bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC-042 HIGHER REOPERATION RATES FOR TISSUE PENETRATING FIXATION METHODS IN LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR
Authors: Mortensen A , Bodilsen A , Friis-Andersen H 
Published: October 2022

Abstract

Aim
The study compares three types of mesh fixation techniques of laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) in regards to recurrence: non-tissue penetrating (NP), tissue-penetrating (TP) and no fixation (NF).

Methods
The cohort was established retrospectively by way of the Danish Hernia Database, and all patients operated for inguinal hernia using TAPP from January 2010 to February 2021 in Denmark were identified. Logistic regression analyses were performed, with multivariate analysis correcting for significant confounding variables, yielding adjusted odds ratios for reoperation for the three fixation methods.

Results
A total of 38,503 primary TAPP repairs were included (penetrating fixation n=25,216, non-penetrating n=10,172, no fixation n=3,115). Overall recurrence rate was 3.57% over the 133 month follow-up period (mean length 59 months) with significant differences between the three methods: recurrence was 1.23% for NP, 2.87% for NF and 4.84% for TP. Using NF as reference, the adjusted odds ratio for reoperation was 1.80 for NF (p=0.007) and 3.51 for TP (p=0.001).

Conclusions
This comprehensive analysis demonstrated significant superiority of non-penetrative mesh fixation followed by no mesh fixation and lastly penetrative fixation. We corrected for significant confounding variables. With TP being the most widespread method of fixation, these results encourages reconsideration of standard practices for mesh fixation in TAPP.
OC-044 TOTAL EXTRAPERITONEAL ENDOSCOPIC INGUINAL HERNIOPLASTY (TEP) IN PATIENTS WITH PREVIOUS LOWER ABDOMINAL SURGERY. IS IT A WORRISOME INDICATION?
Authors: Zárate Gómez J , Álvarez De Sierra Hernández P , Bernal Marco B , Fernández Luengas D , Conde Someso S , Supelano Eslait G , Peinado Iríbar B , Merello Godino J 
Published: October 2022

Abstract

Aim
The purpose of the study is to analyze whether a previous medical history of lower abdominal surgery (or pelvic radiotherapy) involves a different postoperative outcome in TEP inguinal repairs.

Material & Methods
We performed a retrospective analysis of 1252 TEP procedures included from 2015 to 2019 at our institution. We compared the short-term intraoperative difficulties and the postoperative outcome in patients with and without previous lower abdominal surgeries.
The postoperative data collected included variables such as comorbidities, hernia classification, intraoperative complications, rate of conversion to open surgery, admission status, postoperative follow-up, chronic pain, and hernia recurrence.
We defined a “surgical success” dichotomous variable only for patients in an outpatient setting. It included cases with no complications during surgery, no need for conversión, and no chronic pain, no readmission or recurrence during followup.

Results
Out of the 1252 TEP procedures, 250 (19%) had previous lower abdominal surgery (or pelvic radiotherapy).
At the time of applying the “surgical success” variable we found a statistically significant difference in the conversion to open surgery rate between both groups (0.7% versus 5.6% p value 0.005). No differences were found in complications, readmissions, chronic pain, functional recovery or recurrence rates.

Conclusions
TEP procedure in patients with previous lower abdominal surgery showed a higher rate of conversion to open surgery compared to previously non operated patientes. The fact of having previous surgery did not imply however a worse postoperative outcome after a TEP procedure.
OC-053 LONG-TERM FOLLOW-UP OF A SLOWLY RESORBABLE BIOSYNTHETIC MESH IN VHWG GRADE 3 HERNIA REPAIR
Authors: Van Den Dop M , Tollens T , Jørgensen L , De Vries-Reilingh T , Piessen G , Köckerling F , Miserez M , Dean M , Berrevoet F , Dousset B , Van Westreenen G , Gosetti F , Lange J , Tetteroo G , Jeekel H 
Published: October 2022

Abstract

Background
Incisional hernia recurrence occurs frequently after initial repair. In potentially contaminated hernia, these numbers can rise up to 50%. Recently, resorbable meshes have been used to prevent infection in complicated incisional hernia and prevent long term mesh complications. Present study focuses on the long term outcomes of a resorbable mesh.

Methods
Patients included in the priorly conducted Phasix trial with Ventral Hernia Working Group (VHWG) grade 3 hernia were invited for an abdominal CT scan and physical examination. Primary outcome was hernia recurrence, secondary outcomes comprised of abdominal wall configuration, mesh resorption and long term mesh complications.

Results
Of the 84 patients included in the 2-year follow-up, 56 were available for long term follow-up up to five years. Mean follow-up time was 4.2 years. CT scan was made in 36 (64.3%) of patients. Kaplan-Meier analysis showed a recurrence rate of 16.7% after five years. Four (7.1%) new recurrences were found between 2-year and 4.2 years follow-up of which three by CT scan. In 50% of CT scans, no signs of postoperative distortions of the abdominal wall were observed. No long term mesh complications were reported.

Conclusion
After long term follow-up, VHWG 3 hernia repair with biosynthetic mesh demonstrated good performance with regard to hernia recurrence. Possibly, tissue reconstruction took place in the first two years after implantation by the use it or lose it principle, which led to sufficient native abdominal wall strength to prevent recurrences after resorption of the mesh.
OC-056 AUTOIMMUNE/INFLAMMATORY SYNDROME INDUCED BY SYNTHETIC HERNIA MESH IN ADULTS – DESCRIPTION OF THE PATHOPHYSIOLOGY AND SYSTEMATIC REVIEW OF THE EVIDENCE
Authors: Jíšová B , Woleský J , Střížová Z , de Beaux A , East B 
Published: October 2022

Abstract

Background
There is an increasing number of patients following hernia surgery with implanted mesh reporting symptoms that could indicate autoimmune or allergic reactions. ‘Allergy’ to metals, drugs, and chemicals is well recognised. However, allergy or autoimmunity caused by mesh has not been proven by a scientific method to date. The aim of this study was twofold: to describe the pathophysiology of autoimmunity and foreign body reaction and to undertake a systematic review of mesh implanted at the time of hernia repair and the subsequent development of autoimmune disease.

Methods
A systematic review using the PRISMA guidelines was undertaken. Pubmed, Google Scholar, and Cochrane databases were searched for English-written articles published between 2000 and 2021. The search was performed using keywords “hernia”, “mesh”, “autoimmunity”, “ASIA”, “immune response”, “autoimmune response”

Results
Seven papers, were included in the final analysis – three systematic reviews, three cohort studies and one case report. Much of the current data regarding the association of hernia mesh and autoimmunity relies on retrospective cohort studies and/or case reports with limited availability of cofounding factor data linked to autoimmune disease. Three systematic reviews have discussed this topic, each with different approach and none of them has identified causality between the use of mesh and development of autoimmune disease.

Conclusion
There is evidence that certain biomaterials can lead to immune dysregulation and induce autoimmunity. However, this has never been proven with synthetic hernia mesh. The bias in trials are high. And scientific studies have not been undertaken mesh-related autoimmunity.
OC-084 PRACTICE AND SHORT-TERM OUTCOMES IN VENTRAL HERNIA REPAIR: FIRST PROSPECTIVE MULTICENTER DATA ANALYSIS FROM INDIA
Authors: Sheth H , Baig S , Priya P , Ashfaque Y 
Published: October 2022

Abstract

Aim
Recording short and long term outcomes of primary ventral hernia (PH) and incisional hernia (IH) surgeries performed in India.

Materials and Methods
Members of Indian Association of Gastrointestinal Endo Surgeons (IAGES) were approached via mails and social media. Forty-five centres agreed to participate. The participating surgeons prospectively recorded the data of patients who underwent VHR from January 21, 2021- April 20, 2021, on a predesigned excel sheet. They were followed for 6 months.

Results
Data from 648 patients were analysed in this study for demographics, hernia characteristics, technical variations, and outcomes. 375 (57.8%) were primary ventral hernias (PH) and 273 (42.15%) were incisional hernias (IH), of which 63 (9.7%) were recurrent hernias.
In the PH group, 171 patients underwent minimal access repair (MAS) and 170 patients underwent open repair. The commonest procedure were open onlay and open pre-peritoneal repairs were performed least frequently. There were 3.73% seroma, 3.2% SSI, 0% 90-day readmission, 0% recurrence, and 0.3% mortality.
In the IH group, 164 patients underwent open repair and 104 underwent MAS repair. The most commonly performed procedure were open onlay and IPOM/IPOM plus. There were 13.92% seroma, 4.4% hematoma, 9.5% SSI, 1.1% mesh explantation, 0.4% wound sinus, 2.2% 90-day readmission, 0% recurrence, and 1.1% mortality.

Conclusion
Despite the guidelines favouring sublay repairs, onlay mesh hernioplasty is the commonest procedure practiced in India. IPOM/IPOM plus is the second commonest procedure. TAR is the preferred component separation technique in India. Complication rates in this study are comparable to published world literature.
P-001 FORMING A LIVING TISSUE MODEL OF THE POSTERIOIR RECTUS SHEATH
Authors: Whitehead-Clarke T , Mair A , Kureshi A , Mudera V 
Published: October 2022

Abstract

Aim
To develop an in-vitro model of the posterior rectus sheath. The model should be formed of living cells and aligned collagen that is of a similar thickness and tensile strength to the posterior rectus sheath.

Materials and Methods
Rectangular Fibroblast populated Colagen matrices (FPCMs) were formed using rat-tail collagen and seeded with an immortal cell line of human fibroblasts. FPCMs were formed into 3D-printed tethered gel moulds where they were tethered at opposing ends to induce the formation of an aligned construct. FPCMs were cultured for 10 days. After 10 days, excess fluid was removed and the constructs were plastic compressed under custom made compression blocks. Constructs were fixed in 4% paraformaldehyde. Constructs underwent flouresence icroscopy, second harmonic generation microscopy and uniaxial tensile strength analysis.

Results
6 constructs were developed. Lateral alignment of both fibroblatss and collagen were confirmed on flouresence and second harmonic generation microscopy respectively. Median construct thickness after compression was 0.57mm. Tensile strength analysis still awaited.

Conclusion
- here we present one of the first ever in-vitro models of the posterioir rectus sheath made with living human fibroblasts. It represents a novel potential development of a “living mesh” or rectus shetah transplant. Our model will be further optimised in the coming months by introducing human rectus sheath fibroblasts.
P-002 PREOPERATIVE USE OF BOTULINUM TOXIN A FOR COMPLEX ABDOMINAL WALL HERNIAS: SIMPLIFICATION OF ANATOMICAL RECONSTRUCTION AND REDUCTION OF COMPONENT SEPARATION TECHNIQUES
Authors: Wöhler A , Schaaf S , Willms A , Schwab R 
Published: October 2022

Abstract

Aim
Botulinum toxin A (BTA) may facilitate abdominal wall reconstruction for giant abdominal wall hernias. Complications after preoperative conditioning of the abdominal wall with BTA and subsequent surgical treatment have been poorly studied.

Methods
From 2018 to 2021, 31 patients with complex abdominal wall hernia were enrolled. Data were analyzed descriptively, risk factors, comorbidity, operative procedure, surgical site occurrences, and especially BTA-associated complications were documented. Key points were adverse effects, the rate of anatomical reconstruction, and reduction of component separation techniques.

Results
23 male and 8 female patients with a mean age of 62.7 years were included. The mean body mass index was 27.8 kg/m2. 61% had an ASA-Score over 3. The median duration of hospital stay was 11.6±5.2 days. The mean horizontal hernia defect was 13±5 cm, and the mean hernia gap area was 181.7±116 cm2. 83% were medial hernias with more than 10 cm hernia gap. Surgical reconstruction was performed using component separation techniques (CS) with mesh augmentation (61%), retromuscular sublay with CS (20%), and hybrid procedure (VAMOS) (9%). Complete closure of the anterior fascia was achieved in 100%. Anterior CS was necessary for 19%, and posterior CS was needed in 61%. The surgical site occurrences rate was 19%, with no BTA-associated complications. No hernia recurrence occurred during the follow-up period to date since 2018.

Conclusion
Preoperative conditioning of the lateral abdominal muscles with BTA seems to be a safe and effective method to facilitate tension-free anatomic reconstruction of the abdominal wall under the reduction of component separation.
P-014 RISK FACTORS FOR SHORT- AND LONG-TERM COMPLICATIONS FOLLOWING VENTRAL HERNIA REPAIR WITH THE PERITONEAL FLAP TECHNIQUE
Authors: Nielsen K A , Jogvansson B , Valsamidis A N , Pedersen A , Tulloh B , de Beaux A , Helligsø P , Mogensen C B , Nielsen M F 
Published: October 2022

Abstract

Aim
The peritoneal flap technique has been introduced for the repair of complex abdominal wall defects. The present study was conducted to determine the association between preoperative risk factors and the incidence of short and long-term complications.

Material & Methods
Patients undergoing abdominal wall repair between January 2010 and September 2020 were included in the study. Patient files were retrospectively reviewed and the presence of risk-factors and the incidence of postoperative short and long-term complications were recorded. A multivariable logistic regression analysis was used to estimate odds ratio (OR) for postoperative complications.

Results
327 patients were included. 48.0% were male. Median body mass index(BMI) was 30.9, 13.8% had diabetes and 23.2% were active smokers. Median defect size was 8 cm2 and median mesh size was 667.5 cm2. Median length of hospital stay was 5 days. 13.1% of patients developed a superficial wound infection, 10.4% seroma and 1.2% skin necrosis. Chronic pain was observed in 4.6% and recurrence in 2.4%. The regression analysis demonstrated a stepwise increase in OR for short and long-term complications. This risk was increased by 10% per unit BMI (P&lt;0.01). Smoking and hernial defect size contributed only to a minor extent to the risk of postoperative complications.

Conclusion
The peritoneal flap method is a safe procedure associated with a low risk of recurrence. The risk of complications is associated with BMI whereas smoking and hernial defect size only contributes to a minor extent.
P-018 ACUTE APPENDICITIS IN DE GARENGEOT'S HERNIA - A LITERATURE REVIEW
Authors: Allu V , Chowdhury A 
Published: October 2022

Abstract

Aim
This study aims to undertake a systematic review of published data, focussing on the incidence of acute appendicitis within a de Garengeot hernia, the relationship between pre-operative diagnosis, surgical technique, incidence and surgical outcomes.

Methods
A PRISMA modelled literature search was carried out across PubMed, ProQuest, and BMW Case Report databases with the search terms ‘Femoral Hernia’, ‘Appendix’, ‘de Garengeot's’ in combinations, limited to English language, published between 1960 to 2019. Authors report another case study that was not included in the systematic review.

Results
Systematic review identified 84 published data reporting 112 such cases. 74(66%) presented with painful groin swellings. CT performed in 43(38%) accurately diagnosed de Garengeot's in 32(74%) patients. The most common surgical approach was low approach 35(31%) followed by the inguinal approach 23 (21%). 81 (72%) underwent herniorrhaphy with non-absorbable sutures and 20 had mesh repairs (18%). Ten (9%) patients were reported to have postoperative morbidity with wound infection being the most common complication and one recorded death.

Conclusion
Rarity of de Garengeot's hernia is shown by the limited availability of data that restricted our ability to conclude a single diagnostic pathway or a specific surgical technique for this condition. CT has shown, relatively accurate form of imaging tool, as well as Ultrasound scans in some. Sequestrated appendicectomy and hernia repair via laparoscopy is an option, however, there is lack of data to warrant its effectiveness as the surgical option of choice over an open groin approach in the presence of incarcerated groin swelling.
P-029 A NOVEL USE OF FULLY ABSORBABLE PHASIXTM MESH FOR LAPAROSCOPIC INGUINAL HERNIA REPAIR
Authors: Alshammari S , Aldohayan A 
Published: October 2022

Abstract

Background
An inguinal hernia is repaired usually with synthetic non-absorbable mesh resulting in collagen formation leading to chronic inflammation, and fibrosis with significant reductions in hernia recurrence. However, chronic pain may affect quality of life. The new mesh introduced to minimize complications. Poly-4-hydroxybutyrate (P4HB) mesh starts to degrade in 12–18 months. We are reporting our results of TAPP inguinal hernia repair using P4HB mesh (PhasixTM Bard in, Murray Hill, NJ).

Method
A pilot study is carried-out for laparoscopic TAPP repair for inguinal hernia using P4HB mesh assessing the recurrence rate and chronic pain for 30 months with IRB approval (E-19–3735). The study was conducted from 24 Jan 2016 to July 2017. The study included postoperative pain, reactions, mesh sensation, discomfort, and recurrence.

Results
Laparoscopic TAPP inguinal repair using P4HB mesh for 15 patients. 14 male and 1 female patient were involved, average age 55.8 years old,and an average BMI of 27.4 kg/m2. No recurrence or mesh sensation encountered except one patient has mild chronic inguinal pain for one year without affecting his usual activity.

Conclusion
Laparoscopic TAPP inguinal hernia repair using PhasixTM mesh is safe to use in combined direct (medial) and indirect (lateral) inguinal hernia with no recurrence. The use of P4HB absorbable mesh led to less chronic pain and discomfort. However, longer follow-up and a higher number of patients are needed to allocate the status and the place of P4HB in the world for inguinal hernia repairs.
P-039 COMPOSITE PP/PLLA MONOFILAMENT 4DVENTRAL® PROMOTES AN ANTI-INFLAMMATORY RESPONSE FROM HUMAN MACROPHAGES IN VITRO
Authors: Daoudi M , Myslakowski A , Abechir K , Carton A , Ouerghemmi S , Caillibotte M , Thomas P 
Published: October 2022

Abstract
The repair of abdominal hernias with prosthetic mesh can significantly reduce the risk of hernia recurrence. A new type of hernia implants combines monofilaments, Polypropylene (PP) and a biobased and natural slowly bioabsorbable polymer, Poly-L-Lactic Acid (PLLA). The partially (60%) resorbable PLLA/PP and PP meshes manufactured by COUSIN Surgery are 4DVentral® and Biomesh P1®. The contribution of PLLA in regulated inflammatory response and in enhancing abdominal repair remains unknown. Inflammation has a functional role during tissue regeneration process. An abnormal macrophage response characterized by an uncontrolled release of pro-inflammatory cytokines, chemokines, and tissue-degrading enzymes has been shown to be responsible for postoperative complications. In contrast, the angiogenic and tissue remodeling activities of the alternative anti-inflammatory M2 macrophages have potential use in tissue regenerative. Here, the characterization of the inflammatory response of human macrophages in vitro regarding 4DVentral® compared to Biomesh P1® was performed. Human monocytic THP-1 cells were differentiated into macrophages and polarized in M1 macrophages by incubation with IFN-γ and LPS or not (M0 macrophages). We found that 4DVentral® induced higher secretion of anti-inflammatory cytokines (IL-10 and Il1-RA) compared to PP Mesh in M0 macrophages. Interestingly, the secretion of pro-inflammatory cytokine IL-6 in M1 macrophages was dramatically reduced in the presence of 4DVentral® mesh compared to PP Biomesh P1®. However, the secretion of IL-10 was significantly increased with 4DVentral®. The composite PLLA/PP monofilament 4DVentral® positively drives human macrophages to an anti-inflammatory profile, resolving inflammation and promoting tissue repair.
P-069 A SINGLE CENTRE RETROSPECTIVE 14 YEAR REVIEW OF PATIENT OUTCOMES FOLLOWING IPOM LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH PVDF MESH
Authors: Byrne H , Ansong E , Abdul-Kaliq A , Finch G 
Published: October 2022

Abstract

Aim
Laparoscopic ventral hernia repair (LVHR) is a widely accepted minimally invasive technique. However, there remains debate regarding appropriate patient selection, the type of mesh used and for what size and type of defect. We aimed to review our experience of IPOM LVHR using PVDF mesh and compare our outcomes to the current literature.

Material and Methods
Operative records identified all patients who had undergone an IPOM LVHR with PVDF mesh from 2007–2021. The type, number and size of hernial defects, the sac contents, along with the size of mesh used and the type of fixation was collated. Length of stay (LoS), as well as early and late post-operative complications were also analyzed.

Results
A total of 287 patients are included in the study to date. 32.3% of patients were categorised within Obese Class II or III (BMI 35 – &gt;40). Major early and late complications were observed in 4.6% and 3.1% of cases respectively. An 8.7% recurrence rate was observed. 87% of recurrences had an original defect classed as large (&gt;4cm), with a median BMI of 30.5.

Conclusion
In conclusion, our post-operative outcomes are in keeping with those reported in the literature. In our experience, a high BMI does not preclude patients from undergoing a LVHR and having a good result. Debates are ongoing with regards to the timing and indication for LVHR in the obese and our results are encouraging, especially considering current national statistics estimate approximately 30% of the UK population are classed as obese.
P-074 BIOMECHANICALLY STABLE INCISIONAL HERNIA REPAIRS WITH DIS CLASS A MESHES ARE DURABLE AFTER A 3 YEAR FOLLOW UP
Authors: Kallinowski F , Löffler T , Rinn J , Nessel R , Görich J , Wielpütz M 
Published: October 2022

Abstract

Aim
Hernia meshes can be classified according to the tackiness towards cyclic load. Meshes with the best adhesiveness are named DIS class A. Are reconstructions with these meshes durable after 3 years?

Material and methods
Biomechanical principles of the reconstruction of the abdominal wall were analyzed ex vivo with cyclic loading common in material sciences. The resulting GRIP concept was clinically applied. The patients were followed in yearly intervals.

Results
A total of 129 patients (68 males and 61 females) were followed for 3 years after treatment for 93 primary and 36 recurrent incisional hernia. Progrip® was used in 53 cases (P), Dahlhausen® Cicat in 76 cases (C). P was used for smaller hernia with lower overlap due to the higher tackiness. Hernia sizes treated with C were significantly larger (u-test: p &gt; 0.001). The mesh-defect area ratio was higher with P compared with C (11.9 vs 5.8). Fixation requirements were lower with 8 points for P and 80 points for C to reach adequate GRIP levels. GRIP was twice that minimally required. Larger hernia took longer OR times (median P: 104 vs. median C: 183 min; p &gt; 0.001). Larger hernias were associated with more postoperative minor complications (6–14%, 1 re-operation for seroma). Length of stay was comparable with 5–6 days. During follow up, no recurrence was detected. Pain levels were low (median NAS = 0 after 3 years; u-test: p = 0.07672).

Conclusion
Incisional hernia can be repaired safely and durably based on biomechanical principles.