bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC-007 ATHLETES TREATED FOR INGUINAL-RELATED GROIN PAIN BY ENDOSCOPIC TOTALLY EXTRAPERITONEAL (TEP) REPAIR: LONG-TERM BENEFITS
Authors: Meuzelaar R , Visscher L , Den Hartog F , Goedhart E , Schiphorst A , Burgmans I 
Published: May 2023

Abstract

Aim
Inguinal-related groin pain (IRGP) in athletes is a debilitating condition with a multifactorial origin. Hence, it creates difficulties in diagnosis and treatment, demanding a multidisciplinary approach. If conservative treatment fails, totally extra-peritoneal repair (TEP) has been shown effective in pain relief within 3 months, but results of long-term follow-up are sparse. For that reason, it is important to know whether these positive outcomes are maintained with longer term follow-up. This study aimed to evaluate whether these patients still benefit many years after the procedure.

Material & Methods
Patients that participated in the initial prospective, observational cohort study (TEP-ID-study) were subjected to two telephone questionnaires. The first questionnaire aimed to detect recurrence of initial complaints and the occurrence of new groin-related complaints. Secondly, physical functioning was assessed by using the Copenhagen Hip and Groin Outcome Score (HAGOS).

Results
Out of 32 male participants in the original study, 28 patients (88%) were available with a median follow-up of 83 months (range: 69–95). Seventy-five percent of athletes were pain-free during sports (p &lt; 0.001). At very long-term follow-up, a median NRS of 0 was observed (IQR 0-2). This was a significant decrease compared to scores pre- and 3-months post-operatively (p ≤ 0.001). Although ten patients described recurrence of symptoms, physical functioning improved on all HAGOS subscales (p ≤ 0.005).

Conclusions
This study demonstrates the safety and effectivity of TEP-repair in a prospective cohort of athletes with IRGP, for whom conservative treatment had failed, with a follow-up period of over 80 months.
OC-008 NEURAL NETWORKS PREDICTING HERNIA RECURRENCE AFTER ABDOMINAL WALL RECONSTRUCTION (AWR) PERFORM BETTER WITHOUT PREOPERATIVE IMAGING
Authors: Wilson H , Ma C , Ku D , Scarola G , Polcz M , Augenstein V , Colavita P , Heniford B T 
Published: May 2023

Abstract

Introduction
Image-based deep learning models (DLMs) have shown promise in predicting surgical complexity and wound complications for AWR with the potential to augment other clinical information in surgical decision-making. The purpose of this study is to evaluate a preoperative image-based DLM in predicting hernia recurrence.

Methods
A prospective single-institution database was queried for open AWR patients with preoperative CT imaging. Patient demographics and hernia recurrence were collected. Patient data were batched into training (80%) and test (20%) sets. A convolutional neural network was trained to evaluate image characteristics alone. A feedforward neural network (FNN) was also trained to evaluate clinical data alone. Another FNN was designed to incorporate the outputs from both models. The primary outcome was the ability to accurately predict hernia recurrence, as assessed by the area under the curve (AUC) for each model.

Results
There were 190 patients in this dataset who underwent AWR. Overall, 28 (14.7%) had a recurrence with a median follow up of 85 [56, 113] months. Preoperative CT imaging alone returned an AUC = 0.500. Clinical data alone performed better with an AUC = 0.667. Incorporating both models resulted in an AUC = 0.604.

Conclusions
In this study, the DLM with clinical data alone outperformed an image-based DLM in predicting recurrence. Clinical data alone also outperformed the model incorporating both clinical data and preoperative imaging. DLMs have shown significant potential to predict AWR outcomes and may be used in the future to guide care and aid in patient consent for surgery.
OC-023 INCIDENCE OF TRUE CONTRALATERAL METACHRONOUS INGUINAL HERNIA ON LONG TERM FOLLOW-UP AFTER UNILATERAL INGUINAL HERNIA REPAIR: A SYSTEMATIC REVIEW
Authors: Vissers S , De Groof P , Fieuws S , De Raeymaeker X , Abramovich T , Van De Winkel N , Miserez M 
Published: May 2023

Abstract

Aim
The repair of inguinal hernias is one of the most common surgical procedures with few complications. Some patients will need a second operation because of the development of a metachronous contralateral inguinal hernia (MCIH). The suggestion has been made to strengthen the contralateral side at the same time as primary surgery. In this study we aim to determine how many patients, with a unilateral inguinal hernia will develop a MCIH.

Methods
We performed a literature review following the PRISMA guidelines. As outcome measure, the number of patients diagnosed with a MCIH were registered. A meta-analysis was performed to obtain a summary estimate of the percentage of patients with MCIH.

Results
A total of 19 articles with a combined total of 277.288 patients who underwent elective unilateral inguinal hernia repair were included. The combined estimate for MCIH equaled 8.3% (95%CI: 7.1%-9.5%). A random-effects meta-regression was performed to obtain the percentage of MCIH as a function of the median follow-up time. The percentage of MCIH at 3, 5 and 10 years was estimated as 5.2%, 8% and 17.1%, respectively.

Conclusion
We believe there is not enough clinical evidence to support the idea of prophylactic contralateral repair. We suggest a patient-specific approach in the decision to perform prophylactic repair, taking into account potential risk factors, type of surgical approach, and general risk factors for chronic postoperative inguinal pain. More long term prospective data are needed to guide the decision for prophylactic contralateral mesh placement in a clinical healthy groin.
OC-026 LONG-TERM OUTCOMES AFTER EPIGASTRIC HERNIA REPAIR IN WOMEN – A NATIONWIDE DATABASE STUDY
Authors: Willaume M , Henriksen N 
Published: May 2023

Abstract

Aim
Outcomes after epigastric hernia repair are rarely reported independently. Repair of an epigastric hernia is more frequently performed in women. The aim of this study was to evaluate long-term outcomes after epigastric hernia repairs in women on a nationwide basis.

Methods
Nationwide database cohort study using prospectively recorded data from the Danish Hernia Database of women undergoing elective repair for epigastric hernias, during a 4-year period (2018–2021). A 100% follow-up was obtained by combining intra-operative data with data from the National Civil Register (NRC). The primary outcome was operation for recurrence, secondary outcomes were readmission and operation for complications.

Results
In total, 3031 women underwent elective epigastric hernia repair during the study period. Some 2462 were performed as open repairs and 569 underwent laparoscopic repair. Follow-up was median 4.8 years. The cumulative operation rate for recurrence for open mesh repairs was 3.3% vs. 7.7% for sutured repair (P=0.002). The risk of operation for complications was significantly higher after mesh repair vs. sutured repair (2.0% vs. 3.6%, P = 0.014) with more operations for surgical site infection in the mesh group. In multivariable analyses, risk factors for recurrence were operation for complications and sutured repair. For open vs. laparoscopic repairs there were no differences in recurrence rates (6.3% vs. 6.3%, P=0.915), but the readmission rate was higher for laparoscopic repairs 10.9% vs. 6.1 (P&lt;0.001).

Conclusion
Mesh repair reduces the risk of operation for recurrence but at the expense of an increased risk of operation for superficial wound infection.
OC-032 SAFETY OF PERFORMING CONCOMITANT GASTROINTESTINAL RESECTIONAL SURGERY WITH COMPLEX ABDOMINAL WALL RECONSTRUCTION
Authors: Kulkarni G , King E , Hammond T 
Published: May 2023

Abstract

Aim
The literature regarding combined complex abdominal wall reconstruction (CAWR) and gastrointestinal surgery (GIS) is limited and largely suggests staged procedures due to a reported increased incidence of surgical site occurences (SSO), hernia recurrence and anastomotic leak. However this exposes patients to the risks of two substantial procedures and having general anaesthetic twice. This study aimed to evaluate outcomes of single-stage GIS involving a substantial GI resection with CAWR.

Materials & Methods
Analysis of a 8 years prospectively maintained single surgeon CAWR database of 205 patients identified 14 such patients who had undergone concomitant CAWR GIS cases (5 segmental colonic resections, 2 completion proctectomies, 5 Hartmann's reversals and 2 small bowel resection and anastomoses) but excluding cholecystectomy, gynaecological surgery and adhesiolysis alone.

Results
CAWR-GIS mean operating time was significantly longer (5.8hrs vs 3.8hrs) with an increased incidence of post-operative ileus (40% vs 18%, p&lt;0.05) with increased mean length of stay as expected (7.8 days v/s 5.1 days). There was a slightly higher incidence of SSO but there were no anastomotic leaks. Hernia recurrence rate at 2 years follow up was 10% which is comparable to our cohort (8%). None of the 14 patients required reoperation within 30 days or mesh explantation yet. 11 patients had a synthetic mesh and 3 patients had a bio-synthetic mesh used. Patients informally reported high satisfaction for having undergone combined procedures.

Conclusion
Concomitant intestinal surgery during complex abdominal wall repair can be performed safely without increased risk of hernia recurrence, mesh infections or anastomotic leak.
OC-038 LATERAL INCISIONAL VENTRAL HERNIA: CAN ETEP APPROACH ENHANCE THE OUTCOMES?
Authors: Salido S , Hernández S , Gutiérrez E , Guevara-Martínez J , Zapata C , Chavarrías N , Fondevila C 
Published: May 2023

Abstract

Objective
To present the application of the extended totally extraperitoneal (eTEP) approach in lateral incisional hernias and to analyze the results in our series of cases.

Materials and Methods
Retrospective comparative multicenter study based on a prospective database conducted at Fundacion Jimenez Diaz University Hospital and La Paz Hospital in Madrid that includes eTEP incisional ventral hernia repairs performed between March 2019 and January 2023. The inclusion criteria were lateral incisional hernias W1 and W2 according to the classification of the European Hernia Society (EHS). Preoperative, intraoperative, and postoperative data were collected.

Results
In the study period, 159 ventral hernias were intervened by eTEP access and a total of 49 incisional hernias were analyzed. By location, 3 cases were L1, 25 cases were L2, 15 cases were L3, and 6 cases were L4. The median defect size was 48mm (11–126). The median surgical time was 115 minutes (45–237) and transverse muscle release was applied in 36 cases (73.5%). The median length of stay was 1 day (1–7) and 14 (28.6%) patients were intervened on an outpatient basis. Four (8.2%) postoperative complications and 1 (2%) recurrence were evident. The median follow-up was 21 months (3–46).

Conclusions
The treatment of lateral incisional hernias by eTEP approach is feasible and abdominal transverse muscle release may have to be applied in many cases. It presents excellent results in our series in terms of complication rate, recurrence rate, hospital stay, and proportion of outpatient treatment.
OC-042 LAPAROSCOPIC ETEP APPROACH TO VENTRAL HERNIAS: SHORT-TERM OUTCOMES
Authors: Trujillo Díaz J , Gómez López J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martín Del Olmo J C 
Published: May 2023

Abstract

Aim
Ventral hernias are a pathology with a high incidence within general surgery.Repair techniques have been evolving, and the minimally invasive approach to this type of pathology is currently on the rise due to the advantages of the MIS.

Material & Methods
We analyzed our database of patients with ventral hernias undergoing laparoscopic-eTEP approach,August-2021 to December-2022. We present our short-term outcomes.

Results
A total of 31 patients(men:54.8%,age:64(RIQ:43–73years)). LOS:1.48±0.62days. Pathological history:diabetes mellitus(19.4%),arterial hypertension(45.2%),dyslipidemia(51.6%), smoking(25.8%), alcohol consumption(13.3%), cardiovascular disease(12.9%). ASA Classification:I(32.3%), II(45.2%), III(22.6%). BMI:30.6±4.68kg/m2. Overweight:11(35.5%) and obesity:17(54.8%).
Primary hernias:4(26.7%) and incisional hernias:19(61.3%).Location:midline(100%), supraumbilical:58.1%,umbilical:87.1% and infraumbilical:25.8%.Hernia width (EHS classification): W1:12.9%, W2:80.6% and W3:6.5%, transverse hernia diameter: 5.5±2.1cm, hernia length size:6.1±4.4cm. Associated with diastasis:24(77.4%),diastasis width:4.9±1.7cm. Associated with inguinal hernia:6(19.4%).
Type of laparoscopic surgical technique performed:Rives-Stoppa: 24(77.4%), unilateral TAR:5(16.1%), bilateral TAR:2(6.5%).Number of trocars used by procedure:4(RIQ:4–5). Preoperative botulinum toxin:7(22.6%). Posterior sheath closure:23(74.2%). Mesh fixation type:Glutack 5(16.1%), Tisseel 19(61.3%), no fixation 7(22.6%). Mesh type used: Low density wide-pore polypropylene 11(35.5%),PVDF-Mesh 18(58.1%), PVDF-IPOM mesh 2(6.5%). Mesh size: width 18(RIQ:16–22cm) and length 28(RIQ:25–30cm). Drainage: 3(9.7%). Surgical time:200(RIQ:180–300min). Global and serious complications (CD≥III): 4(12.9%) and 1(3.2%), Re-IQ due to incarcerated hernia due to posterior sheath dehiscence: 1 (3.2%). No intraoperative complications. Clinical seroma:3(9.7%).No cases of hematoma or surgical wound infection.No recurrence.

Conclusions
The laparoscopic eTEP approach of ventral hernias has a low rate of global complications,despite being our first cases performed. It also has low rates of postoperative pain and shorter LOS.We can conclude that in our Hospital the laparoscopic eTEP approach is a safe, efficient and effective technique.
OC-043 SYSTEMATIC REVIEW AND GUIDELINES FOR MANAGEMENT OF SCROTAL INGUINAL HERNIAS
Authors: Tran H , Macqueen I , Chen D , Simons M 
Published: May 2023

Abstract

Introduction
6% of all inguinal hernias are scrotal in high-resource countries rising to 67% in low-resource countries. This represents a heavy disease burden on relatively young men during their most productive period of life. Despite limited evidence these guidelines aim to improve treatment for scrotal hernia patients.

Methods
After developing 19 key questions a systematic literature review was performed Statements and recommendations were formulated. Online Consensus meetings with 25 HerniaSurge members were organised with voting and grading Recommendations as “strong” (recommendations) or “weak” (suggestions) and by consensus, in some cases upgraded.

Results
23 studies were selected. Scrotal hernia is defined as an inguinal hernia which has descended into and causes any scrotal distortion. A new classification for scrotal hernias was proposed based on hernia size, SI=upper third thigh, SII=middle thigh and SIII=lower third thigh or below. IR denotes irreducibility. Despite weak evidence antibiotic prophylaxis and urinary catheterization is recommended (upgraded) in complex cases (S2–3) due to prolonged operative time. Scrotal hernia repairs have higher associated morbidity and mortality compared to non-complex groin hernia repairs. Open anterior (mesh) approach is commonest technique and suture techniques in low resource countries. TAPP resulted in less conversion to open approach compared to TEP.

Conclusions
Although evidence is scarce and often low-quality scrotal hernia management guidelines recommend more tailored approaches for better surgical outcomes based on available resources and appropriate skills and provide an impetus for future research where adoption of proposed classification will enable more meaningful comparison of different techniques for different hernia sizes.
OC-055 Mesh infections – frequency, risk factors and treatment options from a Swedish cohort
Authors: Westin L , Sandblom G , Gunnarsson U , Dahlstrand U 
Published: May 2023

Abstract

Aim
To describe the incidence of mesh infection after inguinal hernia repair and the treatment given as well as to investigate possible risk factors.

Material & Methods
Patients with a groin hernia repair in one of Sweden's health care regions during 2005–2020 were identified in the Swedish Hernia Register (SHR). Data from the SHR was collected for all patients with reported infectious complication and for a matched (1:1) reference group without reported complication. Medical records were studied for risk factors, clinical presentation, lab, imaging, treatment provided and duration of treatment.

Results
8350 groin hernia repairs were performed during the study period. Infectious complications were reported to the SHR in 137 cases. Medical records for cases and controls were reviewed to identify infection and treatment given. Mesh infections, or presumed such, constituted 6.5% of all registered infectious complications. Mesh infection was thus seen after 0.11% of repairs. Deep infection was treated with antibiotics, sometimes accompanied by wound revision for drainage. Cases where bowel ischemia necessitated resection were more prone to infections, as were patients with an ASA class of 2 or higher.

Conclusion
Mesh infection is extremely rare after inguinal hernia repair in Sweden. The majority of these infections can be treated with antibiotics and drainage of infectious fluids and almost never has to result in the removal of the mesh.
OC-058 VENTRAL HERNIA REPAIR (VHR) FOR RECURRENT HERNIAS SIGNIFICANTLY IMPROVES QUALITY OF LIFE
Authors: Wilson H , Ku D , Scarola G , Polcz M , Augenstein V , Colavita P D , Heniford B T 
Published: May 2023

Abstract

Introduction
Quality of life (QOL) has become a key outcome measure in VHR. Although recurrent hernias can be more challenging to repair and often have more postoperative complications compared to primary hernias, QOL outcomes have not been specifically studied between these two groups.

Methods
The International Hernia Mesh Registry was queried for patients who underwent either recurrent or primary VHR. Patients detailed QOL using the Carolinas Comfort Scale (CCS). Patient characteristics and preoperative and 1-year postoperative CCS scores were compared between groups with standard statistical methods.

Results
There were 1,349 patients identified from 2008–2019 who underwent VHR with preoperative and 1-year postoperative CCS data, 227(16.8%) of which had recurrent hernias and 1,122(83.2%) had primary hernias. The recurrent group had a higher BMI(32.5±6.7 vs 30.7±6.5 kg/m2,p&lt;0.001), larger hernia defects(78.9±103.5 vs 39.0±79.9 cm2,p&lt;0.001), and more postoperative hernia recurrence(13.7% vs 5.3%,p&lt;0.001). Recurrent patients had increased(difference=3.1±7.9) mesh sensation and more mesh sensation at 1-year(4.6±7.7 vs 2.7±5.5,p&lt;0.001) compared to the primary group. They had greater preoperative(11.1±9.6 vs 6.7±8.2,p&lt;0.001) and 1-year postoperative(4.1±7.2 vs 2.3±5.6,p&lt;0.001) pain but had greater improvement in their pain after surgery(-6.3±10.2 vs -4.3±8.3,p=0.002). They also had greater preoperative(9.4±9.1 vs 5.2±7.1,p&lt;0.001) and 1-year postoperative(4.1±7.2 vs 1.9±4.8,p&lt;0.001) movement limitation but experienced greater improvement in this category (-5.5±10.0 vs -3.2±7.2,p&lt;0.001).

Conclusion
Patients presenting with recurrent hernias had more hernia-related symptoms than patients presenting with primary hernias but experienced greater improvement with pain and movement limitation. They did have increased mesh sensation postoperatively. These data may help in counseling patients preoperatively.
OC-066 TEMPORAL PATTERN FOR REOPERATION OF INGUINAL HERNIA RECURRENCE AFTER A PRIMARY SHOULDICE REPAIR
Authors: Spencer Netto F , Mainprize M , Ylbas A , Svendrovski A , Degani C , Szasz P 
Published: May 2023

Abstract

Aim
To identify timing patterns associated with reoperation for recurrence of inguinal hernia in patients undergoing Shouldice repair (RIHaSR) for primary inguinal hernias.

Material and methods
Patients undergoing a recurrent inguinal hernia repair from 2013–2017 were initially identified. Subgroup analysis of the first recurrence after a Shouldice repair at this institution were selected. Data collection of this subgroup of patients and data analysis were performed.

Results
From the 138 patients undergoing a re-operation for a first time inguinal hernia recurrence after a Shouldice repair, 125 patients were included in the analysis. The mean age was 50.8±13.9, BMI 24.6+2.6 and 97% were male. Regarding time to surgery for recurrence, the most common interval was in the first 5 years after surgery (37.6% of patients; mode: 1 year; median: 7 years; mean: 13.7±13.8 years). A bimodal pattern of temporal recurrence was noted according to patient age: patients &gt;50 had a peak of reoperation for recurrence in the first 5 years (68% of reoperations for recurrence) with a decrescendo pattern, meanwhile patients &lt;50 demonstrated a stable incidence of reoperation for recurrence in the initial 25 years of follow-up.

Conclusions
Patients undergoing surgery for RIHaSR presented a bimodal temporal pattern according to age at the time of primary surgery. Patients older than 50y.o. presenting a peak of RIHaSR in the first 5 years after primary surgery in comparison to younger patients that present a relatively stable frequency of reoperation for recurrence up to a 25-year follow-up.
OC-067 COST-EFFECTIVENESS AND CLINICAL OUTCOMES ANALYSIS OF LAPAROSCOPIC TOTAL EXTRAPERITONEAL (TEP) AND LAPAROSCOPIC TRANS- ABDOMINAL PREPERITONEAL (TAPP) INGUINAL HERNIA REPAIR
Authors: Ferri V , Vicente E , Quijano Y , Duran H , Diaz E , Fabra I , Caruso R , Malave L , Ruiz P , Naldini C 
Published: May 2023

Abstract

Objective
A cost-effective analysis of the laparoscopic total extraperitoneal (TEP) repair and laparoscopic trans- abdominal preperitoneal (TAPP) laparoscopic versus open inguinal hernia repair is still not well addressed. The aim of this study is to compare the clinical and cost-effective outcomes of TEP repair and TAPP repair for unilateral inguinal hernia.

Methods
This is a clinical and cost-effectiveness analysis within a randomized prospective study conducted at Sanchinarro University Hospital. Cases of primary, reducible unilaterl inguinal hernia were included and randomized using a simple randomization program. The outcome parameters included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio.

Results
Between January 2020 and January 2023, 60 patients were enrolled in this study (30 of them underwent TEP and 30 TAPP). The TEP procedure had less early postoperative pain (p=0.035). The operative time was higher in the TAPP group with respecto to the TEP group (p =0.05). The overall cost of TAPP procedure was higher compared with the TEP cost but without statically significance (883.93s vs 780 p&gt;0,05). The mean QALYs at 1 year for TEP (0.7094) was higher than that associated with TAPP (0.541) (p=0,038). At a willingness-to-pay threshold of 20,000 s and 30,000 s, there was a 85.28% and 91.44% probability that TEP was more cost-effective relative to TAPP.

Conclusions
The TEP procedure for unilateral and bilateral inguinal hernia appears to be more cost-effective compared with TAPP.