bluuebunny/crossref_metadata_2025_split huggingface dataset:
RISK FACTORS FOR CHRONIC PAIN FOLLOWING LAPAROSCOPIC GROIN HERNIA REPAIR IN THE SWEDISH HERNIA REGISTRY: 1. PREOPERATIVE PREDICTORS
Authors: Novik B 
Published: May 2024

Abstract

Aim
This prospective cohort study aimed to identify and quantify preoperative risk factors for chronic postoperative inguinal pain (CPIP) after laparoscopic groin hernia repair.

Material and Methods
Virtually all patients ≥15 years, operated with TEP or TAPP in Sweden during September 2012–December 2018, were routinely sent a CPIP questionnaire at 1 year postoperatively. This study defined CPIP as “non-ignorable pain in the operated groin anytime during the recent week”.
The survey results were analyzed with regard to conceivable preoperative risk factors for CPIP, being previously recorded in the Swedish Hernia Registry.
Multivariable logistic regression rendered adjusted odds ratios (OR), with 95% confidence intervals (CI).

Results
From 80 surgical centers, 29,109 laparoscopic repairs (78% male) were included, with patient mean age 58 years. From 20,455 (70%) questionnaire responders, 5,786 (28%) qualified as having CPIP according to this wide definition. Younger patients were less inclined to respond.
Preoperative predictors significantly associated with higher CPIP risk were:
Younger and elderly patients.
Increasing ASA.
Increasing BMI.
Female (OR 1.3, CI 1.2–1.4).
Smoking (OR 1.4, CI 1.1–1.7).
Recurrent hernia (OR 1.3, CI 1.2–1.4).
Emergency repair (OR 1.3, CI 1.03–1.7).
Each groin in a bilateral repair (OR 1.1, CI 1.05–1.2).
Femoral (OR 1.3, CI 1.1–1.6), combined latero-medial (OR 1.2, CI 1.04–1.3) vs. medial hernia.
Small vs. large defect (OR 1.2, CI 1.1–1.3).

Conclusions
The findings should be useful in planning and interpreting other studies, and for clinical counseling and decision making.
An age-dependent response rate asymmetry, which is a previously overlooked systematic selection bias issue with CPIP surveys, complicates interpretation.
SURGEON PERFORMED ABDOMINAL WALL BOTULINUM TOXIN A INJECTION IN THE OUTPATIENT SETTING MAY RESULT IN SIGNIFICANT REDUCTION OF COMPLEX LOGISTICS AND COSTS
Authors: Quintens J , Zwaans W A R , ten Have T , Lubbers T , Wevers K P 
Published: May 2024

Abstract

Aim
Incisional hernia is a frequent complication encountered after open abdominal surgery. Multiple techniques have been developed over the past few years, however recurrence rates remain high. New strategies to aid midline fascial closure are being developed, such as preoperative ultrasound guided Botulinum toxin A (BTA) injections in the lateral abdominal muscle layers. In most clinics, these injections are performed by radiologists or anesthesiologists. With rising ultrasound capabilities among surgeons and the already extensive anatomical knowledge in this group, a significant reduction in logistics can be achieved when these BTA injections are performed at the outpatient clinic by the surgeon.

Material and Methods
In the outpatient clinics of Maastricht University Medical Center and Máxima Medical Center Veldhoven, 22 BTA injections were perfomed from February 2022 until December 2023. Technique feasibility and pain scores were registered. Average costs from previous BTA injections performed by an anesthesiologist were compared with those for the injections performed by the surgeon in the outpatient setting.

Results
A total of 22 patients received BTA injections from February 2022 until December 2023. Patients tolerated this procedure well, with a mean numeric pain rating score of six out of ten. No post-BTA or periprocedural adverse events occurred. BTA injections by the surgeon in the outpatient clinic resulted in a cost reduction of €495 to €2185.

Conclusions
Outpatient ultrasound guided BTA injection performed by a hernia surgeon is feasible for both patient and surgeon, resulting in a significant reduction of logistics and costs in our experience. For dedicated abdominal wall surgeons with experience in ultrasound-guided injections, it seems safe to perform these procedures at their outpatient clinic.
TREATMENT OF POSTPARTAL RECTUS DIASTASIS WITH SYMPTOMATIC UMBILICAL AND/OR EPIGASTRIC HERNIA PLUS EXCESSIVE/REDUNDANT SKIN – PROCEDURE AND OUTCOME
Authors: Reiners B , Gröger C , Kundel L , Riediger H , Ostapowicz D , Köckerling F 
Published: May 2024

Abstract

Background
In standard treatment of epigastric and/or umbilical hernias with concominant rectus diastasis a high recurrence rate must be expected. As it is a common postpartal defect in fit female patients, linea alba repair with use of the anterior rectus sheath plus mesh reenforcement combined with abdominoplasty provide both effective reconstructive and aesthetic results for this particular patient cohort.

Methods
We present our 2 years data regarding operative approach and early outcome.

Results
Between 12/2021 until 01/2024 52 female patients underwent this specific procedure. All patients presented with primary or recurrent umbilical hernia combined with postpartal rectus diastasis as well as abdominal skin excess. Additional epigastric hernias occured in 43 patients. Mean BMI was 23 kg/m². Mean surgery duration was 171 minutes. Mean defect area was 18 × 8 cm (140 cm²). Routinely, a nonresorbable polypropylen mesh was placed for augmentation of the reconstructed abdominal wall (mean diameter 17 × 9 cm). Abdominoplasty was performed in all patients removing 658 g of fatty tissue and excessive skin. Mean hospital stay was 4,3 days. Minor postoperative complications with conservative treatment occurred in 5 patients (Clavien Dindo 1: seroma, wound healing disorder). Two patients had local revision surgery for wound complication (Clavien Dindo 3: bleeding, drainage removal).

Conclusion
Performing the abdominal wall reconstruction with use of parts of the anterior rectus sheath and mesh augmentation as well as abdominoplasty is safe and shows promising perioperative results. Long term results and Quality of Life after surgery need to be further investigated.
UTILITY OF THE CARBONELL´S RULE IN eTEP VENTRAL HERNIA REPAIR: A MULTICENTER RETROSPECTIVE STUDY
Authors: Salido S , Guevara-Martínez J , Gutiérrez E , Zapata C , Reinoso F , Georgiades A , Monje B , Fondevila C 
Published: May 2024

Abstract

Objectives
The study aimed to assess the applicability of the Carbonell rule as a predictive tool for the need of component separation (TAR) in extended totally extraperitoneal access (eTEP) ventral hernia repair.

Materials and Methods
A multicenter retrospective study was conducted on prospectively collected data from patients undergoing eTEP repair for midline incisional hernias (W2 and W3 size classification according to EHS) at Fundación Jiménez Díaz and La Paz hospitals in Madrid, between January 1, 2019, and January 31, 2024. Preoperative, intraoperative, and postoperative data were collected. The width of the hernia defect (DW) and the muscle bellies' width (RW) of both rectus abdominis were measured, with the Carbonell rule expressed as 2xRW:DW. CarboTAR was considered predictive of the need for TAR if the value was less than 2.

Results
One hundred eight patients were included. Statistically significant differences were not observed in the studied variables when stratifying patients with positive and negative CarboTAR except for CT-measured defect size, mesh size, and case complexity (37.5% vs. 8.9%; p &lt; 0.001). Overall, the rule demonstrated a sensitivity of 22.73% and specificity of 39.33%. Among patients with botox: sensitivity 21.67%, specificity 78.26%, positive predictive value (PPV) 27.22%, and negative predictive value (NPV) 27.66%. Without botox: sensitivity 33.33%, specificity 78.95%, PPV 33.33%, and NPV 50%.

Conclusions
The Carbonell rule exhibited significant limitations in sensitivity and predictive value for determining TAR necessity in the eTEP technique. These findings highlight the need for alternative diagnostic and technical approaches in addressing potential TAR in eTEP ventral hernia repairs.
USE OF BOTULINUMTOXIN A IN HERNIA SURGERY – RESULTS OF A SURVEY AMONG CERTIFIED GERMAN HERNIA CENTERS
Authors: Schaaf S , Wöhler A , Gerlach P , Willms A G , Schwab R 
Published: May 2024

Abstract

Background
Botulinum toxin A is increasingly used in complex hernia surgery, and the growing body of evidence supports the observation of beneficial effects, such as easing fascial defect closure and reducing the need for component separation and bridging techniques. However, there is no approval for this indication, and thus the use of botulinum toxin A in hernia surgery represents an off-label use that might hamper its applicability in daily routine. The aim of this study was to elucidate the use of botulinum toxin A in certified German hernia centers.

Method
We conducted a survey that covered the indications, methods of administration, suspected effects, and the need for guidance, education, and reimbursement. As of July 2023, a total of 127 hospitals were certified as hernia centers by the German Society of General and Visceral Surgery and were asked to complete an online survey.

Results
56 (44%) centers answered the questionnaire, being level 1 and 2 hospitals in 85% (n = 48). 28 (47%) centers used botulinum toxin in hernia surgery. If it wasn't used, the main reasons were lack of experience (n = 20) and reimbursement (n = 14). The main indications were M2–M4 and all lateral hernias, with a hernia width of W2 or more. The interval to surgery was mostly 4–6 weeks (85%). 77% of the responses agreed on the need for hernia-specific courses for botulinum toxin application held by scientific societies.

Conclusion
Botulinum toxin A application in hernia surgery shows promising results; however, it is still not a standard of care, even in specialized hernia centers. There is a need for education and training held by scientific societies.
PULSED RADIOFREQUENCY OR SURGERY FOR ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME: LONG-TERM RESULTS OF A RANDOMIZED CONTROLLED TRIAL
Authors: ten Have T , van Geffen S T , Zwaans W A R , Maatman R C , Boelens O B A , Steegers M A H , Scheltinga M R M , Roumen R M H 
Published: May 2024

Abstract

Background
Patients with Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) often require a step-up treatment strategy including abdominal wall injections, Pulsed Radiofrequency (PRF) or neurectomy. However, long-term success rates of PRF and neurectomy remain largely unknown. The aim of the current study was to report long-term treatment outcomes of PRF and neurectomy in ACNES patients who have participated in the randomized controlled PULSE-trial, which compared the short-term outcomes of both treatments.

Method
Patients who completed the PULSE-trial were contacted about pain status and additional treatments in the subsequent years. Treatment success was based on Numerical Rating Scale (NRS) and Patient Global Impression of Change (PGIC) scores.

Results
A total of 44 of the original 60 patients (73.3%) were eligible for analysis. After a median of 71.5 months, one patient (4.3%) was still pain-free after a single PRF treatment, and five additional patients (21.7%) were pain-free by repetitive PRF treatments. By contrast, 13 patients (61.9%) in the neurectomy group were still pain-free without additional treatments. At the end of follow-up, regardless of additional treatment(s), 35 patients (79.5%) had a significant improvement in pain level based on NRS, while 36 patients (83.7%) scored at least ‘much improvement’ on the PGIC.

Conclusion
Approximately one in five ACNES patients undergoing PRF treatment reports long-term success obviating the need of surgical intervention. Surgery for ACNES is long-term effective in approximately two of three operated patients. Moreover, about 80% of the ACNES patients have a significant long-term pain reduction after their treatment(s).
PROPHYLACTIC MESH-RELATED REOPERATIONS AND MESH-RELATED PROBLEMS DURING RE-LAPAROTOMY: LONG-TERM RESULTS FROM THE PRIMA TRIAL
Authors: van den Berg R , van den Dop L M , Timmermans L , van de Berg M , Pierik E G J M , Roumen R , Reim D , Buijk S , van Brussel J , Lange J F , Jeekel H J , Tanis P J 
Published: May 2024

Abstract

Background
Prophylactic mesh reinforcement (PMA) has proven to reduce the incidence of incisional hernia, especially in high-risk patients, but the morbidity of long-term mesh-related complications are largely unknown. This study aims to evaluate all reoperations after mesh-reinforcement 14 years since the initiation of the PRIMA-trial.

Study design
Patients receiving prophylactic onlay or sublay-mesh in the PRIMA-trial between 2009 and 2012 were included on an as-treated basis from participating centers that made reoperation notes available. Main outcomes were the incidences of abdominal wall complications requiring mesh-explantation, mesh-related ileus, and mesh-related problems during laparotomy for other diagnoses.

Results
Out of 373 patients randomized to PMA, 242 could be included: 127 with onlay and 115 with sublay mesh. Median follow-up was 69 months (IQR 30–199). Thirty-four patients underwent re-operation for any reason during entire follow-up, 22 after onlay (17.3%) and 12 after sublay mesh (10.4%). Reoperation rate for abdominal wall complications that required mesh explantation was 4/127 (3.1%) after onlay and 0% after sublay mesh. Mesh-related ileus occurred in none of the onlay group, and 3/115 (2.6%) in the sublay group. During subsequent laparotomies for other primary diagnoses, adhesions to the meshes were noted in 3/10 (33%) patients in the onlay-group and 1/5 (20%) in the sublay-group, and the mesh was removed in 10/127 (7.9%) and 7/115 (6.1%) patients, respectively.

Conclusions
In high-risk patients receiving a prophylactic mesh during midline laparotomy closure, low incidences of mesh complications requiring re-operation and mesh-related problems during unrelated subsequent laparotomies were found, both for the onlay and sublay techniques.
PREVENTION OF INCISIONAL HERNIA WITH PROPHYLACTIC ONLAY AND SUBLAY MESH REINFORCEMENT VERSUS PRIMARY SUTURE ONLY IN MIDLINE LAPAROTOMIES (PRIMA): LONG-TERM OUTCOMES OF A MULTICENTRE, DOUBLE-BLIND, RANDOMISED CONTROLLED TRIAL
Authors: van den Dop L M , Sneiders D , Yurtkap Y , Werba A , van Klaveren D , Pierik E G J M , Reim D , Timmermans L , Fortelny R , Mihaljevich A L , Kleinrensink G , Tanis P J , Lange J F , Jeekel J ,   PRIMA Trialist Group
Published: May 2024

Abstract

Background
Incisional hernia occurs approximately in 40% of high-risk patients after midline laparotomy. Prophylactic mesh placement has shown promising results, but long-term outcomes are needed. The present study aimed to assess long-term incisional hernia rates from 2009 until 2022 of the previously conducted randomized controlled PRIMA trial with radiological follow-up.

Methods
In the PRIMA trial, patients with increased risk of incisional hernia formation (AAA or BMI ≥ 27 kg/m2) were randomised into primary suture, onlay mesh or sublay mesh closure in three different countries in eleven institutions. Incisional hernia during follow-up was diagnosed by any of: CT, ultrasound and physical examination, or during surgery. Assessors and patients were blinded until 2-year follow-up. Time-to-event analysis according to intention-to-treat principle was performed with the Kaplan–Meier method and Cox proportional hazard models.

Results
Between 2009 and 2012, 480 patients were randomized: 107 primary suture, 188 onlay mesh and 185 sublay mesh. Five-year incisional hernia rates were 53.4% (95% CI: 40.4–64.8), 24.7% (95% CI: 12.7–38.8), 29.8% (95% CI: 17.9–42.6), respectively. Compared to primary suture, onlay mesh (HR: 0.390, 95% CI: 0.248–0.614, p &lt; 0.001) and sublay mesh (HR: 0.485, 95% CI: 0.309–0.761, p = 0.002) were associated with a significantly lower risk of incisional hernia development.

Conclusion
Prophylactic mesh placement remained effective in reducing incisional hernia occurrence after midline laparotomy in high-risk patients during follow-up from 2009 until 2022. Hernia rates in the primary suture group were higher than previously anticipated, with up to 62% in the AAA group.
HYBRID OPERATION TECHNIQUES ARE A PROMISING OPTION IN THE REPAIR OF VENTRAL ABDOMINAL WALL HERNIAS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Visscher L , Roovers S L , Hueting W E , Tanis P J 
Published: May 2024

Abstract

Background
Ventral abdominal wall hernias (VAWHs) can be repaired using a wide variety of techniques. Most techniques make use of a solely open or solely laparoscopic approach. Novel hybrid approaches intend to combine the advantages and lessen the disadvantages of both. This systematic review and meta-analysis aims to evaluate the complications of hybrid VAWH repair.

Methods
A literature search was performed in five online databases until August 31st 2023. All studies describing hybrid VAWH repair were included. Studies were screened and evaluated independently by two authors. Data on the occurrence of complications were extracted. Meta analyses were performed on studies comparing hybrid and laparoscopic techniques. The study protocol was registered in PROSPERO (CRD42023460789).

Results
A total of 25 studies, based on 22 study populations, were included. Only one randomized control trial has been conducted on this topic. Seven studies, comprising of 815 patients who underwent hybrid repair, made a comparison between hybrid and laparoscopic repair techniques. Fewer surgical site occurrences were seen in patients who underwent hybrid repair (OR 0.36; 95% CI: 0.20–0.64), but no significant difference was found in recurrence rates (OR 0.34; 95% CI: 0.10–1.18).

Conclusion
The hybrid approach appears to be a safe technique for the repair of VAWHs, as it shows fewer postoperative complications and recurrence rates seem promising. More controlled studies are necessary to be able to confirm the strengths of hybrid repair, as current studies are of moderate quality and only of a low level of evidence.
SURGICAL PRACTICES IN EMERGENCY UMBILICAL HERNIA REPAIR AND IMPLICATIONS FOR TRIAL DESIGN
Authors: Walshaw J , Kuligowska A , Smart N J , Blencowe N S , Lee M J 
Published: May 2024

Abstract

Background
There is variation in the investigation, management, and surgical technique of acutely symptomatic abdominal wall hernias and optimal strategies remain to be established. This survey aimed to identify key variables influencing decision-making and preferred surgical techniques in emergency umbilical hernia care to help inform trial design and understand potential challenges to trial delivery.

Methods
A survey was distributed to surgeons through social media, personal contacts, and ASGBI lists. It comprised five sections: (i) performer of repair, (ii) repair preferences, (iii) important outcomes, (iv) antibiotic use, and (v) trial design.

Results
There were 105 respondents, of which 49 (46.6%) were consultants. The median largest defect surgeons would attempt to repair with sutures alone was 2 cm (IQR 2–4cm). In the acute setting, the most common mesh preferences are preperitoneal plane placement (n = 61, 58.1%), with synthetic non-absorbable mesh (n = 72, 68.6%), in clean (n = 41, 39.0%) or clean-contaminated (n = 52, 49.5%) wounds. Respondents believed suture repair to be associated with better short-term outcomes, and mesh repair with better long-term outcomes. The trial design felt to most likely influence practice is comparing mesh and suture repair, and also comparing post-operative antibiotics versus no post-operative antibiotics. Respondents indicated that to change their practice, the median difference in surgical site infection rate and recurrence rate would both need to be 5%.

Conclusion
This survey provides insight into surgical preferences in emergency umbilical hernia management, offering guidance for a future trial design.
LAPAROSCOPIC eTEP IN ACQUIRED ABDOMINAL INTERCOSTAL HERNIA WITH PERITONEAL FLAP WITH LARGE POLYPROPELENE MESH PLACEMENT
Authors: Baste N 
Published: May 2024

Abstract

An 83-year-old Male patient presented with complaints of Swelling in the right lower chest, Right Hypochondrium and Right lumbar region.
H/O – Chronic Cough for 6 months. Swelling increases in size on coughing.
USG S/O – Right Lateral Ventral Hernia (L1 W2).
CT Abdomen S/O – 8x6 cm defect in right anterolateral abdominal wall.
Plan – Laparoscopic E-TEP with unilateral TAR Hernioplasty.
Port position.

Intraop Steps
Supine position under General Anesthesia.
Extended Retro-rectus space created from left side. Bottoms-up right-sided TAR done.
Opening of peritoneum found near defect.
A defect was identified between the right three lower ribs, with 1 rib being the content of the hernia. Evidence of Diaphragmatic hernia was seen. Thoracic contents visualised from the hernia defect. Hence, the diagnosis of acquired abdominal inter-coastal hernia was confirmed.
Omentum & Transverse Colon were also contents of the hernia.
The peritoneal Flap surrounding the defect raised superiorly till the Diaphragm, laterally to Gerota’s Fascia. Peritoneal Flaps were under tension, so the decision was taken to utilise the peritoneum flap of the hernial sac, and accordingly, peritoneal flaps were mobilised.
Diaphragmatic hernia defect sutured with non-absorbable barbed sutures.
Peritoneal defect approximated with absorbable barbed suture.
30 × 25 cm Polypropylene mesh placed in pre-peritoneal space.
Mesh fixed to the edge of the defect.
Pneumo pre-peritoneum deflated.
Ports sites closed and strapping done post op.
Post-operative recovery was uneventful, with a stay in the ICU for 3 days.
Discharged on 7th day post op.
LAPAROSCOPIC MANAGEMENT OF STRANGULATED RECURRENT INGUINAL HERNIA WITH TACKLING OF INTRAOP UNUSUAL DEFECT CLOSURE TROUBLESHOOTING
Authors: Baste N 
Published: May 2024

Abstract
65/male
Presented in casualty with pain in the abdomen, vomiting, distension, constipation, and irreducible swelling in the right inguinal region. Since 3 days.
Ultrasonography – acute intestinal obstruction. X ray of abdomen- air-fluid levels.
Plan – diagnostic laparoscopy.
Procedure – Under GA. 3 ports 1–10 mm umbilical- camera port. 2–5 mm left midclavicular line below 2 cm umbilicus. 3–5 mm right midclavicular at the level of the umbilicus.
Dilated bowel loops.
Hernia defect identified with bowel.
Loops going into defect.
Difficult to reduce bowel loop.
The decision was taken to enlarge the defect. Previously put mesh identified.
Mesh cut in neck of the sack reached with a monopolar hook. Strangulated bowel loops delivered into peritoneum.
Defect closure started with 1 number nonabsorbable barbed suture.
While suturing needle broke.
As the patient is not much afforded, we decided to go ahead with the same suture.
1 mm skin incision with stab knife on the inguinal region. Suture passer needle introduced. But the suture passer needle broke while inserting.
Next plan – prolene loop with veress needle.
Veress needle introduced from same stab incision. Barbed suture introduced into prolene loop n removed outside. Now, the same barbed suture has to go into the abdomen from the opposite side of the defect. But there is difficulty in putting barbed suture into abdomen with a prolene loop and vereses needle. 3 attempts done. Not successful. After thinking for 2–3 minutes, the decision was taken to introduce suture with a Rhoeders knot pusher. The same stab knife incision is used in the different directions. Defect closure completed with Rhoeders knot pusher.
Gangrenous bowel resection and anastomosis were done through a 4 cm laparotomy incision.