bluuebunny/crossref_metadata_2025_split huggingface dataset:
AMBULATORY TAPP VERSUS TEP FOR GROIN HERNIA IN WOMEN: A RANDOMIZED CLINICAL TRIAL
Authors: Martínez-Núñez S , Tinoco-González J , Moreno-Suero F , Sánchez-Arteaga A , Suárez-Grau J , Bustos M , Padillo-Ruiz J , Tallón-Aguilar L 
Published: May 2024

Abstract
Groin hernia in women is understudied. Minimal invasive techniques may be preferred because of the female higher rate of femoral hernia, often overlooked with open techniques. To date, there are no studies comparing laparoendoscopic techniques in women.
A randomized controlled trial is conducted between 2019 and 2023. Women over 18 with primary groin hernia are randomly assigned to ambulatory TAPP or TEP approach. The main objective is to compare hospital postoperative length of stay. The secondary objective is to evaluate discharge pain, and chronic postoperative inguinal pain (CPIP) during the first postoperative year. Recurrence and adverse events are calculated.
78 patients are recruited, 39 for each group. 2 patients are excluded. Median postoperative stay is 360 minutes for TAPP group and 300 minutes for TEP group (p &lt; 0.001). Globally, median pain at discharge is 3.5 without differences between techniques. Postoperative length of stay is related to pain at discharge (ρ = 0.268, p = 0.021), increasing intensity with bilateral repair (ρ = 1.223, p = 0.002) or usage of tacks (ρ = 1.833, p = 0.034). Incidence of CPIP is 14,8% one year after surgery (n = 61; TAPP 12,5%, TEP 17,2%, p = 0,724). CPIP limits daily life at the third month (p = 0,040), but not at the one-year follow-up. Radiological recurrence rate is 7,9% at the one-year follow-up (TAPP 11,4%, TEP 3,6%, p = 0,371). No relevant adverse events are registered.
Ambulatory laparoendoscopic surgery is feasible and safe for female groin hernia. The TEP approach implies less median hospital stay, although not clinically relevant. CPIP affects daily-life activities in the early postoperative, but wanes at the one-year follow-up.
GLOBAL ACCESS TO TECHNOLOGIES TO SUPPORT SAFE AND EFFECTIVE INGUINAL HERNIA SURGERY: A PROSPECTIVE, INTERNATIONAL COHORT STUDY
Authors: Picciochi M , Eseenam Agbeko A 
Published: May 2024

Abstract

Acknowledgments
This study was supported by NIHR Global Health Research Unit Grant (NIHR16.136.79) and a project research grant from Portuguese Hernia and Abdominal Wall Society (Sociedade Portuguesa de Hernia e Parede Abdominal). The funders had no role in study design or writing of this report. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the UK Department of Health and Social Care.

Background
Technologies such as mesh and minimally invasive surgery (MIS) are recommended for inguinal hernia repair, but access and expertise varies significantly across different contexts. This study aimed to assess variability in the use of these two technologies, and evaluate their safety.

Methods
This was a pre-planned analysis of adults undergoing elective inguinal hernia repair in a prospective, international, cohort study between 30 January and 21 May 2023. Recurrent hernias and open midline approach were excluded. The primary outcome was the placement of mesh during open repair. The secondary outcome was adoption of MIS. A mixed-effects logistic regression model was used to identify factors associated with the adoption of these two technologies.

Results
This analysis included 14,768 patients from 612 hospitals in 81 countries: 8,916 (60.4%) from high-, 2,575 (17.4%) from upper-middle-, 2,642 (17.9%) from lower-middle and 635 (4.3%) from low-income countries. Mesh use in open surgery decreased from high- to low-income countries (98.9%, 94.4%, 82.3%, 72.1% respectively). MIS was adopted in less than a quarter of patients (3,661/14,768, 24.7%), and also decreased across income groups (29.3%, 27.6%, 12.5%, 1.1%). Surgery in a low-middle income country was associated with both lower mesh use (adjusted odds ratio 0.02, 0.01–0.06, p &lt; 0.001) and lower MIS (0.11, 0.07–0.18, p &lt; 0.001).

Conclusion
Global priority is to increase access and training programmes for mesh inguinal hernia repair in low-middle income countries. Expanding the role of MIS in well-resourced settings will require expansion of dedicated training programmes and a focus on patients who will have the most clinical benefit.
SECURITY ANALYSIS OF A NO-ADMISSION CIRCUIT IN HIGH-INTERMEDIATE-RISK PATIENTS WITH INGUINAL HERNIA
Authors: Álvarez-Aguilera M , Martínez-Núñez S , Moreno Suero F , De Jesús Gil A , Sánchez-Arteaga A , Tinoco-González J , Padillo Ruiz J , Tallón-Aguilar L 
Published: May 2024

Abstract

Background
The aim of the study is to assess the impact of different preoperative risk classification criteria on postoperative outcomes and hospital stay in patients undergoing inguinal hernia surgery in a no-admission circuit (NOADS) compared to a conventional admission circuit (ADS). The goal is to provide information to assist in decision-making and choice of surgical circuit.

Methods
Single-center retrospective comparative analysis of a continuous prospective database of moderate-to-high-risk inguinal hernia interventions in a no-admission circuit (NOADS) compared to a conventional admission circuit (ADS) from 2018–2021. A predictive model of multiple regression was designed, followed by a retrospective retest to assess the impact of each risk criterion on postoperative stay.

Results
No significant differences were found in the complication or hospital readmission rate (p = 0.343 and p = 0.563), however, a shorter total hospital stay was observed in NOADS circuit patients (p = 0.000). The analysis of the hierarchical predictive model of multiple regression proposed two opposite scenarios. The best scenario, patients who probably do not require admission, were women operated laparoscopically for a primary unilateral hernia (Estimated postoperative stay: 0.049 days). In contrast, the worst scenario or one in which patients probably need admission consisted of male patients operated openly for bilateral and recurrent inguinal hernia (Estimated postoperative stay: 1.505 days).

Conclusion
Patients with high-intermediate-risk inguinal hernia could safely benefit from a no-admission circuit. Our predictive model could be useful in the decision-making process for surgical circuits.
AN EVALUATION OF RANDOMIZED CONTROLLED TRIALS UTILIZING MESH IN ABDOMINAL WALL RECONSTRUCTION
Authors: Ayuso S A , Holland A M , Lorenz W R , Scarola G T , Fischer J P , Smart N J , Todd Heniford B 
Published: May 2024

Abstract

Background
The fragility index (FI) was developed in order to assess the robustness of clinical trials. FI calculates the number of individual outcomes that would need to change in order to make a significant result insignificant. The aim of this study is to evaluate the fragility of mesh RCTs in AWR.

Methods
Google Scholar® and PubMed were used to query for mesh RCTs in AWR from 2000–2023. FI and Reverse Fragility Index (RFI) I were calculated. Fragility quotient (FQ) and reverse fragility quotient (RFQ) were determined by dividing FI and RFI by sample size. The impact factor (IF) of each journal and conflicts of interest (COI) were reported.

Results
There were 37 RCTs identified. The median FI for positive RCTs was 2 (range: 0–37), and the median RFI nor negative RCTs was 3.5 (range:1–8). For all studies, 11 of 17 (64.7%) had an FI or RFI ≤3. Four studies had an FI/RFI of one, and one study that had an FI of zero, which indicated that if a different statistical test was used for the same data (e.g., Fisher’s exact), then the study outcomes would not be significant. Mean FQ was 0.04 ± 0.06 and mean RFQ was 0.04 ± 0.04. IF of journal did not correlate with FI/RFI (p = 0.67). There was COI reported in 5/17 (29.4%) of studies; 4/5 of these studies had an FI/RFI ≤3.

Conclusions
The majority of mesh RCTs in AWR were fragile and lacked robustness. For fragile studies, a change in very few patient outcomes would have altered their conclusions.
THE DANGER OF OPERATING BY NUMBERS IN INCISIONAL HERNIA SURGERY
Authors: de Beaux A , East B 
Published: May 2024

Abstract

Background
Fascial closure is held as a key step in abdominal wall repair. How ‘tight’ the abdomen can be closed to effect this, or when other intra-operative techniques are required to gain closure is not clear, and are likely surgeon dependent.

Methods
Popular pre-operative measurements: hernia width; hernia area; rectus hernia ratio; and component separation index were considered. Theoretical modelling of a variety of incisional hernias was undertaken.

Results
Following modelling of incisional hernias, all of these measurements are adversely affected by the state of play once abdominal contents are restored to the abdominal cavity. Fascial closure is also influenced by the actual elasticity of the abdominal wall, the effect of pre-operative muscle relaxation, and weight loss by the patient if they can lose weight or indeed have weight to lose. Pre-operative planning that no additional intra-operative techniques are necessary to facilitate abdominal wall closure (techniques which can have a significant learning curve) is difficult except in very small hernias.

Conclusion
Surgery by numbers in predicting fascial closure during incisional hernia repair (with a plan to leave easy cases in the hands of generalists) is a dangerous strategy. Intra-operative plans may need to change in light of the intra-operative findings, and AWR surgeons need to be competent to move to plan B or C, minimising the risk to patients.
TRENDS AND PREVALENCE OF UMBILICAL HERNIA REPAIRS IN SWEDEN; A NATIONWIDE POPULATION-BASED REGISTER-STUDY
Authors: Bergström M , Widhe B , Bringman S , Melkemichel M 
Published: May 2024

Abstract

Aim
Umbilical hernia repairs (UHRs) are widely performed worldwide, yet knowledge about their repairs remains underexplored. Guidelines suggest that UHR larger than 1 cm should preferably be repaired using mesh. The aim was to assess trends and prevalence over time for the use of suture versus mesh following UHR in Sweden.

Material and Methods
This observational population-based register study included prospectively collected data from the nationwide Swedish Perioperative Register (SPOR). Patients &gt;18 years old with a UHR between 2017–2022 in SPOR were eligible. Surgical units were categorized into six healthcare regions. Primary outcome was change in method of repair over time. Secondary outcome was regional variations in method of repairs.

Results
Out of 10,356 elective primary UHRs; mesh was used in 47.9%, whereas 14.1% of these were repaired laparoscopically. Women were less frequently repaired with mesh (38.8%) compared to men (52.1%). Suture repairs had a lower median age (49 years) and BMI (27.2 kg/m2) compared to mesh repairs (55 years, BMI 29.7 kg/m2). Lower ASA class (1–2) were predominant in suture repairs (53.8%), while higher ASA class (3–4) were predominant in mesh repairs (59.1%). Mesh repairs increased marginally, 46.1% to 49.3% during the study period (p &lt; 0.001). Only the Southest healthcare regions had a significant increase from 25.9% to 56.4% for mesh repairs (p &lt; 0.001).

Conclusion
Mesh repairs, despite guidelines, have still not significantly influenced UHR practices in Sweden. Mesh was more commonly used for men, obese patients, those of older age and with a greater co-morbidity.
BILATERAL INGUINAL HERNIOPLASTY IN EMERGENCY SURGERY IS FEASIBLE. COMPARATIVE RETROSPECTIVE STUDY USING PROPENSITY SCORE MATCHING
Authors: Bravo-Salva A , Ochoa-Segarra F , Pérez-Guitart M , Riba L , Juvany-Gómez M , Pereira-Rodriguez J A 
Published: May 2024

Abstract

Aim
The aim of this study is to determine if bilateral emergency hernioplasty practice is safe.

Material and Methods
We have performed a retrospective, observational, single-center study comparing by propensity score matching analysis two similar characteristics groups: patients who underwent emergency inguinal hernioplasty for complicated unilateral groin hernia (UH group) and patients who underwent emergency bilateral inguinal hernioplasty for complicated unilateral hernia, with non-complicated contralateral hernia (BH group).

Results
A total of 341 patients were included in analysis. Bilateral inguinal hernioplasty was performed in 38 of them (11.1%). Complication in study sample rate was high, with 143 complicated patients (41.9%), and a 90-day mortality of 20 patients (5.9%). In long-term analysis, recurrence was observed in 6.5% (22 patients). When comparing both groups short-term results, there were no statistically significant differences between the two groups. 4 recurrences were diagnosticated in BH group.

Discussion
In conclusion, emergency inguinal hernioplasty has high morbidity and mortality in our serie. Performing bilateral inguinal hernioplasty in this urgent situation does not seem to add morbidity or lengthen hospital stay, thus avoiding the need for a new intervention with inherent risks and costs.
MINIMIZING SEROMA INCIDENCE BY QUILTING IN ENDOSCOPIC REPAIR OF CONCOMITANT VENTRAL HERNIAS AND DIASTASIS RECTI
Authors: Cossa J P , Ngo P , Gillion J F , Pelissier E 
Published: May 2024

Abstract

Aim
To assess efficacy of the quilting technique to reduce the incidence and severity of seromas after endoscopic-assisted subcutaneous repair of concomitant ventral hernia (VH) and diastasis recti (DR).

Methods
176 consecutive patients operated for concomitant VH and DR by double layer suturing technique were divided in two groups: Group 1 comprised 102 patients operated without quilting, and Group 2 comprised 74 patients operated with quilting.
Seromas were ranked in two types: Type A included spontaneously resorbable seromas and seromas drained by a single puncture; Type B included seromas requiring two or more punctures, and complicated cases requiring reoperation.

Results
The global percentage of seromas was 24.4%. In Group 1 there were more seromas (27.5%) and more Type B seromas (19.6%) than in Group 2 (20.3% and 5.4% respectively). Conversely, the percentage of Type A seromas was higher in Group 2 (14.9%) than in Group 1 (7.9%). The differences were significant (p &lt; 1.4%). The mean operation duration was significantly longer in Group 2 (84 mn) than in Group 1 (70 mn). Four complicated cases requiring reoperation (included in Type B) were observed in Group 1: three cases of persistent seroma that required surgical drainage in general anesthesia and one case of encapsulation that was reoperated.

Conclusion
The quilting technique adapted to the endoscopic-assisted bilayer suturing technique of repair of concomitant VH and DR, can significantly reduce the incidence and severity of postoperative seromas.
THE IMPORTANCE OF EVIDENCE-BASED SURGERY – THE CASE OF FEMALE GROIN HERNIA
Authors: Dahlstrand U , Melkemichel M , Österberg J , de la Croix H 
Published: May 2024

Abstract

Background
In 2005 the first study regarding outcome after groin hernia repair in women, based on data from the Swedish Hernia Register (SHR), was published. Women had a substantially higher risk of reoperation due to recurrence than men, and poorer results after open anterior mesh repair. Recommendations and guidelines were issued. The aim of this study was to investigate how implementation of guidelines regarding treatment of groin hernia in females have affected the outcomes.

Material and Methods
Epidemiological study on prospective data in the SHR. The studied outcome was reoperation due to recurrence, by Cox proportional hazards regression analyses.

Results
A total of 35,179 groin hernia repairs in women have been registered. The proportion of endo-laparoscopic repairs have increased from 4.9% in 2005 to 84.2% in 2023. The 5-year rate of reoperation due to recurrence for procedures before 2012 was 4.2%, with a hazard ratio of 1.25 (95%CI 1.16–1.35) compared to males. For groin hernia repairs in women 2012–2022 the 5-year reoperation rate was 2.1% with a hazard ratio of 0.67 (95% CI 0.58–0.76) compared to men. There was a significantly reduced risk for women who had endo-laparoscopic repair (HR 0.30, 95% CI 0.23-0.40).

Conclusions
Following implementation of the evidence-based guidelines for treatment of groin hernia in women the results in terms of reoperation for recurrence have improved significantly.
NEUROSENSORY ALTERATIONS FOLLOWING ANTERIOR OPEN INGUINAL HERNIOPLASTY: AN INCONVENIENT TRUTH
Authors: Gómez-Torres I , Menor-Duran P D , Gamón-Giner R L , Jara-Benedetti G , Queralt Escrig M , Alcobilla-Ferrara E 
Published: May 2024

Abstract

Aim
Neurosensory dysfunction represents a prevalent complication after open inguinal hernia repair. Nevertheless, the prevalence study of hypoesthesia and chronic neuropathic postoperative inguinal pain (CPIP) remains deficient. The principal objective of this prospective observational investigation is to ascertain the incidence of neurosensory aberrations within the first post-surgery year, employing the dermatome mapping test as the primary assessment modality, while concurrently assessing the trajectory of these manifestations and their enduring presence.

Material and Methods
A total of 129 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between January 2020 and January 2022, were included in this prospective observational study.
All patients were assessed at 30 days, 6 months, and 1 year postoperatively using the dermatome mapping test.

Results
At 30 days, the rate of sensory alteration for the ilioinguinal (II), Iliohypogastric (IH), and genitofemoral (GF) nerves was 57.3%, 11.6%, and 45%, respectively, with a rate of chronic neuropathic pain (CPIP) of 10%, 3.1%, and 7%. At 6 months, it was 35.6%, 2.3%, and 32%, with a CPIP rate of 4.6% for the II nerve. Finally, at one year, it was 20.9%, 1.5%, and 10.8%, with a persistent CPIP rate of 4.6% for the II nerve.

Conclusions
Sensory alteration (hypoesthesia or CPIP) is the most common long-term complication following open anterior inguinal hernia surgery, with significant rates affecting up to 1 in 5 patients for the ilioinguinal territory, and 1 in 10 for the genitofemoral territory one year after surgery.
These results raise questions about whether other surgical techniques, such as the open posterior approach (Nyhus) or laparoscopic or endoscopic surgery (TAPP and TEP), can reduce or prevent these long-term alterations.
The dermatome mapping test is a tool that helps us detect these alterations in an easy and effective manner, and it should be systematically performed in postoperative evaluations of all inguinal hernia surgeries.
ADDRESSING THE BURDEN OF HERNIAS IN AFRICA: A COMPREHENSIVE ANALYSIS OF CHARITY-DRIVEN SURGICAL INTERVENTIONS" – 14 YEARS OF EXPERIENCE WITH CHARITY SURGERY MISSIONS
Authors: Gorjanc J 
Published: May 2024

Abstract
This abstract outlines a research endeavor focused on the charitable provision of hernia surgeries in Africa, seeking to shed light on the challenges, successes, and potential avenues for improvement in addressing this prevalent health issue. Starting with the organisation “Operation Hernia” and continuing with “Hernia International”, we today know that hernias pose a substantial burden in resource-limited settings in Africa, and charitable surgical interventions play a pivotal role in alleviating this burden. There is an alarming prevalence of 6,3 million untreated hernias in Sub-Saharan Africa. This study aims to evaluate the effectiveness of current charity-driven hernia surgery programs and explore strategies for enhancing their impact.
Our research employs a mixed-methods approach, combining quantitative data analysis of surgical outcomes with qualitative insights gathered through interviews with healthcare professionals, patients, and organizations involved in charity hernia surgery initiatives. Preliminary findings underscore the positive impact of these programs, showcasing improved patient outcomes and increased accessibility to surgical care. However, challenges such as surgical capacity constraints, logistical hurdles, and long-term follow-up care disparities are identified as critical areas requiring attention.
This abstract contributes to the broader discourse on healthcare accessibility in Africa by presenting evidence-based recommendations for optimizing charity hernia surgery programs. The findings presented in this abstract serve as a foundation for a comprehensive congress presentation, fostering dialogue and collaboration among researchers, practitioners, and policymakers committed to advancing charity hernia surgery and healthcare accessibility in Africa.
COMPARATIVE ANALYSIS OF PERITONEAL FLAPS (PF) AND ENDOSCOPIC TRANSVERSUS ABDOMINIS RELEASE (eTAR) FOR MIDLINE RESTORATION IN eTEP INCISIONAL HERNIA REPAIR
Authors: Guevara Martínez J , Gutiérrez E , Zapata C , Abad R , del Mar Olmedo M , Reinoso F , Fondevila C , Salido S 
Published: May 2024

Abstract

Aim
This study aims to compare the utilization of peritoneal flaps (PF) with endoscopic transversus abdominis release (eTAR) for midline restoration in incisional hernia repair via the enhanced-view totally extraperitoneal (eTEP) approach.

Patients and Methods
A total of 115 eTEP incisional hernia repairs were initially considered, with exclusion criteria applied to patients requiring combined PF and eTAR procedures or those not requiring either. The final analysis included 14 patients treated exclusively with eTAR and 36 with PF. Parameters compared included hernia defect size, operative time, length of stay, and postoperative complications.

Results
The mean hernia defect size for the eTAR group was 70 mm, and for the PF group 79 mm, although this disparity lacked statistical significance. The length of stay was marginally higher for the PF group, averaging 3 days, compared to 2 days in the eTAR cohort. Notably, a statistically significant difference in operative time was observed (p: 0.022), with eTAR requiring a mean of 180 minutes and PF 148 minutes. Postoperative complications, including seromas and surgical site infections, occurred in 22.2% and 7.1% of patients for eTAR and PF, respectively (p: 0.207). No hernia recurrences were observed.

Conclusion
Both PF and eTAR procedures demonstrated comparable hernia defect sizes, complication rates, and lengths of stay, with eTAR exhibiting a longer operative time. This study suggests that PF can be considered as a valid alternative in the armamentarium of techniques for midline restoration during eTEP incisional hernia repair, with similar outcomes to eTAR.