bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-131 SHORT TERM RESULTS OF PREOPERATIVE TOXIN BOTULINUM A IN PREPARATION FOR ABDOMINAL WALL RECONSTRUCTION
Authors: Amaral P , Dias E , Carvalho J P , Macret J , Pivetta L , Malheiros C A , Roll S 
Published: October 2022

Abstract

Aim
to report short term outcomes of preoperative toxin botulinum A (TBA) in preparation for abdominal wall reconstruction (AWR).

Material and Methods
Patient with a hernia width&gt;10cm and/or loss of domain who underwent elective AWR from April 2021 through March 2022 were included. All patients received ultrasound-guided administration of 300 units of TBA prior the surgery. Outcomes of interest included: changes in hernia dimensions and CT-Scan volumetric measurements after treatment, rates of complete fascial closure, postoperative intraabdominal hypertension, unplanned readmission and hernia recurrence.

Results
Fifteen patients were included (53% males; mean age 61years, mean body mass index 28.9kg/m2). Median hernia width decreased by 2cm (before 15cm [IQR 14–18.5], after 13cm [IQR 10.3–15]; p=0.002) and median abdominal cavity volume increased by 1.4L (before 4.8L [IQR 3.8–11.1], after 6.2L [4.2–9.2]; p=0.594). Thickness of lateral abdominal wall muscles decreased (before 2cm [IQR 1.6–3], after 1.1cm [IQR 1–1.3]; p=0.008 and the Tanaka Index decreased (12% [IQR 3.6–24.2] and 5% [IQR 1.4–16.8]; p=0.066)
Complete fascial closure was achieved in 13cases(87%). Three patients did not require component separation. Mean endotracheal pressure was 19mmHg. There were no intraabdominal hypertension. At a median 9months follow-up [range 6.2–11.5] wound morbidity rate was 20%(N=3), N=1 recurrence, N=1 unplanned readmission.

Conclusions
TBA promotes changes to the lateral abdominal wall with decrease on defect width and thickness of lateral muscles and increase in cavity volume and Tanaka index. Randomized clinical trials are needed to determine the clinical implication of preoperative TBA in preparation for AWR.
P-136 MANAGEMENT OF DIRTY ABDOMINAL WALL SITUATIONS WITH AN OVINE RUMEN BIOLOGIC MESH WITH POLYPROPYLENE REINFORCEMENT
Authors: Lopez-Monclus J , Muñoz Rodriguez J , Roman García De Leon L , Grillo Marin C , Iglesias García E , Fernandez Rodriguez M , Robin A , Lucena De La Poza J L , Blazquez Hernando L , Garcia Ureña M A 
Published: October 2022

Abstract

Aim
To present our initial results of abdominal wall surgery in dirty situations with an ovine rumen (OR) biologic mesh reinforced with polypropylene.

Patients and Methods
Five patients with elective abdominal wall surgery in a dirty setting were included. Two cases were previous PTFE mesh infections after IPOM repairs, one case of enteroatmospheric fistula through a previous posterior component separation repair, one deep tissue infection after a MILOS retromuscular repair and one definitive closure after a 8 weeks open abdomen in a liver transplantation patient. In the five cases cultures showed polymicrobian infections. Both PTFE meshes were removed and substituted by the OR biologic mesh. In the enteroatmospheric fistula patient the exposed mesh was resected together with the fistula take down, and a re-Rives was performed. In the case of the MILOS deep tissue infection after two weeks with an open abdomen and a temporary abdominal closure the definitive closure was performed with the biologic mesh in the retromuscular space. In the definitive closure of the liver transplantation patient the mesh was placed intraperitoneally as prophylaxis.

Results
In four cases there weren´t any surgical sites ocurrences. In the case of the enteroatmospheric fistula the patient presented a partial fascial dehiscence with mesh exposure, managed with a VAC system. With less than a year follow up no hernia recurrence has taken place.

Conclusión
The use of an OR biologic mesh with polypropylene reinforcement seems to be safe in abdominal wall repair in dirty settings, with good results during early follow up.
V-004 REDO ETEP APPROACH FOR SMALL BOWEL INCARCERATION DUE TO POSTERIOR SHEATH SEPARATION: AN UNUSUAL COMPLICATION
Authors: Trujillo Díaz J , Jezieniecki Fernández C , Gomez Lopez J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C 
Published: October 2022

Abstract

Aims
The retromuscular-preperitoneal approach of primary or incisional hernias is a technique that is being performed more frequently due to the more anatomical position of the mesh, the lower rates of complications and recurrences in the short and long term.However, this technique is not without complications, the most frequent being retromuscular seromas or hematomas, the rarest being incarcerated hernias secondary to dehiscence of the posterior sheath closure,hence the importance of presenting this case.

Methods
Video-case presentation.

Results
40-year-old man with surgical histories:open appendectomy 20years-ago, and endoscopic repair(eTEP-Rives) of umbilical hernia and diastasis of the rectus abdominis. He went to the emergency room 4days after surgery(eTEP) due to sudden, intense abdominal pain, located in the mesogastrium.Abdominal-CT:hernial defect at the umbilical level (posterior-sheath-dehiscence) with incarcerated and dilated small-bowel inside.
We decided to perform urgent surgical intervention.An iterative eTEP-retromuscular-laparoscopic-approach was performed,observing hernial defect due to dehiscence of the posterior-sheath suture at the umbilical level with incarcerated small bowel loops within the retromuscular space.Hernia content revision and reduction is performed, previous mesh is removed and since tension is visualized for the closure of the hernial defect, right Hemi-TAR is performed, after which a tension-free closure of the the posterior sheath, and PVDF-mesh is placed.The patient presented a satisfactory evolution.

Conclusions
The enhanced view totally-extraperitoneal-approach(eTEP) is a valid, effective and safe option in cases of acute complications,such as the one presented,through which more complex separation techniques(TAR) can be associated to achieve a correct and tension-free closure of the abdominal wall, presenting the advantages of MIS.
V-018 PREOPERATIVE OPTIMIZATION AND POSTERIOR COMPONENT SEPARATION WITH INTRAOPERATIVE MONITORING OF RECTUS MUSCLE INERVATION FOR LOSS OF DOMAIN INCISIONAL HERNIA
Authors: Medina M , Garcia-Urena M A , Aviles A , Robin Valle De Lersundi A , Cruz A , Munoz-Rodriguez J , Blazquez Hernando L A , Martinez J , Perez-Flecha M , Lopez-Monclus J 
Published: October 2022

Abstract

Aim
The importance of an appropriate patient optimization (botulin toxin and pneumoperitoneum) and adequate surgical technique is highlighted.The possibility of intraoperative monitoring of the nerves that may be injured during posterior component separation is explained

Material and methods
We present a 74 years old man, past smoker, with history of hypertension, steatohepatitis and chronic bronchopathy

Results
This is a disastrous but unfortunately not so uncommon story of a failed repair of a simple umbilical hernia with 3 previous unsuccessful attempts of repair with and without mesh. After the last surgery the patient developed a giant incisional hernia with loss of domain. Optimization consisted of improving nutritional status, respiratory physiotherapy, botulin toxin and pneumoperitoneum. The surgery was made using previous skin scar. After dissecting the retrorectus space, a posterior component separation was made with the aid of monitoring the nerves that come to innervate the rectus abdominis. An overextended overlapped was obtained. A patch of absorbable mesh was used to completely close the peritoneum. A combination of absorbable and permanent synthetic mesh was used as giant reinforcement of the visceral sac. The only points of fixation were the Cooper Ligaments. The patient had a satisfactory recovery without complications and was discharged on the 8th postoperative day.

Conclusions
Loss of domain incisional hernias is a real surgical challenge. The combination of a good preoperative strategy (preoperative neumoperitoneum) and surgical technique (TAR and pannniculectomy) gives a great opportunity to solve very complex cases of incisional hernia.
V-019 LAPAROSCOPIC CONTROL OF HEMOPERITONEUM AFTER TACKER FIXATION IN TAPP HERNIA REPAIR
Authors: Ramirez A , Bascuas B , Delgado M , Licardie E , Guadalajara J 
Published: October 2022

Abstract

Aim
The use of tackers for peritoneal closure in TAPP (transabdominal preperitoneal approach) is controversial because of the associated risk of vasculo-nerve injury. We present the case of a 56 years old male who came for hypovolemic shock due to hemoperitoneum after TAPP hernia repair in another center 72 hours earlier.

Material & Methods
We opted for an exploratory laparoscopy showing a massive hemoperitoneum due to a bleeding from the left epigastric artery at the site of placement of a tacker. Hemostasis was performed with bipolar energy and peritoneal approximation with glue after washing and aspiration.

Results
The patient was discharged on the third day without any complications.

Conclusions
Peritoneal flap closure in TAPP remains a controversial issue despite finding no significant differences between the different closure methods in the literature. Blind placement may injure vessels and nerves that require subsequent urgent surgery.
In selected patients, if the patient is stable, laparoscopy through the same trocars is a safe and reliable option to resolve hemoperitoneum after epigastric artery injury.
V-021 REPORT OF AN ACQUIRED INTERCOSTAL HERNIA REPAIR USING A BILAYER MESH
Authors: Burns E , Aliar A , Baltatzis M , O'keeffe N , Sheen A J 
Published: October 2022

Abstract

Aim
A 53-year-old male underwent a T10/11 discectomy with partial removal of the right T9 rib. 10 years later, he developed an acquired painful intercostal hernia, worsened by leaning against the defect. CT imaging demonstrated an 8cm hernial defect containing the posterior lobe (segment VII) of the liver with a loss of integrity of the diaphragm.

Methods
Open surgical repair though the original incision was undertaken, with the patient in the left lateral position. The hernia was entirely reducible in this position.

Results
The liver was replaced into the peritoneal cavity, the hernial sac and the weakness at the postero-lateral edge of the diaphragm were then identified. The edges of the hernial sac were dissected off the ribs. An intraperitoneal mesh (SymbotexTM; Medtronic, Lyon) was cut to size, placed, and fixed to the undersurface of the ribs, with a 5cm overlap obtained medially and laterally. Care was taken to avoid damaging the neurovascular bundle and breach of the pleural cavity was not observed.
A bridging mesh was then used to reinforce the repair (VersatexTM; Medtronic, Lyon) with fixation to the ribs using ethibond sutures and cyanoacrylate glue (Glubran®; Viareggio). The repair was checked by Valsalva manoeuver prior to wound closure.
Post operative pain control was achieved using intercostal nerve block and patient-controlled analgesia. A post-operative chest x-ray did not demonstrate a pneumothorax. The patient was discharged on postoperative day 2.

Discussion
The patient experienced no serious postoperative sequelae and was pain free with no hernia at 30 days post-surgery.
V-023 R-TAPP AS A TRAINING MODEL IN ROBOTIC SURGERY
Authors: Esposito S , Pecchini F , Casoni Pattacini G , Trapani V , Gozzo D , Piccoli M 
Published: October 2022

Abstract

Aim
The main aim of the project will be evaluating the effectiveness of an experimental structured didactic program in robotic surgery in filling the training gap caused by the pandemic. We intend to evaluate how establishing a training pathway could improve young surgeons’ robotic skills and implement their participation in robotic procedures during the COVID-19 pandemic. We will also evaluate the learning curve of robotic transabdominal preperitoneal inguinal hernia repair (TAPP) for young surgeons with limited experience as first operators at the dual console.

Matherials and Methods
We designed an experimental stepwise training program in robotic surgery that starts from a first step of theoretical and laboratory lessons, followed by a second phase of bedside assistance training, and finally the completion of low complexity procedures by the trainees proctored at the dual console by senior surgeons. Robotic TAPP was selected as training model. The performance of each trainee will be registered in an evaluation data sheet and Learning scores will be recorded by the tutor with the evaluation of 6 corner steps of the procedure.

Results
Preliminary results showed improved technical skills and increased team spirit and wellbeing.

Conclusions
TAPP is a good training model because involves technical steps useful for more complex procedures. The robotic dual console represent an extraordinary training tool and a structured training program positively impacts technical skills and could help filling the training gap caused by the pandemic.
V-024 LAPAROSCOPIC ENHANCED-VIEW TOTALLY EXTRAPERITONEAL RIVES-STOPPA REPAIR (E-TEP RS). FIRST EXPERIENCE AT HOSPITAL UNIVERSITARIO DE CANARIAS
Authors: Marrero Marrero P , Delgado Plasencia L J 
Published: October 2022

Abstract
We present the case of a 55-years-old female with a personal history: high blood pressure, dyslipidemia, without previous abdominal surgeries. Height: 1,65 m; Weight: 62 Kg. BMI: 22,7. Clinical and ultrasound diagnosis of a painful and partially reducible ventral hernia M2 W1 (EHS Classification). It is programmed for hernia correction using the Laparoscopic Enhanced-View Totally Extraperitoneal Rives-Stoppa Repair (e-TEP RS) technique adapted to the hernia defect. Access is made to the left retrorectal space on the left flank, medial to the semilunar line but lateral to the epigastric vessels; dissection of the retrorectal space with a disector balloon on a 5 cm perimeter around the hernia defect; pneumoperitoneum; cross-over manoeuvre connecting the two retrorectal spaces with the medial preperitoneal space; dissection and reduction of the hernia sac; closure of the hernia defect with bearded reabsorbable suture. Implantation of polyvinylidene fluoride (PVDF) macroporous mesh in retrorectal space without using any type of fixation. A retromuscular closed-suction drain is then placed and the place is then desuflatted. The patient is discharged at 12 hours postoperative with in situ drainage, wich was removed in consultation 48 horas after surgery due to null debit. We present the first published case, in our latitude, of a e-TEP RS adapted to the hernia defect. It is a challenging but safe and effective technique as well as practically painless postoperative technique.
V-034 IPOM PLUS: IS THERE ANY PLACE LEFT? WHY WE (STILL) DO IT
Authors: Agresta F , Licitra E , Mazzarolo G , Savino G , Pontarolo N , Montori G 
Published: October 2022

Abstract

Aim
In this video, we want to share and discuss what we have learned from our 20-year experience in IPOM PLUS, for scheduled as emergencies

Material and Methods
We use only all 5 mm trocars, instruments, and 30-degree optics and we always use low intra-abdominal pressure - 10mmHg.
The technical trick is to carefully prepare and manage the abdominal wall context, to free all the hernia areas.

Results
Our experience is almost more than 500 cases, elective as an emergency. In the last years, we normally use a prosthesis, made with a monofilament macroporous mesh and transparent film(with the film versus the intestine), with a 5 cm overlap. Besides the well known needed physical characteristics of the mesh, on the surgeon's side, a mesh should be smooth, stiff, wide enough to cover all the possible defects, easy to handle, and, especially for its possible use in laparoscopy, with a certain degree of and thickness just what it is needed to let it pass through a 5 mm trocar once rolled up. We use to close the defect to avoid serosa and SS - Morbidity and we use to fix the mesh with absorbable tackers. Above all we do believe in the diagnostic value of the technique, cause allows us to better see and judge the intraabdominal context

Conclusions
The advantages of laparoscopy rely on the minimal access and the possibility to manage and examine the abdominal context, especially in emergencies, close the defect, and fix the mesh with tackers.
V-044 ABDOMINAL WALL RECONSTRUCTION OF A POST-HEMIPELVECTOMY INCISIONAL HERNIA: AT THE LIMITS OF WHAT IS POSSIBLE
Authors: Blázquez Hernando L , García Ureña M Á , Molina Villar J M , Oto D , Muñoz Rodriguez J , Lopez Mónclús J , Porrero Guerrero B , Robín Valle De Lersundi A 
Published: October 2022

Abstract

Incisional hernias in patients with bone defects are a real challenge. There is very little evidence of how to repairing them.

Clinical Case
56-year-old patient. He underwent a left external hemipelvectomy for osteosarcoma of the iliac bone in 2012 and a left nephrectomy in 2013. The patient presents an inguinal and right thigh root bulge of progressive growth with severe pain and limited mobility. In the past month, he was unable to walk.
Physical examination: inguinal defect, defect in the right thigh root and a large lateral bulge.
Preoperative CT scan: atrophy of the left abdominal musculature, absence of the left hemipelvis, left hip prosthesis with a pseudocapsule, a large lumbar defect, and a large defect in the inguinal area.

Surgery
Dissection of hernia sacs and retroperitoneal/preperitoneal dissection was performed, cranially to the retrodiaphragmatic area, medially to the linea alba, posteriorly to the spine and caudally to the pelvis. The abdominal wall is reconstructed with a polyglycolic acid and trimethylene carbonate mesh to reinforce the abdominal wall and a large polypropylene mesh that envelops the visceral sac and is fixed to the right pubis and the pseudocapsule of the hip prosthesis.
In the postoperative period, the patient presented pulmonary thromboembolism and surgical wound infection. He was discharged on the 17th postoperative day.
One year after surgery, the patient is asymptomatic, and has a continent wall with discrete lateral bulging.
Preperitoneal dissection makes it possible to solve very complex wall defects, even with very large bone defects.
V-046 LAPAROSCOPIC SURGICAL MANAGEMENT OF AN HUGE DIAPHRAGMATIC HERNIA
Authors: Costa J , Monti E , Latham L , Marzorati A , Odeh M , Colombo E M , Ballabio A , Zanchetta M , Inversini D , Ietto G , Carcano G 
Published: October 2022

Abstract

Introduction
Diaphragmatic hernias (DH) in most cases are the consequence of a diaphragmatic trauma causing a missed injury. Less frequently, DHs are congenital.

Case Presentation
A 52 years old patient came to our attention due to a worsening severe dyspnea. A chest CT scan were performed, showing an extensive left-side DH. We present the video of the surgical procedure.
The patient mentioned a severe left hemithorax trauma occurred almost twenty years before due to a motorbike accident. Possibly, a diaphragmatic injury was not diagnosed at the time. Subsequently, a Covid-19-related chronic cough resulting in a persistently increased intra abdominal pressure may have caused the herniation of abdominal viscera.
The surgical procedure was laparoscopic. The whole greater omentum and most of the transverse colon were herniated and, after a thorough adhesiolysis between the herniated tissues and the left diaphragmatic crus, the DH was reduced. It was confirmed the presence of a 8 cm defect of the left hemidiaphragm, it was repaired with a absorbable continuous suture. A 08×10 cm Bio-A patch was positioned over. The herniated tissues were meticulously examined and showed no signs of damage.

Conclusions
Diaphragm's injuries are unfortunately difficult to diagnose in an acute setting, thus remaining often unbeknownst to the surgeon. Some patients never develop any symptoms because of such missed diaphragmatic injuries. Some others instead, due to an increase in the intra abdominal pressure, may develop symptomatic DHs. In the latter case, surgical management becomes mandatory.
V-050 WEDGE RESECTION AND CLOSURE OF ENTEROCUTANEOUS SMALL BOWEL FISTULA CONTAINING MESH FOLLOWING PREVIOUS INCISIONAL HERNIA REPAIR
Authors: Ewan H , Zanellato A 
Published: October 2022

Abstract

Aim
To demonstrate a technique to manage complications of mesh migration into bowel and subsequent enterocutaneous fistula following incisional hernia repair that avoids large laparotomy, adhesiolysis, removal of all abdominal wall mesh, and risk of bowel injury.

Methods
A 74 year old developed an enterocutaneous fistula with migration of mesh into the small bowel following an incisional hernia repair with sublay mesh. She’d previously had multiple laparotomies and subsequently turned down for surgical management of her fistula due to the hostile nature of her abdomen and complication risk. She developed pancreatitis and the increase in intra-abdominal pressure made her fistula unmanageable. Following a period of parental feeding and a contrast follow-through study, surgery to resect the fistula containing mesh and primary closure with minimal adhesiolysis was performed.

Results
Subcutaneous tissue around the fistula was resected down to fascia. Bowel was mobilised 5cm and a foley catheter inserted to check diameter. Mesh was resected with part of the small bowel which was then closed. Pre-peritoneal space was dissected to remove a further segment of mesh invading bowel. Posterior rectus sheath was cleared for 5cm before abdominal wall closure in 3 layers. No complaints or problems reported after 2 years follow-up.

Conclusions
This technique avoids laparotomies, associated adhesiolysis and large enterectomy with the associated risks. A limited wedge resection of mesh and small bowel for enterocutaneous fistula can be done and eliminates the need to remove all abdominal wall mesh in such scenarios. Another tool in the arsenal for complex patients.
V-051 URINARY BLADDER HERNIA: THE PATIENT IS ALWAYS RIGHT
Authors: Gadgil M 
Published: October 2022

Abstract
Inguinal bladder hernia is rare condition found in about 1–5% of inguinal hernias.
Unless suspected, it can be missed and can cause injury to the urinary bladder.
We hereby present a video of one such rare variety of inguinal bladder hernia which was missed by all preop investigstions done as a result of unequivocal clinical findings and not taking patients verbatim too seriously.
V-052 REAL TIME TRANSILLUMINATION TECHNIQUE FOR AVOIDING VASCULAR INJURY DURING IPOM
Authors: Gadgil M 
Published: October 2022

Abstract
Injury to inferior epigastric vessels during tacking is the Achilles heel of the traditional IPOM method of Lap ventral hernia repair.
Although surface marking preoperatively with USG guidance and / or other ingenious methods are described, none of them are in real time and hence, not fool proof.
We hereby describe real time transillumination technique of localising inferior epigastric pedicle during IPOM to avert a catastrophe.