bluuebunny/crossref_metadata_2025_split huggingface dataset:
PATIENT REPORTED OUTCOMES: PILOT ANALYSIS OF 500 PATIENTS
Authors: Mainprize M , Paasch C , Svendrovski A , Netto S 
Published: May 2024

Abstract

Background
Implement patient reported outcome assessments for Shouldice Hospital patients and evaluate these assessments.

Method
A 30–40-day postoperative follow-up of patients at Shouldice Hospital was conducted. Data collection involved chart review and online surveys. The survey included questions like those used in HerniaMed, with additional questions on reasons for surgery, decision making and knowledge, and experience. After preliminary review, it became apparent that some of the questions were not clear and possibly misunderstood by participants. To further verify the participant’s responses (surgical site infection and relapses) follow-up telephone call (conducted by a surgeon) and emails were done.

Results
500 patients underwent primary and recurrent surgery (males: 442; females: 58). The median age and body mass index were 61.1 years and 24.9 kg/m2. Most patients had American Society of Anesthesiologists (ASA) score II (43.0%, ASAI:25.2%; ASAIII:31.8%). There were 432 groin and 65 ventral hernias, and 3 other hernia related surgeries. Hernias were repaired by Shouldice (83.4%), tissue (14%), and mesh (2.6%). When patients were asked about pain, 5% had at rest, 20% on exertion, and 1.8% required treatment. Ten participants responded with a relapse and upon contacting these participants, 9 did not have a relapse but had misinterpreted the question (1 could not be reached). Furthermore, 6 participants responded with a surgical site infection and upon contact 2 were confirmed, 2 remain unconfirmed, and 2 were other complications (hematoma and seroma).

Conclusion
Patient reported outcomes are increasingly important, however, not all assessments may be clear enough for patients, leading to possible insufficient measurements of outcomes.
SEQUENTIAL SURGERIES FOLLOWING TRANSVERSUS ABDOMINIS RELEASE FOR ABDOMINAL WALL RECONSTRUCTION: INSIGHTS FROM A SINGLE-CENTER ANALYSIS
Authors: Messer N , Ellis R C , Maskal S M , Chang J H , Prabhu A S , Miller B T , Beffa L R A , Petro C C , Mazzola Poli de Figueiredo S , Fafaj A , Essani V , Rosen M J 
Published: May 2024

Abstract

Introduction
Abdominal surgery following transversus abdominis release (TAR) procedure commonly involves incisions through the previously implanted mesh, potentially creating vulnerabilities for hernia recurrence. This study aims to reveal the incidence and outcomes of post-TAR non-hernia-related abdominal surgeries of any kind.

Methods
Adult patients who underwent non-hernia-related abdominal surgery following ventral hernia repair with concurrent TAR procedure and permanent synthetic mesh in the Cleveland Clinic Center for Abdominal Core Health between January 2014 and January 2022 were identified. We evaluated 30-day wound morbidity, perioperative complications, and long-term hernia recurrence.

Results
A total of 1137 patients who underwent TAR procedure were identified, with 53 patients (4.7%) undergoing subsequent non-hernia-related abdominal surgery post-TAR. Small bowel obstruction was the primary indication for reoperation (22.6%), and bowel resection was the most frequent procedure (24.5%). 49.1% required urgent or emergent surgery, with the majority (70%) having open procedures. Fascia closure was achieved by absorbable sutures in 50.9%, and of the open cases, fascia closure was achieved by running sutures technique in 35.8%. 20.8% experienced SSO, the SSOPI rate was 11.3%, and 26.4% required more than a single reoperation. A total of 88.7% were available for extended follow-up, spanning 17–30 months, resulting in a 36.1% recurrent hernia diagnosis rate.

Conclusions
Abdominal surgery following TAR surgery is associated with significant comorbidities and significantly impacts hernia recurrence rates. Our study findings underscore the significance of making all efforts to minimize reoperations after TAR procedure and offers suggestions on managing the abdominal wall of these complex cases.
FEASIBILITY OF INTEGRATING PATIENT-REPORTED OUTCOME MEASURES (PROMS) IN A NATIONAL INGUINAL HERNIA REGISTRY – A SINGLE-CENTER PILOT STUDY
Authors: Meuzelaar R R , Smit H V , den Hartog F P J , Schiphorst A H W , Tanis P J , Burgmans J P J 
Published: May 2024

Abstract

Aim
Inguinal hernia (IH) repair is a common surgical procedure. Therefore, minor improvements have the potential to seriously impact quality of life (QoL). Improving healthcare quality and transparency can be accomplished by establishing a national registry, exposing between-hospital variation. Given the absence of the patient’s perspective in clinical data, patient-reported outcome measures (PROMs) are crucial for displaying daily functioning and QoL. This pilot study assessed the feasibility of implementing automated PROMs in a national IH registry, without any healthcare personnel interference to minimize administrative burden.

Methods
A retrospective cohort study of prospectively collected data was conducted in a high-volume IH clinic between January 18, 2023, until February 6, 2024. All adult patients who underwent IH surgery received automated PROMs questionnaires by email pre-operatively, 6 weeks, 3 months, 1 and 2 years postoperatively. The primary outcome was the response rate at different follow-up moments. A rate of 60% was considered sufficient. Secondary outcomes included the questionnaires’ responses about pain, return to work and exercise, patient satisfaction and recurrence.

Results
In total, 1291 patients were included. Response rates were: 81% pre-operatively, 45% at 6 weeks (n = 1221) and 50% at 3 months (n = 837). One and two years of follow-up are pending.

Conclusion
Overall, a declining response rate was observed, which impacts the data’s validity. This decrease can be attributed to the patients unawareness of the recently adopted method. Integration of PROMs into routine patient care may result in improved adherence. Strategies to optimize response rate must be incorporated to ensure successful implementation.
INCREASING THE EFFICIENCY IN THE ROBOTIC ASSISTED PCS (POSTERIOR COMPONENT SEPARATION) SURGERIES BY OPTIMISING THE WORK FLOW
Authors: Misra S 
Published: May 2024

Abstract

Aim
Increasing the efficiency in robotic pcs surgeries by optimising the surgical practice for maximal utilisation of the resource.

Material and Methods
47 PCS were done between Feb 2023 to Jan 2024. Of them 37 surgeries were for r TEP RS (Robotic totally extra-peritoneal Rives Stoppa Repair) with AWR (anterior wall reconstruction) and 10 procedures were r TAR (robotic Transverses abdomens release) procedures. All surgeries were performed on the DA Vinci XI platform.
The need for these measures arose due to the fact that multiple departments were competing for the same resource, i.e., the Robot!
These measures taken to improve the efficiency were as follows:
Pre-Operatively:
All patients were admitted one day in advance.
All patients had an USG marking of the linea semilunaris.
Intra-Operative:
The Port placements were revised.
Only 3 robotic instruments were utilized.
The left retro-rectus plane and the space below the arcuate lines were created before the robot was deployed with the help of the Ligasure.
The midline was reconstructed by using only 15 cm sutures barbed sutures.
Wherever possible, self-fixation meshes were used.

Result
By changing few aspects of our surgical practice, we were able to reduce the operating time of our Robotic PCS from 85 min to 46 minutes.

Conclusion
By optimising the resources, methods and practices, the utilisation of robots can be increased without compromising the safety of the patient.
A META-ANALYSIS OF EMERGENCY INCISIONAL HERNIA REPAIR: DO OUTCOMES DIFFER FROM ELECTIVE SURGERY?
Authors: Quiroga-Centeno A C , Schaaf S , Morante A , Gómez-Ochoa S A , Stabilini C 
Published: May 2024

Abstract

Background
Incisional hernias (IH) have been progressively recognized as independent entities in the hernia field. However, the same indications for deferred treatment of ventral hernias are generally applied to IH, regardless of the potentially different outcomes. This meta-analysis aims to compare the characteristics and outcomes of patients treated urgently for IH with those undergoing elective surgery.

Method
Medline and Scopus were systematically searched from 1990–2023. Original studies comparing patients treated for emergency vs. elective IH were included. Study screening was performed using ASReview®. Data were pooled using random-effects models.

Results
Seventeen studies assessing 88,743 patients were included. Emergency IH patients were significantly older (MD 4.51 years; 95%CI 2.38–6.64. I2: 62%), more frequently women (RR 0.76; 95%CI 0.61–0.94. I2: 73%), and had a higher prevalence of ASA score III-IV (RR 1.38; 95%CI 1.03–1.84. I2: 30%). Furthermore, emergency surgery was associated with a longer hospital stay (MD 4.61 days; 95%CI 3.78–5.45. I2: 0%), higher need for reoperation (RR 2.20; 95%CI 1.73–2.80. I2: 0%), and higher mortality (RR 10.06; 95%CI 3.82–26.52. I2: 45%) compared to elective procedures. No differences in hernia recurrence rates or mesh repair were identified.

Conclusion
Emergent IH repair was associated with worse postoperative outcomes and higher mortality than elective repair. Nevertheless, scarcity of data precluded the inclusion of additional factors (type of repair, hernia size) and stratified/meta-regression analysis by relevant variables (age, sex, surgical risk). Larger studies are needed to determine predictors and outcomes of emergent repair in IH and appropriately identify patients who may benefit from watchful waiting.
ROBOT-ASSISTED REPAIR OF POST-GESTATIONAL RECTUS DIASTASIS WITH THE TARUP APPROACH – A RETROSPECTIVE EVALUATION OF PATIENT SATISFACTION
Authors: Rothman J V , Billustovum B , Henriksen N A 
Published: May 2024

Abstract

Background
To evaluate the TARUP (robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair) technique used for post-gestational rectus abdominis diastasis (RD) in terms of complications and patient satisfaction.

Methods
We retrospectively identified patients with a repair of RD from January 2018 to August 2023. Patients were invited to participate in the study by telephone. Participants completed a questionnaire on physical and cosmetic complaints and patient satisfaction.

Results
Twelve women had a repair of RD during the study period, and 75% (9/12) participated in this study. All patients had a diastasis of at least 3 cm and a concomitant hernia. The mean length of stay was 1,4 days. No patients were readmitted, but two were seen in the emergency room due to pain. Prior to the surgery 67% (6/9) had limitations with strenuous activities, 78% (7/9) with sport activities and 44% (4/9) with daily tasks, this was significantly reduced after surgery to 0%, 22% (2/9), and 0%, respectively. Daily pain or discomfort from the abdominal wall or back was reported in 56% (4/9) at rest and 67% (6/9) while doing activities, and this was reduced to 11% (1/9) and 22% (2/9) after surgery. Cosmetic satisfaction with the shape of the abdomen was improved, but the main complaint was continuous bulging of the skin in the midline and a crooked midline after surgery.

Conclusions
The robot-assisted TARUP repair for RD seems to reduce pain and limitations in daily life, however further studies including more patients are needed.
EVOLUTION OF THE eTEP TECHNIQUE FOR VENTRAL HERNIA REPAIR: SIX-YEAR SINGLE-SURGEON EXPERIENCE WITH TECHNICAL ADVANCEMENTS AND ADAPTATIONS
Authors: Salido S , Guevara-Martínez J , Zapata C , Gutiérrez E , Reinoso F , Abad R , Georgiades A , Monje B , Fondevila C 
Published: May 2024

Abstract

Objective
The aim of this study was to assess the learning curve and the implementation of tools for the correction of ventral hernias using the extended totally extraperitoneal (eTEP) approach.

Materials and Methods
All patients underwent eTEP ventral hernia repair performed by one surgeon. A prospective multicenter study involving patients from General Hospital of Villalba, Jiménez Díaz Foundation, and La Paz Hospital in Madrid was conducted from May 2018 to January 2024.

Results
Over the 6-year period, 216 patients (133 midline and 83 laterals) were operated on. There was an increased percentage of incisional and recurrent hernias compared to primary hernias, along with an observed rise in case complexity and defect size, with no significant increase in surgical time or complications. Over the technical evolution in the last 6 years, a decreasing trend in the utilization of posterior component separation with transversus abdominis release (TAR) for midline defect closure was noted, despite the increased complexity and hernia size. This shift was attributed to the use of peritoneal flap instead of TAR for closing the posterior plane in extensive defects, as well as the use of BOTOX and fascial traction for hernia defect closure.

Conclusions
The results demonstrate a significant evolution in the eTEP technique for treating incisional hernias, addressing larger and more complex hernias over time. Furthermore, the decreasing use of TAR for both posterior and anterior closure, in favor of adjuncts such as BOTOX, peritoneal flap, and fascial traction, facilitated a surgical downstaging and led to low complication rates.
THE INFLUENCE OF ULTRASOUND IN THE CHOICE OF SURGICAL TECHNIQUE TO REPAIR INGUINAL HERNIA: A PROSPECTIVE MULTICENTRIC COHORT STUDY
Authors: Sampaio-Alves M , Alagoa João A , Taveira-Gomes T , Picciochi M 
Published: May 2024

Abstract

Background
Inguinal hernia is diagnosed by physical examination (PE) alone in most patients. Imaging is helpful if there is diagnostic doubt. A previous cohort study identified a high rate of ultrasound (US) use to diagnose inguinal hernias. This study assessed if the use of US influenced the choice of surgical technique to repair inguinal hernias.

Methods
Multicenter prospective cohort study of consecutive patients undergoing elective inguinal hernia repair between October and December 2019. Patients diagnosed with other image exams were excluded. The group of patients diagnosed with PE was compared to the group diagnosed with US. The primary outcome was surgical technique. The association between use of US and choice of surgical technique was tested through a logistic regression model.

Results
A total of 911 patients from 33 Portuguese hospitals were included, 49.2% were diagnosed with PE only and 50.8% had an US. There were no statistically significant differences in the characteristics of the patient, symptoms or hernia between the two groups. Lichtenstein was the most used surgical technique in both groups. There was no association between the use of US and the choice of surgical technique (adjusted odds ratio 1.02, 0.71–1.48, p = 0.901).

Conclusion
The use of US had no impact in the choice of surgical technique to repair inguinal hernias and is not recommended for their diagnosis. Its use can increase costs of care and delay patients' treatment. A plan to decrease the use of the US in this setting is needed.
SURFACE MODIFICATION OF ARTIFICIAL IMPLANTS BY HYBRID NANOLAYERS – ANTIMICROBIAL SURFACE FINISHING TESTS, STRENGTH TESTS, LEACHATES AND SCANNING ELECTRON MICROSCOPE ANALYSIS
Authors: Skach J , Slamborova I , Exnar P 
Published: May 2024

Abstract

Aim
The aim of this study was to evaluate the antibacterial efficacy of surface treated hernia implants modified by a hybrid nanolayer with incorporated Ag, Cu and Zn cations using the sol-gel method and to evaluate minimal influence of these modifications on the mechanical properties of the meshes.

Material and Methods
The materials (polypropylene, polyester and polyvinylidendifluoride) were activated by vacuum plasma treatment or UV C radiation, than modified and tested for bacterial strains of Escherichia coli (Gram-) and Staphylococcus aureus (Gram+).
Maximum strength and ductility of modified samples were measured on a universal Testometric tensile testing machine.
The gradual release of incorporated ions was monitored over time in simulated body fluids using inductively coupled plasma mass spectrometer.
The thickness and the homogeneity of the layers were measured with scanning electron microscope analysis (SEM) and evaluated with an elemental analysis.

Results
Qualitative and quantitative microbiological tests clearly showed the great suitability of surface treatment of all tested implants.
A slight reduction of mechanical properties in modified meshes were not of clinical importance.
The absolute concentration of Ag, Cu and Zn cations in leachates was very low.
SEM showed a high degree of homogeneity of the layer and only very rare nanocracks by all tested materials appeared after mechanical stress.

Conclusions
This study confirms that surface treatment of meshes using the sol-gel method significantly increases the antibacterial properties, does not affect mechanical properties of implants and the nanolayers are sufficiently mechanically resistant, stable and pose no threat to health.
SURGICAL UNIT VOLUME AND REOPERATION FOR RECURRENCE FOLLOWING TOTALLY EXTRA-PERITONEAL GROIN HERNIA REPAIRS
Authors: Widman F , Bergström M , Widhe B , Bringman S , Melkemichel M 
Published: May 2024

Abstract

Background
Quality of totally extra-peritoneal groin hernia repair (TEP-GHR) and recurrence are related to several factors and possibly to the annual volume of repairs carried out by surgical units. The nature of this relationship is still unclear. The aim of this study was to investigate the surgical unit volume influence on reoperation for recurrence.

Material
This observational nationwide population-based study was based on prospectively collected data from the Swedish Hernia Register. All patients ≥15 years old who underwent a TEP-GHR between 2015–2019 were eligible. Follow-up time was minimum 3 years after surgery. Surgical units were grouped into; low-volume (&lt;12 repairs/year), low-medium volume (12–50 repairs/year), medium-high volume (&gt;50–150 repairs/year) and high-volume (&gt;150 repairs/year) units. Primary outcome was reoperation for recurrence. Secondary outcome was postoperative complications within 30 days.

Results
In total, 20,616 elective TEP-GHR within 75 surgical units were included. The reoperation rate was higher in all three lower-volume groups; low-volume (5.3%), low-medium (3.8%) and medium-high (3.5%) compared with the high-volume group (2.9%). Adjusted multivariate cox regression analysis showed a statistically significant increased hazard ratio for reoperation for recurrence in the low-volume group; 1.87 (95% CI 1.31–2.67) and in the low-medium volume group; 1.32 (95% CI 1.07–1.62) compared to the high-volume group. No difference was seen between the groups regarding the risk of postoperative complications.

Conclusion
The reoperation risk for recurrence following TEP-GHR was significantly increased in surgical units with less than 50 TEP-GHR’s per year. This may influence guidelines on required annual surgical unit volume to improve patient outcomes following TEP-GHR.
INTRAOPERATIVE FASCIAL TRACTION FOR THE TREATMENT OF LARGE HERNIAS – RESULTS OF A MULTICENTRE STUDY
Authors: Woeste G , Meier H , Sardoschau N , Kiehle A , Niebuhr H 
Published: May 2024

Abstract

Background
The incidence of incisional hernias after laparotomy ranges between 5 and 20%. Closure of the defect and mesh reinforcement is therapeutic standard. Intraoperative fascial traction (IFT) is a new technique for hernia closure.

Materials and Methods
We analyse data of IFT from five hospitals between 12/2020 and 9/2023. In all cases the Fasciotens®Hernia System was applied. When fascia closure was not possible, transversus abdominis release (TAR) was performed. During follow-up all patients were examined according to a standardized protocol including ultrasound. Quality of life was assessed using the HerQLes questionnaire.

Results
A total of 96 patients were included in the study (HH-62, DA-11, SB-10, D-9, L-4). The age was 59.9 ± 14.1 years, 41% were female, BMI was 31.0 ± 7.3 kg/m², hernia width was 15.7 ± 5.1 cm. 88.5% underwent pretreatment with botulinum toxin (BTX). A TAR was performed in 28.1% cases. Bridging was necessary in 5.2%. Length of stay was 8.3 days.
In the postoperative course, 39/96 (40.6%) patients experienced a complication: 20.8% seroma, 9.4% wound infection, 4.2% haematoma, 2.1% intestinal injury, 1.0% wound dehiscence, 3.1% pneumonia and 2.1% urinary tract infection. No patient died. The incidence of wound infections was higher in patients with additional TAR (11.1% vs. 8.7%).
During the mean follow-up of 15.7 ± 12.6 months 2 hernias at the border of the mesh were recognized. The HerQLes summary score was 64.5.

Conclusion
This multicentre study shows a low incidence of wound infection and recurrences using IFT. The fascia closure rate is high when combining IFT with BTX pretreatment.
Further randomised studies of IFT should follow to support these findings.
APPLICATION OF THREE-DIMENSIONAL VISUALIZATION TECHNOLOGY IN PREOPERATIVE PLANNING OF COMPLEX ABDOMINAL WALL DEFECT REPAIR AND RECONSTRUCTION
Authors: Yang D , Song Z , Song H , Yang J , Gu Y 
Published: May 2024

Abstract

Aim
To prospectively study the role of three-dimensional visualization (3DV) technology in preoperative planning of complex abdominal wall defect repair and reconstruction.

Methods
210 patients with complex abdominal wall defects who underwent reconstruction surgery were enrolled. Preoperative planning was performed by CT imaging (CT group) or 3DV technology (3DV group).

Results
The methods of repair and reconstruction of abdominal wall defects included single or double patch, three-layer bridging (mesh+greater omental flap+mesh), CST+mesh, CST+mesh+omental flap, mesh+tissue flap repair. There was no significant difference in the clinical cure rates of abdominal wall defect observed between the CT group and 3DV group (82.61% vs.91.30%, P &gt; 0.05). The clinical cure rates of abdominal wall defect caused by primary and secondary abdominal wall tumors were 96.23% and 89.66% in the 3DV group, respectively, which were significantly higher than those in the CT imaging group (84.91% and 68.97%, both P &lt; 0.05).

Conclusion
3D visualization technology can accurately evaluate the indicators of complex abdominal wall defects before surgery, helping clinicians to make an improved individualized surgical planning.