bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC-086 THE NEW ERA OF 3D-PRINTING TECHNIQUES IN A MEDICAL SETTING: EARLIER EXPERIENCE WITH THE USE OF BOTULINUM TOXIN FOR COMPLEX VENTRAL INCISIONAL HERNIA
Authors: Caruso R , Vicente E , Quijano Y , Ferri V , Duran H , Diaz E , Fabra I , Malave L , Ruiz P , Pizzuti G , Naldini C 
Published: May 2023

Abstract
In the last years 3D printing has progressively gained widespread interest for its several applications in many medical fields. Among the most common diagnostic imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI) allow only two-dimensional images to obtain information on different pathologies. This requires excellent visualization skills from not specialized medical doctors. The 3D printing has been developed to overcome the current disadvantages of conventional imaging techniques.
The 3D models are created from the diagnostic studies of the patient (MRI, CT, PET or a combination of those) with a process that fuse advanced medical imaging algorithms and medical image processing, which are supervised by specialized radiologists. Hereby we describe the cases of two patients with giant incisional hernias. The patients underwent 3D study before botulinum toxin treatment and another 3D model a months after the botulin toxin. With the 3D model we calculated the abdominal cavity volume before and after the treatment with botulinum toxin. Six weeks after the toxin we planned the surgery.
The operation time was 180 min and 150 min respectively. The patient's diet was resumed on the first day postsurgery, and the postoperative hospital stay was five days.
Our experience gives an overview of the current use of 3D-techniques, more specifically in the field of abdominal wall defect.
OC-096 Short-Term Results of Transversus Abdominis Release in Patients under Immunosuppression
Authors: De Troyer A , Allaeys M , Molnar A , Berrevoet F , Hasan E 
Published: May 2023

Abstract

Aim
Immunosuppressive medication might increase the likelihood of wound morbidity, with possible higher rate of surgical site infections (SSIs). We aim to identify short-term outcomes and hospital stay after incisional hernia repair with transversus abdominis release (TAR) in patients with versus without immunosuppression.

Material & Methods
All patients undergoing open incisional abdominal wall hernia repair with uni-or bilateral TAR from January 2021 through November 2022 were identified using a prospectively maintained database. Minimum follow-up was 30 days. Outcomes included 30-day SSIs, seroma rate, hospital stay, and early recurrence.

Results
Twenty-seven patients with immunosuppressive medication were identified and 75 without (mean age 59.0 ± 13.9 vs. 65.1 ± 11.4, 74.1% vs. 46.7% male, respectively). Median hernia width was 7.7 ± 5.1 cm vs. 7.9 ± 4.3 cm respectively. At 30 days follow-up, SSI rate was 1/27 (3.7%) in the group under immunosuppression and 5/75 (6.7%) in the group without (p = 0.575). Seroma rate was 3/27 (11.1%) vs. 12/75 (16.0%), respectively (p = 0.539). Mean hospital stay was 6.0 ± 3.6 days in the immunosuppression group vs 8.1 ± 6.7 days in the group without (p = 0.052). No early recurrences were detected in either group.

Conclusion
Immunosuppression does not significantly increase the risk of short-term complications in incisional hernia repair with transversus abdominis release. There is a trend towards a shorter hospital stay in patients under immunosuppression, possibly related to a reduced inflammatory response.
OC-102 NUCK HYDROCELE DURING INGUINAL HERNIA REPAIR IN ADULT FEMALES. REPORT OF TWO CASES
Authors: Chamzin A , Galyfos G , Triantafyllou A , Theodoropoulos C , Toutouzas K , Theodorou D , Zografos G 
Published: May 2023

Abstract

Aim
To present both the open and laparoscopic technique when encountering a Nuck hydrocele during an inguinal hernia repair in females.

Methods
Two cases of incidentally encountered cysts of Nuck during elective inguinal hernia repair in females are presented.

Results
Hydrocele of Nuck is a type of primary idiopathic hydrocele. It can occur due to partial remaining of the physiologically obliterated Canal of Nuck. In females, cysts of Nuck are frequently clinically misdiagnosed as inguinal hernias. A 42-year-old woman was subjected to a left TAPP repair for a symptomatic inguinal bulge. Intraoperatively a cystic lesion was attached to the round ligament of the uterus. The cyst contained clear fluid and was progressively dissected from the round ligament, excised and sent for a pathological examination. A typical TAPP repair with mesh ensued. A second case of a 45-year-old woman was submitted to a laparoscopic exploration of an ultrasonographically identified cystic lesion inside the inguinal canal. Intraabdominal reduction of the cyst was not possible, so conversion to open surgery was decided. A clear-fluid cyst was then excised and a typical Lichtenstein repair was performed.

Conclusions
Symptomatic inguinal bulge especially in women may warrant ultrasound examination for preoperative clarification of the underlying pathology and intraoperative management. The surgeon should be aware of the existence and pathogenesis of this rare entity.
OC-123 COMPARISON OF COMPLICATION RATES BETWEEN INTRA- AND EXTRAPERITONEAL HERNIA REPAIRS
Authors: De Deken J , Stavrou G A 
Published: May 2023

Abstract

Aim
With the emergence of new laparoscopic techniques, Intra-Peritoneal-Onlay-Mesh (IPOM) has fallen out of favor for repairing abdominal wall hernias due to reported complications, including adhesions and bowel injury, our aim is to compare complication rates in our center between intra- and extraperitoneal techniques.

Material & Methods
A retrospective analysis was conducted on data from our certified hernia center from 2018 to 2021. All patients who underwent an umbilical, epigastric or incisional hernia-repair were included. The primary outcome measures were complications, including bowel injury and adhesions.

Results
A total of 188 patients underwent a hernia repair. 74 (39%) patients hat an umbilical hernia, 22 (12%) an epigastric hernia and 92 (49%) had an incisional hernia. Most patients (110–58%) were treated with laparoscopic IPOM, 14 (7,4%) of them underwent an open IPOM. 46 (25%) had hernias repaired with direct suture and the remaining patients were treated with other techniques, including open sublay and mini or less open sublay (MILOS). After an average follow-up of 36months, only two (1%) patients developed a mechanical ileus, one after laparoscopic and one after open IPOM surgery. Bowel lesions occurred in two (1%) patients who underwent open IPOM and direct suture hernia repairs. There was no difference in complications between the different surgical techniques.

Conclusion
Our study suggests that the different techniques for hernia repair have similar rates of complications. Further research is needed to determine the most effective and safe approach for hernia repair.
P-017 TROCAR SITE HERNIA: IS IT A MINOR PROBLEM ?
Authors: Zaragoza Zaragoza C , Duque Alvarez N X , Parra Chiclano J , Gomis Martin A , Rubio García J J , Viñas Martínez T , Ramia Ángel J M 
Published: May 2023

Abstract

Aim
Describe the characteristics of a trocar site hernia (TSH) in our center.

Materials and methods
Descriptive retrospective observational study. Tertiary hospital center. Period: July 2018 - November 2022. Inclusion criteria: Patients operated on for TSH. We analyzed patient characteristics, type of the primary procedure (appendectomy, cholecystectomy or other), TSH data and characteristics of TSH repair.

Results
150 patients were included. Patient data: 65.3% were women. Median age: 59.54 years. BMI &lt;35 in 47%. BMI was higher in cholecystectomies than in appendectomies. 66% were ASA II. 31.3% were active smokers. Surgical primary procedures: 59.4% cholecystectomy, 17.3% appendectomy, 23.3% others. Surgical TSH time: 30–90 minutes (59.6%) and 36.7% were performed as an emergency procedure. TSH data: 85.3% were M3, mean size was 3.8 cm Time between primary surgery and TSH: 39.6 months. The size of the TSH only had a statistically relationship with the time between primary surgery and TSH diagnosis. Furthermore, 17.3% of the TSH were recurrences, of which 77% already had a mesh. 91% of the TSH were scheduled surgery, with a mean surgical time of 70 minutes. All were repaired with a mesh, 68.6% preperitoneal/medial retromuscular. Regarding complications, 7.4% presented after a month and 1.3% recurred after 6 months.

Conclusions
According to our data, the TSH is not a minor problem with high morbility and resource consumption. The rate of TSH is greater in obese women undergoing cholecystectomy. Perhaps a prophylactic mesh policy should consider in these cases.
P-038 BOTULINUM TOXIN IN THE TREATMENT OF COMPLEX ABDOMINAL HERNIAS: A REVIEW OF CLINICAL OUTCOMES
Authors: Oliveira A , Fonseca T , Barbosa E , Barbosa E 
Published: May 2023

Abstract

Aim
Adjuvant use of botulinum toxin (BTX), which causes temporary paralysis of the lateral abdominal wall muscles, may have a roll in achieving a functional abdominal wall reconstruction when treating complex hernias, without the need of component separation techniques (CST).

Methods
Retrospective analysis of all patients with complex hernia between April 2021 and October 2022 in which BTX was used. Patients that would have to go through CST regardless and patients with other adjuvant treatments were excluded.

Results
22 patients had BTX, with a total of 13 patients included in this study. The median age was 64 and BMI 30,7kg/m2. The average CT imaging measurement of the transverse defect was 13,7cm. The median of Cedar's calculation was 27%. 7 patients (54%) only needed a Rives Stoppa Wantz (RSW) for midline closure, but 6 patients still needed a CST. The median time of the surgery for the RSW was 233 min and for the CST 330 min. Of the patients submitted to RSW, 1 complicated with a deep incisional infection and 2 CST patients had surgical complications. No recurrences in the RSW group and one hernia persistence after a major complication on the CST group.

Conclusion
The BTX can have an important role as an adjuvant in the treatment of large incisional hernias and in some patients may allow its repair with a less invasive surgical technique, with less operative time and less complications. More studies are needed in this area.
P-042 SHORT-TERM RESULTS OF LAPAROSCOPIC TOTALLY EXTRAPERITONEAL (TEP) GROIN HERNIA REPAIR WITH LIGHTWEIGHT FLAT MESH WITHOUT FIXATION. AGAINST THE ESTABLISHED?
Authors: Marrero Marrero P , Delgado Plasencia L J , Lorenzo Rocha N , Rodríguez Castellano D , Fernández Hernández L , Bravo Gutiérrez A F 
Published: May 2023

Abstract

Aim
International guidelines concerning mesh and mesh fixation options in TEP and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. The value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The Swedish Hernia Registry Study published in 2022 a cohort study where it recommended in TEP and TAPP the use of lightweight flat mesh with fibrin glue fixation and the use of standar polypropylene flat mesh without fixation, as the two methods with the lowest rate of reoperations for recurrence (3,7%). We present the short-term results of TEP groin hernia repair with lightweight polypropylene flat mesh without fixation.

Material and Methods
In 2021, 32 TEP were electively performed in 27 adults with inguinal hernias L, M, F, P or R (EHS-Classification). The endpoint was reoperation due to recurrence at 1 year after surgery.

Results
32 hernias L1 P, 1 L2 P, 2 L2 R and 1 F1 P were operated as outpatient surgery. 24 males and 4 females. Average age 57,5; Average BMI 28; The most frecuent postoperative complication was mild self-limiting scrotal hematoma (10%; Clavien-Dindos-I). Recurrence rate of hernia was 3,7%.

Conclusions
The TEP groin hernia repair with lightweight flat mesh without fixation could be an option to consider. However, due to the small sample size used in this study, the results should be interpreted with caution and longer-term studies are needed.
P-045 OUR EXPERIENCE WITH THE PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM
Authors: Santidrián Zurbano M , Domínguez Bastante M , Salmerón Ruiz Á , Diaz Ríos P , Medina Benitez A , Mansilla Roselló A 
Published: May 2023

Abstract

Aim
Complex incisional hernias (IH) pose a surgical challenge. Prehabilitation of the abdominal wall favors surgery and improves outcomes. We present our results with the use of preoperative progressive pneumoperitoneum (PPP) in complex abdominal wall pathology.

Material and Methods
Single-centre, retrospective, observational study (March 2018-July 2022), including patients receiving PPP (Tanaka index &gt;20% or &lt;20% if facing a non-reducible or incarcerated IH). The insufflation catheter is placed under ultrasound control, initially administering 500 cc. The total volume of PPP to be administered is three times the volume of the hernia sac. Administration is effectuated on an outpatient basis, starting 15 days before surgery, administering 1000–1200 cc every 24–48 hours. Antithrombotic prophylaxis, incentive inspirrometry and prescribed analgesia are performed.

Results
68 patients were included, 39 females/29 males, age 63.3 years (24–85), body mass index 33.7 (20–48) and CeDAR 38.9% (11–92). Classification of IH (EHS): M 72% (49), L 15% (10), ML 6% (4), parastomal 4% (3), groin hernia 4% (3) and other primary hernia 3% (2). Mean Tanaka index is 26% (3–85), mean PPP insufflated 3395 cc (1800–15000 cc). Mean PPP time before surgery was 14 days (3–70).
Eight complications related with the procedure were observed: 3 subcutaneous emphysema (4.3%), 2 ineffective PPP (2.8%), 1 catheter exit (1.4%), 1 catheter infection (1.4%) and 1 laparoscopic approach (1.4%). In three cases it was not feasible to place the PPP catheter.

Conclusions
PPP is an effective and safe treatment to facilitate the repair of complex IH, with minimal morbidity and zero mortality.
P-082 THE EFFECT OF CLOSED DRAINAGE SYSTEM ON SEROMA IN LAPAROSCOPIC TOTAL EXTRAPERITONEAL INGUINAL HERNIA REPAIR
Authors: Agca B , Iscan Y , Ergin A , Bilgili A C , Topaloglu B , Fersahoglu M , Memisoglu K 
Published: May 2023

Abstract

Aim
Seroma that can be seen after endoscopic completely extraperitoneal inguinal hernioplasty (TEP) is a major problem in patients who are concerned about recurrence.In this study,a prospective study design was prepared in our clinic in order to see the incidence of seroma afterTEP and the effect of closed system negative pressure drainage, which is one of the methods thought to reduce it.

Methods
January2021-February2022patients who will undergo unilateral TEP were randomly selected and divided into two groups.Group I was the group where a drain would be placed after TEP,and Group II was the group where no drain was placed after TEP.A hemovac drain was placed behind the mesh, with the perforated end of the drain coming into the preperitoneal cavity,in the patients in Group I.All cases were anatomical 3Dmesh(3DMax™Mesh,BD,USA)was applied to all cases.

Results
There were 41patients in Group I and 39patients in Group II.73 of the patients were male and 8 were female.According to the EHS classification,47of the hernias wereL1 and 33 were M1 hernias.On the 7th postoperative day,seroma was observed in 5patients in Group I and13 patients in Group II (p&lt;0.024).There was no difference between the groups in the seromas seen at the postoperative 3rd month.

Conclusion
The frequent occurrence of seroma after TEP is confused with recurrence, especially after hernia surgery.This may cause fear and panic in the patient.It is effective for the patients to come to the surgeon who performs the operation at regular intervals for control in order to eliminate the concerns of the patients.
P-097 FEMORAL AND OBTURATOR HERNIA INCARCERATED: A CASE REPORT
Authors: Lourenço R , Peixoto I , Santos A , Lopes A , Matos D , Pinto R , Alpoim C 
Published: May 2023

Abstract
Obturator hernia is a very rare type of abdominal wall hernia, accounting for less than 1% of all abdominal wall hernias. They can be confused with femoral hernias as well as they can arise simultaneously, just like in this clinical case.
A 82 year old female, with multiple comorbidities including a right inguinal hernioplasty, was brought to our emergency department complaining of abdominal pain, distension and vomiting in the last 24 hours.
On physical examination, there where abnormally active, high-pitched bowel sounds, abdominal distension and pain on left lower quadrant but no tenderness. Palpation of groin area showed an incarcerated left femoral hernia, apparently containing only omentum. As the patient maintained left lower abdominal pain, we proceed to a CT scan, which demonstrated small bowel dilation with air-fluid levels consistent with a small bowel obstruction originating from an obturator hernia.
Open tension-free mesh repair of femoral hernia was done and no need for ressection since it only contained omentum, without ischemic signs. Open transperitoneal nonmesh repair of obturator hernia was performed after hernia reduction. There was no irreversible ischemia. Evolution during hospitalization was uneventful.
Regarding obturator hernias, there is no optimal approach since it is a very rare type of hernia, so it probably depends on patient condition and surgeon experience. A transperitoneal approach is preferred when there's signs of bowel obstruction, as we proceed on this clinical case.
V-001 ROBOTIC E-TEP APPROACH FOR RECURRENT INCISIONAL HERNIA AFTER LAPAROSCOPIC IPOM REPAIR: HAZARD OR RIGHT CHOISE?
Authors: Cobuccio L , Tartaglia D , Coccolini F , Chiarugi M 
Published: May 2023

Abstract
The video shows the case of a 40-year-old male patient with a recurrent umbilical hernia after a laparoscopic IPOM repair. The preoperative CT scan with Valsalva shows a M3 defect with a width of 7 cm at the lower border of the intraperitoneal mesh, associated with upper midline diastasis. We decide to address the hernia repair with a robotic e-TEP approach and a lateral docking. Despite a difficult access and dissection of the retromuscular space due to the adhesions beetwen the rectus muscle and the non-absorbable tacks, the procedure was successful and the patient was discharged the day after the surgery. No complications or recurrence were detected at the 6-month follow-up.
V-018 PAULI REPAIR FOR THE COMBINATION OF MIDLINE INCISIONAL AND PARASTOMAL HERNIAS
Authors: García Ureña M Á , Medina M , Avilés A , Morejon S , Robin Valle De Lersundi A , Martínez J , Lopez Monclús J , Blazquez Hernando L A , Jiménez Ceinos C , Vaello V 
Published: May 2023

Abstract

Introduction
Parastomal hernias (PH) can be a complex surgical problem. When there is a combination of midline and parastomal hernias, an option could be using both posterior component separation technique and an intraparietal Sugarbaker as described by Pauli. We present a case with the combination of midline and parastomal hernias. The aim of this video is to offer the most relevant steps that should be followed for a Pauli repair.

Methods
This is a 75 years-old man,, that underwent abdominoperineal resection for rectal cancer T3N2 in 2018. He developed a very symptomatic incisional hernia + parastomal and repaired was offered. After adhesiolysis, a retromuscular Rives dissection and a left posterior component separation were made. A Pauli was planned lateralizing the bowel in the retromuscular plane (like an intraparietal Sugarbaker repair) and a biosynthetic mesh was used in the retromuscular preperitoneal plane, making an inner stoma site with the mesh and bringing the colon trough the previous stoma site. Finally, anterior abdominal wall was closed

Results
The patient was discharged uneventfully on the 6th postoperative day.

Discussion
Pauli described 3 patients in similar circumstances but leaving the new posterior ostomy site lateral to the mesh. This technique that we describe in this video could be particularly useful in patients in whom a simpler Sugarbaker laparoscopic repair is not adequate and in those cases with PH with concomitant midline defects.
V-019 Spiegel hernia repair using eTEP approach
Authors: Gómez López J R , Concejo Cutoli P , Trujillo Díaz J J , Martínez Moreno C M , Montenegro Martín M A , Atienza Herrero J , Martín Del Olmo J C 
Published: May 2023

Abstract

Objective
Spiegel hernia is a rare entity that accounts for less than 1% of operated hernias. Its clinical diagnosis is difficult and its treatment is varied.
The objective of this work was to show the eTEP approach for the treatment of this pathology.

Methods
Despite the fact that this entity accounts for less than 1% of all hernia outbreaks, we had three probable cases of Spigelian hernia in the last quarter. The last of them was resolved with Extended Totally Extraperitoneal (eTEP) Approach for Hernia Repair.

Results
We show a 62-year-old man, previously operated on for bilateral inguinal hernia and Spiegel hernia on the right side by TAPP laparoscopic approach. He presents a left Spiegel hernia now, for which a totally extraperitoneal approach is proposed. The surgery was uneventful and the patient was discharged the day after the intervention. At two months of follow-up, the patient is asymptomatic.

Conclusions
Spiegel hernia is a rare hernia, difficult to diagnose and can present itself as complicated. It can be treated with various approaches. Laparoscopic Spiegel hernia repair is gaining popularity for its safety and patient benefits. The eTEP approach is useful tool in the management of the abdominal wall and, as demonstrated in our case, for the treatment of Spiegel hernia.
V-022 POSTOPERATIVE INGUINODYNIA: LAPAROSCOPIC NEURECTOMY AND MESH REMOVAL
Authors: Olivero A A , Valinoti A C , Giacone J A , Sadava E E 
Published: May 2023

Abstract

Aim
Chronic groin pain following a hernioplasty is a complication with an incidence of 10–12%. A multidisciplinary approach, including pain management services, interventional radiology and surgery, has proven the best outcomes. Persistence of symptoms and lack of efficacy of non-surgical treatments make surgical treatment with prosthetic removal and neurectomies an appropriate alternative.

Material & Methods
We present the clinical case of a 35-year-old male with a history of bilateral laparoscopic groin hernioplasty performed at another institution 10 years ago. After the surgery, he developed chronic groin pain, predominantly on the left side, and underwent multiple interventions. He complained that the pain was severe and incapacitating, affecting his quality of life. Dermatome mapping evidenced compromise of the three inguinal nerves (ilioinguinal, iliohypogastric and inguinal branch of genitofemoral). A multidisciplinary approach including NSAIDs, pregabalin, tricyclic antidepressants and periradicular blocks followed by radiofrequency ablation was established, without success. A laparoscopic left inguinal exploration with mesh removal and triple neurectomy was then decided.

Results
The patient had an adequate postoperative course. He returned to daily activities including sports practice, and no recurrence was observed after 1 year of follow up.

Conclusions
A multidisciplinary approach is suggested for the treatment of postoperative inguinodynia. Neurectomy and mesh removal is a safe and effective strategy, and must be considered for the management of severe postoperative groin pain in which non-operative approaches failed. Surgery entails a great challenge and therefore should be performed in specialized centers.