bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-024 INITIAL EXPERIENCE OF EXTENDED TEP REPAIR FOR VENTRAL AND INCISIONAL HERNIAS IN OUR HOSPITAL
Authors: Lee E J , Park I K , Park D J 
Published: May 2023

Abstract

Aim
The purpose of this study was to investigate the treatment outcomes and feasibilities of the enhanced view totally extraperitoneal (eTEP) repair for ventral and incisional hernias in our hospital.

Material & Methods
We retrospectively reviewed the medical records of patients who underwent eTEP repair for ventral and incisional hernias in our hospital from October 2018 to April 2022. Demographic information, preoperative evaluations, intraoperative variables, postoperative outcomes were collected and analyzed. The surgical techniques were followed the article published by Daes et al in 2021.

Results
Thirty-two patients underwent eTEP repair during the study period. These patients had mean age of 60.8 years, mean BMI 27.1 kg/m2, and median ASA score 2. Twenty-six had incisional hernias (4 were recurrent incisional hernias) and six were primary ventral hernias. Nineteen had hernias in M3 location, mean defect width and length size were 6.00 and 7.47 cm. Sixteen had diastasis rectis and eight had incarcerations at the time of surgery. Twenty-eight underwent eTEP Rives-Stoppa (RS) repair (23 the conventional laparoscopic ports, 2 reduced ports, 1 single port, and 1 robotic). Four underwent eTEP transversus abdominis release (TAR) using the conventional laparoscopic ports. Mean operation time was 199 (±48.5) minutes and mean estimate blood loss volume was 25.8 (±27.2) ml. The common postoperative complications were seroma and voiding difficulty and mean hospital stay length was 8.25 (±4.45) days. There were two recurrences within follow-up period.

Conclusion
Our initial experience of eTEP repair for ventral and incisional hernias showed favorable treatment outcomes and feasibilities.
P-029 USE OF INTRAOPERATIVE FASCIAL TRACTION DEVICE (FASCIOTENS®). INITIAL EXPERIENCE IN A WALL SURGERY UNIT
Authors: Mellado Sánchez I , Sánchez López D , Ferrero Celemín E , García Virosta M , Rodríguez Haro C , Hernández O'reilly M , Gajda Escudero J , Picardo Nieto A L 
Published: May 2023

Abstract

Aim
We present the use of the Fasciotens-abdomen® fascial traction device for the closure of large eventrations in three patients treated in our department.

Material & Methods
Description of three cases of large eventration in which we used the Fasciotens-abdomen® device.

Results
The first patient is a 61-year-old woman with a history of anterior ultra-low rectal resection. She presents an M2-M4W3 10 cm eventration. A Rives eventroplasty was performed with placement of a 25×10cm retromuscular PPL mesh. Fasciotens-abdomen® device was applied with a 14–16 kg load during 25 minutes.
The second case is a 45-year-old female patient with a previous umbilical hernioplasty in 2016. She presents an M2-M4W3R1 11 cm eventration. During the eventroplasty, fascial approach with Fasciotens-abdomen® device was performed for 25 minutes/14–16 kg, and a mesh of 22×11 cm was placed onlay.
Thirdly, a 60-year-old female patient with a previous eventroplasty in 2015. She presented an M2-M3W3 14 cm eventration. During the Rives eventroplasty, 70 cm of small bowel were resected due to firm adhesions. The closure was performed with retromuscular mesh placement and fascial approximation with Fasciotens-abdomen®, for 25 minutes/14kg.
All three patients received an infiltration of 15 IU of botulinum toxin weeks before the reconstruction surgery and were discharged from the hospital uneventflul.

Conclusions
Large incisional hernias pose a challenge to the surgeon. Adjunctive procedures for abdominal wall reconstruction, like the Fasciotens®fascial traction device, help to achieve tension-free midline closure.
P-032 INCISIONAL HERNIA WITH LOSS OF DOMAIN AS A CONSEQUENCE OF BOTULINUM TOXIN A AND THE COVID-19 PANDEMIC
Authors: Rodicio J , Del Val P , Silva D , Rodriguez R , Sanz S , Suarez A , Sanz L , Garcia-Ureña M A 
Published: May 2023

Abstract

Introduction
Abdominal wall surgery has been one of the major victims of the COVID-19 pandemic, with a large number of patients who have seen their surgery delayed and many are still waiting to be operated on today. On the other hand, botulinum toxin is one of the main protagonists in optimizing abdominal wall surgery, especially important in complex hernia, but we must not forget that it can have adverse effects.

Case report
We present the case of a 54-year-old man with a history of obesity, diabetes, hypertension, chronic renal failure and kidney transplant in 2000, who presented a midline incisional hernia as a result of an epigastric hernia operated on in 2006 and subsequently two onlay permanent synthetic mesh in 2010 and 2015. In February 2020 he presented an incisional hernia M2–4W3R3 with a volume of 35%, botox was infiltrated as optimization for surgery and while awaiting placement of a pneumoperitoneum catheter, the surgery was suspended due to the COVID-19 situation. He returns to our clinics in 2022 with a growth of the hernia and a volume of 95%. Weight loss, botulinum toxin and preoperative pneumoperitoneum were indicated. We performed a reconstruction of the abdominal wall with bilateral transversus abdominal release and preperitoneal 45×60cm polyvinylidene fluoride mesh and abdominoplasty.

Discussion
Botulinum toxin can facilitate abdominal surgery, especially in complex hernias, but we must not forget that blocking the abdominal muscles can have adverse effects. The COVID-19 pandemic has been especially hard on surgical waiting lists, delaying surgeries and aggravating pathologies.
P-047 REDUCING THE RISK OF MESH EROSION IN A MODIFIED RETROMUSCULAR SUGARBAKER TECHNIQUE FOR PARASTOMAL HERNIA REPAIR
Authors: Ruano-Campos A , Pérez-Jiménez A E , Ossola Revilla M E , Gómez Latorre L , Del Campo Martín M , García-Galocha J L , Peña Soria M J , Torres García A 
Published: May 2023

Abstract

Aim
Modified retromuscular Sugarbaker procedure (SP) is a promising approach for parastomal hernia repair. However, its potential complications, including the risk of mesh erosion, encourages us to develop other techniques of mesh placement. We propose an addition to this parastomal retromuscular mesh reinforcement.

Materials and Methods
We present the case of a 53 year old-woman, with a history of proctocolectomy with end ileostomy due to anal adenocarcinoma, undergoing emergency surgery due to parastomal hernia incarceration. Sugarbaker repair was performed placing inlay composite mesh fixed with reabsorbable tackers. Subsequently, the patient was admitted for recurrent parastomal hernia and midline ventral hernia surgery.

Results
We performed a modified retromuscular SP as described by Pauli in 2016. After midline laparotomy, hernia content was reduced and extensive retromuscular dissection with transversus abdominis release (TAR) performed, placing a wide retromuscular polypropylene mesh prior to closing parastomal fascial defect. Stoma was parietalized from lateral to medial in an S-shaped configuration. We placed a segment of bioabsorbable mesh covering the parietalized stoma to avoid direct contact with the polypropylene mesh. No recurrence was detected 3 months after surgery, pending reassessment at 6 months.

Conclusions
This repair provides the benefits of an open posterior component separation with TAR, maintaining the biomechanics of a functional abdominal wall, whilst offering the advantages of mesh reinforcement in a modified Sugarbaker configuration. Our experience with this novel technique seems promising. Rate of mesh erosion is yet to be defined and requires long-term studies before widespread adoption, with special concern on mesh placement.
P-049 DAMAGE CONTROL SURGERY FOR AN INCARCERATED GIANT UMBILICAL HERNIA IN A SUPEROBESE PATIENT
Authors: Rodríguez Haro C , Mellado Sánchez I , Sánchez López J D , García Virosta M , Hernández O'reilly M , Gajda J , García-Sancho L , Ferrero Celemín E , Martínez Alegre J , Vaquero Pérez M A , Picardo Nieto A L 
Published: May 2023

Abstract

Aim
To report the case of the emergency management of an incarcerated giant umbilical hernia in a superobese patient with a damage control surgery as the first step for its treatment.

Material & Methods
We present the case of a 47-year-old man with a BMI of 62 kg/m2 who arrived to the emergency department for abdominal pain. Examination and CT scan revealed a giant umbilical incarcerated hernia with loss of domain, with an 8 cm hernia neck and containing the entire bowel except for the rectosigmoid and duodenum.

Results
The emergency managment was a laparotomy with a subcutaneous right lateral approach, opening first the hernia sac to verify bowel viability. Then, we performed a tranverse chelotomy on the right side of the defect, leaving the defect open and wider to prevent hernia strangulation. We left two drains in the subcutaneuos space and the wound was covered with vacuum therapy dressing. The patient recovery was uneventful and he was discharged in the sixth postoperative day.
After this episode the patient started a very strict weight loss treatment, so we coul plan the final wall reconstruction surgery, which hasn't already been performed, but which will include botulinum toxin and progressive preoperative pneumoperitoneum.

Conclusions
We belive that damage control surgery was the most appropiate option as the first step for the management of an incarcerated complex hernia, so in a second time an elective complex wall reconstruction surgery could be performed.
P-058 In the path of a hernia center?
Authors: Figueiredo J , Souto R , Trindade M , Henriques S , Branco A , Costa P 
Published: May 2023

Abstract

Introduction and aim
Hernia surgery is becoming more complex and demanding, increasing the need for specialization. Certification of units dedicated to hernia surgery must follow some requirements linked to surgical skills, resources, and outcomes.
We aim to analyze the outcomes and benefits of a dedicated hernia unit.

Methods
We conducted a retrospective analysis of 333 abdominal wall hernia repairs performed from the start of a dedicated unit in 2020, until 2022. A total of 187 patients underwent groin hernia repair, 70 primary ventral and 75 incisional hernia. Demographic and clinical data, surgical techniques, and outcomes were assessed. The results were analyzed according to the accreditation and certification requirements for hernia centers and surgeons from European Hernia Society.

Results
The group performed 124 open and 63 laparoendoscopic groin hernias, 50 open and 20 laparoendoscopic primary ventral hernia, and 36 open and 39 laparoendoscopic incisional hernias.
The total complication rate for groin hernia surgery, 30 days postoperatively, was 2,7% (&lt; 5%) (1,6% wound dehiscence, 1,1% seroma, 0% pulmonary or cardiovascular), reoperation rate was 0% (&lt;2%), recurrence 1,6%, and chronic pain 2,15%. In primary ventral repair, the morbidity within thirty days was 1,4%, infection was 1,4% and recurrence 0%. According to incisional hernias, the infection/revision rate after open surgery was 11/% (&gt;10%), after laparoscopic surgery was 2,5% (&lt;3%) and the reoperation rate was 0,5% (&lt;10%).

Conclusions
Optimal results in hernia surgery can only be guaranteed in dedicated units that follow a “tailored-approach” concept, yet need expert hernia surgeons with increasing knowledge and experience.
P-073 RESORBABLE SYNTHETIC VS. BIOLOGIC MESH VENTRAL HERNIA REPAIR IN CONTAMINATED FIELDS
Authors: Amro C , Niu E F , Honig S , Davis H D , Habarth-Morales T E , Broach R B , Fischer J P 
Published: May 2023

Abstract

Aim
Abdominal wall reconstruction (AWR) with ventral hernia repair (VHR) in the setting of contamination poses unique and controversial challenges. The purpose of this study was to examine the efficacy of resorbable biosynthetic mesh against biologic mesh in contaminated VHR with AWR.

Methods
A single-center, retrospective review from 2015–2021 was performed examining subjects who underwent VHR with AWR in contaminated fields (CDC wound class II-IV). A matched paired analysis based on Age, BMI, and CDC wound class was conducted among patients who utilized resorbable biosynthetic mesh in an onlay fashion and biologic mesh in an underlay fashion.

Results
A total of 94 patients (47 per group) underwent VHR with AWR in contaminated fields. Patients who utilized biosynthetic mesh had an average defect size of 314.56 ± 214.65 cm2, required component separation (57.4%), and were often recurrent (61.7%). Majority of contamination were clean-contaminated (68.1%), followed by dirty/infected (19.1%), and contaminated (12.8%). Patients utilizing resorbable biosynthetic mesh experienced fewer surgical site occurrences (46.8% vs 72.3%, p &lt;0.05) and fewer surgical site occurrence procedural interventions (19.1% vs. 38.4%, p&lt;0.05). Patients with biosynthetic mesh had fewer hernia recurrences compared to biologic mesh use, however was not statistically significant (14.9% vs. 30.4%, p = 0.07), with a mean follow up of 25.73 ± 18.66 months.

Conclusion
Utilization of resorbable biosynthetic mesh may be preferable to biologic mesh in contaminated fields due to lower rates of surgical site occurrences and interventions, ultimately reducing the post-operative clinical and financial burden for this patient population.
P-084 INDEPENDENT PATIENT DATA META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS ON PROPHYLACTIC MESH PLACEMENT FOR INCISIONAL HERNIA PREVENTION: STUDY PROTOCOL
Authors: Van Den Berg R , Den Hartog F , Sneiders D , Stabilini C , Lange J , Muysoms F , Tanis P 
Published: May 2023

Abstract

Aim
In high risk groups such as patients undergoing open abdominal aortic aneurysm (AAA) surgery, the risk of incisional hernia (IH) formation is up to 69%. IH can be prevented through prophylactic mesh augmentation (PMA). Several randomized controlled trials (RCT) have shown a significant decrease in IH formation after PMA. However, due to study design and sample size issues, implementation of PMA into daily practice is lacking.

Methods
International collaboration will be initiated under the guidance of the European Hernia Society. RCTs studying PMA after open AAA surgery will be identified through a literature search. Corresponding authors of the selected studies will be approached for participation by e-mail, telephone or other means. Where independent patient data (IPD) are available, a suitable data delivery agreement (DDA) will be drafted and signed upon agreement. Pseudonymised or anonymised data sets will be securely transferred and stored, and relevant study parameters will be harmonized. A 1-stage IPD meta-analysis (IPDMA) will be performed, stratified per centre, assessing PMA effectivity according to the intention-to-treat principle. If a 1-stage IPDMA is not feasible, a 2-step IPDMA will be performed, analysing each RCT separately and pooling outcomes. Results will be published in internationally recognized, peer-reviewed journals. This study protocol was registered under PROSPERO number CRD42022347881.

Conclusions
Gathering IPD across relevant RCTs and performing an IPDMA on the combined data will help to better establish effectiveness of PMA in preventing IH after open AAA surgery. Secondarily, subgroup analyses will allow identification of patients who will benefit from PMA most.
P-094 FLAT PATCH MESH VERSUS THREE-DIMENSIONAL MESH (PLUG) FOR OPEN UMBILICAL OR EPIGASTRIC HERNIA REPAIR: A RETROSPECTIVE STUDY
Authors: Sangiorgio G , Falzone U , Sapienza E , Lombardo F M , Zanghì M , Vacante M , Zanghì G 
Published: May 2023

Abstract

Aim
The aim of this retrospective study was to compare open small- and medium-sized ventral hernia repair with flat patch mesh versus three-dimensional mesh (plug) in terms of recurrence and complication rates.

Methods
The medical records of 300 patients who underwent ventral hernia repair using flat mesh versus plug between January 2010 to December 2015 were reviewed. All patients were followed up after 1 month, 3 month and 1 year. The rate of recurrence, and short-term postoperative complications such as incidence of Surgical Site Infections (SSIs), hematoma and seroma were evaluated.

Results
Short-term follow-up data were available for all patients. The first group was composed of 150 patients that were treated with plug (60% presented umbilical hernia and 40% presented epigastric hernia). The second group was composed of 150 patients that were treated with flat mesh (68% presened umbilical hernia and 32% presented epigastric hernia). The majority of postoperative complications were wound related, representing superficial SSI or seroma. Our results showed a statistically significant reduction of SSIs [3 (2%) vs 13 (8.6%); p = 0.038] and seroma [2 (1.3%) vs 12 (8%); p = 0.030] in the group of patients treated with plugs. There was no statistically significant difference in hernia recurrences.

Conclusions
Usage of plugs represents a feasible and safe technique that significantly lowers the incidence of complications. Furthermore, compared to flat mesh, plugs displayed non-inferiority in terms recurrence. Further, well-designed clinical trials could be realized to investigate possible applications of plugs for umbilical and epigastric hernias repair.
V-006 Lumbar hernia: Novel eTEP robotic approach
Authors: Villalobos R , Maestre Y , González Barranquero A , Escartin A , Olsina J 
Published: May 2023

Abstract

Aim
Primary lumbar hernias are rare defects on the posterior abdominal wall. The study of these hernias has been described from the anatomical point of view of the anterior pathway (Petit 1783 and Grynfelt 1866). The preperitoneal/retromuscular view has interesting anatomical differences as was described by Moreno-Egea. Open and laparoscopic approach treatment have been described in different articles and lately Kudsi described in his book Robotic Hernia Surgery (2020), an incisional lumbar hernia repair by robotic extended totally extraperitoneal (eTEP) approach placing the trocars in the midline. Kudsi describes an ipsilateral retrorrectal access and a TAR procedure. The aim of this video is to describe a novel eTEP approach in a primary lumbar hernia placing the trocars beyond the semilunaris line avoiding an unnecessary dissection of the retrorrectal space.

Material and Methods
The case is a 62 years old woman patient with a BMI of 35 who presented a progressive 1-year discomfort bulging in her right lumbar back that turned in pain the last 6 months. MRI was made showing a right lumbar defect with a huge fat tissue content. Once the patient was assessed, an eTEP robotic approach was planned with a Xi Da Vinci robotic platform. The patient was in a hyperextended left-side position.

Result
The patient was discharged the same day of operation with a mild pain controlled by oral medication.

Conclusion
The eTEP robotic lumbar hernia approach beyond the semilunaris line is feasible, avoiding a retrorrectal and TAR unnecessary procedure.
V-008 RTARUP (ROBOTIC TRANSABDOMINAL RETROMUSCULAR UMBILICAL PROSTHETIC) - «BOTTOM-UP APPROACH»
Authors: Quagli O , Bertoglio C L , Alampi B , Morini L , Grimaldi S , Ferrari G C 
Published: May 2023

Abstract
Robotic surgery is gaining more space in every country at every level. Wall surgery is one of the fields in which technology can help the surgeons and can give more opportunities to the patients.
One of the biggest differences between laparoscopic surgery is that the use of the robot provides excellent 3D VISION of the abdomen and can ease the surgeon, during difficult and tricky situation mostly.
One of this wall affection is diastasis recti. It affects about 1/3 of women after childbirth, yet it is still little talked about today. Often underestimated or confined to a cosmetic problem, most of the times abdominal diastasis is a functional problem primary and must be addressed in the correct way.
In this video, we report a case of diastasis recti associated with a primary umbilical hernia in a multipara woman.
She was 45 with a BMI of 26.4 kg/m2 and she came to our attention after a long period of discomfort and pain. She told us that her umbilical hernia was growing fast in the last months and that the condition of her abdomen was getting worse, with pain and digestive difficulties. At the physical examination we found an umbilical hernia of 3 cm of diameter and a diastasis recti of 6 cm of width.
Due to the conditions of the patient, the young age and the will not to have children anymore, we decide to perform a robotic transabdominal retromuscular umbilical prosthetic (rTARUP) «bottom-up approach» (the patient never underwent abdominal surgery).
V-017 LAPAROSCOPIC TRANSVERSUS ABDOMINIS RELEASE (L-TAR) VIA TOTALLY EXTRAPERITONEAL REPAIR (TEP)
Authors: Olivero A A , Valinoti A C , Giacone J A , Sadava E E 
Published: May 2023

Abstract

Aim
Posterior component separation via transversus abdominis release (TAR) allows the treatment of complex incisional hernias, although it is associated with high morbidity rates. In recent years, the laparoscopic TAR was introduced, showing the benefits of the minimally invasive surgery such as less postoperative pain, less surgical site infection, and a shorter hospital stay. When compared to the transabdominal preperitoneal (TAPP) approach, the Totally Extraperitoneal Repair (TEP) technique avoids entry into the abdominal cavity, making it a suitable strategy for patients with previous abdominal surgeries.

Material & Methods
We present the case of a 68-year-old male with three previous umbilical repairs, one of them with mesh. He consulted for a recurrent umbilical hernia associated with a large weakness on the abdominal wall in the left flank. He complained that it increased in size and significantly altered his quality of life. Computed tomography scan revealed weakness and atrophy of the abdominal wall muscles in the left anterolateral area, which measured 22×10×15 centimeters. Surgical repair was decided and a TEP-TAR technique with mesh reinforcement was performed to restore the abdominal wall anatomy.

Results
The patient had an uneventful postoperative course and was discharged 36 hours after surgery. No recurrence was observed at 6 months.

Conclusions
Complex abdominal wall defects are challenging. The use of minimally invasive advanced techniques is feasible and safe, making it a suitable tool for the management of this type of cases.