bluuebunny/crossref_metadata_2025_split huggingface dataset:
EVALUATING EHS PARASTOMAL HERNIA CLASSIFICATION FOR SURGICAL PLANNING: A RETROSPECTIVE ANALYSIS OF 160 CONSECUTIVE HyPER TECHNIQUE CASES IN A SINGLE CENTER
Authors: Szczepkowski M , Zamkowski M , Witkowski P , Przywózka-Suwała A , Śmietański M 
Published: May 2024

Abstract

Introduction
Parastomal hernia (PH) is a prevalent complication following ostomy formation, presenting significant challenges in surgical management. This study aims to validate the European Hernia Society (EHS) classification for PH through the application of the Hybrid Parastomal Endoscopic Repair (HyPER) method. The study focuses on establishing the practical utility of the EHS classification in a clinical setting, particularly in guiding surgical approaches and improving patient outcomes.

Materials and Methods
This retrospective observational study was conducted at Bielanski Hospital in Warsaw and involved a cohort of 160 patients treated using the HyPER method. Patients were classified according to the EHS criteria, and data were collected on patient demographics, clinical presentations, and surgical outcomes. The study aimed to assess the consistency and applicability of the EHS classification in predicting surgical challenges and outcomes.

Results
The study found a predominance of complex Type III and IV hernias. The EHS classification was effective in categorizing PH, aiding in surgical planning and highlighting the increased complication rates associated with more complex hernia types. This study represents the largest single-center cohort treated for PH by a single team, providing a controlled evaluation of the HyPER technique's effectiveness.

Conclusions
The validation of the EHS classification in this study is a significant advancement in the standardization of PH management. The findings demonstrate the classification’s utility in enhancing surgical planning and patient-centered care. The study also opens avenues for further research into standardized approaches and techniques in PH treatment. The single-center, single-team nature of the study, while offering consistency, invites further investigation into the generalizability of these results across different clinical settings.
STRENGTHENING PRIMARY HEALTH CARE THROUGH A LONGSTANDING GLOBAL HEALTH PARTNERSHIP: CHARTING THE TRANSITION FROM SHORT-TERM HERNIA MISSIONS TO A SELF-SUSTAINING HOSPITAL
Authors: Asubiojo B , Inchley J , Smith A , Leyden K , Wilson J , Hicks R 
Published: May 2024

Abstract

Aim
Hernia missions to low- and middle-income countries (LMIC) are well described and effectively reduce the global public health burden of this condition. When linked to wider health care interventions, education, and training, they deliver a more sustainable impact. The considerable impact of a 15-year-long global health partnership in the Savannah region of Ghana is described.

Methods
Since 2008, 13 hernia teams have visited the village of Carpenter to perform surgery. These visits have taken place alongside a team of health professionals from Canada and the UK, supported by charities and working in partnership with a Ghanaian non-governmental organisation (NGO).

Results
2,618 hernia patients, 55,000 medical patients, 6,335 eye patients and 2,120 dental patients have been treated. Scholarships support training of rural health care workers, and have supported health care management training, specialist training in obstetrics and gynaecology, general surgery and orthopaedics, pharmacy, nursing, and midwifery. In 2023, a 100-bed general hospital, the Leyaata Hospital, opened and has become the area’s essential health care hub. It offers specialist care, maternity, chronic disease management clinics, diagnostic imaging services and emergency services. The global health partnership has pivoted to teaching, training, and supporting the Leyaata house staff based on identified needs. This partnership continues to make significant contributions to UN Sustainable Development Goals 3, 4, 10, 17.

Conclusions
Humanitarian missions in the context of a longstanding global health partnership can have a considerable impact in an LMIC by strengthening primary health care, improving equity, and driving sustainable change.
DELPHI CONSENSUS STATEMENT FOR UNDERSTANDING AND MANAGING THE SUBCOSTAL HERNIA: SUBCOSTAL HERNIAS COLLABORATIVE REPORT (SCHOLLAR STUDY)
Authors: Baig S J , Kulkarni G V , Priya P , Afaque M Y , Bueno-Lledo J , Chintapatla S , de Beaux A , Gandhi J A , Garcia Urena M A , Hammond T M , Lomanto D , Liu R , Mehta A , Miserez M , Montgomery A , Morales-conde S , Palanivelu C , Pauli E M , Rege S A , Renard Y , Rosen M , Sanders D L , Singhal V K , Slade D A J , Warren O J , Wiejrathne S 
Published: May 2024

Abstract

Aim
Subcostal hernias are categorized as L1 and frequently involve M1, M2, L2 sites. The literature on subcostal hernias comprises poor-quality retrospective reviews of small heterogenous cohorts, unsurprisingly leading to no consensus or guidelines. Given the limited literature, we planned for a modified Delphi consensus to establish consensus regarding the definition, characteristics, and surgical aspects of managing subcostal hernias (SCH).

Materials and Methods
It was a four-phase Delphi study reflecting the widely accepted model, consisting of the phases: 1. Creating a steering panel and a query. 2. Building an expert panel. 3. Executing the Delphi rounds. 4. Analyzing, presenting, and reporting the results. More than 70% of agreement was defined as a consensus statement.

Results
The 22 experts who agreed to participate in this Delphi process for Subcostal Hernias (SCH) comprised 7 UK surgeons, 6 mainland European surgeons, 4 Indians, 3 from the USA, and 2 from Southeast Asia. This Delphi study on subcostal hernias achieved consensus on the following areas – definition, use of mesh in elective cases; the retromuscular position with strong discouragement for onlay mesh; use of macroporous medium-weight polypropylene mesh; use of the subcostal incision over midline incision if there is no previous midline incision; TAR over ACST; defect closure where MAS is used; transverse suturing over vertical suturing for closure of circular defects; and use of peritoneal flap when necessary.

Conclusion
This Delphi consensus defines subcostal hernias and gives insight into the incision, dissection plane, mesh placement, mesh type, and mesh fixation for these hernias.
THE IMPORTANCE OF HERNIA CENTERS TO IMPROVE ABDOMINAL WALL RECONSTRUCTION OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Balthazar da Silveira C A , Dias Rosador A C , Lima D L , Nogueira R , Sanha V , Kasakewitch J P G , Cavazzola L T , Sreeramoju P , Malcher F 
Published: May 2024

Abstract

Aim
Hernia registries report that general surgeons do not always implement guidelines and suggest that the success rate of this procedure is higher in hernia specialty centers. There are many definitions of hernia centers, but their objectives consist of improving health care by homogenizing the clinical practice. We performed a systematic review and meta-analysis to analyze hernia centers' definitions and compare outcomes for inguinal and ventral hernia repairs from hernia centers with non-specialized centers.

Material and Methods
Cochrane Central, Scopus, Scielo, and PubMed were systematically searched for studies defining a hernia center or comparing hernia centers and non-specialized centers. Outcomes assessed were recurrence, surgical site events, hospital length of stay (LOS), and operative time (OT). Statistical analysis was performed with R Studio.

Results
3,260 studies were screened and 13 studies were included. Five studies defined a hernia center and eight studies, comprising 141,366 patients, compared a hernia center with a non-specialized center. The definitions were similar, but differed in structural aspects and the steps required for the certification. We found lower recurrence rates for hernia centers for both inguinal (1.08% versus 5.11%; RR 0.21; 95% CI 0.19 to 0.23; P &lt; 0.001) and ventral hernia (2.03% versus 4,16%; RR 0.54; 95% CI 0.3 to 0.96; P = 0.03). Hernia centers also presented lower surgical site infection (RR 0.43; 95% CI 0.21 to 0.9; P = 0.03), and hematoma (RR 0.21; 95% CI 0.06 to 0.81; P &lt; 0.02) rates in ventral hernia repair.

Conclusion
Our study support that the establishment of a hernia center can improve postoperative outcomes.
TIPP VERSUS TAPP/TEP FOR PRIMARY INGUINAL HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Balthazar da Silveira C A , Dias Rasador A C , Kasakewitch J P G , Lima D L , Nogueira R , Sreeramoju P , Malcher F 
Published: May 2024

Abstract

Aim
The transinguinal preperitoneal (TIPP) technique is an open approach to groin hernia repair (GHR) with posteriorly positioned mesh supposed to reduce recurrence rates. However, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques have similar mesh positioning with the advantages of minimally invasive surgery (MIS). Hence, we performed a systematic review and meta-analysis comparing TIPP and MIS for GHR.

Material and Methods
Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing TIPP and MIS techniques for GHR. Outcomes assessed were recurrence, chronic pain, surgical site infection (SSI), seroma, and hematoma. We performed a subgroup analysis of TAPP and TEP techniques separately. Statistical analysis was performed with R Studio.

Results
81 studies were screened and eight studies were included, of which three compared TIPP with TEP technique, three compared TIPP with TAPP, and two compared TIPP with both MIS techniques. The TEP technique was associated with lower recurrence rates when compared to TIPP (0.38% versus 1.19%; RR 2.68; 95% CI 1.01 to 7.11; P = 0.04). The TIPP approach was associated with lower seroma rates when compared with MIS (RR 0.21; P = 0.002). There were no differences regarding overall recurrence (RR 1.54; P = 0.2), chronic pain (RR 1.39; P = 0.26), SSI (RR 2.51; P = 0.47), and hematoma (RR 1.2; P = 0.77) between MIS and TIPP. There was no difference in outcomes when comparing TIPP and TAPP techniques for all outcomes.

Conclusion
There may be benefit in using the MIS techniques to prevent recurrence in patients undergoing inguinal hernia repair when compared with the TIPP technique.
ANATOMICAL AND MECHANICAL PROPERTIES OF DIFFERENT ABDOMINAL WALL CLOSURE METHODS: THE NEW DAWN OF THE MECHANICAL CLOSURE OF THE ABDOMINAL WALL
Authors: Costa T 
Published: May 2024

Abstract

Aim
The closure of the abdominal wall remains one of the most debated issues in the field of hernia. Years ago we developed the usage of surgical staplers to perform this closure. That has the rationale of the small bites, with tension distribution and the usage of non-absorbable material.
However, there is a question if the stapler could hold the tension of the abdominal wall compared with a standard suture. Hence, we developed a study to compare the anatomical and mechanical properties of both types of closure.

Methods
Using a validated model, 8 male pigs, weighing between 30 and 35 kg were randomized into two groups: 1) running suture using PDS 0 and 2) Stapler (4,5 mm).
After the closure of the aponeurosis, gas was inflated into the peritoneal cavity until the evidence of friction of the aponeurosis and the tension in the wall was measured, as well as its elasticity.
Comparisons were performed using the Mann-Whitney non-parametric test.

Results
The study showed that the resistance of a continuous suture was 93 mmHg, with a standard deviation of 8.54 mmHg. The closure of the aponeurosis with a stapler showed a result of 105 mmHg, with a standard deviation of 22.73 mmHg.
There was no statistical difference (p = 0.083) between groups, showing non-inferiority of the stapler compared to the suture.

Conclusion
This study demonstrated that the stapled technique is viable compared to the standard type of closure. The non-inferior results shows that this technique may become an excellent option.
PERSISTENT MORE EMERGENCY HERNIA REPAIR BEYOND THE PANDEMIC
Authors: de Jong D L C , de Vries Reilingh T S , Hoek P E N , Zwaans W A R , Nienhuijs S W 
Published: May 2024

Abstract

Introduction
During the COVID-19 pandemic, elective surgeries including hernia repairs, were postponed, or cancelled completely. However, it has been stated previously that the volume of surgical emergency hernia repairs did not drop during this period. Due to the disruption in elective surgeries, waiting lists have increased rapidly, causing a suspected treatment delay.
To gain improve preoperative patient prioritization, the aim of this multicenter study was to track volumes of hernia surgery before, during and after the pandemic to investigate for a shift from elective towards emergency hernia surgery.

Methods
A retrospective study using hernia databases from four regional hospitals to account for altered referral patterns (elective versus emergent), capturing patients’ admissions and surgery times for both groin and ventral hernia repair was conducted. Study period was predefined from March 2019 to March 2023. Data are presented as descriptive statistics.

Results
During the historic period, 106 of 2267 hernia surgeries (4.7%) performed were defined as emergency repairs. During the pandemic, 1551 elective surgeries were executed, of which 103 (6.6%) emergencies. During the current period, the portion of emergencies dropped to 5% (205 emergency hernia repairs); (p = 0.039). A significant increase in emergent hernia cicatricalis repair during the pandemic period was found: chronologically 9.9%, 19.2% and 9.3% emergent repairs (p = 0.005).

Discussion
Regionwide data showed a 34% decline in hernia repairs during the pandemic compared to historical levels. Surgery rates are still convalescent, with a persistent proportion of emergent surgeries. These numbers emphasize the challenges in selecting patient whose hernia repair should not be postponed.
PREVENTION OF COMPONENT SEPARATION IN COMPLEX ABDOMINAL WALL SURGERY BY BOTOX PREHABILITATION: A PROPENSITY-MATCHED STUDY
Authors: de Jong D L C , Wegdam J A , Van der Wolk S , Nienhuijs S W , de Vries Reilingh T S 
Published: May 2024

Abstract

Aim
To facilitate midline fascial closure in complex abdominal wall surgery, component separation techniques (CST) are usually required. However, CST is associated with enlarged morbidity. Prehabilitation could increase the compliance of the abdominal wall and decrease the necessity of myofascial release. This can be accomplished by administration of Botulinum Toxin Type A (BTA) in the lateral abdominal wall musculature. The aim of this study was to determine the effect of BTA on the necessity to perform CST in patients with complex abdominal wall hernias.

Methods
Patients with a complex abdominal wall hernia, planned to undergo CST by myofascial release (MFR) between July 2020 and November 2022 were included. Outcome of procedures with 300U BTA 4[2–6] weeks prior to surgery, were retrospectively analyzed by comparison with propensity matched subjects of an historical group. Muscle length was assessed by CT and operative details were included.

Results
13 patients with a median hernia width of 12 cm (IQR 9–14, range 24) were prehabilitated with BTA between July 2020 and November 2022. An MFR was planned for all, however not required in 6/13 patients (46%) to accomplish midline fascial closure. A mean elongation of lateral abdominal wall musculature of 4.01 cm was seen in patients not requiring MFR. Compared to the propensity score matched control group, a 27% reduction (p = 0.08) in the need for MFR was observed.

Conclusion
There is a tendency for decrease of necessity for MFR by preoperatively administered BTA in patients with complex abdominal wall defects. Although small, as this study used propensity matched comparison, further exploration of BTA should be encouraged.
THE INCIDENCE AND SEVERITY OF ANXIETY, PAIN, SUBCLINICAL STRESS, SLEEP DISTURBANCES, AND DELIRIUM IN THE SURGICAL POPULATION: A PROSPECTIVE COHORT STUDY
Authors: Geensen R , Kakar E , Stoop J , Van Rosmalen J , Verhofstad M , Jeekel J , Klimek M 
Published: May 2024

Abstract
The BIG-5; anxiety, pain, stress, sleep impairment and delirium, are frequent problems among surgical patients. However, incidence, mutual correlations and correlations with patient related factors are still largely unknown. Therefore, a prospective cohort study was executed.
Patient inclusion occurred in 2021. Repeated, validated questionnaires were assessed daily in hospitalized, surgical patients until discharge.
500 patients were included. Postoperative pain and anxiety were found in 13.5% and 67% of participants. Impaired sleep quality and increased stress during hospitalization were found in 87.6% and 61.9% of all participants. Significant differences were found between all post-operative and pre-operative scores (p &lt; 0.001). Delirium incidence was 3.4%. Impaired postoperative sleep quality was positively correlated with hospital length of stay (ρ = 0.425, p &lt; 0.001) and surgical duration (ρ = 0.357, p &lt; 0.001). Postoperative anxiety and postoperative stress had the strongest correlation (ρ = 0.573, p &lt; 0.001). Woman had a relative risk (RR) of 1.32 (95% CI: 1.00–1.27) of postoperative anxiety compared to men. Non-oncological procedures are associated with an RR of 0.792 (95% CI: 0.63–1.00) of preoperative anxiety, RR of 0.84 (95% CI: 0.75–0.95) of postoperative anxiety and an RR of 0.84 (95% CI: 0.73–0.97) of stress, compared to oncological surgeries.
The BIG-5 are highly frequent complications in surgical patients, with an incidence of up to 87.6%. Adequate measures should be taken for prevention and treatment. Multiple correlations have been found amongst the BIG-5. The risk of BIG-5 differs in certain subgroups.
INCIDENCE OF AUTOIMMUNE DISEASE AFTER PLACEMENT OF A POLYPROPYLENE MESH: COHORT STUDY USING A NATIONAL HOSPITAL BILLING DATABASE
Authors: Gielen M J C A M , Roumen R M H , Bouvy N D , Zwaans W A R 
Published: May 2024

Abstract

Purpose
A number of patients claim to suffer from diverse systemic symptoms after surgical placement of a polypropylene (PP) implant, including unexplained fatigue, joint pain, and muscle weakness. As these complaints could resemble systemic disease, or Autoimmune disease (AID), commotion among patients exists that PP could induce such disease. The aim of this study was to identify the incidence of AID after PP-implantation, compared to controls where no PP was implanted.

Methods
In this retrospective cohort study with Dutch health insurer ‘Coöperatie VGZ’, over four million insurees were screened between January 2013 and January 2022, to identify operative procedures for inguinal hernia repair and incisional hernia repair. Cholecystectomy patients were included as controls without PP-implantation. Patients were followed from two years before, to three years after surgery, in which AID diagnoses were registered, as well as age, sex, and socio-economic status. Primary outcomes were incidence of AID after implantation of a PP mesh, and incidence of Not-Otherwise-Specified AID, compared to an index-operation without implant.

Results
The cohort consisted of 37,723 patients (19,464 inguinal/incisional hernia, 86% male vs. 18,259 cholecystectomies, 32% male). Baseline characteristics were comparable after correction by Propensity Score Matching (N = 1,500/group, Table 1). Incidence of new AID during follow-up was not statistically different between both groups (intervention 0.01 ± 0.11; control 0.01 ± 0.12; p = 0.4).

Conclusion
Incidence of AID after implantation of PP is comparable to surgery without PP-implantation, in the three years following surgery. Based on this cohort study, PP-implants do not increase medium-term risk for developing AID.Table 1.Patient characteristics after Propensity Score MatchingCharacteristicsNTotal, N = 3,000aHernia-repair with mesh, N = 1,500aCholecystectomy,N = 1,500ap-valuebSex3,000&gt;0.9 Male2,550 (85%)1,275 (85%)1,275 (85%) Female450 (15%)225 (15%)225 (15%)Age3,00061.22 (14.39)61.12 (14.43)61.31 (14.35)0.8SES3,000-0.07 (1.92)-0.06 (1.89)-0.09 (1.95)0.5AID_before3,0000.6 Absent2,949 (98%)1,477 (98%)1,472 (98%) Present51 (1,7%)23 (1.5%)28 (1.9%)AID_after3,0000.01 (0.11)0.01 (0.11)0.01 (0.12)0.4an/N (%); Mean (SD)bFisher's Exact Test for Count Data; Wilcoxon rank sum testAbbreviations: AID, Autoimmune Disease; SES, socio-economic status.
LINEA ALBA 3D MORPHOMETRIC VARIABILITY BY CT SCAN EXPLORATION
Authors: Gueroult P , Joppin V , Chaumoitre K , Di Bisceglie M , Masson C , Bege T 
Published: May 2024

Abstract

Purpose
The width of the Linea alba, which is often gauged by inter-rectus distance, is a key risk factor for incisional hernia and recurrence. Previous studies provided limited descriptions with no consideration for width, location variability, or curvature.

Aim
We aimed to offer a comprehensive 3D anatomical analysis of the Linea alba, emphasizing its variations across diverse demographics.

Material and Methods
Using open source software, 2D sagittal plane and 3D reconstructions were performed on 117 patients’ CT scans. Linea alba length, curvature assessed by the sagitta (the longest perpendicular segment between xipho-pubic line and the Linea alba), and continuous width along the height were measured.

Results
The Linea alba had a rhombus shape, with a maximum width at the umbilicus of 4.4 ± 1.9 cm and a larger width above the umbilicus than below. Its length was 37.5 ± 3.6 cm, which increased with body mass index (BMI) (p &lt; 0.001), and was shorter in women (p &lt; 0.001). The sagitta was 2.6 ± 2.2 cm, three times higher in the obese group (p &lt; 0.001), majorated with age (p = 0.009), but was independent of gender (p = 0.212). Linea alba width increased with both age and BMI (p &lt; 0.001 to p = 0.002), being notably wider in women halfway between the umbilicus and pubis (p = 0.007).

Conclusion
This study provides an exhaustive 3D description of Linea Alba’s anatomical variability, presenting new considerations for curvature. This method provides a patient-specific anatomy description of the Linea alba. Further studies are needed to determine whether 3D reconstruction correlates with pathologies, such as hernias and diastasis recti.