bluuebunny/crossref_metadata_2025_split huggingface dataset:
O12 OPEN PREPERITONEAL INGUINAL HERNIA REPAIR, TREPP VERSUS TIPP IN A RANDOMIZED CLINICAL TRIAL
Authors: Bökkerink Willem , Koning Giel , Vriens Patrick , Mollen Roland , Akkersdijk Willem , van Laarhoven Kees 
Published: December 2021

Abstract

Aim
The preperitoneal mesh position for inguinal hernia repair showed beneficial results regarding Chronic Postoperative Inguinal Pain (CPIP) with low recurrence rates. Two open preperitoneal techniques, the TransREctus Sheath PrePeritoneal (TREPP) and the TransInguinal PrePeritoneal (TIPP) technique, were compared in a randomized clinical trial with the hypothesis of less patients with CPIP after TREPP due to complete avoidance of nerve contact.

Materials and Methods
Adult patients with a primary unilateral inguinal hernia were randomized to either TREPP or TIPP in four hospitals. Prior to the trial’s start the study protocol was ethically approved and published. Outcomes included CPIP after 1 year (primary outcome) and recurrence rates, adverse events and Health related Quality of Life (secondary outcomes). Follow-up was performed at 2 weeks, 6 months and 1 year.

Results
Baseline characteristics were comparable in both groups. Pain was less often present after TREPP at 2 weeks and 6 months, but the CPIP at rest at 1 year was comparable 1.9% after TREPP vs 1.4% after TIPP, p = 0.535). The overall recurrence rate was higher in the TREPP group, 8.9% vs 4.6%, p = 0.022). Corrected for a learning curve for TREPP, no significant difference could be assessed (TREPP 5.7% and TIPP 4.8%, p = 0.591).

Conclusions
both the TREPP and TIPP technique resulted in a low incidence of CPIP after 1 year follow-up. The TREPP method can be considered a solid method for inguinal hernia repair if expertise is present. The learning curve of the TREPP techniques needs further evaluation.
O16 THE TOR-CONCEPT (TRAINING-OPERATION-REHABILITATION) APPLIED TO A COHORT OF POST-PARTUM WOMEN WITH SYMPTOMATIC DRA (DIASTASIS RECTI ABDOMINIS). EVALUATION OF PHYSICAL FUNCTION AND QUALITY OF LIFE ONE YEAR AFTER SURGERY
Authors: Olsson Anders , Woxnerud Katarina , Sandblom Gabriel , Stackelberg Otto 
Published: December 2021

Abstract

Aim
Management of diastasis recti abdominis (DRA) differs regarding core training, surgical repair methods and post-operative rehabilitation. The purpose of this prospective cohort study was to evaluate the effect of a novel concept of treatment for DRA, the TOR-concept (Training, Operation and Rehabilitation). The concept includes preoperative evaluation of symptoms and instructed abdominal core training; tailored surgical repair of the DRA; and an individualized postoperative rehabilitation program.

Material and Methods
A cohort of seventy-five post-partum women with diagnosed DRA and training resistant core dysfunctions were evaluated and included to the study during 2018-2020. After surgery, all participants underwent an individualized supervised rehabilitation program with progressive increasing load for four months. Physical function was registered preoperatively and one year after surgery with the disability rating index (DRI) questionnaire. Quality of life (QoL) was assessed with the SF-36 questionnaire. The DRA and the surgical result were assessed with ultrasonography before and one year after surgery.

Results
Sixty-nine participants, 92%, completed the study. There were no DRA-recurrences at the 1-year follow-up. Early results shows that self-reported physical function, (DRI), improved in 88.8 % of patients, with a mean score improvement of 78.5 %. Quality of life, (SF-36), improved significantly compared with the preoperative scores, and reached a level similar to, or higher than, the normative Swedish female population.

Conclusions
In this cohort of post-partum women with DRA combined with core instability symptoms resistant to training, surgical reconstruction within the TOR-concept resulted in a significant improvement of physical function and QoL.
O18 LONG-TERM CROSSOVER RATE FROM WATCHFUL WAITING TO SURGERY OF INITIALLY MIDLY SYMPTOMATIC OR ASYMPTOMATIC INGUINAL HERNIAS IN MEN AGES 50 YEARS AND OLDER
Authors: Van den Dop Matthijs , van Egmond Sarah , Wijsmuller Arthur , Goede Barry De , Kleinrensink Gert-Jan , Jeekel Hans , Lange Johan 
Published: December 2021

Abstract

Aim
Inguinal hernia (IH) belongs to the most common surgical pathology worldwide. Approximately, one third of patients are asymptomatic. Watchful waiting (WW) has been regarded as a justifiable treatment option, but doubts still exist since high crossover (CO) rates to surgery may occur. The aim of this study is to assess the CO rates after 13-year follow-up of our randomized controlled trial (RCT).

Material and Methods
In our original study, 496 men with an asymptomatic or mildly symptomatic IH were randomly assigned to elective repair or WW. A retrospective review was conducted of patients initially assigned to WW. Primary outcome was CO rate to surgery. Secondary outcomes included reason for crossing over and time between initial randomisation and the CO to surgery.

Results
In the original RCT, 95 of 262 WW patients electively crossed over to surgery (35.4%) after 32.9 months. Currently, 212 of the 262 (81.0%) WW patients were reviewed, and 133/212 (62.7%) crossed over to surgery. Median follow-up was 13 years (range, 8-15 years). Mean time to CO was 35.2 months SD (40.8). Motivations for crossing over to surgery were predominantly due to progression of symptoms (83.5%), and in 8 (3.8%) cases due to an emergency event.

Conclusions
In the presented population, WW on the long-term remains a safe strategy, saving one third of patients an operation, although CO to surgery will likely occur. Insights into the natural course of untreated inguinal hernia that are valuable during patient counseling can be offered in the form of long-term CO rate due to progression of symptoms.
O19 5-YEAR OUTCOMES OF A RANDOMIZED CLINICAL TRIAL OF MESH FIXATION WITH CYANOACRYLATE OR SUTURES FOR LICHTENSTEIN HERNIA REPAIR: RECURRENCE, CHRONIC PAIN AND QUALITY OF LIFE
Authors: Hoyuela Carlos , Guillaumes Salvador , Veres Antoni , Hidalgo Nils Jimmy , Juvany Montserrat , Ardid Jordi , Martrat Antoni , Bachero Irene , Cano Manuel López 
Published: December 2021

Abstract

Aim
To assess the 5-year outcomes of mesh fixation with cyanoacrylate or sutures for Lichtenstein hernioplasty (recurrence rate, chronic pain, and patient’s quality of life (QoL).

Methods
370 patients who underwent Lichtenstein hernia repair were randomized to receive either cyanoacrylate or non-absorbable sutures for lightweight polypropylene mesh fixation. Postoperative outcomes were evaluated by an independent blinded observer. QoL was assessed using the EuraHS-QoL questionnaire (European Registry for Abdominal Wall Hernias).

Results
Initially 188 patients received Glue and 182 Suture. Mean follow-up: 72.6±7.8 months. 78.1% patients (Glue:147,Suture:142) completed 5-years follow-up. No significant differences were observed in terms of chronic pain. VAS score≥3: 8.1% vs 9.1%, Glue vs. Suture, respectively (P = 0.836). 8 patients (2.7%) (4 in each group) reported pain at rest, reaching 10.7% when analyzing pain during activity.
QoL was unaffected (EHS-QoL score=0) in the majority of patients: 131 (89.2%) vs. 127 (89.5%) for Glue or Suture respectively (p = 0.930). QoL-score greater than 20/90 points: 2 patients (Glue) vs. 6 (Suture) (p = 0.099). The Suture group QoL-score was higher in all domains but without statistical significance. Foreign body sensation was slightly higher in Suture group (7.5% vs. 9.3%) but without reaching statistical significance (p = 0.534). There were no differences in the recurrence rate (2.6% vs. 3.8% for Glue and Suture respectively) (p = 0533).

Conclusions
Chronic discomfort rate after Lichtenstein hernioplasty is not negligible. Atraumatic mesh fixation with glue was quicker and resulted in less acute postoperative pain than sutures for Lichtenstein hernia repair, but with no statistical differences in terms of chronic pain nor the long-term patients’ QoL.
O25 MORTALITY AFTER EMERGENCY VERSUS ELECTIVE GROIN HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Saeter Ann Hou , Fonnes Siv , Rosenberg Jacob , Andresen Kristoffer 
Published: December 2021

Abstract

Aim
This systematic review and meta-analysis aimed to investigate 30- and 90-day postoperative mortality in patients undergoing emergency or elective groin hernia repair.

Material and Methods
This review is reported after the PRISMA 2020 guidelines. A protocol (CRD42021244412) was registered to PROSPERO. Three databases (PubMed, EMBASE, and Cochrane CENTRAL) were searched in April 2021. The identified studies were screened for eligibility and included if they reported 30- and/or 90-day mortality following emergency or elective groin hernia repair. Meta-analyses were conducted when possible, and a subgroup analysis on patients undergoing bowel resection was made.

Results
We included 37 studies with a total of 30,740 patients receiving emergency repair and 457,253 receiving elective repair. Meta-analyses could not be conducted for the two repair settings separately due to heterogeneity. However, the 30-day mortality ranged from 0.0–1.7% following elective repair and 0.0–11.8% following emergency repair. The risk of 30-day mortality following emergency repair was estimated to be 26-fold higher than after elective repair. A subgroup meta-analysis on bowel resection in emergency repair estimated 30-day mortality to be 7.9%.

Conclusions
Emergency groin hernia remains a challenging and potentially fatal surgical emergency. This review emphasizes the importance of performing hernia repair in an elective setting to prevent a potential acute presentation with acute surgical intervention. Patients presenting with symptoms of emergency groin hernias should receive particular attention to minimize the high risk of mortality and morbidity following emergency repair.
O33 TREATMENT OF INCARCERATED GROIN HERNIA - EMERGING EVIDENCE BASED ON THE SWEDISH HERNIA REGISTER
Authors: Lederhuber Hans , Croix Hanna de la , Dahlstrand Ursula 
Published: December 2021

Abstract

Aim
The evidence base for statements about risk factors, morbidity and mortality for emergency hernia repair is mostly low quality. The aim of this study is to elucidate risk factors for the development of incarcerated hernia and outcome after adult emergency hernia repair using data from the Swedish Hernia Register (SHR).

Material and Methods
Data in this observational study were extracted from the SHR. It included registered cases between January 1, 2009 and December 31, 2019. Maximal follow-up was until December 31, 2020. Demographic data were analysed descriptively, risk analyses were performed using multivariate- and Cox-regression models.

Results
A total of 164.844 cases could be included after application of the in- and exclusion criteria. Women [odds ratio (OR) 1.42 99%CI 1.32–1.51], patients with lateral hernia [OR 1.54, 99%CI 1.47–1.61], femoral hernia [OR 14.63, 99%CI 13.32–16.06] and hernia recurrence [OR 2.46, 99%CI 2.33–2.60] were at higher risk of developing an incarcerated hernia. The highest strangulation risk was seen among women [OR 2.36, 99%CI 1.91–2.90], femoral hernia [OR 7.00, 99%CI 5.40–9.11] and recurrent hernia [1.90, 99%CI 1.54–2.33]. Patients with hernia incarceration or strangulation suffer significantly more frequent from postoperative complications [16.7% and 40.9% respectively, both p &lt; 0.001].

Conclusions
The data demonstrate that certain risks groups exist, which are prone to suffer from hernia incarceration and strangulation. These at risk patients should be prioritized, especially during the reorganisation of services to cope with the massive surgical backlog in the aftermath of the COVID-19 pandemic.
O46 SUTURABLE MESH IMPROVES OUTCOMES FOR LAPAROTOMY CLOSURE IN COMPARISON TO POLYPROPYLENE SUTURE IN A REALISTIC PORCINE MODEL
Authors: Dumanian Gregory 
Published: December 2021

Abstract

Aim
Laparotomy closures fail due to suture pull-through. We hypothesize that a novel suturable mesh device may limit pull-through via mechanisms of force distribution at the suture-tissue interface and fibrous encapsulation of the device filaments. This new tissue approximation device may lead to improved outcomes for laparotomy closure.

Material and Methods
Fifteen domestic swine 74 kg in size were randomly allocated to three groups for epigastric laparotomy closure with either size 0 suturable mesh, number 1 suturable mesh, or number 1 polypropylene. All three devices were placed in running fashion with 1 cm bites and 1 cm travels. Primary endpoints were hernia formation at 13 weeks and a semiquantitative analysis of the histological tissue response. Secondary endpoints included adhesions, surgical site occurrence (SSO), and documentation of “loose sutures”.

Results
There were numerically fewer hernias in the number 1 suturable mesh group. Nine of the 10 suturable mesh devices were well encapsulated within the tissues and could not be pulled away, while 4 of the 5 polypropylene sutures were loose. Adhesions were least for number 1 suturable mesh. Histologically, the suturable mesh implanted devices showed good fibrovascular ingrowth and were judged to be “non-irritants”. The soft tissue response was statistically greater (p = .006) for the number 1 suturable mesh than for the number 1 polypropylene.

Conclusions
The mechanism of how meshes support closure sites is clearly demonstrated with this model. Suturable mesh has the potential to change surgical algorithms for abdominal wall closure.
OV09 ROBOTIC REPAIR OF SUBXIPHOID INCISIONAL HERNIA POST CABG
Authors: El-Matbouly Moamena , Janahi Yaser , Suliman Ahmed , Atalah Hany , Albahrani Ahmed 
Published: December 2021

Abstract

Aim
A median sternotomy that extends toward the epigastric area can weaken the upper abdominal wall and result in the development of subxiphoid incisional hernia. We aim to assess the efficacy and the feasibility of repair of subxiphoid incisional hernia post CABG robotically. In this video; we will also review the surgical technique and the steps for robotic repair of subxiphoid incisional hernia

Material and Methods
57-year-old female presented with subxiphoid swelling post CABG in 2019. Her surgery was complicated with sternotomy wound infection with VAC dressing application and ARDS with prolonged intubation. She had 5x7 cm hernia defect that showed on the CT thorax along with sternal wound dehiscence. She underwent robotic repair of her hernia with phasix mesh and recovered well after surgery.

Results
The subxiphoid hernia is known for its repair complexities and high recurrence rate because the subxiphoid area is a complex structure consisting of boney structures, the rectus abdominis muscles, linea alba, and the diaphragm. The Da Vinci platform allows for accessing hard-to reach area with enhanced precision in dissection and superior dexterity compared to laparoscopy. The Robotic platform allows for manipulation of the camera to assess and operate on the abdominal wall with ease as compared to laparoscopy.

Conclusions
robotic repair of subxiphoid incisional hernia with mesh is safe and effective method of repair. There are no short-term or long- term side effects of the procedure with no recurrence at 6 months follow up.
OV12 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: VIDEO PRESENTATION
Authors: Birolini Claudio , Tanaka Eduardo , Miranda Jocielle , Murakami Abel , Utiyama Edivaldo 
Published: December 2021

Abstract

The early outcomes of abdominal wall reconstruction with polyvinylidene (PVDF) mesh in the infected setting: video presentation

Aim
The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. The study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting.

Material and Methods
Video presents the technical aspects and some of the outcomes of patients included in a prospective clinical trial designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects.

Results
The technical aspects of the operation, and the management of complications such as wound breakdown, exposed mesh and post-operative seromas are shown in this short video. The early and late outcomes are presented for discussion.

Conclusions
The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.
Maribavir for Refractory Cytomegalovirus Infections With or Without Resistance Post-Transplant: Results From a Phase 3 Randomized Clinical Trial
Authors: Avery Robin K , Alain Sophie , Alexander Barbara D , Blumberg Emily A , Chemaly Roy F , Cordonnier Catherine , Duarte Rafael F , Florescu Diana F , Kamar Nassim , Kumar Deepali , Maertens Johan , Marty Francisco M , Papanicolaou Genovefa A , Silveira Fernanda P , Witzke Oliver , Wu Jingyang , Sundberg Aimee K , Fournier Martha ,   SOLSTICE Trial Investigators
Published: December 2021

Abstract

Background
Therapies for refractory cytomegalovirus infections (with or without resistance [R/R]) in transplant recipients are limited by toxicities. Maribavir has multimodal anti-cytomegalovirus activity through the inhibition of UL97 protein kinase.

Methods
In this phase 3, open-label study, hematopoietic-cell and solid-organ transplant recipients with R/R cytomegalovirus were randomized 2:1 to maribavir 400 mg twice daily or investigator-assigned therapy (IAT; valganciclovir/ganciclovir, foscarnet, or cidofovir) for 8 weeks, with 12 weeks of follow-up. The primary endpoint was confirmed cytomegalovirus clearance at end of week 8. The key secondary endpoint was achievement of cytomegalovirus clearance and symptom control at end of week 8, maintained through week 16.

Results
352 patients were randomized (235 maribavir; 117 IAT). Significantly more patients in the maribavir versus IAT group achieved the primary endpoint (55.7% vs 23.9%; adjusted difference [95% confidence interval (CI)]: 32.8% [22.80–42.74]; P &lt; .001) and key secondary endpoint (18.7% vs 10.3%; adjusted difference [95% CI]: 9.5% [2.02–16.88]; P = .01). Rates of treatment-emergent adverse events (TEAEs) were similar between groups (maribavir, 97.4%; IAT, 91.4%). Maribavir was associated with less acute kidney injury versus foscarnet (8.5% vs 21.3%) and neutropenia versus valganciclovir/ganciclovir (9.4% vs 33.9%). Fewer patients discontinued treatment due to TEAEs with maribavir (13.2%) than IAT (31.9%). One patient per group had fatal treatment-related TEAEs.

Conclusions
Maribavir was superior to IAT for cytomegalovirus viremia clearance and viremia clearance plus symptom control maintained post-therapy in transplant recipients with R/R cytomegalovirus. Maribavir had fewer treatment discontinuations due to TEAEs than IAT.
Clinical Trials Registration. NCT02931539 (SOLSTICE).
Chronic prescription of antidepressant medication in patients with chronic kidney disease with and without kidney replacement therapy compared with matched controls in the Dutch general population
Authors: van Oosten Manon J M , Koning Dan , Logtenberg Susan J J , Leegte Martijn J H , Bilo Henk J G , Hemmelder Marc H , Jager Kitty J , Stel Vianda S 
Published: December 2021

ABSTRACT

Background
Chronic kidney disease (CKD) is associated with a higher prevalence of depression, neuropathic pain and insomnia. These conditions are often treated pharmaceutically. In this study we aimed to determine the prevalence of chronic antidepressant use among CKD patients with and without kidney replacement therapy (KRT).

Methods
By using the Dutch health claims database, we were able to determine the prevalence, type and dosage of chronic antidepressant prescriptions in patients with CKD Stage G4/G5 without KRT (n = 14 905), patients on dialysis (n = 3872) and patients living on a functioning graft (n = 8796) and compared these to age-, sex- and socio-economic status (SES)-matched controls from the general population.

Results
Our data show that the prevalence of chronic antidepressant prescription is 5.6%, 5.3% and 4.2% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively, which is significantly higher than in matched controls. Although our data revealed more prescriptions in female patients and in the age category 45–64 years, our data did not show any association between antidepressant prescriptions and SES. Selective serotonin reuptake inhibitors were the most prescribed drugs in all patient groups and controls. Tricyclic antidepressants were more often used in patients compared with controls.

Conclusion
This nationwide analysis revealed that chronic antidepressant prescription in the Netherlands is higher in CKD patients with and without KRT than in controls, higher in middle-aged patients and women, unrelated to socio-economic status and lower than chronic use reported in other countries.
Validation study of the use of the HRVCAM software for the evaluation of heart rate and heart rate variability at rest
Authors: Martins Patrícia Cândida de Matos Lima , Barbosa Talles Marcelo Gonçalves de Andrade , Lima Lucas Monteiro , Souza Israel Machado Brito , Ramos Gabrielly Craveiro , Souza Pedro Henrique de Brito , da Rocha Adson Ferreira , Barroso Weimar Kunz Sebba , Vitorino Priscila Valverde de Oliveira 
Published: December 2021

Abstract

Aims
The existing instruments for assessing heart rate (HR) and heart rate variability (HRV) require contact area. This is difficult to obtain from specific groups of patients and from those moving. The aim of this study was to validate the use of the HRVCam software for measuring HR and HRV in healthy adults.

Methods and results
The HR and HRV variables were evaluated in terms of time and frequency using a webcam and Polar® S810i. The Shapiro–Wilk test was used to test the normality of the data, and the Pearson’s correlation coefficient (r) was used to identify the possible correlation between the two instruments. The size of the effect was calculated based on a generalized linear model, and the Bland–Altman plots were used to analyse the agreement between the methods. The level of significance for all analyses was set at P &lt; 0.05. We evaluated 102 participants, of whom 52% were men; 83.3% were aged between 18 and 29.9 years; and 84.3% were single.

Conclusion
There was a good agreement and moderate to strong correlations among all analysed variables. The biases were low, except for the low frequency/high frequency measures. Moreover, the difference between the samples was small to moderate. The results of this study corroborate the use of HRVCam for measuring HR and HRV.