bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC-045 RECURRENCE AFTER RETROMUSCULAR REPAIR OR POSTERIOR COMPONENTS SEPARATION: HOW TO ADDRESS THEM. A RETROSPECTIVE MULTICENTRE COHORT STUDY
Authors: Robin Valle De Lersundi A , López-Monclús J , Blazquez Hernando L , Muñoz Rodriguez J , Medina Pedrique M , Avilés Oliveros A , Morejón Ruiz S , García-Ureña M A 
Published: May 2023

Abstract

Introduction
Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. The aim of this study is to analyse results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation.

Material and Methods
We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2O14 and December 2021.

Results
Fifty-one patients complied with the criteria to be included in this study. Thirty-three patients had midline defects, 9 patients a combination of midline and lateral defect, 4 lateral defects alone and 5 patients parastomal hernia. We managed those patients with different approaches. We have found 11,5% surgical site infection rate and surgical site ocurrencies rate was 33,3%. We identified 3 patients with hernia recurrence. One patient died during postoperative course.

Conclusions
Treating hernia recurrences after retromuscular or posterior components separation is a challenge. Several reconstructive techniques might be planed and adapted to patients with complex abdominal wall defects. We have widely used components separation procedures to treat this type of recurrences. Although technically challenging, reoperation of hernia recurrence after posterior component separation or retromuscular repair should be considered in experienced centres with promising results, even though we may expect severe complications.
OC-047 ENHANCED RECOVERY AFTER ROBOTIC VENTRAL HERNIA REPAIR
Authors: Marckmann M , Willaume M , Kiim Jensen K 
Published: May 2023

Abstract

Aim
Enhanced recovery after surgery (ERAS) protocols lead to reduced postoperative stay and improved outcomes after most types of abdominal surgery. Little is known about the optimal postoperative protocol after robotic ventral hernia repair (RVHR), including the potential limits of outpatient surgery. We report the results of an ERAS protocol after RVHR aiming to identify predictors of overnight stay in-hospital, as well as patient-reported pain levels in the immediate postoperative period.

Material & Methods
This was a prospective cohort study of consecutive patients undergoing RVHR. Patients were included in a prospective database, registering patient characteristics, operative details, pain and fatigue during the first three postoperative days and pre- and 30-day postoperative hernia-related quality of life, using the EURA-HS questionnaire.

Results
A total of 109 patients were included, of which 66 (61%) underwent incisional hernia repair. The most performed procedure was TARUP (Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair) (60.6%) followed by bilateral roboTAR (robotic Transversus Abdominis Release) (19.3%). The mean horizontal fascial defect was 4.8 cm and the mean duration of surgery was 141 minutes.
In total, 78 (71.6%) patients were discharged on the day of surgery, and confounders associated with overnight stay were increasing fascial defect area, duration of surgery, and addition of TAR. There was no association between postoperative pain and overnight hospital stay. The mean EuraHS score decreased significantly from 38.4 to 6.4 (P &lt; 0.001).

Conclusions
The application of an ERAS protocol after RVHR enabled a high rate of outpatient procedures with low patient-reported pain scores.
OC-051 CAN ETEP APPROACH IMPROVE COMPLEX INCISIONAL HERNIA REPAIR OUTCOMES?
Authors: Salido S , Guevara-Martínez J , Hernández S , Gutiérrez E , Zapata C , Chavarrías N , Arteaga P , Fondevila C 
Published: May 2023

Abstract

Aim
To compare postoperative results of two cohorts of patients with simple and complex incisional hernias, operated using the extended totally extraperitoneal technique (eTEP).

Materials and Methods
Retrospective comparative multicenter study based on prospective database conducted at the Fundación Jiménez Díaz University Hospital and La Paz Hospital in Madrid, including eTEP repairs performed between March 2019 and January 2023. Patients were classified as complex hernias if they met at least one criterion according to the Slater definition (1). If no criteria were met, it was classified as a simple hernia.

Results
159 patients were operated on via eTEP during the study period, and 111 incisional hernias were analyzed according to the EHS classification: 38 complex cases and 73 simple cases. The median defect size was 50mm (40–97) in simple cases and 66mm (24–126) (p&lt;0.01), the median surgical time was 130min (59–360) and 145min (63–240) respectively without significant differences. TAR was required in 26 (35.6%) simple cases versus 23 (60.5%) complex cases (&lt;0.01). One (1.4%) recurrence was observed in simple cases and 2 (5.3%) in complex cases, as well as 7 (9.6%) complications in simple cases and 5 (13.2%) in complex cases, both without statistical significance. The median follow-up was 26 months in simple cases and 11 months in complex cases (p&lt;0.01).

Conclusions
The application of the eTEP approach in selected complex cases can improve postoperative results close to simple hernias.
1. Slater NJ et al. Criteria for definition of a complex abdominal wall hernia. Hernia 2014, 18:7–17.
OC-053 POSTERIOR COMPONENT SEPARATION AND THE USE OF BOTULINUM TOXIN IN ABDOMINAL WALL RECONSTRUCTION: NEED TO LEARN THE TECHNIQUE DURING THEIR RESIDENCY?
Authors: Aguilar C , Quiroz O , Mata C , Montalvo J , Jordan E , Ricarte E , Ruiz A , Sandoval S , Grajeda O , Bustamante L 
Published: May 2023

Abstract

Tittle
Posterior component separation and the use of botulinum toxin in abdominal wall reconstruction: need to learn the technique during their residency?

Aim
We aim to evaluate the transversus abdominis release (TAR) and the use of botulinum toxin A (BTA) in abdominal wall reconstruction learning curve based on proper identification of muscle layers and nervous component in the surgery and by US.

Material and Methods
Prospective study including patients submitted to TAR and preoperative BTA injection (n 15), perform by 3 seniors surgeons and a group of residents (10). Resident's acquisition and development of fundamental skills were evaluated by comparing pre (theorical: identification of muscle layers and by US and in images of the surgeries) and post-course (identification of muscle layers by US, BTA injection, and in surgery) assessment measurements.

Results
Out of 20 captured attempts by novices, 20 successful trials were evaluated. An increase in identification post-course of the abdominal wall components by US was shown in comparison of the attempt´s pre-course (p ≤ 0.023) and application of BAT in the patients was success in all the patients. Components of the abdominal wall (muscles layers and nervous component) improve after theorical course (p ≤ 0.048).

Conclusions
Correct identification by US and images of all the components during training showed to be effective in determining acquisition and development of basic surgical skills. The outcomes indicated that skills in vivo improved and that this training should therefore be part of the regular residency training program.
OC-056 CLOSURE STRENGTH OF SUTURE TECHNIQUES AND SUTURE MATERIALS
Authors: Allaeys M , Visscher L , Den Hartog F P J , Tanis P J , Jeekel J , Lange J F , Berrevoet F , Eker H H 
Published: May 2023

Abstract

Aim
Small bites closure is being implemented as standard of care (SOC) for laparotomy closure, but no consensus on which suture material to use is reached. The aim of our study was to compare biomechanical properties of four different closure techniques to SOC.

Materials & Methods
Fifty porcine abdominal walls were divided into five groups: 1. SOC (2/0 polydioxanone); 2. interlocking 2/0 polydioxanone; 3. size 0 barbed polydioxanone; 4. size 0 barbed glycolic acid and trimethylenecarbonate (GATC); 5. size 0 suturable polypropylene mesh. The small bites technique was used for closure of the linea alba in all groups. The abdominal walls were divided into a supra- and infra-umbilical half, which resulted in 20 specimens per group that were pulled apart in a tensile testing machine. Maximum tensile strength and types of suture failure were registered.

Results
The highest tensile strength was measured in the barbed polydioxanone arm (334.8 N ± 157.0) but did not reach statistical significance compared to the other groups. Infra-umbilical abdominal walls endured a significantly higher maximum tensile force compared to supra-umbilical (397 N vs 271 N, p&lt;0.001). Resorbable GATC barbed suture failed significantly more often (25% vs 0%, p = 0.008).

Conclusion
When using small bites for fascial closure, the highest tensile strength was found using size 0 barbed polydioxanone suture, but results were similar among all groups. Tensile strength in infra-umbilical abdominal walls was significantly higher compared to supra-umbilical. Use of GATC barbed suture should be discouraged, as this suture fails significantly more often.
OC-057 VENTRAL HERNIA REPAIR WITH CONCURRENT INTRA-ABDOMINAL SURGERY: RESULTS FROM AN ELEVEN-YEAR POPULATION-BASED COHORT IN SWEDEN
Authors: Lindmark M , Löwenmark T , Strigård K , Gunnarsson U 
Published: May 2023

Abstract

Aim
One remaining question in ventral hernia repair is whether to perform concurrent abdominal surgery or plan two-stage procedures. The aim was to explore the risk for reoperation and mortality due to surgical complication during index admission.

Method
Eleven-year data were retrieved from the National Patient Register and 68,058 primary surgical admissions were included, divided into minor and major hernia surgery and concurrent abdominal surgery.
Results were evaluated by logistic regression analysis.

Results
The risk for reoperation during index admission was higher for patients with concurrent surgery. Major hernia surgery and major concurrent surgery had an OR 37.9 compared to major hernia surgery only. Mortality rate within 30 days increased, OR 9.32. The combined risk for serious adverse event was accumulative.

Conclusion
These results stress the importance of critically evaluating needs for and planning of concurrent abdominal surgery during ventral hernia repair. Reoperation rate was a valid and useful outcome variable
OC-060 PREDICTING FACTORS OF RECURRENCE AFTER TRANSVERSUS ABDOMINIS MUSCLE RELEASE (TAR) FOR COMPLEX INCISIONAL HERNIAS. RETROSPECTIVE ANALYZE OF A COHORT
Authors: Oprea V , Toma M , Grad O , Bucuri C 
Published: May 2023

Abstract

Background
Transversus Abdominis Muscle Release (TAR) is used to provide adequate coverage for large abdominal wall defects and appears to be more advantageous compared to Anterior Component Separation concerning complications and recurrence rates. The aim of this study was to identify the independent predictors associated with hernia recurrence after TAR in the treatment of complex incisional hernias.

Methods
This is a retrospective observational study of 191 patients who underwent TAR between November 2014 and December 2021. The main inclusion criteria were adults with large complex incisional hernias larger than 10 cm in transverse diameter. The recurrence rate was determined by clinical examination and by abdominal CT scan.

Results
At a median of 49.6 months (range 36–75 months) of postoperative follow-up, we reported 19 cases of recurrence (9.94%). Recurrences occurred after a mean period of 12.4 months (range 10–49 months). On multivariate analysis, the development of postoperative hematoma (OR 2.9; CI 1.55–4.10, p = 0.001), and needing surgery for the hematoma (OR 2.1; CI 1.21–3.29, p = 0.004), obesity and chronic pulmonary disease (COPD) were predictors of recurrence after TAR. The area under Curve (AUC) was highly specific for all these independent factors (AUC = 0.842). There was no significant difference in recurrence rate among obesity, smoking, urgent repair, type of mesh fixation, operative time, type of prosthesis, or concomitant procedures.

Conclusions
In our current study, the development of postoperative hematoma and needing surgery for the hematoma, and obesity were associated with an increased risk of hernia recurrence after RSR.
OC-065 THE USE OF CAROLINAS COMFORT SCALE TO COMPARE MESH-RELATED SENSATION BETWEEN BIOSYNTHETIC AND SYNTHETIC MESH: A PILOT STUDY
Authors: Kulkarni G , Elliott Z , Rajoo J , Barnes D , Hammond T 
Published: May 2023

Abstract

Aim
Bio-synthetic meshes potentially disappear from the body after certain timeframe leaving behind strengthening scaffold matrix when used for Complex Abdominal Wall Reconstruction (CAWR). We used Carolinas comfort scale (CCS) to assess mesh sensation differences between biosynthetic and synthetic mesh at different time points.

Material and Methods
This pilot study focusses on patients having undergone CAWR within the unit in the last 3 years. Patients were categorised into four groups of 10 patients each; those repaired with synthetic mesh or biosynthetic mesh within the last 8 months and beyond 18 months. All 40 patients answered all questions of the Carolinas CCS. Decision of mesh type was governed by patient characteristics.

Results
10 patients were included in each group (total 40 patients) consecutive retrospective enrolment. We excluded those who had further abdominal surgery or clinical recurrence since. 20 patients repaired with biosynthetic and 20 with synthetic were included. Two-way ANOVA and post HOC Turkey's difference test showed significant difference (p&lt;0.05) in scores in favour of less scores for patients repaired with biosynthetic mesh. This was more pronounced in the beyond 18 month group. Component separation did not make a significant difference in mesh sensation. Logistic Regression analysis revealed patients scored higher on questions related to bending, sitting up and exercise and these were linked.

Conclusions
This outcome provides a review of current surgical practises and meshes, helping surgeons & patients make better informed decisions. Bio-synthetic meshes have better comfort outcomes for patients with lower CCS scores in the long term.
OC-070 EVALUATION OF PATIENTS’ QUALITY OF LIFE AFTER OPEN REPAIR OF INGUINAL HERNIAS BASED ON THE WEIGHT OF THE MESHES
Authors: Pepe F , Giaccone M , Gambali E , Turturica D I , Rosati S , Balestra G , Sandrucci S 
Published: May 2023

Abstract

Aim
The aim of this retrospective observational study with prospective follow-up is to evaluate the clinical outcomes and patients’ Quality of Life (QoL) after open repair of inguinal hernias using different meshes (48, 127 or 177–220 g/m2, pre-shaped meshes)(1).

Materials and Methods
382 patients who underwent inguinal hernia repair (Lichtenstein, Trabucco or Plug & Patch) from 2017 to 2018 were included in this analysis. All the patients’ baseline characteristics, peri- and post-operative outcomes were collected from the hospital medical records. A phone interview investigating long-term outcomes and patients’ QoL (EuraHS-QoL) was performed between December 2022 and January 2023. The primary endpoint of this study was the evaluation of patients’ QoL in three meshes’ subgroups: lightweight (nA=69), standard-weight (nB=143) and heavyweight (nC=170).

Results
The three subgroups didn't show significant differences in main baseline characteristics. Patients’ QoL improvement compared to the baseline was statistically significant in all three groups. In addition, all the post-operative QoL scores were significantly worse in group C. No differences in complications rate and recurrence rate were detected among the three groups. On the other hand, the surgical techniques did not affect the outcomes (recurrency and QoL).

Conclusion
This analysis performed at our center did not show any significant differences in outcomes between meshes of different weights except for the patients’ QoL which proved to be better in patients with light and standard-weight meshes. Based on our experience the surgical techniques could be chosen depending on the surgeons’ preferences.
References: 1.Dipromed Srl
OC-073 THE 3-D FUNNEL MESH TECHNIQUE FOR PARASTOMAL HERNIA REPAIR
Authors: Köhler G 
Published: May 2023

Abstract

Background
In previous studies, three-dimensional funnel mesh devices have been used successfully for the repair of PSHs by combining a laparoscopic and ostomy-opening approach

Methods
We performed an analysis of prospectively collected data of patients who underwent a same-sided stoma reposition with 3D funnel-shaped mesh augmentation in intraperitoneal- onlay position at three departments between the years of 2012 and 2021. 56 patients received an implant with 2.5 cm funnel length and 25 patients with 4cm funnel length. Primary outcome parameters were surgical complications and recurrence rate.

Results
81 patients could be included in this analysis. PSH repair was performed in 91% as elective surgery and in 87% in laparoscopic technique. A concomitant incisional hernia (EHS type 2 and 4) was found in 39% and repaired in a single-step procedure with PSH. Major postoperative complications requiring redo surgery were identified in 9.8% (8/81). Overall recurrence rate was 11% (9/81). Only 1 recurrence occurred in the group of 4 cm long implants (1/25= 4%). Median follow-up time was 44 months, and a 1-year follow-up rate of 91.4% was reached.

Conclusion
PSH repair with 3D funnel mesh in IPOM technique is safe, efficient and easy to perform providing advantageous results compared to other techniques. However the origin mesh funnel (2.5cm length) becomes shortened over time and further shrinkage happens eccentric concerning the flat mesh parts widening the funnel. Changing mesh construction according to consequently use the narrowest funnel (2cm) and it`s lengthening to 4cm led to reduction in recurrence without increasing implant-associated complications
OC-079 LAPAROSCOPIC TAPP APPROACH FOR A RECURRENT INGUINAL HERNIA
Authors: Santilli O , Santilli H , Nardelli N 
Published: May 2023

Abstract

Aim
To analyze the safety, feasibility, and effectiveness of a systematized laparoscopic transabdominal preperitoneal approach for a recurrent inguinal hernia.

Material & Methods
A retrospective observational analysis of a database between July 2012 and July 2022. Inclusion: all patients with a standard laparoscopic tapp approach to treat a recurrent inguinal hernia. The variables were compared with our results in primary inguinal hernias: laparoscopic finding (cause and type using the EHS classification) conversion rate, cause of conversion, complications, and quality of life outcomes. Demographic analysis of the population Age, BMI, and a number of recurrences.

Results
In this period, 5452 patients underwent a tapp laparoscopic approach to treat an inguinal hernia. 372 (6.82%) were registered as recurrent hernias. Men (98.4%). BMI: (26). When comparing the patients with a previous anterior approach: 316 patients (90%), there were no differences with the results of the primary hernia. Patients with the antecedents of the posterior approach were 39 patients (10,4%). Reviewed case by case, the effectiveness in diagnosis was (100%), and the conversion rate of 8 patients (20,5%). The cause of conversion was severe mesh adhesions to the vascular triangle and vesical preperitoneal space. There were no significant differences when comparing the results between patients who underwent tapp repair in primary and recurrent hernias. There was also no significant difference according to the number of recurrences.

Conclusions
The laparoscopic systematized approach in recurrent hernias shows effective rates in providing safe diagnosis and treatment while maintaining the quality of life standards.
OC-081 DIASTASIS RECTI REPAIR – DEVELOPMENT OF A PATIENT REPORTED OUTCOME MEASURE THROUGH QUALITATIVE ASSESSMENT
Authors: Amro C , Mcauliffe P B , Niu E F , Bilger A , Broach R B , Rendle K A , Fischer J P 
Published: May 2023

Abstract

Aim
Diastasis recti may lead to undesirable symptoms including aesthetic dissatisfaction and decreased quality of life (QoL). Currently, there is no validated disease-specific patient reported outcomes (PRO) measure to assess patient satisfaction and facilitate personalized care after repair. Our study aimed to develop a diastasis-specific PRO-measure through qualitative assessment within this population.

Methods
Diastasis recti repair patients were enrolled and semi-structured cognitive interviews using the think-aloud technique were conducted by a trained qualitative research member of the Mixed Methods Research Laboratory. Patients answered a 23-item questionnaire, derived from BODY-Q and AHQ, addressing four components–Physical, Appearance, Surgical Team, and Satisfaction with Abdomen.

Results
Thirteen patients who underwent diastasis repair completed the interviews, which were conducted an average of 353 days after surgery. All participants reported the questions in the survey were easy to interpret and assessed different constructs. Most questions in the study were relevant and easily interpreted, however, a few participants reported some items were unclear, specifically related to discerning between size and shape of their abdomen. When asked about aspects of their experience not addressed by the survey, patients mentioned sensory changes around the incision, and accordingly a question was added to the instrument.

Conclusion
As a first step toward creation of a diastasis recti PRO-measure, we present the results of qualitative patient assessment. Patients found the instrument clear and relevant to their experience. A void remains to optimize PROs after diastasis repair; therefore, our PRO-measure will provide surgeons a qualitative tool for quantitative assessment of their QoL.
OC-087 THE MESH AND THE MACHINE: DEEP LEARNING TO IDENTIFY HERNIA MESHES ON CT SCANS
Authors: Rengan V , Sundaram P M , Arora E , Bawa A , Alexander N , Rengan R S 
Published: May 2023

Abstract

Aim
To identify the presence of meshes in CT scans of patients who have previously undergone hernia repairs using our novel deep learning algorithms.

Materials & Methods
We annotated mesh data from 30 ventral hernia CT scans of patients who had undergone previous ventral hernia repairs using computer vision tools. The annotated slices from the CT scans qualified as the ground truth. 80% of the data was used for training and validation. 20% data was used for testing. The novel deep learning model we used had previously identified meshes with lower accuracy levels due to inferior data sets.

Results
Our deep learning model was able to identify the mesh with an accuracy of 70% when compared to a manual annotator. Retraining our model with more varied mesh data gave us improved results.

Conclusions
Identification of the mesh is a challenge for surgeons and radiologists. The evolution of deep learning techniques made the identification of obscure structures possible. Meshes present a unique challenge as they constitute a foreign tissue which integrates into native tissue. Our team's novel deep learning algorithms have been effective in identifying meshes, This could play a major role in automated hernia reporting. The surgeon will be benefited from additional information about the plane of mesh and level of integration while planning surgeries for recurrence or mesh explantation.