bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC-118 INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE FOR THE TREATMENT OF PRIMARY AND INCISIONAL VENTRAL HERNIAS – OUR EXPERIENCE
Authors: Pepe F , Giaccone M , Gambali E , Turturica D I , Rosati S , Balestra G , Sandrucci S 
Published: May 2023

Abstract

Aim
IPOM technique is a well-established technique for the repair of primary and incisional ventral hernias. In this retrospective observational study, we evaluated the application of IPOM technique with the use of polypropylene composite meshes (1)

Materials and Methods
194 patients who underwent a laparoscopic hernia repair from 2011 to 2022 for either a primary(Group A= 83) or an Incisional (group B=111) ventral hernia were included in the study. The primary endpoint was the evaluation of the recurrence rate and the mean hospital stay in the two Groups. All the procedures were performed through three abdominal trocars executing cold adhesiolysis to release the contents of the hernial sac without dissecting the latter. Partial peritonectomy was then performed by blunt dissection to promote adhesion of the mesh. Mesh fixation was achieved using trans-parietal suture and resorbable tackers.

Results
The two groups showed significative differences in baseline characteristics with Group B including older patients with higher ASA scores, defect number and dimension, rate of later hernia and defect closure. One-day surgery setting was more common in group A (80.7% vs 64.0%, p=0.01). The defect closure shows increasing hospital stay in both groups, with statical significance only in group A. The recurrence rate was slightly higher in group A (3.6% vs 2.7%, p=0.41) with comparable median follow-up (42 vs 45 months, p=0.41).

Conclusion
Our clinical experience showed that IPOM technique with polypropylene composite meshes is a safe and effective approach for the treatment of primary and incisional hernias.

References
1(ClearMesh-Composite, Dipromed srl).
OC-119 Specialization is essential: our results in 139 incisional hernia repairs with a high percentage of moderate-to-high complex cases.
Authors: Trebol J , Sánchez-Casado A B , García-Plaza A , González-Muñoz I , Muñoz-Bellvís L 
Published: May 2023

Abstract

Aims
Presenting 139 repairs by 4 specialised surgeons, mostly of moderate/high complexity.

Material & Methods
Prospective study (EVEREG registry).

Results
65 men. 65.49 (35–93) year-old. Middle BMI 30.31 kg/m2 (52%≥30). 96.4% ASA II/III.
Hernias: 113 midline, 15 lateral, 11 combined. Mean defects 86.25cm2 (2–480). 29 W3, 92 W2, 4 paraostomal, 34 recurrent. 9 received botulinum toxin.
Surgeries: 132 elective. 89.9% open. 30 components separations (21.6%, 23 TAR). 23 (16.5%) received two meshes. Principal mesh position: 55.4% retromuscular, 34.5% preperitoneal, 6.5% intraperitoneal, 3.6% others. Defect closure: 87.1%. Mean overlap 8.3cm (1–23).
61 associated procedures highligthing 18 dermolipectomies, 10 colorectal surgeries, 8 diffuse adhesiolysis, 8 mesh explants (2 infected).
Intraoperative complications: 9 patients (6.5%). 8 bowel injuries (5 serosal tears), 1 muscular bleeding, 1 bladder injury.
Postoperative complications: 22.3% patients. 21 grade I, 6 II, 3 III, one IV. Highlighting: ileum (9), hematoma/anemia (9), general (6), seroma (4), 4 surgical site infections (SSI, 1 deep, 2 organ/space, 1 superficial), 1 bowel perforation. 4 reinterventions (2.9%), 2 due to visceral complications. No exitus. Mean stay: 4.46 days.
1 month: 36 patients complicated (25.9%); highlighting 21 seromas (76% types 0-I), 6 superficial SSIs and 3 bowel obstructions (1 required surgery).
6, 12, 24 months: complications stabilized at 8–10%. 4 bulging, 2 late seromas, 1 temporal SSI (1 year), 1 chronic SSI, 6 chronic pains (4 at 24 months), 8 recurrences (5.75%, 7 in mesh border, 1 complete; 6 in highly-complex).

Conclusions
Specialised surgeons obtained comparable to accreditation standards outcomes even the high complexity.
OC-121 TRANSVERSUS ABDOMINIS RELEASE (TAR) IN CONTAMINATED FIELDS
Authors: Giacone Aguiar J A , Valinoti A C , Olivero A A , Sadava E E 
Published: May 2023

Abstract

Aim
Complex abdominal wall reconstructions in contaminated fields is a controversial topic. Although some prefer a staged approach, others advocate performing a single surgery even associating bowel and colon resections with synthetic mesh reinforcement. We aimed to evaluate and compare results of Transversus Abdominis Release (TAR) in clean and contaminated fields.

Material & Methods
A consecutive series of patients undergoing TAR for complex incisional hernias between 2014 and 2022 with a minimum of 6-month follow-up was included. The cohort was divided into 2 groups according to the Modified Hernia Grading System of the Ventral Hernia Working Group (VHWG): G1, Grade 1 (low risk) and Grade 2 (comorbid); and G2: Grade 3 (contaminated). Demographics, operative and postoperative variables were analyzed and compared.

Results
A total of 69 TAR repairs were performed; 54 (78,3%) were included in G1 and 15 (21,7%) in G2. There were no differences in overall morbidity at 30 postoperative days (G1 19% vs G2 27%; p=NS). Surgical Site Infection (SSI) was significantly higher in G2 (G1 11,1% vs G2 46,6%; p=0,01), however Surgical Site Occurrence Requiring Procedural Intervention (SSOPI) was similar in both groups (G1 5,5% vs G2 11,1%; p=NS). No mesh removal was recorded. After 31 ± 10 months follow-up, the recurrence rate was 2.9% (2 patients).

Conclusions
TAR technique is feasible and safe for the treatment of complex hernias in contaminated fields. Although an increase in SSI rate might be observed, most cases are superficial without the need for invasive procedures.
OC-127 Chlorhexidine encoated thread for Trocar Incision after Laparoscopic Appendectomy and Cholecystectomy (NOVOTILAC-trial) – final results
Authors: Golling M , Breul V , Steurer W , Hoyuela C , Julián J F , Baumann P 
Published: May 2023

Abstract

Aim
Of this multicenter, international, prospective, randomized, controlled, double blinded trial (NOVOTILAC) was to assess the effectiveness (e.g. SSI acc. to CDC) of chlorhexidine (CHD)-coated Novosyn sutures for fascial and skin closure (trocar incisions) following laparoscopic appendectomy (APP) & cholecystectomy (CHO) compared with non-coated Novosyn sutures.

Methods
This study was performed in spanish (2) & german centers (2) and recruited 377 pts, with 54 drop-outs, eventually including 323 pts., 297 were included for a 12 month follow up. Pt. were assigned for APP (164) and CHO (159). Pat. clientel (♀:161, ♂: 162) risk factors (ASA 1–4: 200/79/43/1) hypertension etc. were comparable. A two group Chi-Square test was used to compare proportions of events.

Results
Intraoperative organ pathology and inflammation (innocent appendix, phlegmonous or gangrenous appendicitis and symptomatic vs acute cholecystitis) varied substantially, as did duration of surgery (APP: 48±20.5, CHO: 65±30.7 min). Operating Surgeons included assistants (n=140), senior registrars (n=99) and Consultants (n=84). Adverse events (AE) occurred in 12,7%, 32 patients had one, 8 pts two, and 2 pts had 3 respectively 4 events. Serious adverse events (SAE) were seen in 14 pts., 1 pt died. SSIs were seen overall in 16/323 pts (5.0%). Assigned to the groups we found 10 SSIs / 162 pts (6.1%) in the Novosyn arm & 6 SSIs / 158 pts (3.7%) in the Novosyn-CHD arm (n.s.). Incidence/severity of the infection required no postoperative revision operation.

Conclusion
The Chlorhexidine-coated Novosyn sutures (Novosyn-CHD) did not significantly reduce wound infections following laparoscopic appendectomy & cholecystectomy.
OC-128 DETERMINING THE MAXIMUM DIAMETER FOR PRIMARY CLOSURE OF AN ABDOMINAL WALL DEFECT: AN EXPERIMENTAL STUDY
Authors: Den Hartog F P , Verdonschot L , Aijtink V , Visscher L , Lange J F , Tanis P J , Kleinrensink G J 
Published: May 2023

Abstract

Introduction
Presently, the standard therapeutic option for ventral abdominal wall hernia is surgical repair with mesh reinforcement for all but the smallest (&lt; 1 cm) hernias. The aim of this experimental study was to determine the maximum defect diameter that can still be closed without mesh, only using the small bites suture technique.

Methods
Hernias were simulated by creating circular defects in intact abdominal walls of fresh-frozen ­post-mortem human specimens. The defect diameter ranged from 0.5 to 5.5 cm, in 0.5 cm increments. Defects were closed in two layers using the small bites suture technique. After closure, the abdomen was insufflated in order to stress the closure. Intra-abdominal pressure (IAP) and macroscopic suture or tissue failure were recorded.

Results
Eleven defects were created in the abdominal walls of three fresh post-mortem human specimens. After defect creation, diameters were found to have increased by a median of 20% (IQR 5–53%). All defects were closed cranio-caudally. From 4 cm, it became impossible to close the posterior rectus sheath without suture pull-through. From 5 cm, the anterior rectus sheath showed tearing during suturing. During insufflation, complete suture pull-through of the anterior rectus sheath was seen at 5.5 cm.

Conclusion
Experimental findings indicate that tension-free closure of both rectus sheath layers is possible in defects with a diameter up to 4 cm. Further experiments in more specimens, using defects ranging from 4 to 6 cm, will add measurements of suture tension in order to assess failure before becoming macroscopically visible.
P-001 RISK FACTORS, HEALTHCARE RESOURCE USE AND COSTS ASSOCIATED WITH INCISIONAL HERNIA REPAIR IN ENGLAND USING HOSPITAL EPISODE STATISTICS
Authors: Torkington J , Smith L , Cornish J , Westlake P , Mccormak M , Alexander M , Rolfe C , Brooks P 
Published: May 2023

Abstract

Aim
To evaluate the burden of incisional hernia (IH) to patients and healthcare services in England.

Material & Methods
We conducted a retrospective observational study in Hospital Episode Statistics including adult patients who underwent stoma, transplant, or aortic surgery (index) between 01/04/2017 and 31/03/2022. We followed patients for development of incisional (including parastomal) hernia necessitating repair within 2 years post-index operation, describing patients by surgery type, number of comorbidities (prior abdominal surgery, chronic lung disease, diabetes, immunosuppressed status, obesity, smoker), and financial year. We evaluated costs associated with inpatient, outpatient, and Accident & Emergency attendances within 2 years post-index operation using National Health Service reference costs.

Results
Of 430,339 patients (132,584 stoma, 3,247 transplant, 294,508 aortic surgery), 24,949 developed IH requiring repair (6.74% overall, 13.74% stoma, 5.51% transplant, 2.80% aortic surgery). Operative IH was observed in 11.46%, 5.54%, and 1.94%, for patients with 0–2 comorbidities following stoma, transplant, and aortic surgery, respectively; for patients with 5–6 comorbidities, 29.70%, 5.97%, and 6.91% underwent repair of IH. For all years, costs were higher for patients with IH versus those without IH. Costs varied by surgery type and number of comorbidities and were driven by non-elective admissions. The difference in mean total costs for IH versus non-IH following surgery performed in 2017 was £16,350 for stoma, £19,268 for transplant, and £54,518 for aortic surgery.

Conclusions
Rates of IH repair increase alongside the number of comorbidities. A large number of patients require IH repair within 2 years of surgery, increasing the cost of care.
P-007 ACQUIRED “INTERSTITIAL” HERNIA: A REPORT OF TWO CASES
Authors: Ribeiro Dias R , Miguel Almeida N , Fonseca T , Barbosa E , Barbosa E 
Published: May 2023

Abstract

Aim
Acquired “interstitial” hernias are extremely rare and can be a serious complication after ventral hernia repair with placement of an onlay mesh.

Material and Methods
We describe two cases of interstitial hernias after onlay repair. Case 1: male patient of 59-year-old was submitted to a segmental enterectomy due to intestinal perforation and developed a hernia that was then surgical repaired with closure and an onlay mesh . Case 2: 58-year-old male with medical history of polimyelitis with two previous umbilical hernia repair interventions, being the last one with an onlay mesh.
Both patients at the physical examination revealed a symptomatic bulge difficult to characterize and the CT scan showed multiples defects with the hernia sac between the anterior aponeurosis and the onlay mesh.

Results
In both cases, the previous mesh was surgically removed, and repair of the abdominal wall was achieved with the placement of a macroporous retromuscular polypropylene mesh with 48mg/m2 density and complete medialization of the rectus muscles.

Conclusions
The diagnosis of interstitial hernias may be challenging, and CT imaging is mandatory for confirmation. Due to the high risk of complications such as strangulation, these hernias should always be corrected in a timely manner.
P-009 COMPLEX ABDOMINAL RECONSTRUCTION COMBINED WITH CYTOREDUCTIVE SURGERY (CRS) + HIPEC IN PATIENT WITH PARIETAL RELAPSE OF COLORECTAL CANCER
Authors: Garcia Garcia L , González Sánchez L , Antón Fernández I , López-Tomassety E , Hernández Hernández J R 
Published: May 2023

Abstract

Objectives
Presentation through a clinical case of complex reconstruction of the abdominal wall after resection of a parietal metastatic lesion in a difficult location.

Material and Methods
A 56-year-old male with T3N0M0 adenocarcinoma of the rectum underwent Hartmann's surgery in 2018 with subsequent cytoreductive surgery (CRS) + HIPEC in 2019 due to relapse of his disease. He presented a second relapse of CRC in the form of a parietal lesion of 8×5×6cm with bilateral involvement of the anterior rectus abdominis muscle and contact with the symphysis of the pubis.

Results
The operative findings showed a large tumor with involvement of both rectus abdominis muscles and the pubic symphysis. Complete resection of the lesion is performed and treatment is completed with HIPEC cycle with MMC in a total of 5 hours. Reconstruction was performed using intraperitoneal biological mesh prosthesis in the area of the parietal defect, together with placement of supra-aponeurotic polypropylene mesh. The patient did not present specific complications of abdominal reconstruction (SSO) and was discharged in 11 days.

Conclusions
The association of complex abdominal reconstruction techniques after cytoreduction surgery + HIPEC seems to increase the morbidity rates of these patients according to several studies. However, in our experience the use of abdominal wall reconstruction techniques after CRS and HIPEC is safe and does not increase complications, presenting good functional and oncologic results.
P-013 No recurrence after 15 years prospective long-term follow-up of open Total ExtraPeritoneal / TransInguinaI PrePeritoneal (oTEP/TIPP) inguinal hernia repair
Authors: Ribokas D 
Published: May 2023

Abstract

Aim
Evaluation of long-term follow-up results after open transinguinal preperitoneal (TIPP) technique with preformed lightweight mesh (PLM).

Method
This unicentric study included all consecutive 102 patients(10 women, 92 men; 93 primary, 9 recurrent hernias) operated for a groin hernia by the same surgeon using the same technique between June 2008 – September 2009.
All patients were postoperatively followed-up with a control after 1 month and a survey follow-up between 40 and 54 months after surgery with subsequent clinical control if something abnormal appeared in the survey in January 2013.
Results up until January 2023 were retrieved from the Swedish Hernia Register.

Results
102 hernia repairs - 54 in general, 48 in local anesthesia.
Clinical control after 1 month:
There was no infection of the mesh, no clinical recurrence.
-No reoperations were required.
Questionnaire follow-up:
-95 patients (93%) were followed-up.
Slight, not permanent pain in 8.8% of patients who did not require the consumption of systematic painkillers and are not limited in their activities.
No reoperations have so far been recorded in the Swedish Hernia Register with 81 patients still alive in long-term follow-up .

Discussion
-No recorded recurrences after 15 years of follow-ups is encouraging.
-This technique consisted of the placement of a patch in the preperitoneal space, which combines the benefits of the anterior approach (i.e., easy and safe technique, short learning curve, local anesthesia, low cost) and the preperitoneal placement of the mesh (less recurrence, less pain). This procedure is a good alternative to eTEP technique.
PLM=PolysoftMesh/Bard
P-014 SURGICAL TREATMENT OF COMPLEX INCISIONAL HERNIAS
Authors: Gogia B , Chertova A , Aljautdinov R 
Published: May 2023

Abstract

Aim
to study the early and long-term outcomes of the abdominal wall reconstruction (AWR) of complex incisional hernias.

Material & Methods
We retrospectively reviewed prospectively collected data from 121 patients with 1 to 7 years of follow-up, who underwent midline AWR between 2015 and 2022. The complexity of hernia was determined according to the criteria of N. J. Slater et all. All patients had a hernia gate width ≥10cm (W3). “Loss of domain”≥20% had 38% of patients, a recurrence after previously performed mesh-reinforced AWR (R1–5) - 36%, purulent fistulas, trophic ulcers and chronic seromas - 9%. Three laparotomies or more in anamnesis had 48.7% patients. Obesity had 74.4%; type II diabetes mellitus - 26.5%; COPD - 15.7%. Mesh-reinforced fascial repairs were used in 73 (60.33%) cases, bridged repairs were used in 48 (39.67%) cases.

Results
Wound complications in the early postoperative period were observed in 48 (40.5%) patients. Long-term outcomes: recurrence hernia - 7 (5.8%), ligature fistula - 3 (2.5%), chronic wound - 2 (1.6%), pseudocyst - 3 (2.5%), building of the mesh - 7 (5.8%). Mesh-reinforced AWRs with primary fascial coaptation resulted in fewer hernia recurrences (2.7% vs 10.4%) and fewer wound (31.5% vs 52.2%) and overall (5.5% vs 16.6%) complications than bridged repairs. At the same time, bridged repairs resulted in fewer postoperative pain (9.6% versus 4.2%) than mesh-reinforced AWRs.

Conclusions
Surgical treatment of patients with complex incisional hernias requires the use of combined techniques for AWR using a mesh, which reduces the recurrence to 5.8%.
P-015 PREVENTION OF INCISIONAL HERNIA WITH ONLAY MESH IN LOOP ILEOSTOMY CLOSURE
Authors: Olona C , Caro A , Sales R , Ruiz C , Gonçalves C , Casanova R , Jorba R 
Published: May 2023

Abstract

Aim
The primary aim of the study is to determine the efficacy of the placement of an onlay mesh for prevention of incisional hernia after loop ileostomy closure

Material & Methods
This is a multicentric, prospective, randomized controlled trial including patients operated on for loop ileostomy closure after a prior rectal resection for rectal cancer.
In the control group (C), after the digestive tract is reconstructed, the closure of the abdominal wall is performed by a 4:1 ratio running suture of polydioxanone. Patients in the study group (M) had the same closure procedure performed, and a light polypropilene mesh is placed onlay.
The presence of incisional hernia was evaluated by physical examination at scheduled clinical visits and radiologically by an abdominal CT scan performed at the end of follow-up (6 month after surgery)

Results
58 patients were included (27 in control group and 31 in mesh group) . Both groups had similar characteristics, except for a higher rate of smokers in the control group (48% vs 6%). During the follow-up, 5% of patients developed an incisional hernia (Group M 0 vs Group C 11%). At 30 days of follow-up 5 (16%) surgical site occurrences were detected in Group M for 4 (15%) in Group C.

Conclusions
A low incidence of IH after ileostomy closure is detected. All the IH were presented in the control group with no stadistically significant differences between groups. Larger trials with longer follow-up are needed to confirm the results.
P-016 INCISIONAL HERNIA AFTER ABDOMINAL EMERGENCY SURGERY. IMPACT OF PREVENTIVE SELF-ADHESIVE POLYESTER MESH PLACEMENT
Authors: Huerta G , Pellicena A , Garcia M , Aguila R , Sanz M , González D , Navarro B , Torrado Á , Tavira H 
Published: May 2023

Abstract

Objective
Analyze the results of the self-adhesive polyester mesh placement in the prevention of the postoperative evisceration and incisional hernia after median abdominal incision during an emergency digestive surgery.

Material and methods
A prospective observational study was done in those patients who underwent a midline abdominal incision and a self-adhesive polyester mesh was placed in onlay position, for an emergency digestive surgery between December 2020 and December 2022. Analysis was done by means of demographics, body mass index (BMI), blood tests, ASA, P-Possum score, etiology, surgical contamination, abdominal incision closure, postoperative records (≥ 90 days) categorized with Clavien-Dindo (CD) classification and 1 year of follow-up.

Results
Sixty patients were included, mean age 62.86, (57.6% men), 52% were ASA III, BMI&gt;30 12%. Most frequent etiologies were complicated small bowel obstruction (17) and complicated acute sigmoid diverticulitis (12). Postoperative records showed a 26,6% of morbidity, 93.7% were D I- II (minor) and 6.3% CD IIIb. Neither wound evisceration nor incisional hernia was observed during the follow-up. A significative relationship (p&lt;0.05) was observed between BMI, preoperative C-reactive protein and ASA classification with postoperative complications, same relationship was observed between surgical contamination but without statistical significance.

Conclusions
In this series, a preventive self-adhesive polyester mesh placement after abdominal midline incision during emergency digestive surgery, showed an acceptable rate of postoperative complications with a low rate of local morbidity and a good results during the follow-up
P-018 ABDOMINAL WALL REPAIR IN JEHOVA´S WITNESSES. PRE, INTRA AND POSTOPERATIVE MANAGEMENT
Authors: Serrano González J , Díaz Pérez D , Román García De León L , Esteban Agustí E , Hernández Bartolomé M , Gutiérrez Samaniego M , Colao García L , Galindo Jara P 
Published: May 2023

Abstract

Aim
Abdominal Wall Repair (AWR) is a surgical procedure with a risk of bleeding during and after its performance. Patients who reject blood transfusion require strategies to avoid bleeding or to increase the margin of indication for transfusion.

Materials and methods
We analyzed the Jehovah's Witnesses patients who underwent AWR in our hospital and the perioperative management aiming to prevent fatal anemia and allow the performance of the surgery in this group of patients.

Results
We present three Jehovah's Witnesses patients undergoing AWR for multirecurrent midline incisional hernias. All of them attended hematology consultation prior to surgery to improve their situation at the time of surgery. During surgery, hemostatic material was used in areas at risk of subsequent bleeding. All received iron after surgery and, prior to hospital discharge, a dose of erythropoietin if needed. Patient characteristics are presented in the table.
No bleeding requiring blood transfusion or other complications occurred.
Follow-up in outpatient clinics showed a correct evolution.

Conclusions
Multidisciplinary care and particular attention to avoid bleeding and improve the condition of patients with refusal of blood transfusion makes complex abdominal wall surgery feasible and safer.