bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMPLICATIONS AND RECONSULTATION PATTERNS IN PREOPERATIVE WEIGHT OPTIMIZATION FOR COMPLEX ABDOMINAL WALL HERNIA SURGERY: A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Jaume-Bottcher S , Bravo-Salva A , Casajoana A , Pera M , Pereira J 
Published: May 2024

Abstract

Background
Prehabilitation is known to enhance postoperative outcomes after different surgical procedures, but no such evidence is found in abdominal wall surgery. Our aim is to analyse the complications and need for reconsultation in patients undergoing weight optimization prior to abdominal wall hernia surgery.

Methods
Prospective observational study including all patients diagnosed with complex abdominal wall hernia and IMC &gt; 30 kg/m2 between January 2019 and December 2022. Patients were included in a pre-intervention weight optimization circuit. The need for reconsultation to the emergency room or outpatient clinic during the prehabilitation period was analysed, as well as the surgical results and post-surgical complications of those patients who underwent elective or emergency hernia repair.

Results
83 patients were included (56 female, mean age 62 years, 18 patients with Charlson ≥3). The primary hernia defect averaged 7.9 cm (SD 3.9), with 4.8% having a primary ventral hernia and 37.2% having recurrent hernias. During prehabilitation, 22.9% of patients reconsulted in the outpatient clinic, while 31.3% consulted in the emergency service. 37.3% underwent surgical hernia repair, with 12.9% of them requiring emergency surgery. Postoperative complications, classified according to the Clavien-Dindo system as &gt;IIIa, occurred in 6.2% of cases. One patient (3.2%) required readmission after emergency hernia repair. After a median follow-up of 15 months, a recurrence rate of 3.2% was observed in the emergency hernia repair group.

Conclusion
Preoperative weight loss prehabilitation is associated to high outpatient-clinic consultation, emergency consultation and emergency hernia repair rates. Patients with a need for emergency surgery have worse postoperative outcomes.
AUTOIMMUNE RESPONSE TO HERNIA MESH
Authors: Jisova B , Strizova Z , Smetanova J , Benesova I , East B 
Published: May 2024

Abstract

Introduction
Hernioplasty is a widely performed surgical procedure globally. And usage of hernia mesh is often recommended. However, with the increasing prevalence of allergies and some intolerances, concerns about polypropylene have arised. So we tried to dispel the myths about allergies to hernia mesh. And in our previous research, there was no relevant information about polypropylene.

Methodology
In our database, we selected patients who underwent hernia surgery with polypropylene mesh implantation. inclusion criteria involve patients under 60 years without a history of allergy, autoimmune diseases or cancer. They provided us with a sample of venosus blood.
Database was included 34 patients in the study. 7 women and 27 men. With an additional control group of 4 women and 4 men.

Results
The initial phase of the study- lab test examination- show just a few relevant results. The control group has a higher CD4 / CD8 ratio.
Absolute number of lymphocytes was lower in the health control group, while leukocytes were elevated in study patients. Complement factor C3 is part of the innate immune system and shows variation between the two groups.
The subsequent phase of the study involved examination of specific immune reactions. Blood samples were analyzed for immune response to mesh microparticles, cultivated with T-lymphocytes.

Discussion
Although the study results are currently incomplete, we found significant differences between patients with mesh and control group. And the second part of study – the specific immune reactions will provide further insights.

Conclusion
We anticipate obtaining comprehensive results by May. And we will have clear information if polypropylene mesh should cause an autoimmune reaction.
ENDOSCOPIC RETROMUSCULAR MESH REPAIR OF SUBCOSTAL INCISIONAL HERNIA-OUR EXPERIENCE AND EARLY OUTCOME
Authors: Khetan M , Kalhan S 
Published: May 2024

Abstract

Aim
Subcostal lateral abdominal wall defects are encountered less frequently and their surgical management is difficult and not standardized. They vary in their anatomy and behaviour and can lead to significant comorbidity, therefore need to be managed differently.
We are presenting our experience of utilising the enhanced view total endoscopic preperitoneal (e-TEP) technique and Tranversus abdominis release (TAR) for the management of subcostal incisional hernia with early outcome.

Material and Methods
All patients with subcostal incisional hernia managed by e-TEP technique from August 2018 – December 2020 were included and data analysed. Besides recording patient demographics and hernia characteristics, the intraoperative findings and postoperative complications were also analysed.

Results
We found that out of total seven patients operated, 3 required hybrid approaches because of scar revision or bowel adhesions. In all patients endoscopic Rives-Stoppa with TAR is done with wide mesh coverage and defect closure. All patients had uneventful recovery except two who had small seroma formation, and one had local wound infection which were managed conservatively.

Conclusions
No best approach for lateral abdominal wall hernia repair has been described in the available literature. Regardless of the technique, it is recommended that the mesh area be much greater than the area of the hernia defect, i.e., the mesh should overlap the defect by 5–10 cm in all directions.
With our experience we want to emphasise that e-TEP TAR repair of lateral subcostal incisional hernia is feasible with acceptable postoperative complication rates.
PROSPECTIVE COHORT STUDY OF THE CAROLINAS EQUATION FOR QUALITY OF LIFE IN MULTIPLE LANGUAGES AMONGST THE ASIAN POPULATION AFTER INGUINAL HERNIA SURGERY
Authors: Loo L M A , Mani H , Arunoda M K P D , Madeeha A , Richie G , Lee K F S , Wijerathne S , Lomanto D 
Published: May 2024

Abstract

Introduction
Despite the ubiquity of inguinal hernia repair, evidence remains sparse about the validity of tools that assess post-repair Quality of Life (QoL) outcomes in Asian populations. This prospective observational study assessed the QoL outcomes post-surgical repair via the Carolinas Comfort Scale (CCS) to validate translated versions in the multi-lingual Singaporean population.

Methods
Patients undergoing elective inguinal hernia repair surgery were enrolled in this study from the National University Hospital (n = 156). Clinical data was extracted from electronic records. QoL was assessed using CCS administered at 4 time-points: pre-operatively (baseline), and post-operatively short-term (1 day–POD1), mid-term (3 months–POD3M) and long-term (1 year–POD1Y), available in English, Mandarin and Malay.

Results and Discussion
Median age and BMI of this cohort were 65 years and 23.39 kg/m2 respectively with a preponderance of males (92.9%), laparoscopic surgery (91.6%) and bilateral operations (65.6%). Post-surgery, while the mean scores for sensation of mesh, pain and movement limitation all decreased with time, only the reduction in pain scores between baseline and POD1 was statistically significant. ASA status was determined to be a significant risk factor for all 3 aspects at POD3M whilst age, race, BMI, ASA status, previous abdominal surgery, laterality of operation, smoking history and surgical approach did not significantly affect the QoL outcomes at baseline and POD1. However, smoking history and laterality of operation significantly affected scores at POD1Y.

Conclusion
QoL in terms of pain significantly improved in the immediate post operative period. Risk factors for poorer long-term QoL outcomes included worse ASA status, smoking history and unilateral operations.
THE IMPACT OF A CLOSING PROTOCOL (CP) IMPLEMENTATION ON WOUND MORBIDITY IN ABDOMINAL WALL RECONSTRUCTION (AWR) WITH MESH
Authors: Lorenz W , Polcz M , Holland A , Scarola G T , Ku D , Kercher K , Ayuso S , Augenstein V , Heniford B 
Published: May 2024

Abstract

Background
Wound complications (WC) are associated with increased cost, recurrence, and mesh infection. Operative CPs have not been evaluated in AWR. Our aim was to evaluate the effect of a CP on wound infection (WI) and WC.

Method
A prospective, institutional database was used to compare AWR with and without CP. Descriptive statistics and a Bayesian Structured time series analysis (BSTA) were performed to evaluate rates of WI and WC. Data is reported as means unless stated. The CP involves antibiotic wound irrigation, glove and instrument exchange, re-draping the field, surgeon-only handling the mesh prior to mesh implantation. The introduction of on-going quality improvement efforts were accounted for in the model.

Results
A total of 2541 patients were examined with an age of 57.9 ± 12.6 years, 56.7% female, BMI 32.9 ± 9.8 kg/m2, 24.2% diabetic, and 41.2% former-smokers. Defect size was 203.1 ± 205.8 cm2 and 83.1% were CDC Class 1 or 2 wounds. Follow-up was 31.5 ± 41.4 months. Overall WI and WC rate decreased after CP (14.5% vs. 2.6% and 29.3% vs. 10.3%, P &lt; 0.001). Specifically, the rate of wound cellulitis (9.7% vs. 2.7%, P &lt; 0.001), wound infection (13.8 vs. 1.8%, P &lt; 0.001), and mesh infection (2.1% vs. 0.6%, P &lt; 0.004) were reduced after CP.
For WI, BSTA revealed a relative effect of 83% (±2%, 95%CI:-87%,-78%; P = 0.0002) reduction compared to counterfactual. For WC, the BSTA revealed a relative effect reduction compared to counterfactual of 67% (±3%, 95%CI:-60%, -72%; P = 0.0002).

Conclusion
Introduction of a CP prior to mesh implantation in open AWR led to a significant reduction in overall wound infections and wound complications. The use of a CP should be strongly considered.
IS MESH TERROR ENDEMICAL? A GEOGRAPHICAL ANALYSIS OF TRENDS
Authors: Martin-del-Campo L A , Cethorth Fonseca R K 
Published: May 2024

Abstract

Introduction
Mesh reinforcement for hernia repair has demonstrated to reduce recurrence rates for many scenarios of ventral and inguinal defects. In recent years, many hernia surgeons from specific geographies have encountered patients who feel strongly against the use of mesh, while physicians from other areas of the world have not reported this situation. This study aims to explore the regional trends associated with this phenomenon.

Methods
A global Google Trends search using the query “hernia”, “mesh complications” and “hernia mesh lawsuit” was used for data analysis. Search results are normalized to the time and location of a query by the following process: each data point is divided by the total searches of the geography, language, and time range it represents to compare relative popularity. The popularity index is represented as a percentile.

Results
An increase in popularity of hernia-related topics has been consistent for the past 15 years and this phenomenon has been consistent almost worldwide. The search term “mesh complications” also showed an increase in popularity mainly among English-speaking countries: the average popularity index since 2004 for this term has been 12% for the United States, 8% for the United Kingdom and &lt;1% for Australia. “Hernia mesh lawsuit” has shown a significant increase in its popularity within the United States with an average popularity index score of 4% since 2004 and growing to 10% after 2016; while remaining relatively low (1–2%) for the rest of English-speaking countries. Even after adjusting for proportionality, non-English (Spanish, Mandarin, Portuguese and Hindi) mentions of “mesh complications” and “hernia mesh lawsuit” were significantly less frequent and were, in fact, very often advertising translations of legal firms within the United States.

Conclusion
Parallel to a global increase in the interest in hernia knowledge, there has been an escalation in the search for mesh complications information especially within the United States. This increase appears to be related to a surge in law firm advertising for hernia related issues. Further studies should focus on improving understanding of the general public perception and refining education mechanisms to assist patients and surgeons.
MESH TO DEFECT RATIO (MDR) IN OPEN VENTRAL HERNIA REPAIR (OVHR): DOES SIZE REALLY MATTER?
Authors: Mead B S , Lorenz W R , Holland A M , Scarola G T , Heniford B T , Augenstein V A 
Published: May 2024

Abstract

Background
There is limited data concerning adequate mesh overlap in OVHR. Recommendations of 5 cm of mesh overlap exist primarily in the context of small-to-medium sized hernias repaired laparoscopically, yet there is little substantive information supporting this. Some consider that MDR, rather than simple overlap, may be a more physiologically appropriate approach. The goal of this study was to examine MDR in OVHR and its association with hernia recurrence.

Methods
A prospective, institutional database was queried for OVHR performed by general surgeons (GS) versus fellowship trained hernia surgeons (HS) Forty cases were propensity score matched on hernia defect size, mesh location, and procedure date by each group. The patient’s demographics, mesh size, defect size, hernia recurrence rates and composite postoperative wound complications were analyzed using standard descriptive and inferential statistical analyses.

Results
A total of 80 patients were examined, there were no significant differences in age, sex, BMI or tobacco use. There was no difference in mean hernia defect size (HS:105 cm2 vs. GS:116 cm2; p = 0.703). HS tended to use larger mesh (559 ± 434 cm2 vs. 426 ± 333 cm2; p = 0.187) with a larger MDR (13.3 ± 15.8 vs. 9.0 ± 8.1; p = 0.161), but not significantly so. At an average follow-up of 46 months, HS had a significantly lower rate of hernia recurrence (5% vs. 25%; p = 0.025) and post-operative wound complications (17.5% vs. 37.5%; p = 0.024).

Conclusions
HS had significantly lower rates of hernia recurrence and wound complications after OVHR. MDR, while not statistically significant in this small study, may play a role in reducing hernia recurrence.
ANTERIOR RECONSTRUCTION OF THE ESOPHAGEAL HIATUS: A NOVEL APPROACH FOR THE REPAIR OF LARGE DIAPHRAGMATIC HERNIAS
Authors: Messer N , Ben Yehuda A , Idan C , Mimouni I , Warnaar N , Szold A 
Published: May 2024

Abstract

Introduction
Paraesophageal hernias (PEH) often require surgical repair. The standard approach, primary posterior hiatal repair, has been associated with a high recurrence rate. Over the past few years, we have developed a new approach for repairing these hernias, which we believe restores the original anatomy and physiology of the esophageal hiatus. Our technique includes anterior crural reconstruction with routine anterior mesh reinforcement and fundoplication. This study aims to determine the safety and clinical success of anterior crural reconstruction with routine mesh reinforcement.

Methods
Data were collected on 178 consecutive patients who had a laparoscopic repair of a symptomatic primary or recurrent PEH between 2011 and 2021 using the above technique. The primary outcome was clinical success, secondary outcome was 30 days major complications and patient satisfaction. This was assessed by imaging tests, gastroscopies, clinical examination, and direct contact with each patient.

Results
Mean follow-up is 65 (SD 37.1) months. No intraoperative or 30-day postoperative mortality or major complications were recorded. Recurrence rate requiring a re-operation was 8.4% (15/178). Radiological and gastroenterological evidence of minor type 1 recurrence was 8.9%.

Conclusion
This novel technique is safe with satisfactory long-term results. The outcome of our study will hopefully motivate future randomized control trials.
EVALUATING THE IMPACT OF LIFTING MANDATORY SMOKING CESSATION PRIOR TO ELECTIVE ABDOMINAL WALL RECONSTRUCTION. A SINGLE-CENTER EXPERIENCE
Authors: Messer N , Melland M S , Miller B T , Krpata D M , Beffa L R A , Tu C , Petro C , Maskal S M , Ellis R C , Rosen M J , Prabhu A S 
Published: May 2024

Abstract

Introduction
Many studies identify active smoking as a significant risk factor for postoperative wound and mesh complications in patients undergoing abdominal wall reconstruction surgery. However, our group conducted an analysis that revealed similar rates of surgical site infection (SSI) and surgical site occurrence requiring procedural intervention (SSOPI) between active smokers and non-smokers (1). As a result, the Cleveland Clinic Center for Abdominal Core Health instituted a policy change where active smokers were no longer subject to surgical delay.
In this analysis, we compared the effect of this policy change on clinical outcomes and wound morbidity.

Methods
We identified active smoking patients who had undergone open, elective, clean ventral hernia repair (VHR) with transversus abdominis release (TAR) and permanent synthetic mesh. Propensity matching was performed to create a 1:3 ratio of "current-smokers" and "never-smokers" and compared wound complications and all 30-day morbidity.

Results
106 current-smokers and 304 never-smokers were matched. Rates of SSI (12.2% vs. 6.9%, p = .13), SSO (21.7% vs. 13.2%, p = .052), SSOPI (11.3% vs. 6.3%, p = .13), and reoperation (1.9% vs. 3.9%, p = .53) were not significantly different between active smokers and never-smokers correspondingly. The current-smokers group exhibited a significantly higher incidence of pneumonia compared to the never-smokers group (5.7% vs. 0.7%, p = .005).

Conclusion
Operating on active smokers did result in a slight increase in wound morbidity, although it did not reach statistical significance. However, we did not see any mesh infections in the smoking group during early follow-up.
EFFECTIVENESS OF TOTAL EXTRAPERITONEAL HERNIA CORRECTION FOR CLINICALLY OCCULT INGUINAL HERNIA (EFFECT-TRIAL) – A MULTICENTRE RANDOMIZED CONTROLLED TRIAL
Authors: Meuzelaar R R , Verleisdonk E J M M , den Hartog F P J , Schiphorst A H W , Tanis P J , Burgmans J P J ,   EFFECT Triallists’ Collaboration
Published: May 2024

Abstract

Background
Groin pain in adults is a common complaint in surgical practice, often related to an inguinal hernia (IH). An IH is occult when it is detected on ultrasound, but the patient does not manifest any clinical signs. Current international guidelines lack specific recommendations for managing occult IH accompanied by groin pain, potentially leading to unnecessary surgical interventions and inadequate patient counselling. This multicentre randomized controlled trial aimed to determine whether watchful waiting (WW) is non-inferior to totally extraperitoneal (TEP) repair in terms of pain for this condition.

Method
The primary outcome was the difference in pain scores between baseline and 3 months of follow-up, measured at rest and during exercise, in patients with groin pain and occult IH. Total follow-up was 12 months. Secondary outcomes included quality of life, patient satisfaction and cross over.

Results
Ninety-nine patients were randomized, of which 14 participants had withdrawn before treatment. A total of 85 patients (TEP repair n = 36, WW n = 49) were included in an as-treated analysis. At three months of follow-up, the difference in pain scores at rest (p = 0.691) and during exercise (p = 0.139) were comparable between both groups. Equivalence tests were significant for the primary outcome (p &lt; 0.001), which indicated similarity. After three months, six patients (12%) crossed over from the conservative to the operative arm. Other outcome parameters were not significantly different.

Conclusion
The EFFECT-trial suggests that WW is non-inferior to TEP repair regarding pain 3 months after the start of treatment in patients with groin pain and occult IH.
EFFICACY AND SAFETY OF BILAYERED POLYPROPYLENE MESH FOR TEMPORARY ABDOMINAL CLOSURE: A PROSPECTIVE MULTICENTRIC STUDY
Authors: Munoz-Rodriguez J M , Román García de León L , Gil Cidoncha L , Grillo Marin C , Fernández Rodríguez M , Valle de Lersundi R , Medina Pedrique M , Garcia-Urena M A , Blazquez Hernando L A , Lopez-Monclus J 
Published: May 2024

Abstract

Background
This study evaluates the efficacy and safety of a bilayered reticular and laminar polypropylene (PLP) mesh for temporary abdominal closure in managing open abdomen cases.

Methods
A prospective multicentric study was conducted involving consecutive patients with the open abdomen of any aetiology. Temporary abdominal closure utilized a bilayered PLP mesh, with an intraperitoneal laminar 30 × 40 cm PLP layer covering viscera and a 30 × 40 cm large pore PLP layer tailored to defect size and sutured to the fascial border. Reticular PLP plicatures were performed based on clinical evolution. Post-treatment, the mesh was explanted, and attempts were made for complete fascial closure.

Results
Thirty-four patients (vascular: 29.4%, sepsis: 29.4%, trauma: 14.7%, abdominal compartment syndrome (ACS): 14.7%, prevention of ACS: 11.8%) participated, mean age 63 years (range 19–86), 52.9% females. Ten patients died before achieving full abdominal wall closure. Twenty-four patients achieved a mean open abdomen duration of 9.12 days (range 1–53), all achieving total fascial closure with no observed adhesions between visceral and parietal peritoneum. Five patients were lost to follow-up. During mean follow-up of 14.13 months (range 2–33) for fifteen patients, one (6.6%) developed an incisional hernia.

Conclusion
Temporary abdominal closure with bilayered reticular and laminar polypropylene mesh is safe and effective, achieving 100% fascial closure. This approach shows promise in managing open abdomen cases across various etiologies, including vascular, trauma, ACS, and sepsis scenarios.
USE OF MESH REPAIR IN HIATAL HERNIAS: OUR EXPERIENCE
Authors: Navarro-Morales L , Licardie-Bolaños E , Moreno-Suero F , Morales-Conde S 
Published: May 2024

Abstract

Aim
The use of meshes, their composition and fixation as reinforcement in hiatal hernia (HH) is currently controversial. The aim of this study is to evaluate the safety of the use of mesh in hiatoplasty, as well as to compare the medium-term results between absorbable and non-absorbable prosthesis.

Methods
Prospective study of a series of cases of patients with hiatal hernia operated on in our center between July 2010 and December 2023. In all cases, reinforcement hiatoplasty with prosthesis. Intra-surgical and post-operative complications were recorded. Clinical and radiological recurrence was evaluated.

Results
A total of 84 patients were operated on, in 12 cases (14.3%) a APTC mesh was placed, in 38 (45.2%) a cPTFE mesh and 34 (40.5%) a P4HB mesh.
The percentage of overall clinical recurrence that we found occurred in 6 patients (7.1%). Radiological recurrence occurred in 9 patients (10.7%), of which 4 (10.5%) were treated with cPTFE mesh and another 4 (11.8%) with P4HB mesh, and 1 (8.3%) with APTC mesh. No statistically significant differences.
2 (16.7%) in the APTC group had some complication, 11 (28.9%) in the cPTFE group and 7 (20.6%) in the P4HB group.

Conclusions
No cases of serious intra- or posto-perative complications have been reported.
The main medium-term complication was dysphagia with no differences between groups.
There are no statistically significant differences in clinical or radiological recurrence between patients treated with different prosthetic materials.