bluuebunny/crossref_metadata_2025_split huggingface dataset:
O07 SHORT-TERM OUTCOMES OF A MULTICENTRE PROSPECTIVE STUDY USING A “VISIBLE” PVDF ONLAY MESH FOR THE PREVENTION OF MIDLINE INCISIONAL HERNIA
Authors: Rodicio Jose , Miguel Carlos San , Monclús Javier López , Moreno Maria , López Patricia , Amoza Sonia , Díaz Tamara , Lopez Antonio , Bear Isabel García , Alonso Alfredo , Menéndez Rafael , Díez Isabel , Ureña Miguel Ángel García 
Published: December 2021

Abstract

Aim
Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under MRI.

Material and Methods
This is a prospective multicentre observational cohort study. Preliminary results from the first three months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. MRIs were performed six weeks after treatment. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position.

Results
Between July 2016 and December 2020, 178 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with BMI being the only significant risk factor (OR = 1.14, 95% CI = 1.00-1.31, p = 0.048). The formation of a seroma was also associated with BMI (OR = 1.11, 95% CI = 1.02-1.21, p = 0.02).

Conclusions
The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to understand how the mesh behaves during the early process of integration.
O08 BIOMECHANICS OF MANUAL, STAPLED, AND MANUAL-STAPLED SUTURES ON FASCIA LATA. TIPS FOR ABDOMINAL WALL SURGEONS
Authors: Lauro Enrico , Corridori Ilaria , Luciani Lorenzo , Leo Alberto Di , Sartori Alberto , Andreuccetti Jacopo , Scudo Giovanni , Motta Antonella , Pugno Nicola 
Published: December 2021

Abstract

Aim
No data on the biomechanical properties of staplers’ use in the repair of abdominal wall defects are available. Our objective is to study prospectively the biomechanical properties of manual, stapled and mixed manual/stapled fascial sutures.

Material-Methods
Stress/strain tests were performed on 16 human cadaver fascial samples. The data on strength, strain (deformability), Young’s modulus (elasticity), and dissipated energy (toughness modulus) were recorded for each type of suture.

Results
Stapled and mixed suture showed a significantly higher strength (manual 0.83, stapled 2.10, mixed 2.68 MPa), and a trend towards a higher strain as compared to manual sutures (manual 344, stapled 249, mixed 280%). Stapled and mixed suture were four-fold higher as compared to manual sutures (manual 1.779, stapled 7.374, mixed 6.964 MPa). Manual and mixed sutures showed significantly higher dissipated energy (manual 0.99, vs stapled 0.73, vs mixed 1.35 mJ-mm3).

Conclusions
Stapled and mixed sutures have better strength performances than manual sutures. On the other hand, stapled and mixed sutures have significantly higher Young’s modulus and lower ultimate strain, showing less deformability, possibly translating in less efficiency in large midline defects, where manual sutures might display higher elasticity. Also, hand-sewn sutures (in manual or over-sewn stapled) appear to increase the ability to absorb mechanical energy, whereas stapled sutures showed to be less tough. Furthermore, an over-sewn stapled suture, as compared to a stapled suture, gains in term of strength, ultimate strain, Young’s modulus, and dissipated specific energy, suggesting the need of over-sewn stapled sutures in case of larger fascial defects.
O10 REINFORCED TENSION LINE SUTURE RESULTS IN LOW INCISIONAL HERNIA RATE AFTER CRS/HIPEC OPERATIONS
Authors: Wenzelberg Charlotta , Petersson Ulf , Syk Ingvar , Rogmark Peder 
Published: December 2021

Abstract

Aim
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis entails several risk factors for incisional hernia (IH). At our institution fascia closure has been performed in a 4:1 manner with a 2-0 polydiaxanone suture (the PDS-group) or a 2-0 polypropylene preceded by a reinforced tension line (RTL) suture (the RTL-group). Our hypothesis was that reinforcing the suture line results in fewer IH at one year.

Material and Methods
Single-center retrospective study on primary CRS/HIPEC 2004-2019. CT-diagnosed IH one year ±3 months postoperative. Additional data retrieved from clinical records and a prospective CRS/HIPEC database.

Results
Of 193 patients, 63 were not evaluable for IH of which two, both in the PDS-group, were reoperated for fascial dehiscence (FD). 130 patients; 83 (45 women) in the PDS- and 47 (23 women) in the RTL-group, mean age 57 years (19-77) remained. RTL-patients were five years younger (54 vs 59), had a higher Karnofsky index and less bleeding (807 vs 1409 mL). No differences regarding sex, BMI, recent midline incisions, excision of midline scars, peritoneal cancer index score, complications (Clavien-Dindo 3b or higher), neo-adjuvant or adjuvant chemotherapy were found. Twelve IH (9%) were found, 11 (13%) in the PDS- and 1 (2%) in the RTL-group (p = 0.055).

Conclusions
Despite many potential IH risk factors, the overall IH-incidences do not seem higher than after laparotomies in general. The RTL-group showed 2% IH compared to 13% in the PDS-group. The PDS-group were further burdened by two FD. The results are clinically relevant, suggesting an advantage with RTL-closure for these patients.
O20 ASSESSING THE VALIDITY AND COVER RATE OF NATIONAL HERNIA REGISTERS
Authors: Axman Erik 
Published: December 2021

Abstract

Aim
To assess the validity and cover rate of the Swedish hernia register.

Material and Methods
Annual validation of the Swedish Hernia Register has been carried out since the start in 1992 and since 2013 in a more standardized way to allow a systematic data collection and evaluation. 10% of all participating units are randomly selected each year in a specific region of Sweden, ensuring a systematic validation of all regions from North to South. Data from 2013 to 2018 was analyzed regarding data quality and from 2014 to 2018 regarding cover rate. All operations registered at the validated clinics was checked against the Swedish Hernia Register to assess cover rate. 50 operations were randomly selected at each clinic and data in the Swedish Hernia register was compared to the medical records to evaluate data quality.

Results
In total 55 participating units were evaluated and 73764 variables compared to medical records. Cover rate between 2014 to 2018 was 97% and proportion of correct variables was 98%. Most frequent errors where ASA-grade, date at which the patient was put on the waiting list and postoperative complications.

Conclusions
This unique validation of a national hernia register show a high cover rate and good quality of data. Efforts to maintain and improve national registers are of great importance. Research with data from the Swedish hernia register should be evaluated on the basis of the results presented in this study.
O23 SURGICAL REPAIR OF PARASTOMAL BULGING - A REGISTER-BASED STUDY
Authors: Krogsgaard Marianne , Gögenur Ismail , Helgstrand Frederik , Andersen Rune Martens , Danielsen Anne Kjærgaard , Vinther Anders , Klausen Tobias , Hillingsø Jens , Christensen Bo Marcel , Thomsen Thordis 
Published: December 2021

Abstract

Aim
To examine the incidence of primary and recurrent repair and types of repair performed in patients with parastomal bulging.

Material and Methods
We linked prospectively collected data on parastomal bulging from the Danish Stoma Database to surgical data on repair of parastomal bulging from the Danish National Patient Register. Survival statistics provided cumulative incidences and time until primary and recurrent repair

Results
Of 1016 patients, registered from 2010-2017 with a permanent stoma and a parastomal bulge, 180 (18%) underwent surgical repair. The cumulative incidence of a primary repair was 9% (95% CI [8%; 11%]) within 1 year and 19% (95% CI [17%; 22%]) within 5 years after the occurrence of a parastomal bulge. For colostomies and ileostomies, we found similar probability of undergoing primary repair.
For recurrent repair, the 5-year cumulative incidence was 5% (95% CI [3%; 7%]). The probability of undergoing further recurrent repair was 33% (95% CI [21%; 46%]) within 5 years. For primary repair, open or laparoscopic repair with mesh (43%) and stoma revision (39%) were performed almost equally frequent. Stoma revision and repair with mesh could precede and follow one another as primary and recurrent repair. Stoma reversal was performed in 17% of patients.

Conclusions
Our data offered a new and comprehensive view of the course of surgical treatment of parastomal bulging. Five years after the occurrence of a parastomal bulge the estimated probability of undergoing a repair was 19%. The probability of undergoing recurrent repair was high and stoma reversal more common than expected.
O27 THE IMPACT OF NERVE MANAGEMENT ON THE RISK FOR PERSISTING POSTOPERATIVE PAIN FOLLOWING OPEN ANTERIOR MESH REPAIR OF INGUINAL HERNIA
Authors: Westin Linn , Gunnarsson Ulf , Sandblom Gabriel , Dahlstrand Ursula 
Published: December 2021

Abstract

Aim
The impact of peripheral nerve management on post-operative pain is poorly known. The aim was to evaluate how management of the inguinal nerves during anterior mesh hernia repair affects the risk for long-term postoperative pain.

Material and Methods
Cross-sectional study based on the Swedish Hernia Register (SHR). Includes patients over 18 years of age with an open anterior repair during 2012-2018, who responded to a one-year follow-up questionnaire regarding pain. Ordered logistic regression analysis was applied to determine risk factors for pain.

Results
In total 35,720 patients who were operated with anterior mesh repair responded to the PROM questionnaire. Overall, 15.6% reported pain interfering with daily activities. The risk for persisting groin pain one year after surgery was not impacted by transecting the iilioingiounal nerve (0.49), the iliohypogastric nerve (0.17) or the genital branch of the genotiofemoral nerve (0.25) in a multivariable ordinal regression adjusting for anaesthesia, gender, age and emergency surgery.

Conclusions
Intraoperative management of the three main inguinal nerves was not associated with the risk for persisting pain in the operated groin one year after surgery.
O38 PROPHYLACTIC LIQUID MESH - A SMALL ANIMAL EXPERIMENT
Authors: East Barbora , Woleský Jakub , Divin Radek , Otahal Martin , Koblizek Miroslav , Staffa Andrea , Lorenzova Jana , Beaux Andrew de , Amler Evzen 
Published: December 2021

Abstract

Aim
Background: Surgical mesh is widely used not only to treat but also to prevent incisional hernia formation. Despite much effort by material engineers, the ‘ideal' mesh mechanically, biologically and surgically easy to use remains elusive. Advances in tissue engineering and nanomedicine have allowed new concepts to be tested with promising results in both small and large animals. Abandoning the concept of a pre-formed mesh completely for a ‘pour in liquid mesh’ has never been tested before.

Material and Methods
Thirty rabbits underwent midline laparotomy with closure using an absorbable suture and small stitch small bites technique. In addition, their abdominal wall closure was reinforced by a liquid nanofibrous scaffold composed of a fibrin sealant and nanofibers of poly-ε-caprolactone with or without hyaluronic acid or the sealant alone, placed as an ‘onlay’ over the closed abdominal wall. The animals were sacrificed at 6 weeks and their abdominal wall was subjected to histological and biomechanical evaluations.

Results
All the animals survived the study period with no major complication. Histological evaluation showed an eosinophilic infiltration in all groups and foreign body reaction more pronounced in the groups with nanofibers. Biomechanical testing demonstrated that groups treated with nanofibers developed a scar with higher tensile ultimate and yield strength.

Conclusions
The use of nanofibers in a liquid form applied to the closed abdominal wall is easy to use and improves the biomechanical properties of healing fascia at 6 weeks after midline laparotomy in a rabbit model.
O45 OUTCOMES OF INCISIONAL HERNIA REPAIR SURGERY AFTER MULTIPLE RE-RECURRENCES: A PROPENSITY SCORE MATCHED ANALYSIS
Authors: Sneiders Dimitri , Smet Gijs de , Hartog Floris den , Yurtkap Yagmur , Menon Anand , Jeekel Johannes , Kleinrensink Gert-Jan , Lange Johan , Gillion Jean-François 
Published: December 2021

Abstract

Aim
Patients with a re-recurrent hernia may account for up to 20% of all incisional hernia (IH) patients. IH repair in this population may be complex due to an altered anatomical and biological situation as a result of previous procedures and outcomes of IH repair in this population have not been thoroughly assessed. This study aims to assess outcomes of IH repair by dedicated hernia surgeons in patients who have already had two or more re-recurrences.

Material and Methods
A propensity score matched analysis was performed using a registry-based, prospective cohort. Patients who underwent IH repair after ≥ 2 re-recurrences operated between 2011 and 2018 and who fulfilled 1 year follow-up visit were included. Patients with similar follow-up who underwent primary IH repair were propensity score matched (1:3) and served as control group. Patient baseline characteristics, surgical and functional outcomes were analyzed and compared between both groups.

Results
Seventy-three patients operated on after ≥ 2 IH re-recurrences were matched to 219 patients undergoing primary IH repair. After propensity score matching, no significant differences in patient baseline characteristics were present between groups. The incidence of re-recurrence was similar between groups (≥ 2 re-recurrences: 25% versus control 24%, p = 0.811). The incidence of complications, as well as long-term pain, was similar between both groups.

Conclusions
IH repair in patients who have experienced multiple re-recurrences results in outcomes comparable to patients operated for a primary IH with a similar risk profile. Further surgery in patients who have already experienced multiple hernia re-recurrences is justifiable when performed by a dedicated hernia surgeon.
O51 BIOSYNTHETIC MESH VERSUS NON-ABSORBABLE SYNTHETIC MESH IN COMPLEX ABDOMINAL WALL REPAIR (CAWR): A UK NHS COST-CONSEQUENCE ANALYSIS OF MANAGEMENT STRATEGIES
Authors: Daniels Ian , O'Neill Frank , Martin Antony , Inman Nick , Slater Kellee 
Published: December 2021

Abstract

Aim
CAWR is marked by high complication and hernia recurrence rates. Different management strategies of CAWR may result in a significant reduction in quality of life and increased financial burden. The use of certain non-absorbable synthetic meshes in CAWR may be associated with an increased risk of adverse events for certain patients. Recent evidence suggests that biosynthetic meshes may contribute to lower complications and may be more cost-effective.

Material and Methods
To compare the cost between a synthetic mesh, and a bio-synthetic mesh in the management of patients undergoing CAWR. A cost-consequence model was developed to simulate clinical pathways for patients undergoing CAWR with different management strategies. Clinical parameters were informed by literature review and expert opinion. Adverse events associated with the use of a mesh, resource utilisation and re-admissions were compared between patient management strategies over a period of two years. Costing information were gathered from national tariffs using NICE methodology.

Results
Use of a biosynthetic mesh was associated with a significant reduction in total costs (£15,489 / €17,953) compared to a synthetic mesh at two years. Cost-savings were driven by a lower rate adverse events (hernia recurrence [2% vs.8%] and sepsis [5% vs. 12%] respectively), and resource utilisation after the initial procedure in the management of complications. There was no difference in the intra-procedural time and complications.

Conclusions
The use of a certain biosynthetic mesh is likely to be highly cost saving compared to a certain synthetic mesh in high-risk patients undergoing CAWR. Well conducted comparative clinical studies are needed to inform robust economic modelling.
OV05 CONCOMITANT MIRS (MINI INVASIVE RIVES STOPPA) AND DREAM (DIASTASIS REPAIR ENDOSCOPICALLY ASSISTED MINI-INVASIVE) FOR THE CORRECTION OF COMBINED VENTRAL HERNIA AND DIASTASIS RECTI
Authors: Ngo Philipppe , Cossa Jean Pierre , Pelissier Edouard 
Published: December 2021

Abstract

Aim
Concomitant MIRS (Minimally Invasive Rives-Stoppa) and DREAM (Diastasis Repair Endoscopically Assisted Minimally-invasive) for the correction of combined ventral hernias and diastasis recti.

Material and Methods
The video shows the combined repair of umbilical hernia and diastasis correction by concomitant minimally invasive hernia repair without division of the posterior sheath and diastasis correction by parietoscopy.

Results
A short periumbilical incision is performed, the Alexis retractor is put in place, preaponeurotic dissection is carried out by direct access and two axial incisions of both anterior sheaths are performed parallel to and 1cm next to the midline.
The umbilical hernia and one unexpected epigastric hernia are reduced and repaired by suture. Additional suture approximating the medial borders of anterior sheath incisions over the previous suture is performed to strengthen the repair.
The patch is deployed in the retromuscular space superficial to the suture line, without any incision of the posterior sheath and without any fixation.
Then the top of the Alexis retractor and the camera are put in place, insufflation at 10mm Hg is started and the parietoscopic step is carried out. Two 5mm trocars are placed and preaponeurotic dissection is extended up to the xiphoid process. The diastasis correction is carried out by a continuous suture approximating both rectus muscles from the xiphoid process to the umbilical hernia suture.

Conclusions
The MIRS technique consists of retromuscular patch repair without division of the posterior sheath, and concomitant DREAM technique reinforces the hernia repair and provides diastasis correction.
OV15 EMERGENCY SURGERY OF OBSTRUCTED VENTRAL HERNIA USING TAPP TECHNIQUE: A SAFE AND FEASIBLE APPROACH
Authors: Vaello Victor , Santana Angela , Oto Diego , Juez Luz , Arranz Raquel , Porrero Belen , Molina Jose Manuel , Hernando Luis Blázquez 
Published: December 2021

Abstract

Aim
to explain and show the feasibility of laparoscopic TAPP technique in emergency procedures

Material and Methods
we present a 71-year-old female with personal history of obesity (BMI 32) and a laparoscopic right hemicolectomy performed in 2018, presenting at the ER with a 24-hour intestinal obstruction due to incarcerated ventral incisional hernia.

Results
laparoscopic reduction of the hernia contents was achieved without need of intestinal resection, prior to access to the preperitoneal space, creating a peritoneal flap that was dissected around the hernia. Following closure of the hernia defect, a polypropylene mesh was placed and the peritoneal flap closed. There were no intraoperative or postoperative events and patient was discharged on 3rd POD.

Conclusions
laparoscopic approach to emergency hernias in selected patients doesn’t differ from elective surgery, and offers great advantages in terms of evaluation of the incarcerated elements, and postoperative recovery, especially in obese patients where a conventional open approach has higher morbidity.
OV16 MASSIVE COMPLEX INGUINAL HERNIA
Authors: Elhage Sharbel , Otero Javier , Watson Michael , Davis Bradley , Todd Heniford B 
Published: December 2021

Abstract

Aim
Massive complex inguinal hernias can be exceptionally difficult to repair, especially when they are associated with loss of domain (LOD). We aim to demonstrate an open preperitoneal approach to a complex massive inguinal hernia extending into the scrotum with severe LOD.

Material and Methods
Footage from clinic, diagnostic imaging, and all operative procedures was included. This included botulinum toxin A (BTA) injection, diagnostic laparoscopy and placement of a peritoneal catheter, outpatient pre-operative progressive pneumoperitoneum (PPP), and the preperitoneal hernia repair.

Results
A 53-year-old male construction worker with a known inguinal hernia presented with worsening groin and scrotal pain, associated with fever. CT imaging showed an abscess secondary to perforated diverticulitis within his massive inguinal hernia, as well as massive loss of domain with almost all small and large intestine within the hernia. He was treated with antibiotics and percutaneous drainage in preparation for surgery. He received pre-operative bilateral BTA injection in the oblique abdominal musculature. Subsequently, he underwent diagnostic laparoscopy and peritoneal catheter placement. He received 2 weeks of outpatient PPP. He then underwent open inguinal hernia repair with left orchiectomy and total abdominal colectomy. The hernia was repaired with a biologic mesh placed in the pre-peritoneal plane. The patient recovered very well and had no wound complications post-operatively. He has since followed up in clinic multiple times with no recurrence and excellent cosmetic results.

Conclusions
In this patient with a complex massive inguinal hernia and loss of domain, we demonstrate a successful open preperitoneal repair following pre-operative BTA injection and PPP.
OV17 LAPAROSCOPIC REPAIR OF A DIAPHRAGMATIC EVENTRATION
Authors: Maillo Carmen , Abreu Raquel Camacho , Piçarra Genoveva , Oliveira Maria de Jesús , Figueiredo Nuno 
Published: December 2021

Abstract

Aim
Diaphragmatic eventration (DE) is a rare condition affecting 0,05% of general population. DE is the abnormal elevation of a portion of a entire hemidiaphragm due to a lack of muscle or nerve function. It can be congenital or acquired. The most common cause of DE is cardiac surgery. It can be asymptomatic or present mild symptoms as dispnea, palpitations, pneumonia.

Material and Methods
61 years old male with medical history of arterial hypertension, DMII, Hyperlipidemia.
He had a motor vehicle accident with 6 to 9 left ribs fractures.
One month later complained of dyspnea with shortness of air to normal activity. Rx: elevation of left diaphragm. CT scan: elevation of left diaphragm without rupture, passive atelectasis of inferior left lobe of the lung.
He initiated respiratory physiotherapy without improvement of the symptoms. 4 months after the accident, we had a stroke with right hemiparesis. This situation produced worsening of the dyspnea.
Physiotherapy was reinforced with recuperation of the hemiparesis, but poor improvement of the dyspnea.
10 months after the accident, surgery was indicated for plication of the diaphragm to improve the respiratory function.

Results
The video shows the radiological exams and the surgery performed. Laparoscopic diaphragmatic plication with a reinforcement with a coated mesh (Uncoated monofilament polypropylene mesh on the anterior side with an absorbable hydrogel barrier). He was discharge 2 days after surgery.
The patient improved significantly in his respiratory symptoms an imaging exams.

Conclusions
Posttraumatic DE must be treated surgically with low morbidity and good functional results.