bluuebunny/crossref_metadata_2025_split huggingface dataset:
LONG TERM INGUINAL PAIN COMPARING TEP TO LICHTENSTEIN REPAIR – THE TEPLICH RCT 8 YEARS FOLLOW-UP
Authors: Gutlic A , Petersson U , Rogmark P , Montgomery A 
Published: May 2024

Abstract

Aim
To investigate long-term chronic postoperative inguinal pain (CPIP), QoL and recurrence in patients with a primary inguinal hernia comparing TEP to Lichtenstein.

Material and Methods
A questionnaire-based follow-up containing the Inguinal Pain Questionnaire (IPQ), the Cunningham Pain Scale and SF-36 was done 8 years after the TEPLICH RCT. The primary end-point was non-ignorable pain last week according to IPQ. A phone interview was performed with patients reporting new non-ignorable pain and those having a suspected recurrence. Records were scanned for long-term CPIP and recurrences. A lost to follow-up analysis was performed.

Results
A total of 322 of 366 patients (88%) completed the follow-up of mean 7,94 years (5–10,75 years). Non-ignorable pain last week was reported by 7,6 % in TEP and 6,7% in Lichtenstein (p &lt; 0,73). New non-ignorable pain was reported by 4 patients. No difference in non-ignorable pain over time (1 to 8 years) was observed within groups. Moderate to severe pain, according to Cunningham, was reported by 3,8% in TEP and 5,5 % in Lichtenstein (p &lt; 0,48). QoL remained above the Swedish norm. No recurrences occurred after 3 years follow-up. The lost to follow-up analysis showed no difference in non-ignorable pain.

Conclusions
RCTs, comparing TEP to Lichtenstein repair with follow-up ≥5 years regarding CPIP are sparse with conflicting data. In this study, low frequencies of CPIP present at 3 years seem to persist at 8 years. Recurrences occured within the first 3 years. Patients need to be informed of the risk of long-term CPIP.
LAPAROSCOPIC INGUINAL HERNIA SURGERY CAN BE SAFELY PERFORMED IN A DAY SURGERY CENTRE
Authors: Hayward R , Smith J J , O’Brien P , Teare J , Warren O J 
Published: May 2024

Abstract

Background
Laparoscopic inguinal hernia repair is among the most frequently performed day-case operations. Ambulatory surgery centres alleviate pressures on acute provider hospitals and reduce patient anxiety and nosocomial infection risk. However, concerns remain regarding the safety of these facilities and occurrence of complications that may require inpatient stay.

Method
In 2020, a dedicated day surgical unit was established in London with no inpatient beds, requiring patients to return home on the day of their operation. A prospective database was established for patients undergoing laparoscopic totally extraperitoneal inguinal hernia repair by one experienced consultant surgeon, with routine follow-up occurring at 3–6 weeks post-operatively.

Results
70 patients were operated on between August 2020 and January 2024, 87%male, median age 47 years. ASA grade was 1 or 2 in all patients.
There were no major complications, conversions to open, blood transfusions, admissions for overnight stay, emergency admission to hospital within 30 days, or recurrences, with a median length of follow-up of 1.4 years.
68 patients (97%) made a complication-free recovery. Superficial wound infection at the umbilical port, requiring oral outpatient antibiotics, occurred in 2 patients.

Conclusion
This dataset demonstrates the ability to safely perform laparoscopic inguinal hernia repair in an entirely ambulatory facility with no major complications, no conversions to open and a 0% admission rate in well-selected patients. Ambulatory units place constraints on the surgeons and anaesthetists involved and therefore must occur under strict patient selection and clinical governance. The collection and reporting of prospective safety data helps this process.
THE IMPACT OF PREOPERATIVE BOTULINUM TOXIN A (BTA) INJECTION ON SUBXIPHOID (M1) HERNIA REPAIRS
Authors: Holland A , Lorenz W , Ayuso S , Ku D , Scarola G , Augenstein V , Heniford B T , Polcz M 
Published: May 2024

Abstract

Background
Preoperative relaxation of the abdominal wall with Botulinum Toxin A (BTA) injection can assist with fascial closure and decrease the need for component separation (CST). Its efficacy in subxiphoid (M1) hernias is unclear with high rates of CST reported despite BTA. For M1 hernias requiring CST, we assessed whether use of preoperative BTA offered any additional benefit toward fascial closure or recurrence rates.

Methods
A tertiary hernia center’s prospectively maintained database was reviewed for M1 hernias, as defined on CT imaging. Patients who underwent subsequent CST were grouped based on whether preoperative BTA injections were performed.

Results
Of 67 M1 hernia patients, 30 (44.8%) received BTA and 37 (55.2%) did not. BTA versus non-BTA groups had similar age (56.0 ± 14.1 vs. 61.5 ± 11.8 years; P = 0.087), ASA score, diabetes history, and defect size (499.2 ± 185.5 vs. 416.1 ± 238.6 cm2; P = 0.144). BTA group had lower BMI (28.9 ± 5.1 vs. 32.7 ± 7.2 kg/m2; P = 0.018), fewer current and former smokers (0% vs. 10.8%, 40.0% vs. 62.2%; P = 0.006), more contaminated and dirty cases (20.0% vs. 5.4%, 33.3% vs. 13.5%; P = 0.008), and more biologic mesh used (62.1% vs. 35.1%; P = 0.046). Neither panniculectomy rates nor CST techniques differed (external oblique release: 80.0% vs. 62.2%; P = 0.179, posterior rectus sheath release: 70.0% vs. 67.6%; P &gt; 0.999, transversus abdominus release: 26.7% vs. 35.1%; P = 0.598). Rates of unilateral versus bilateral CST were not statistically different. There were no differences in fascial closure (90.0% vs. 94.6%; P = 0.650), recurrence (6.7% vs. 2.7%; P = 0.583), or in-total wound complication rates (33.3% vs. 43.2%; P = 0.458) between BTA and non-BTA groups with follow-up of 12.7 ± 18.8 versus 24.1 ± 28.2 months (P = 0.062).

Conclusions
M1 hernia repair often requires CST despite BTA injections. BTA as a preoperative adjunct in this population does not benefit fascial closure rates, risk of recurrence, or frequency of bilateral CST.
LAPAROSCOPIC (L) VERSUS OPEN INGUINAL HERNIA REPAIR (OIHR): HOW ROBUST IS THE DATA? A SYSTEMATIC REVIEW AND FRAGILITY ASSESSMENT OF RANDOMIZED CONTROLLED TRIALS COMPARING LAPAROSCOPIC AND OPEN INGUINAL HERNIA REPAIR
Authors: Holland A , Lorenz W , Hollingsworth R , Scarola G , Augenstein V , Ayuso S , Heniford B T 
Published: May 2024

Abstract

Background
For three decades there has been significant debate over LIHR versus OIHR regarding recurrence, pain, and morbidity. This study assessed the robustness of evidence supporting either approach through a fragility analysis. The fragility index (FI) measures the minimum number of participants whose outcome would have to change to turn a significant result non-significant. The reverse fragility index (RFI) calculates the fewest number of events that would convert a non-significant result.

Methods
A systematic search of PubMed, Wake Forest Library, and Google Scholar was performed for randomized controlled trials (RCTs) comparing OIHR and LIHR with dichotomous outcomes from 1995–2023. FI and RFI were calculated for significant and non-significant outcomes, respectively. FI/RFI ≤ 3 were considered fragile.

Results
Review of 319 studies yielded 28 RCTs with a median of 141.5 (Q1, Q3: 103.0, 283.0) participants and 47 primary or secondary outcomes, including recurrence (n = 24), postoperative complications (n = 16), and chronic pain (n = 7). The median FI of all outcomes was 1.0 (1.0, 4.0), and RFI was 4.0 (3.0, 6.0), exhibiting substantial fragility in the significant results. Individually, recurrence, complications, and pain demonstrated median FIs of 3.0, 1.0, and 4.0, respectively. Sixteen (57.1%) RCTs had more participants lost to follow-up (LTFU) than the FI/RFI.

Conclusions
Of the inguinal hernia RCTs that demonstrate significant outcomes, 64.3% draw fragile conclusions. The overall FI of 1.0 indicates that a change in a single outcome could reverse the significance of the trial. Further, 57.1% of RCTs had more participants LTFU than FI/RFI, further weaking these studies’ conclusions. Inguinal hernia RCTs are remarkably fragile.
A.I. MACHINE LEARNING MODEL RELIABLY PREDICTS SUCCESS OF INGUINAL HERNIA REPAIR TO RESOLVE CHRONIC PELVIC AND GROIN PAIN
Authors: Huynh D , Dale R , Oh C , Towfigh S 
Published: May 2024

Abstract

Background
The differential diagnoses of chronic pelvic pain (CPP) and groin pain are vast and may include inguinal hernia (IH) as well as orthopedic, urologic, and gynecologic disorders.

Methods
A 50-point Hernia Health Questionnaireⓒ (HHQ) was administered prospectively to all patients with CPP or groin pain who underwent inguinal hernia repair. Patients were followed for resolution of preoperative symptoms as the endpoint.
The machine learning model randomly split patients into blinded training and testing sets followed by Random Forest modelling of postoperative symptom resolution. Recursive Feature Elimination identified optimal predictive variables from the HHQ. Bootstrapping determined confidence interval.

Results
Between 2008 and 2022, 494 patients underwent primary IH repair. Mean age was 52 years, mean BMI 26.2 kg/m2, and 202 (41%) were female. Postoperative resolution of preoperative pain was confirmed in 426 (86%).
Random Forest model exhibited strong predictive performance, with high two-sided 95% confidence interval (0.72, 0.91, median 0.83). Significant predictors of IH included female sex (p &lt; 0.001), location/radiation of pain (p &lt; 0.001), painful intercourse (p = 0.02), pain medications preoperatively (p &lt; 0.001), and history of hernia in a female family member (p = 0.02).

Conclusion
We present the first A.I. model to reliably predict whether repairing IH will resolve the patient’s CPP or groin pain. This can be valuable to surgeons and non-surgeons, with the aim of reducing delay in diagnosis and treatment of patients with enigmatic CPP or groin pain.Figure 1:Receiver Operator Characteristic of Random Forest Model on Test Set
A COMPARATIVE ANALYSIS OF FOUR PROMS TO ASSESS MEDIUM TO LONG-TERM PATIENT SATISFACTION FOLLOWING OPEN MIDLINE INCISIONAL HERNIA REPAIR
Authors: Kulkarni G , Attafi W , Nanthakumaran P , Barnes D , Hammond T 
Published: May 2024

Abstract

Purpose
Patient-reported outcome measures (PROMs) are increasingly recognised as the most important metric for evaluating outcomes after hernia repair. The study aim was to evaluate patient satisfaction using 4 different PROMS following open repair of midline incisional hernias.

Methods
72 patients with midline incisional hernias underwent open retrorectus mesh repair, with or without component separation, and concurrent abdominoplasty between 2016–2022. They were invited to complete four PROMs including the Carolinas Comfort Scale (CCS, range 0–115), Brehaut decision regret scale (BDRS, range 5–25), Abdominoplasty questionnaire (Q-PROM, range 7–28) and Patient Scar Assessment Scale (PSAS; range 6–60).

Results
50 out of 72 responses were received and analysed. The mean age of respondents was 60.6 years. The mean post-operative PROMs responses were 1260 days (range 366–2553, SD 894.3 days). Overall, the mean CCS score was 11.36 (range 0–68, SD 16.98), mean BRDS 7.10 (range 5–20, SD 3.24), mean abdominoplasty score 20.51 (range 7–28, SD 6.07) and mean PSAS score 17.36 (range 6–44, SD 11.7).

Conclusion
After open mesh repair of midline incisional hernias nearly all patients had self-reported highly satisfactory outcomes and quality of life in the medium to long term. Embedding PROMs into follow-up regimes improves understanding of post-operative outcomes, enables better decision making and development of management strategies.
THE IMPACT OF SMOKING ON VENTRAL AND INGUINAL HERNIA POSTOPERATIVE OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Lima D L , Kasmirski J , Balthazar da Silveira C A , Rasador A C , Kasakewitch J P G , Nogueira R , Malcher F , Sreeramoju P 
Published: May 2024

Abstract

Aim
Active smoking is associated with poor outcomes after hernia repair, but a comprehensive consensus or systematic review is lacking in the literature. Hence, we performed a systematic review and meta-analysis to assess the impact of smoking on the outcomes after ventral hernia repair (VHR) and inguinal hernia repair (IHR).

Materials and Methods
A systematic literature review was conducted in Cochrane Central, Scopus, SciELO, and PubMed/MEDLINE databases on studies mentioning smoking and IHR and VHR outcomes.

Results
Out of 3,296 studies, 35 met the inclusion criteria. These comprised 18 studies (123,506 patients) on VHR and 17 studies (204,337 patients) on IHR. The analysis revealed that smokers had significantly higher rates of SSO (13.6% vs. 12.4%; RR 1.5; 95% CI [1.15; 1.95]; P = 0.002) and SSI (6.51% vs. 4.1%; RR 1.8; 95% CI [1.29; 2.5]; P &lt; 0.001) following VHR. No significant differences were observed in recurrence (RR 1.36; 95% CI [0.94; 1.97]; P = 0.102), seroma (RR 2.63; 95% CI [0.88; 7.91]; P = 0.084), and reoperation rates (RR 1.48; 95% CI [0.77; 2.85]; P = 0.236) for VHR. Additionally, smokers undergoing IHR showed higher recurrence (9% vs. 8.7%; RR 1.91; 95% CI [1.21; 3.01]; P &lt; 0.01), SSI (0.6% vs. 0.3%; RR 1.6; 95% CI [1.21; 2.0]; P &lt; 0.001), and chronic pain (9.9% vs. 9.9%; RR 1.24; 95% CI [1.06; 1.45]; P &lt; 0.01) rates.

Conclusions
There is a clear association between smoking and adverse outcomes in both IHR and VHR based on this meta-analysis. It highlights the need for preoperative counseling for smokers undergoing these procedures and clinical awareness of poor outcomes.
INCISIONAL HERNIA AND ITS INFLUENCE ON ABDOMINAL WALL STRENGTH: A CASE-CONTROL STUDY
Authors: López-Huerta A , Martínez-Núñez S , Gil-Delgado J L , Feria-Madueño A , Tallón-Aguilar L , Padillo-Ruiz J 
Published: May 2024

Abstract

Background
Incisional hernia (IH) might lead to a weakened abdominal wall, potentially reducing patients' functionality. This study aims to assess abdominal muscle strength in patients with IH and compare it with that of healthy subjects.

Method
This prospective case-control study included 80 subjects, 40 patients diagnosed with IH (classified as W2-3 by the European Hernia Society Classification) and 40 healthy controls. IH patients were matched with those without abdominal wall disorders, based on gender, BMI, age, and body composition. Patients were assessed using a strain gauge, performing trunk isometric contractions at 90° and 45°, to measure the anterior abdominal wall and lateral abdominal musculature, respectively.
Peak force and the rate of force development at 90° and 45° were compared between groups.

Results
Patients with IH exhibited a substantial 20% reduction in abdominal wall function. Abdominal wall strength significantly decreased in the IH group compared to controls in both the anterior abdominal wall at 90° (mean peak force: 208.61 vs. 169.2, p = 0.001; mean rate force development: 741.73 vs. 366, p = 0.003) and lateral musculature at 45° (mean peak force: 195.49 vs. 151.63, P = 0.001; mean rate force development: 552.27 vs. 302.90, p = 0.001). Regression analysis (p = 0.001, R2 = 0.43) revealed that gender (P = 0.000) and BMI (P = 0.004) significantly affected abdominal strength. For each centimeter increase in maximum hernia diameter, strength decreased by 5 newtons.

Conclusions
Patients with IH experience a significant decline in abdominal wall strength and rapid force production capacity compared to their healthy counterparts.
DEFECT SIZE AND BIOLOGIC MESH OVERLAP: DOES IT INFLUENCE OUTCOMES IN COMPLEX ABDOMINAL WALL (AWR)?
Authors: Lorenz W , Holland A , Mead B , Scarola G , Colavita P , Kercher K , Heniford B , Augenstein V 
Published: May 2024

Abstract

Background
Data does not exist to suggest a mesh to hernia defect area ratio (M:HDR) in AWR. Furthermore, the data are very limited in this respect for biologic mesh. Our aim was to evaluate whether biologic M:HDR or defect size influences outcomes in AWR.

Method
A prospectively maintained hernia database at a tertiary hernia center was queried for all open ventral hernias repaired with a biologic mesh (2003–2023). Patients were stratified by terciles based on defect size, &lt;168 cm2 (HD1), 168–299cm2 (HD2), and ≥300 cm2(HD3). Univariate analysis and multivariable regression were performed.

Results
Overall, 408 patients were evaluated. There were 142, 132, and 134 patients in the HD3,2,1 groups respectively. There were differences in race (Caucasian:86.6% vs. 81.8% vs. 76.1%, P = 0.047), sex (female:43.7% vs. 50.8% vs. 66.4%, P = 0.0005), age (57.9, 61.3, 56.3 years, P = 0.003), ASA score (ASA 3: 54.9% vs. 54.5% vs. 41.8%, P = 0.004) and recurrent hernias (66.2% vs. 59.1% vs. 51.5%, P = 0.045). The rate of diabetes, COPD, overall comorbidities, smoking, and BMI were similar. There was no difference in wound class.
HD3 had more component separations (72.5% vs. 52.3% vs. 39.6%, P &lt;0.0001). Fascial closure was achieved in all patients. HD3 had larger mesh (804.1 vs. 616.9 vs. 416.9 cm2, P &lt;0.0001), longer operative time (246.2 vs. 204.6 vs. 198.3 minutes), and smaller M:HDR (2.0 vs. 2.7 vs. 5.4, P &lt;0.0001).
HD3 patients had longer length-of-stay (11.0 vs. 8.3 vs. 7.6 days, P = 0.0002) and ICU admissions (6.3% vs. 0% vs. 2,2%, P = 0.007). Wound complication and respiratory-failure rates were not different. Hernia recurrence was similar between groups (8.5.vs. 8.2 vs. 3.8, p = 0.227) with 24.5-months follow-up. On logistic regression, the wound complication rate was an independent predictor of recurrence (OR = 3.95,CI [1.82,8.6], P = 0.0005).

Conclusion
HD3 were more complex, had larger hernia defects and mesh size, but smaller M:HDR. Despite this, wound complications and recurrence rate were similar between groups. Fascial closure with biologic mesh reinforcement provides a durable repair across defect sizes despite varying mesh overlap.
LONG-TERM EVALUATION OF THE HERNIA COMPACT COURSE OF THE GERMAN HERNIA SCHOOL
Authors: Lorenz R , Paasch C , Stechemesser B , Reinpold W , Niebuhr H , Fortelny R H , Mayer F , Köckerling F , Mantke R 
Published: May 2024

Abstract

Introduction
Since 2011, the German Hernia Society has developed the German Hernia School (GHS) as a standardized hernia surgery training program for younger surgeons, consisting of the Hernia Compact basic module. It is a standardized three-day training program (cadaver workshop, ultrasound simulation training, and hands-on training). After 12 years of experience, a survey was conducted to evaluate the long-term effect of this training.

Method
Using an anonymous online-questionnaire, we contacted from September 2023 to November 2023 the Hernia Compact course participants via the congress organizer “Weitmeer” and the German Hernia Society. This online questionnaire contains 18 multiple choice questions regarding participants’ age, gender, professional experience, participation in other modules of the German Hernia School, the effect of the course on their daily practice and their specific interest in hernia and abdominal wall surgery.

Results
A total of 146 participants responded to the anonymous online questionnaire. A majority of 132 of 146 participants (90.42%) responded that this course improved the quality of surgical and hernia training (n = 146, no missing data). 141 of 146 individuals (96.58%) recommended the course to surgical colleagues (n = 146, no missing data). There were 89.73% of participants, (n = 146, no missing data) that developed a specific interest in hernia and abdominal wall surgery after the course. For 78.08% (n = 146, no missing data) of participants hernia and abdominal wall surgery was one of the most important activities in their daily surgical practice.

Conclusion
The standardized Hernia Compact basic course of the German Hernia School appears to have a huge impact on the quality of hernia surgery training in Germany and Austria. It might also help generate a specific interest in hernia surgery among participants.
THE FRAGILITY OF RANDOMIZED CONTROLLED TRIALS (RCTS) COMPARING BIOLOGIC VERSUS SYNTHETIC MESH IN ABDOMINAL WALL RECONSTRUCTION (AWR)
Authors: Lorenz W , Holland A , Ayuso S , Mead B , Hollinsworth R , Ku D , Scarola G , Augenstein V , Heniford B 
Published: May 2024

Abstract

Background
The robustness of RCTs in AWR remains underexplored. The fragility index (FI) measures the minimum number of events whose outcome would have to change to reverse the significance of a result. Reverse fragility index (RFI) calculates the minimum number to turn a non-significant result to significant. This study aimed to evaluate the fragility of RCTs comparing biologic versus synthetic mesh.

Method
A comprehensive search of RCTs comparing biologic and synthetic mesh outcomes was conducted. Of 274 studies reviewed, 4 RCTs met the inclusion criteria. Primary outcomes were recurrence (n = 2) and major complications (n = 2). FI, (RFI), fragility quotient (FQ), and reverse FQ (RFQ) were calculated.

Results
Four RCTs, enrolling 87–253 patients, were published in journals with a median impact factor of 13.78. There was heterogeneity in hernia characteristics, mesh choice, mesh placement, and fascial closure among the studies. The follow-up time ranged from 12.4–36 months.
For recurrence, the FI was 1 and 7; FQ was 0.008 and 0.028. For major complications, there was one positive study with an FI of 6 and FQ of 0.024. The one negative study was deemed significant using Bayesian statistics, but on review with the frequentist approach, the P-value = 0.071 and FI = 0, indicating non-significance. Therefore, the RFI was calculated as 1 and RFQ was 0.014.

Conclusion
The fragility analysis underscores the vulnerability of RCTs comparing biologic and synthetic mesh in AWR. Despite RCTs favoring synthetic mesh, the low fragility indices and marked differences in study details should caution translating these findings to clinical practice.
PHASIX™ NON-ST MESH FOR GIANT PARAOESOPHAGEAL HERNIAS – THE WAY OF THE FUTURE?
Authors: Lorenzo A 
Published: May 2024

Abstract

Aim
Mesh reinforcement of the oesophageal hiatus decreases recurrence rates for large paraoesophagal hernias. The use of permanent synthetic mesh is associated with significant risk of erosion which is not observed with absorbable biosynthetic mesh, at the hypothetical cost of long-term hernia recurrence. We aim to assess the safety and effectiveness of Phasix™ non-ST mesh in the repair of giant paraoesophageal hernias.

Material and Methods
Patients presenting for elective laparoscopic mesh repair of giant paraoesophageal hernias with modified Dor fundoplication, between 2019–2021, were included in this cohort study. Phasix™ non-ST mesh was used in all patients and fixed with fibrin glue. Clinical follow-up included yearly non-contrast chest-CT and gastroscopy. Primary endpoint was early endoscopic and/or CT-scan recurrence, secondary endpoints were length-of-hospital stay (LoS), morbidity, mortality and symptom recurrence.

Results
Thirty two patients (mean age 68.1 years) with giant paraoesophageal hernias underwent laparoscopic Phasix™ non-ST mesh repair with modified Dor fundoplication. Dyspnoea (63.6%), dysphagia (51.5%), and epigastric/chest pain (48.5%) were the most common symptoms. Reflux was negligible. There were 62.5% type III and 15.6%% type IV hernias. Thirty five (85%) patients had more than 50% herniation of the stomach. Median LoS was 3 days and 97% were symptom free at mean 24-month follow-up. There was no major complication and no mortality. There was one endoscopic and radiological recurrence found in one patient (3.1%) at 24 months.

Conclusions
Phasix™ non-ST mesh reinforcement of the oesophageal hiatus with fibrin glue fixation shows promise in reducing recurrence rates for repair of giant paraoesophageal hernias.