bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC-091 PREVENTION OF PARASTOMAL HERNIAS WITH 3D FUNNEL MESHES IN INTRAPERITONEAL ONLAY POSITION
Authors: Köhler G 
Published: May 2023

Abstract

Introduction
In patients with permanently intended terminal ostomies, parastomal hernias (PSHs) occur on a frequent basis. Various strategies have been evaluated, but there is still a lack of evidence with regard to the best surgical technique for PSH- prevention

Methods
We conducted a retrospective analysis of prospectively collected data of 98 patients, who underwent elective permanent ostomy formation between 2009 and 2019 by means of prophylactic implantation of a specially designed three-dimensional funnel mesh in intraperitoneal onlay position.

Results
PSH developed in five (5.1%) of 92 patients available for follow-up (88 by CT-scan). No mesh-related complications were encountered and none of the implants had to be removed. Ostomy-related complications had to be noted in eight (8.2%) cases. Follow-up time was a median 38 (range 12–60) months.

Conclusion
The prophylactical implantation of a funnel mesh implant in IPOM technique during initial formation of a terminal enterostomy is safe, highly efficient and comparatively easy to perform. As opposed to what can be achieved with purely keyhole meshes regardless of their position in relation to the abdominal wall layers, the inner boundary areas of the ostomy itself can be well covered and protected from the surging viscera with the 3D design and there is no weak point at the lateral edge of the stoma as is typical for the sugarbaker access. A further improvement could be achieved by lengthening the tunnel by the manufacturer in order to counteract the shrinkage of the implant.
OC-095 DUTCH INGUINAL HERNIA AUDIT (DIHA): A SURVEY OF CURRENT REGISTRATION, OBSTACLES AND POSSIBLE AREAS OF IMPROVEMENT
Authors: Meuzelaar R , Den Hartog F , Tanis P , Schiphorst A , Burgmans I 
Published: May 2023

Abstract

Aim
Quality assessment and improvement of surgical procedures can be achieved by clinical audits that provide feedback with benchmarking of surgical outcomes. The Dutch Institute for Clinical Auditing has successfully initiated multiple audits with clear impact on quality of care. Presently, there is no Dutch national inguinal hernia (IH) registry. This survey aimed to investigate current opinions of all Dutch surgeons regarding registration, and to explore potential obstacles in the implementation of a Dutch Inguinal Hernia Audit (DIHA).

Material & Methods
A web-based survey was sent to all (&gt; 2.000) members of the Dutch Surgical Society, including surgeons and residents in training.

Results
Two-hundred sixty-seven respondents replied (hospital distribution: 33% small peripheral, 45% large peripheral, 11% academic, 11% other). Two-thirds (67%) agreed that the quality of IH care should be improved. Similarly, 66% answered that improvement could be achieved by registration of surgical outcomes. Those opposed to registration mainly stated fear of administrative burden and that the quality of care is already adequate. The vast majority of respondents agreed that chronic pain (91%) and recurrence (91%) should be used as indicators of IH surgery, which can both be collected as patient-reported outcome measures (PROMs).

Conclusions
A two-thirds majority of Dutch surgeons agree that the quality of inguinal care should be improved by implementing a Dutch national IH registry. Almost all agree that registration of chronic pain and recurrence as quality indicators can be registered as PROMs without increasing the administrative burden, which will facilitate successful implementation.
OC-097 A THREE LAYERED REPAIR OF A LARGE PERINEAL HERNIA- CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Soback H , Lahav L , Franko R , Avital S 
Published: May 2023

Abstract

Background
A symptomatic perineal hernia is an uncommon complication after abdominoperineal resection (APR). Repairs of such hernias can be achieved by usage of autologous flaps, synthetic mesh or biologic mesh. Studies have shown that prophylactic repair of the pelvic floor with biologic mesh, reduces the incidence of perineal hernia. Data of perineal hernia repair methods are scarce and of poor quality.

Aim
In this paper we aim to share our experience using a non-conventional technic for the repair of A perineal hernia, as it appears to be a surgical challenge without a clear evidence based recommended technique.

Methods
A 71-year-old woman, after extended APR with primary closure of pelvic floor with a biosynthetic absorbable mesh, presented to our clinic with a symptomatic, extensive perineal hernia. The patient underwent an open reconstruction of the pelvic floor using a synthetic composite mesh in an underlay intraperitoneal position and a bilateral gluteal muscle flap closure.

Results
In post-operative-day 11 the patient developed a pelvic fluid collection and surgical site infection. The collection was surgically drained showing clear fluid negative for bacteria and antibiotic treatment was initiated. 3 months after surgery the wound had completely healed and A CT scan showed no recurrence of the hernia.

Conclusion
Considering the increased incidence of perineal hernia after APR and the superiority of a synthetic mesh in minimizing recurrence rates- a primary closure of the pelvic floor with a synthetic mesh or autologous flap might be justified.
OC-098 HERNIA BASECAMP ONLINE LEARNING PLATFORM: AN ANALYSIS OF THE UEMS CME approved module test results
Authors: de Beaux A , Becker S , Parent T , Temporal G , Kummer R , Allouard C , East B 
Published: May 2023

Abstract

Aim
Hernia Basecamp is an online learning platform hosted within the WebSurg website with 205 video lectures. A number of these lectures are selected to create 10 modules of 3 hours each with UEMS CME accreditation. The aim of this study was to review the CME module test results since launch in June 2021.

Methods
Hernia Basecamp was interrogated in January 2023. Data on the number of CME module tests taken, the pass rate and the country of the examinee were collected.

Results
The numbers of tests taken, the number of passes, and the pass rate per module as well as the totals is shown in the table. The UK, Switzerland and Germany were the top 3 countries representing 36% of the modules passed.

Conclusions
The UEMS approved CME accreditation tests generally had a high pass rate. BUT, detailed knowledge of the basics of groin hernia AND published guidelines was poor as reflected in the lower pass rates.
OC-101 PLACEMENT OF INTRAPERITONEAL PREFORMED PROPHYLACTIC MESH IN END COLOSTOMIES TO REDUCE PARASTOMAL HERNIA AND COMPARING WITH CONTROL GROUP. TECHNIQUE AND ANALYSIS OF OUR RESULTS
Authors: Arrayas A , Comas J , Subirana H , Crusellas O , Gonzalez V , Ortiz L , Viso L , Castellví J 
Published: May 2023

Abstract

Objective
To study the effect of the incidence of parastomal hernia (PSH) through the prophylactic placement of a preformed intraperitoneal mesh in patients who must undergo a definitive colostomy. The comparison is made with a homogeneous control group that did not receive prophylactic mesh.

Material and methods
Unicentric, prospective, non-randomized and observational study was performed.
Patients were divided in two groups: 30 patients with colorectal neoplastic disease, collected consecutively,who underwent an end colostomy with a profilactic preformed intraperitoneal mesh (Dynamesh IPST®) versus a homogeneous control group (30 patients) who also underwent a definitive end colostomy without prophylactic mesh placement.
Primary objective is to determine incidence of PSH in both groups. Secondary objectives were mesh related complications.
Demographic variables and early postoperative complications, clinical and radiological follow-up (18–24 months) and presence of clinical and/or radiological PSH were registered.
The surgical technique performed in our center is described.

Results
In the Mesh group there were 0 mesh-related complications at 30 days. In the long term, only 6.6% PSH were recorded in mesh group, while in the control group, a 63% of PSH were observed.

Conclusions
The incidence of PSH is significantly reduced using prophylactic mesh. Our study corroborates what has already been stated in the literature and does not associate complications.
The prophylactic placement of the IPST intraperitoneal mesh in patients who require a definitive end colostomy is a technique that is easy to use in the laparoscopic approach, safe, fast, and easily reproducible, without related complications.
OC-103 SYSTEMATISATION OF TEP IN 10 STEPS: THE WAY WE TEACH
Authors: Peinado Iribar M B , Zárate Gómez J , Fernández Luengas D , Supelano Eslait G , Álvarez De Sierra Hernández P , Conde Someso S , López Baena J Á , Gil Lopez J M , Merello Godino J 
Published: May 2023

Abstract

Aim
Laparoscopic total extraperitoneal approach (TEP) is a widely recognised treatment for hernia repair. As a reference group in minimally invasive hernia repair, with more than 1200 TEP cases performed in the last 5 years, and with more than 25 years of experience, we want to share our TEP systematisation in 10 steps, as we teach in our international courses.

Material and Methods
We describe the technique in 10 simple steps, attaching small video-clips to illustrate each one.

Results
Demostration of the 10 TEP steps:

Conclusions
Together with proctoring, this systematic way of teaching TEP technique allows a safer and shorter learning curve, by providing a series of simple steps to follow and repeat.
OC-104 BROADENING HORIZONS. LESSONS FROM TEP FOR INGUINAL HERNIA REPAIR TO EXTENDED TEP FOR VENTRAL HERNIA REPAIR
Authors: Peinado Iribar M B , Zárate Gómez J , Fernández Luengas D , Supelano Eslait G , Álvarez De Sierra Hernández P , Conde Someso S , López Baena J Á , Gil López J M , Merello Godino J 
Published: May 2023

Abstract

Aim
Laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia can be technically challenging. The learning curve is long, unless you have supervision and systematisation of the procedure. After learning curve of TEP is achieved, it is time to broaden horizons, and repair ventral hernias using the extended totally extraperitoneal laparoscopic technique (ETEP). The purpose of this paper is to describe the key points and pitfalls in the ETEP learning curve, coming from the expertise of TEP hernia repair.

Material and Methods
After overcoming the learning curve of laparoscopic TEP inguinal hernia repair, with more than 110 consecutives procedures performed in an experienced centre, and having reduced operative times and maintaining a minimal complication rate, I start my learning curve of ETEP with supervision and systematisation of the technique. We will move from the key points already known from the TEP learning curve, identifying similarities to the more complex points of ETEP learning curve.

Results and conclusions
The extrapolable key points from TEP are:
The critical points, which need enhanced surveillance, are:
It is important to emphasise that this technique requires patience and proctoring.
OC-107 IMPLEMENTATION OF LAPAROSCOPIC INGUINAL HERNIA REPAIR IN A LOCAL HOSPITAL. 2 YEARS’ EXPERIENCE AND CHALLENGES
Authors: Ye J , Gonzalo B , Lopez S , Alonso V , Morales M A , Solans M , Gonzalez J A , Moral A , Lupu I 
Published: May 2023

Abstract

Background
More than 30 years have passed since the first laparoscopic inguinal hernioplasty but nowadays less than 5% of patients are currently operated by this technique as recent Spanish national data suggest.

Objective
To present our experience 2 years after implementation of laparoscopic inguinal hernioplasty in our local hospital and highlight the challenges we faced.

Methods
Our hospital deals with a high volume of abdominal wall surgery and has more than 20 years experience in ambulatory surgery. A multidisciplinary clinical pathway was implemented. Strict selection criteria were established and pelvitrainer sessions were done.

Results
From January 2021 until December 2022, 196 laparoscopic repairs were performed: 167 transabdominal preperitoneal (TAPP), 29 totally extraperitoneal (TEP). The main challenge was the learning curve. 5 surgeons with experience in laparoscopic surgery were trained. Until now 2 completed their learning curve for TAPP and began training in TEP approach while the others still need senior assistance. The duration of laparoscopic hernioplasty, the need for deep relaxation and the increased carbon dioxide absorption were the biggest concerns for the Anesthesia team. The cost of new materials could be afforded, even though different sutures and types of mesh fixation devices were used until getting the non-invasive one. Surgical outcomes were good, with few minor complications. Moreover the outpatient rate could be maintained but the average time in waiting list for laparoscopic approach was increased.

Conclusion
The implementation of a laparoscopic hernioplasty program is feasible and safe but faces many challenges, especially due to long learning curve.
OC-109 ONE-YEAR FOLLOW-UP ANALYSIS OF WOUND VS SUTURE LENGTH RATIO AS A PREDICTOR OF INCISIONAL HERNIA - A COHORT STUDY (WISER)
Authors: Kumar R , Kumar P , Das Poddar K K , Shastri S , Mishra T , Sasmal P 
Published: May 2023

Abstract

Background
The purpose of the study was to determine if the recommended wound to suture length ratios of 1:4 and 1:6 were followed during midline laparotomy closure with loop PDS and 2–0 PDS, respectively, and whether this affected the development of an incisional hernia three years following the procedure.

Methods
This prospective study included eighty-six patients operated by the midline incision. The closures were performed as per the surgeon's choice. The length of the incision, types and length of suture used were noted. The one-year follow-up data was analyzed.

Results
In thirty cases, loop PDS was used for the closure, and in 56 patients, 2-0 PDS was used. Adherence to the recommendation was better with the loop PDS (13/30,43.33%) vs 2-0 PDS (8/56,14.28%). Eighteen patients were excluded(10-death-,5-loss to follow-up,3-reoperation).46.1%(12/26) developed incisional hernia in the loop PDS group vs 7.14%(3/42) with 2-0 PDS; total 22.05%(15/68). If the recommendations were followed or not, there were 20% (2/10) hernias in the loop PDS group compared to 62.5% (10/16); and 28.57% (2/7) compared to 2.8% (1/35) in the 2-0 PDS group. The loop PDS group had more malignancies (40% vs 20%, p=0.04).

Conclusion
The adherence to the recommendation of wound vs suture length was low. The incidence of incisional hernia was significantly low with 2-0 PDS, at one year, however the results should be interpreted with caution considering many patients closed with loop PDS had malignancies, a risk factor for incisional hernia, and low sample size due to death and loss to follow-up.
OC-110 LAPAROSCOPIC RETROMUSCULAR INGUINAL HERNIA (LRMIHR) REPAIR USING PHASIX TM AND POLYPROPYLENE MESH: 5 YEARS OUTCOME
Authors: Altowaijeri A , Aljomah N , Alshammari S , Binjaloud A , Aldohayan N , Aldohayan A 
Published: May 2023

Abstract

Background and objective
Inguinal hernia routinely repaired with synthetic non-absorbable mesh. However, chronic pain may affect the success of flow recurrence. In contrast, using absorbable mesh and keeping its integrity for nine months as Phasix TM may be a suitable replacement for the synthetic non-absorbable mesh. This work assesses the results and cost of TAPP repair using Phasix TM & lightweight Polypropylene mesh.

Methods
Laparoscopic retromuscular inguinal hernia repair (LRMIHR) was performed from January 2015 to January 2023 with Institutional review board approval for 58 patients, 1 female and 57 males. The average age is 55.8, with a 27.5 mean BMI. The study was done in the hospital by one surgeon. Studying post-operative pain, reaction, mesh sensation discomfort, recurrence, and cost.

Results
In 5 years follow-up, the outcome is comparable without the non-significant advantage of absorbable mesh. Moreover, the cost of absorbable mesh (Phasix ST) is higher.

Conclusion
No clinical advantage of absorbable mesh in repairing the inguinal hernia. However, using phasix TM may have a place in repairing female and sports hernias. Further work is needed to evaluate phasix in hernia inguinal in a prospective multicenter trial.
OC-112 OUTCOMES OF EMERGENCY INGUINAL HERNIA SURGERIES PERFORMED BY TRAINEES AT A TERTIARY CARE HOSPITAL- AN AUDIT OF 43 CASES
Authors: Shastri S , Poddar K K D , Kumar P , Mishra T S , Sasmal P K , Behera P 
Published: May 2023

Abstract

Background
An audit was performed to identify the outcomes after emergency inguinal hernia surgeries performed by trainees at our hospital from April to December 2022.

Methods
The prospectively maintained database of a single clinical unit of the Department of General Surgery of our institute was reviewed. Outcomes such as the types of surgery, SSI, length of hospital stay (LOH), re-exploration, long-term pain, recurrence, and other parameters were reviewed.

Results
43 cases were reviewed. The mean age was 58.4 years. The mean symptom duration was 3.47 days. 16 (37.2%) patients had obstruction and 11 (25.5%) patients suffered strangulation. 25 (58.1%) patients required laparotomy apart from local exploration. Hernioplasty was done in 10 (23.2%) patients. Bassini was done in 10 (23.2%), Lytle's in 10 (23.2%), and Desarda repair in 23 (53.6%) patients. The mean operating time was 116.92 mins and the average blood loss was 93.7ml. 4 (9.3%) patients developed SSI, and 1 (2.32%) patient required mesh explantation. 1 (2.32%) required re-exploration and there was 1 mortality. The mean LOH was 4.33 days (2.32%). 20.93% of patients had long-term pain and none had a recurrence.

Conclusion
Patients getting operated on by trainees had a comparable mean operative time, more blood loss (53.7ml vs 22.0ml), more long-term pain (20.93% vs 1.2%), slightly more wound complications (9.3% vs 6.74%), comparable LOH, and comparable recurrence and mortality rates, when juxtaposed against reported literature. Surgical training should hence focus on meticulous dissection and identification of nerves to reduce blood loss and long-term pain.
OC-113 GENETIC AND BIOLOGIC RISK FACTORS ASSOCIATED WITH HERNIA FORMATION: A SYSTEMATIC REVIEW
Authors: Amro C , Niu E F , Deianni E , Smith L , Qiu M , Torkington J , Broach R B , Maguire L H , Damrauer S M , Fischer J P 
Published: May 2023

Abstract

Aim
The aim of this systematic review is to identify genetic and biologic markers associated with abdominal hernia formation.

Methods
A systematic review, using PRIMSA-guidelines, searched PubMed, MEDLINE, Embase, Scopus, and COCHRANE databases on 25AUG2022. All articles with qualitative or quantitative data regarding biologic factors of hernia formation were included. Review articles, editorials, and non-English articles were excluded. Data from articles were collected for analysis. The Newcastle-Ottawa Scale was used to assess risk of bias.

Results
Of 5,946 initial studies, 77 were included: 17 incisional/ventral, 42 inguinal, 4 hiatal, 1 parastomal, and 13 multiple hernias. Five inguinal hernia studies identified 92 susceptible loci in regions of 66 genes involved largely in antigen processing/presentation and immune-response pathways after enrichment analysis. Three studies identified significant DNA sequence variants (DSV) of three additional genes. Among various biomarkers, eleven studies found increased MMP-2, with seven noting MMP-2 significantly higher in direct versus indirect. In incisional hernias, one study demonstrated 167 genes in skin and 7 genes in fascia with distinct gene-expression profiles associated with the activation of inflammatory response plasma proteins, regulation of immune response, and cell-adhesion. A separate genetic study identified 3 independent loci. Biomarkers were discussed in 15 studies, with inconclusive results. In both incisional/ventral and inguinal hernias, type I/type III collagen ratios were decreased. Data synthesis could not be completed for hiatal and parastomal hernias.

Conclusion
While there is reasonable consensus regarding the role of biologic risk factors in inguinal hernias, further research investigating genetic predisposition to incisional hernias is encouraged.
OC-114 FEASIBILITY OF SUBCUTANEOUS ONLAY LAPAROSCOPIC APPROACH (SCOLA) UNDER LOCAL ANESTHESIA FOR THE PATIENTS WITH INCISIONAL HERNIA
Authors: Wada N , Hori S , Takeuchi M , Shida A , Maeda K , Kitagawa Y 
Published: May 2023

Abstract

Aim
Incisional hernia is a benign disease and the indications for elective surgery are relative. Therefore, it is expected to expand the indications and improve patient quality of life by reducing invasiveness of surgery and anesthesia. We have been performing incisional hernia repair under local anesthesia for the past 12 years and report our clinical results.

Material & Methods
From 2009 to 2021, a consecutive group of 64 patients with incisional hernia was included. We used 0.5% lidocaine with epinephrine as local anesthesia. Pethidine was used as analgesic and dexmedetomidine as sedative. An incision of 30 mm at the top of the hernia bulge was made and a wound protector with sealing silicon cap was attached. We used three 5-mm trocars and a 5-mm flexible laparoscope. A flat self-fixating mesh with was placed over the primarily closed fascia and fixed using laparoscopic tacking devices.

Results
Forty-nine patients operated without endoscopy (Op). The others (n=15) required endoscopic subcutaneous dissection (LA). The mean ages of Op and LA were 66.9 and 64.3, respectively. The mean operating time of Op was significantly shorter than that of LA (100 vs 132, P=0.006). Similar hernia recurrence rete was observed (4.1% vs 6.7%, respectively). Clavien-Dindo Grade III and IV complications were not observed in both groups.

Conclusions
Incisional hernia repair under local anesthesia can be performed relatively safely even on elderly patients with serious co-morbidities, and the possibility of contributing to the improvement of patient quality of life by expanding the indications for surgery was expected.
OC-115 ABDOMINAL RECTUS MUSCLE THICKNESS AS A PREDICTOR FOR PARASTOMAL HERNIA
Authors: Nyman J , Huss K , Flygare L , Strigård K 
Published: May 2023

Abstract

Aim
To examine whether the dimensions of the abdominal rectus muscle (ARM) affect the risk of developing parastomal hernia (PSH). The hypothesis is that a thinner anteroposterior (AP) dimension of the ARM predisposes for PSH.

Material & Methods
Retrospective cohort study of rectal cancer patients undergoing tumour resection and permanent colostomy creation in two Swedish healthcare regions during 2005–2017. Patients were identified from the nationwide Swedish Colorectal Cancer Registry. Measurements of ARM dimensions in the AP and latero-lateral (LL) planes were made on preoperative (before permanent colostomy creation) and postoperative (9–18 months post stoma creation) computerised tomography images. The ARM dimensions were analysed in a multivariate logistic regression model, considering known risk factors and potential confounders.

Results
Some 151 of the planned 200 patients have been included, of which 40% are female and 20% have a radiologically evident PSH at approximately one year postoperatively. Preliminary results from the multivariate model do not indicate that ARM thickness can predict the occurrence of PSH. Body mass index seems to be the only predictor in this material. The study is still including.

Conclusions
Preliminary results indicate that ARM thickness is not an independent risk factor for PSH development. Supplementary results will be presented.