWN: A RETROSPECTIVE COHORT STUDY
Authors: Kollatos Christos , Alhussain Ali , Hanna Sarmad 
Published: December 2021

Abstract

Aim
During the COVID-19 pandemic, Swedish health care centers were restructured. This was accompanied by changes in the surgical programme. The aim of this study was to determine the effects of COVID-19 on emergency and elective hernia surgeries in a Swedish health-care region.

Material and Methods
This was a retrospective, observational cohort study. Data from inguinal and ventral hernia surgeries were retrieved from a medical database using procedure codes from all three hospitals in Region Jönköping County from March 1, 2019 to January 31, 2021. The participants were divided into two groups: COVID-19 group (March 1, 2020 - January 31, 2021) and reference group (March 1, 2019 - January 31, 2020). The incidence rate (IR) and relative risk (RR) of operations over different time frames were analyzed.

Results
A total 1351 participants met the inclusion criteria. 590 were operated during the COVID-19 period and 761 during the reference period. The IR of elective operations was decreased during the COVID-19 pandemic; 146 operations/100.000 population vs 192 operations/100.000 population during the reference period. RR was 0,76 (95% CI 0.6813-0.8545, p &lt; 0.0001). Moreover, IR of emergency operations decreased insignificantly during the COVID-19 pandemic; 17,5 operations/100.000 population vs 19,4 operations/100.000 population during the reference period. RR was 0,9 (95% CI 0.6404- 1.2649, p 0.5441). No significant variations in the emergency operations have identified when different time frames were compared.

Conclusions
There is no evidence to support that COVID-19 pandemic has increased emergency hernia operations during the studied period despite the significant reduction of elective operations.
P061 ANALYSIS OF THE IMPACT DERIVED FROM MORBIDITY IN THE INCISIONAL HERNIA SURGERY
Authors: Olona Carles , Mancilla Alba Varona , Bargalló Jordi Vadillo , Bernal Marc Vallvé , Serafini Joan Ferreres , Marqués Raquel Casanova , Jorba Rosa 
Published: December 2021

Abstract

Aim
To analyse the repercussion derived from the morbidity that appeared after the repair of incisional hernias.

Material and Methods
Descriptive, retrospective and longitudinal study based on a prospective database of all incisional hernia operated patients of a university-level hospital in the period between 2013 and 2019. Anthropometric parameters, classification of the hernia according to the European Hernia Society guides and characteristics of the intervention performed were registered. Complications observed until the end of the follow-up and the final evolution are analysed.

Results
The sample is composed by 244 patients with a mean follow-up of 11 months. In 50% of the surgeries anterior separation of components was performed. In 240 patients, the mesh was placed in the following positions: 68.5% onlay, 13.5% retromuscular, 13% preperitoneal, 3.6% intraperitoneal and 1.3% inlay. During the first postoperative month, 63 patients (25.8%) presented some type of complication: seroma (47.6%), surgical wound infection (20.6%) and dehiscence (17.5%). 31 complications (49.2%) were classified as Clavien-Dindo III or greater severity. In 60% of patients with seroma the mesh was placed onlay. Of the 30 patients with seroma, 9 recurred over a mean of 16 months of follow-up (30%).

Conclusions
In our sample, the main cause of postoperative seroma is onlay placement of the mesh, and this complication may cause recurrence. We consider that it’s important to register our results to obtain a correct analysis and to prevent morbidity in the future.
P062 IMPLEMENTATION OF ETEP (EXTENDED TOTALLY EXTRAPERITONEAL REPAIR) AS A NEW METHOD OF INCISIONAL HERNIA REPAIR
Authors: Nowakowski Krzysztof , Elkalash Ayman Waly , lahaye thomas 
Published: December 2021

Abstract

Aim
To assess the outcomes of implementation of extended Totally Extraperitoneal Repair (eTEP) for incisional hernia in our clinic.

Material and Methods
In our clinic abdominal wall hernias are predominantly repaired in eMILOS (endoscopic Mini or Less Open Sublay)-technique. However, we hoped for advantages in repairing incisional hernias in eTEP-technique.
From 19.09.2019 till 28.04.2021 there were 13 patients with incisional hernias included to be operated in eTEP-technique.

Results
Among 13 patients, mean age was 64,6 years (range 47 – 78 years), 7 females (54%) and 6 males (46%). Average diameter of the hernia was 6,46 cm (range 2 – 14 cm). The mean Body Mass Index of the patients was 29,41 kg/m² (range 18,4 – 48,76 kg/m²). The mean duration of the operation was 162,38 minutes (range 106 – 237 minutes). The mean surface of the mesh was 612 cm² (range 225 – 1200 cm²). Hospital stay lasted mean of 5,8 days (range 2 – 28 days). We observed one postoperative complication as a lung artery embolism occurred in one patient with preperitoneal heamatoma due to needed anticoagulation. Till today we have not observed any recurrence.

Conclusions
Our study shows that a new method of incisional hernia repair with mesh placement can be a safely implemented and may have advantages compering with other laparoscopic methods. It has low complication rate, shows good cosmetic results and is cost effective.
P068 ROBOTIC REPAIR OF VENTRAL AND INCISIONAL HERNIAS: A STUDY ON 118 PATIENTS OPERATED BY RV-TAPP AND R-RIVES
Authors: Dietz Ulrich 
Published: December 2021

Abstract

Aim
The purpose of this study is to compare the results of robotic ventral TAPP and robotic retrorectus repair for ventral and incisional hernias.

Material and Methods
The results of 118 consecutive rv-TAPP (88) and r-Rives (30) surgeries are presented. The study was approved by the ethics committee (Ref. No. 2019-02046). Primary ventral hernias were treated mainly by rv-TAPP approach, incisional hernias by r-Rives Technique. Patients were followed up six weeks postoperatively.

Results
In every third patient, an additional finding at the linea alba was found. Patients in the r-Rives group were significantly older (p = 0.001). Hernia gaps were significantly larger and meshes were significantly larger in the r-Rives group (p &lt; 0.001). The ratio of mesh area to hernia gap area was comparable in both groups (p = 0.142). OR time was significantly shorter for rv-TAPP (82min) than r-Rives (109min). Hospital stay was shorter in the rv-TAPP group than in the r-Rives group (1.5 vs. 2.7 days, respectively) (p &lt; 0.001). There was a significant clustering of type II seromas in the r-Rives group (p &lt; 0.001), however, the total number of seromas was comparable.

Conclusions
rv-TAPP and r-Rives have the advantages of minimally invasive procedures (low complication rate) and most of the advantages of open procedures (morphological reconstruction). Both techniques allow consistent extraperitonealization of meshes. Umbilical and epigastric hernias (&lt;4cm) are treated as rv-TAPP; incisional hernias, large hernia gaps (4-7cm), as well as in case of planned suturing of the linea alba, the r-Rives is indicated. Concomitant hernia gaps of the linea alba are also treated. Both procedures have few complications and are suitable for residents training.
P075 IS INTER-RECTI DISTANCE (IRD) A RELIABLE PROXY FOR EVALUATION OF FUNCTIONAL IMPAIRMENTS ASSOCIATED WITH DIASTASIS RECTI ABDOMINIS (DRA)?
Authors: Bixo Liv , Sandblom Gabriel , Stackelberg Otto , Olsson Anders 
Published: December 2021

Abstract

Aim
Diastasis recti abdominis (DRA) following pregnancy is associated with functional impairment such as back pain, abdominal core instability, urinary incontinence, and abdominal bulging. Several studies have reported functional improvements after surgical repair of the DRA. The aim of this study was to investigate the association between the inter-recti distance (IRD) and self-reported functional disabilities measured with the Disability Rating Index questionnaire (DRI), with the hypothesis that inter-recti distance could serve as a proxy for core instability symptoms.

Material and Methods
A retrospective study based on a consecutive cohort of patients with core instability symptoms combined with DRA. The IRD was measured with ultrasonography among women with symptomatic post-partum DRA and functional impairments were registered with the self-report DRI questionnaire that covers twelve unspecific daily activities. IRD results were analysed against the DRI score with uni- and multivariable regression analyses.

Results
A total of 222 women were included in this study. Univariable regression analyses showed a significant positive correlation between the heavier activities running, heavy work, lifting heavy objects and exercise/sports and IRD, which failed to reach significance in the multivariable regression analysis with adjustments for length, weight, and BMI.

Conclusions
This study could not show any significant correlation between self-reported functional impairments and DRA isolated in the multivariable analysis, even though there is a tendency towards an association between DRA and heavy activities. The post-partum core instability situation is complex and probably origins from more components than solely the inter-recti distance.
P086 A NOVEL CALIBRATION ALGORITHM FOR COMPARISON ACROSS PATIENT REPORTED OUTCOMES (PROS) IN VENTRAL HERNIA
Authors: Patel Viren , Hsu Jesse Y. , Broach Robyn , Christopher Adrienne , Morris Martin , Fischer John 
Published: December 2021

Abstract

Aim
While there are many patient-reported outcome measures (PROMs) used for ventral hernia (VH), disease-specific instruments, like the Hernia-related Quality-of-Life (QoL) Survey (HerQLes) and Abdominal Hernia-Q (AHQ), have greater accuracy in capturing broad VH-related QoL. We present a novel calibration that allows providers to convert scores between the AHQ and HerQLes, enabling unification of QoL data.

Material and Methods
VH patients were prospectively identified and simultaneously administered the AHQ and HerQLes pre-and post-operatively. To ensure validity of the calibration, responses were excluded if patients answered instruments on different dates or if responses were discordant on corresponding questions on each instrument. The calibration was estimated using a linear mixed-effects model, including linear and quadratic scores, timing of survey relative to surgery and their interactions as fixed effects, and patients as random effects to account for multiple surveys from the same patient.

Results
In total, 109 patients were included, responding to 300 pairs of surveys (112 pre-operative and 188 post-operative). Seventeen (5.6%) were statistically excluded due to discordant responses. Conversion of the HerQLes to AHQ was most accurate when including whether the survey was completed pre-or post-operatively, with a mean square error (MSE) of 0.0091. Similarly, converting the AHQ to HerQLes was most accurate when factoring in the timing of survey administration, with a MSE of 0.016.

Conclusions
We present a novel and accurate method to convert scores between the AHQ and HerQLes. Portability of PROMs will be crucial in efforts to more broadly integrate PROMs into routine care in VH.
P087 LONG TERM SURGICAL RESULTS AND QUALITY OF LIFE AFTER LAPAROSCOPIC INGUINAL HERNIA REPAIR (TAPP): A PROSPECTIVE, CASE CONTROL STUDY COMPARING STANDARD HEAVYWEIGHT AND SELFGRIPPING (PROGRIP) MESH
Authors: Giovannini Sara Capoccia , Frascio Marco , Rossi Lisa , Stabilini Cesare 
Published: December 2021

Abstract

Aim
Aim of this study is to compare long term results of efficacy, recurrence and quality of life in patients submitted to TAPP for inguinal hernia repair with standard Heavyweight or Selfgripping mesh.

Material and Methods
A prospective case control study was conducted at single third referral center. The study included adult patients submitted to TAPP, of both sex, with primary and recurrent, unilateral and bilateral inguinal hernia. Patients received non-fixated standard heavyweight meshes (HW) or PROGRIP self gripping mesh (PG), their data were entered in EuraHS platform and the EuraHS Quality of life (QOL) questionnaire was administered before and 1 year after surgery. Primary outcome of the study is to compare long term QOL before and after surgery in HW vs PG group. Secondary outcome is perioperative morbidity and 12 months recurrence assessed with PINQ questionnaire.

Results
Between 2016 and 2020, 100 patients of both sexes (10 female) were enrolled, 50 in HW group and 50 in PG group. The two groups were comparable preoperatively. After 12 months no cases of CPIP were observed and there wasn’t differences in QOL reported by patients, although in both groups there was an improvement of pain, movement limitations and esthetical discomfort after surgery. None recurrence and overall only 4 cases of complications (1 hematoma and 1 seroma for each group) were registered.

Conclusions
Selfgripping Mesh for laparoscopic hernia repair has produced results equal to standard of care meshes in term of recurrence rate, early morbidity and postoperative quality of life of patients.
P098 DO POSTOPERATIVE COMPLICATIONS CORRELATE TO CHRONIC PAIN FOLLOWING INGUINAL HERNIA REPAIR? A PROSPECTIVE STUDY FROM THE SWEDISH HERNIA REGISTER
Authors: Olsson Anders , Sandblom Gabriel , Franneby Ulf , Sondén Anders , Gunnarsson Ulf , Dahlstrand Ursula 
Published: December 2021

Abstract

Aim
To analyse if postoperative complications constitute a predictor for the risk of developing long-term groin pain.

Material and Methods
Population-based prospective cohort study of 30,659 patients operated for inguinal hernia 2015-2017 included in the Swedish Hernia Register. Registered post-operative complications were categorised into hematomas, surgical site infections, seromas, urinary tract complications, and acute post-operative pain. A questionnaire enquiring about groin pain was distributed to all patients one year after surgery. Reported level of pain one year after surgery was analysed against postoperative complications using multivariable logistic regression analyses.

Results
The response rate was 64.5%. In total 19,773 eligible participants responded to the questionnaire whereof 73.4% had undergone open anterior mesh repair and 26.6% had undergone endo-laparoscopic mesh repair.
Registered postoperative complications were: 750 hematomas (2.3%), 516 surgical site infections (1.6%), 395 seromas (1.2%), 1,216 urinary tract complications (3.7%), and 520 hernia repairs with acute post-operative pain (1.6%).
Among patients who had undergone open anterior mesh repair, analyses showed an association between persistent pain and hematomas (OR 2.03, CI 1.30-3.18), surgical site infections (OR 2.18, CI 1.27-3.73) and acute post-operative pain (OR 7.46, CI 4.02-13.87). Analysis of patients with endo-laparoscopic repair showed an association between persistent pain and acute post-operative pain (OR 9.35, CI 3.18-27.48).

Conclusions
Acute postoperative pain was a strong predictor for persistent pain following both open anterior and endo-laparoscopic hernia repair. Surgical site infections and hematomas were predictors for persistent pain following open anterior hernia repair, although the rate of reported postoperative complications was low.
P103 IS BOTULINUM TOXIN PRE-CONDITIONING & 3D PLANNING USEFUL IN A BILATERAL SUBCOSTAL EVENTRATION WITH LAPAROSTOME AND COLOSTOMY?
Authors: Farré Roser , Gobbo Rafael Gerardo Díaz Del , Sanchon Lorena , Osorio Alexander , Guariglia Claudio Antonio , Pardo Sara , Güell Mercè , Collera Pablo 
Published: December 2021

Abstract

Aim
To assess the usefulness of 3D Planning and preconditioning with botulinum toxin in a complex abdominal wall hernia.

Material and Methods
A 54-year-old man with sever alcoholic pancreatitis required surgery due to poor evolution, performing subtotal colectomy with a right colon colostomy and necrosectomy by bilateral subcostal laparotomy. After several operations and not being able to close the wall, the use of negative pressure therapy and subsequently skin grafting was required.
Abdominal wall 3D Planning was performed and botulinum toxin injection was administered before definite surgery.
During surgery, after digestive reconstruction, it was observed that wound’s edges did not approximate due to retraction of rectus in the cranial and caudal pole. Posterior layer was closed with running suture and double polypropylene mesh was placed.
One year after surgery, patient remains without recurrences with a firm abdominal wall and recovery of life’s quality with radiologic confirmation images.

Results
Intestinal and Wall reconstruction in one step was feasible, although botulinum toxin injection did not provide benefits due a bilateral subcostal incision with significant muscle retraction.
The 3D Planning allowed us to assess the degree of retraction of the musculature, much greater than what was appreciated in the physical examination.

Conclusions
The subcostal incision should be avoided in severe pancreatitis.
Surgical planning with 3D technology is developing, allowing the entire anatomy to be assessed globally.
3D, useful tool for teaching, suggests that in subcostal laparotomies, it could help predicting that botulinum toxin would not be useful due to muscular retraction.