bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC-077 OPEN REPAIR OF FLANK AND LUMBAR HERNIAS (FLH): 145 CONSECUTIVE REPAIRS AT A HIGH-VOLUME, TERTIARY HERNIA CENTER
Authors: Wilson H , Ayuso S , Katzen M , Ku D , Scarola G , Colavita P , Kercher K , Augenstein V , Heniford T 
Published: October 2022

Abstract

Aim
FLH present a surgical challenge due to their anatomic location, proximity to boney structures, and lack of elasticity of the surrounding muscle. With less than 1,000 cases reported, there is no uniform operative management. This is the largest study to date evaluating FLH repair (FLHR).

Materials & Methods
A prospective, single-center, hernia specific database was queried for patients who underwent open flank or lumbar hernia repair from 2004–2021. Demographics, operative characteristics, and outcomes were evaluated. Standard statistical methods were used.

Results
145 patients included 109 flank hernias and 36 lumbar hernias. The hernias resulted from prior surgery (73.3%), blunt trauma (19.7%), or primary defects (7.0%). The mean defect size was 125.7±166.8cm2, 46.9% were recurrent, and 11.0% of patients visited a pain specialist preoperatively. Mesh was commonly synthetic (92.4%), a mean of 755.9±373.4 cm2, and placed in the preperitoneal space (92.7%). Component separation technique was utilized in 16.8% of cases and pelvic bone anchor fixation in 13.8%. Preoperative chronic pain was present in 75% of patients receiving bone anchors and only 6.6% postoperatively. Complete defect closure occurred in each case. Wound infection (8.1%) and mesh infection (1.4%) were uncommon. Prolonged, postoperative discomfort was reported in 22%, half of which had chronic pain preoperatively (p&lt;0.01). Hernia recurrence was 3.4% at 29.3±13.2 months follow-up. Recurrences occurred posteriorly in 3 and in 2 mesh infections requiring explantation.

Conclusions
Open preperitoneal repair of FLHs with synthetic mesh results in low rates of postoperative complications and hernia recurrence. Postoperative pain correlated closely with preoperative pain.
OC-080 COMPLETE VERSUS PARTIAL EXCISION OF AN INFECTED MESH FOLLOWING ABDOMINAL WALL HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Patel I , Qayum M K , Kar I , Hajibandeh S , Hajibandeh S 
Published: October 2022

Abstract

Aims
To evaluate comparative outcomes of complete and partial excision of infected mesh following abdominal wall hernia repair.

Methods
A systematic search of electronic databases and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits was conducted. Surgical site infection (SSI), chronic sinus formation, recurrent hernia and need for reoperation were the evaluated outcome measures.

Results
Six comparative observational studies were identified, reporting a total of 317 patients of whom 193 underwent complete mesh excision and the remaining 123 patients underwent partial mesh excision for an infected mesh following abdominal wall hernia repair. The complete mesh excision was associated with significantly lower rates of SSIs (OR: 0.36; 95% CI, 0.16–0.81, p=0.01), chronic sinus formation (OR: 0.11; 95% CI, 0.02–0.71, p=0.02), and reoperation (OR: 0.10; 95% CI, 0.03–0.33, p=0.0001) compared to the partial mesh excision. There was no significant difference in hernia recurrence rate (OR: 3.96.16, 95% CI 0.62–25.44, p=0.15) between two groups.

Conclusions
Our meta-analysis demonstrated that complete mesh excision may be associated with lower SSI, chronic sinus formation and need for reoperation when compared to the partial mesh excision in an infected mesh event. However, the available evidence has failed to report the outcomes with respect to the main confounding factors which, together with other important outcomes such as fistula formation, should be considered by future high quality research.
OC-086 COMPARISON OF MESH-FIXATION TECHNIQUES IN LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA, RELIATACK™ V PROTACK™ (TACKOMESH) NCT 03434301
Authors: Pilkington J , Wilkinson F , Pritchett J , Fullwood C , Sheen A J 
Published: October 2022

Abstract

Background
A study examining post-op pain, comparing permanent versus absorbable tack fixation devices, Protack™ versus Reliatack™, in IPOM plus repair.

Methods
TACKoMesh is a single-centre double-blind RCT conducted from 2017–2020 with 1-year follow up. Patients were randomised to either Protack™ (titanium tacks) or Reliatack™ (an articulating-arm with dissolvable tacks). Primary outcome was reported pain on activity at Day30. Secondary outcomes include recurrence and quality of life measures (SF-36 & Carolina Comfort Score).

Results
67 patients randomised: 36 with Protack™, 27 with Reliatack™, with 4 conversions. No significant difference in reported pain ‘on activity’ (post-operative Day 1, 6, 30 and 365). There was significantly reduced pain ‘at rest’ on Day1 with Reliatack™ (Protack™ 6 [4 to 9] vs Reliatack™ 4 [3 to 5], p = 0.020) and reduced pain at all other points with Reliatack™.
Operation (p = 0.001) & mesh-fixation (p = 0.001) times were longer, with more knots (p = 0.001) & tacks (p = 0.001) used with Reliatack™.
Entire cohort hernia recurrence, seroma formation, SSI & Clavien-Dindo Grade III-V complication were 8/63 (12.7%), 33/63 (52.4%), 7/63 (11.1%), and 12/63 (19.1%) respectively. There were no significant differences in these outcomes between the treatment groups. CCS showed improvement from post-op Day30 to 365. SF36 showed a reduction in baseline scores at post-op Day30.

Conclusion
There is no difference in reported pain ‘on activity’ following elective IPOM plus hernia repair when choosing either Protack™ or Reliatack™. There is a trend towards improved post-op pain ‘at rest’ with Reliatack™.
OC-087 PAIN AND INFLAMMATORY SIGNALLING IN TACKOMESH TRIAL PARTICIPANTS FOLLOWING ELECTIVE LAPAROSCOPIC INCISIONAL HERNIA REPAIR WITH INTRAPERITONEAL ONLAY MESH (IPOM) AND SPIRAL-TACK MESH FIXATION
Authors: Pilkington J , Wilkinson F , Pritchett J , Fullwood C , Sheen A J 
Published: October 2022

Abstract

Background
The aim of this study was to investigate for links between reported pain and inflammation within a sub-cohort of patients undergoing the IPOM plus repair through the measurement of serum/plasma levels of established inflammatory biomarkers in trial participants across 1-year follow up.

Methods
22 patients (12 Protack™ and 10 Reliatack™) within the TACKoMesh randomised controlled trial underwent serial blood sampling as part of their follow up. A panel of pro- and anti-inflammatory biomarkers were assayed using Luminex multiplex assays and ELISAs. Circulating biomarker concentrations were described and compared in the context of clinical and patient reported outcome data that was obtained within the trial.

Results
An increase in the serum concentration of pro- (IL-6 and CRP) and anti- (IL-10) inflammatory biomarkers was seen following IPOM plus repair. Serum IL-6 and CRP were significantly raised compared to baseline at post-operative Days 1, 6 and 30 (p &lt; 0.05). Markers of onward signalling (Cortisol and TNF-alpha) and tissue repair (PDGF-AA and VEGF) showed a trend towards an elevation at similar timepoints (notably at post-op Day 6) but were not significantly different from baseline levels. There were no observed correlations between inflammatory signal and reported pain, treatment allocation within the trial, burden of implanted prosthetic material, or hernia recurrence.

Discussion
This study demonstrates the novel finding of a pro-inflammatory signal at post-operative Day 30 following the IPOM plus repair.
OC-088 CAN PROCOLLAGEN I AND PROCOLLAGEN III SERVE AS PREDICTIVE BIOMARKERS FOR INCISIONAL HERNIA RECURRENCE?
Authors: Pilkington J , Wilkinson F , Pritchett J , Fullwood C , Sheen A J 
Published: October 2022

Abstract

Background
The aim of this study was to determine the temporal evolution of extracellular matrix (ECM) remodelling and collagen biomarkers and their influence on incisional hernia recurrence after the IPOM plus repair.

Methods
A sub-cohort of patients (n=25) undergoing laparoscopic incisional hernia repair within the TACKoMesh randomised controlled trial were bled at serial timepoints up to 1-year following surgery. Serum/plasma concentration of biomarkers (Procollagen I, Procollagen III, Fibronectin, TGF-beta, MMP-2, MMP-9, TIMP-1, and TIMP-2) were quantified using ELISA and Luminex multiplex techniques. Data were described and compared between groups that developed and remained free from recurrence using R statistical software.

Results
Procollagen I was reduced relative to baseline on post-op Day 1 but increased at Days 6 and 30 (p&lt;0.05). Procollagen III showed an elevation at Day 30. Lower levels of Procollagen I were detected at Day 0, Day 1 and Day 6 (p&lt;0.05) and higher levels of Procollagen III at Day 0, Day 1, Day 6 and Day 30 (p&lt;0.05) in patients with a recurrence.
Fibronectin was reduced at Day 1 and 6 (p&lt;0.05) whilst TGF-β was increased at Day 30 (p&lt;0.05). MMP-2 and its inhibitor TIMP-2 were reduced at post-operative Day 1 (p&lt;0.05). MMP-9 was persistently higher than baseline (p&lt;0.05) at all timepoints. TIMP-1 was elevated at post-op Days 6 and 30. No differences were found in the circulating concentrations of these biomarkers to predict a recurrence.

Conclusion
In patients that developed incisional hernia recurrence, low levels of Procollagen I and high levels of Procollagen III were detected.
OC-090 Heterotopic Ossification in a Laparostomy Wound Complicating Reconstruction– a Case Report
Authors: Lumley E , Garner J 
Published: October 2022

Abstract

Introduction
Heterotopic Ossification (HO) is a benign process of osseous matrix deposition in extra-skeletal tissues; it is well recognised in the orthopaedic setting, especially after blast injury, but is a rare phenomenon following abdominal surgery and is likely under reported. The aetiology is unclear but may be due to differentiation of local mesenchymal cells into osteoblasts leading to calcification of the extracellular matrix, or damage to xiphoid or pubis causing liberation of bone-forming cells into the wound.

Case Report
A 46-year-old man, presented with perforated diverticulitis and underwent an emergency Hartmann's procedure with temporary abdominal closure. Sequential returns to theatre failed to achieve fascial closure and he was managed as a laparostomy. Two years later he underwent reversal of Hartmann's with complex abdominal wall reconstruction (CAWR) – the procedure was complicated by an unrecognised ring of HO around the edge of his laparostomy wound, which necessitated additional excision of fascia. Only partial fascial closure could be achieved leaving an 8×4cm bridge over polypropylene mesh. After a complicated post-operative course, he was discharged home with intestinal continuity and healed abdominal wounds.

Discussion
Pre-operative review of the 2-D axial CT images failed to identify the almost complete ring of HO clearly evident on 3-D reconstructions which impacted on the outcome of the CAWR; 3-D reconstructions should be routinely reviewed. It is commoner in males, those with prolonged ICU intubation, hollow viscus injury and non-closure of the fascia. Restoration of intestinal continuity can be safely performed with complex abdominal wall reconstruction.
P-003 LATERAL ABDOMINAL HERNIAS: A REGISTRY-BASED MULTIVARIATE ANALYSIS OF SURGICAL TECHNIQUES AND OUTCOME
Authors: Schaaf S , Willms A , Güsgen C , Köckerling F , Schwab R 
Published: October 2022

Abstract

Aim
Data on lateral incisional hernia (LAH) repair is scarce. The operative therapy is challenging due to complex anatomy and bulging due to previous nerve lesions. Data concerning medial hernias are not necessarily transferable. Therefore, this study evaluates the status-quo of LAH repair, compares different strategies, and identifies risk factors for complications and adverse outcomes.

Materials and Methods
The German Herniamed registry was screened for LAH. Data from patients operated on between 01–05–2009 and 05–31–2020, resulting in 6,306 cases. Data analysis focused on patient-specific, surgery-related factors, complications, and outcome. In addition, a logistic regression analysis of multiple variables was conducted.

Results
Laparoscopic IPOM (27.9%) and open sublay (38.1%) were the most common surgical procedures. Intraoperative complications were more common in laparoscopic IPOM compared to open sublay (1.8% vs. 0.9%; p&lt;0.001), whereas seroma rate was lower (1.8% vs. 3.4%; p&lt;0.001). Open sublay showed a lower risk for intraoperative complications compared to laparoscopic IPOM (OR 0.298 [0.158–0.564]; p&lt;0.001) in the regression analysis. Risk factors for recurrence were large defect size, open onlay/IPOM, and BMI.

Conclusion
LAH repair is especially challenging due to its anatomical complexity, rareness, and weak management evidence. This study adds registry-based data with the largest number of cases yet published. Due to the complexity and the flimsy evidence of treatment options, lateral incisional hernias should be treated in specialized hernia centers. In addition, further evaluation of repair techniques is needed, and particular focus should be put on a proper localization classification and defect size (both according to EHS).
P-004 OUR EXPERIENCE WITH POSTERIOR COMPONENT SEPARATION – TAR (TRANSVERSUS ABDOMINIS RELEASE) IN LARGE COMPLEX INCISIONAL HERNIAS – A SERIES OF 18 PATIENTS
Authors: Ungureanu C , Iordache N 
Published: October 2022

Abstract

Background
Large incisional hernias represent a challenge for parietal surgeon. Thanks to the modification of the Rives-Stoppa technique introduced by Novitsky, a new era in solving complex defects begun. Posterior component separation (PCS) with unilateral/bilateral TAR has promising results in many studies. Our experience is presented in a retrospective study.

Method
We present a study on 18 patients (sex ratio=1:1), operated between 2019–2022, with large complex incisional hernias. Mean body mass index was 37.17 kg/m2 (range 31–42). Mean age – 58 years (range 34–70 years). We used PCS with bilateral TAR in 12 cases (66.66%) and unilateral TAR in 6 cases. One of the hernias was a combined midline-large parastomal hernia operated using Pauli technique. 5 of the hernias (27.78%) were lumbar, of which 2 were operated with hybrid technique (open and laparoscopic), using reverse TAR. Mesh used was polypropylene (61.11%) and ePTFE mesh (38.89%). The prothesis size ranged from 20×25 cm to 34×32 cm. Mean operative time was 3.41 hrs (range 2–4 hrs). Average hospitalization time was 5.44 days (range 2–14 days).

Results
Fascial closure anterior to mesh was achieved in 72.22% of patients. No recurrences were reported in the follow-up (3–12 months). Postoperative morbidity: seromas (33.33%), wound infection (11.11%), hematoma (5.55%).

Conclusions
Rives-Stoppa technique is the gold standard in VHR. Extending this technique with PCS-TAR in complex incisional hernias seems to be the perfect solution in obese patients with great outcome and low postoperative morbidity. Also the hybrid approach has great results and we hence recommend.
P-006 LAPAROSCOPIC ETEP APPROACH TO VENTRAL HERNIAS: INITIAL EXPERIENCE AND SHORT-TERM RESULTS
Authors: Trujillo Díaz J , Jezieniecki Fernandez C , Gomez Lopez J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C 
Published: October 2022

Abstract

Aim
Ventral hernias are a pathology with a high incidence within general surgery.Repair techniques have been evolving,and the minimally invasive approach to this type of pathology is currently on the rise due to the advantages offered by the minimally invasive surgery (laparoscopic or robotic):less postoperative pain, SSI,seromas,length of stay (LOS) and faster return to routine daily activities.We present our initial series of patients with ventral hernias treated by laparoscopic eTEP approach.

Material & Methods
Retrospective-study where we analyzed our database of patients with ventral hernias (primary and secondary)undergoing abdominal wall surgery using laparoscopic-eTEP-approach.

Results
15 patients underwent laparoscopic-eTEP-surgery (men:73.3%, age:64(RIQ:41–74years)). LOS:1.73±0.7days. Pathological history: diabetes mellitus (26.7%), arterial hypertension (46.7%), dyslipidemia (66.7%),smoking (20%), alcohol-consumption(13.3%), cardiovascular disease (13.3%). ASA-Classification: I (26.7%), II(53.3%), III(20%). BMI:29.82±4.78kg/m2. Overweight: 14(93.3%) and obesity: 6(40%).
Primary hernias:4(26.7%) and incisional-hernias:11(73.3%). Location:midline (100%), supraumbilical:60%, umbilical:93.3% and infraumbilical:26.7%.Hernia-width(EHS classification): W1:13.3% and W2:86.7%, transverse hernia-diameter: 6.2±2.1cm, hernia length-size:7.2±4.4cm. Diastasis:10(66.7%), diastasis-width:5.7±1.38cm. Associated with inguinal hernia:5(33.3%).
Type of laparoscopic surgical technique performed: Rives-Stoppa: 10(66.7%), unilateral-TAR: 3(20%), bilateral-TAR: 2(13.3%). #trocars: 4(RIQ:4–5). Preoperative botulinum-toxin: 6(40%). Posterior-sheath-closure: 14(93.3%). Mesh fixation-type:Glutack 5(33.3%), Tisseel 6(40%), non-fixation 4(26.7%). Mesh type: Low density wide-pore polypropylene 6(40%), PVDF-Mesh 8(53.3%), PVDF-IPOM-mesh 1(6.7%). Mesh size: width 20(RIQ:18–25cm) and length 30(RIQ:26–30cm).Drainage:3(20%).Surgical time:240(RIQ:180–300min).
Global and serious complications (CD≥III):1(6.7%) and Re-IQ due to incarcerated hernia due to posterior-sheath-dehiscence:1(6.7%).No intraoperative-complications.Clinical-seroma:0% and ultrasound-seroma:66.7% that resolved completely spontaneously during the first-second postoperative-months.No hematomas or surgical-wound-infection.Until the current follow-up no-recurrence.

Conclusions
The laparoscopic-eTEP-approach of ventral-hernias has a low rate of global-complications,despite being our first cases performed.It also has low rates of postoperative pain and shorter-LOS.We can conclude that in our Hospital the laparoscopic-eTEP-approach is a safe, efficient and effective technique.
P-008 PRELIMINARY RESULTS OF A RANDOMIZED CLINICAL TRIAL COMPARING TWO DIFFERENT MESH FIXATION TECHNIQUES IN OPEN RETROMUSCULAR VENTRAL HERNIA REPAIR
Authors: Chatzimavroudis G , Kotoreni G , Pavlidis T , Beratze N , Kourgiali C , Atmatzidis S , Koutelidakis I , Papaziogas V 
Published: October 2022

Abstract

Aim
Retromuscular ventral hernia repair has become very popular recently due to its very promising results concerning recurrence and other complications. However, controversy exists regarding the optimal mesh fixation method. The aim of this study is to compare the safety and effectiveness of two mesh fixation techniques.

Material & Methods
This is an ongoing randomized, prospective, single-blind study. According to study protocol, patients with midline ventral hernias who meet the inclusion criteria, undergo open retromuscular hernia repair and the mesh is fixed either with transfascial sutures or with n-butyl-2-cyanoacrylate glue. In the three-month follow-up patients answer the EuraHS QoL score to assess postoperative pain and other QoL features and are examined for the identification of postoperative complications. The results of the first 20 patients who have completed the three-month follow-up are presented.

Results
Glue group had an average VAS pain at the site of the hernia of 0.3/10, 0.9/10 and 0.3/10, in rest, during activities, and during last week, respectively, while suture group had 0.3/10, 1.1/10 and 0.6/10, respectively. Concerning the restrictions of daily activities: inside, outside the house, during sports and during heavy labor, glue group had 0.2/10, 0.3/10, 0.6/10 and 1/10 and suture group 0.2/10, 0.4/10, 0.9/10 and 1.1/10, respectively. All differences between groups were not statistically significant. Regarding postoperative complications, only one patient from the suture group presented with seroma.

Conclusions
The preliminary results slightly favor the glue group, without reaching statistical significance. Retromuscular hernia repair leads to very good early results concerning pain and other complications.
P-011 FEASIBILITY OF VENTRAL-TAPP FOR VENTRAL HERNIA REPAIR IN A LOW INCOME COUNTRY LIKE INDIA
Authors: Rodha M S , Gupta D 
Published: October 2022

Abstract

Aim
Minimal invasive repair is now the established procedure for ventral hernia. Surgeons are now validating newer techniques each year to deal with the ventral hernia. It becomes difficult to choose, best fit technique from this large armamentarium. For a low income country like India, ventral- trans abdominal preperitoneal (TAPP) technique is cost effective and uses simple polyester or polypropylene mesh.

Methods
For this article we used our experience with ventral-TAPP performed from July 1, 2021 to May 31, 2022. Patients were followed up for 6 months.

Results
In the above time period, we had performed 10 ventral-TAPP. Out of these, 3 had completed the follow up. Median age was 45.0 years, BMI was 26.56 kg/m2. One patient was male (33.33%). All patients were presented to surgery due to bulge or pain in the anterior abdominal wall.
The median hernia defect measured 80 mm, median mesh diameter was 15 cm and median operative time was 125 min. No intraoperative complications occurred.
Postoperatively, none of the patients developed complications. Length of hospital stay was 3.0 days. Six months after surgery, neither recurrence nor chronic pain were recorded.

Conclusion
We have concluded that mesh used in repair with ventral-TAPP costs one fourth to one-fifth to that of composite mesh used in intraperitoneal onlay mesh (IPOM) repair with the comparable results. So in a low income country like India, ventral TAPP should be a preferred approach.
P-015 POLY-4-HYDROXYBUTYRATE ABSORBABLE BARRIER COMPOSITE MESH AND POLY-PROLINE MESH: DUAL REPAIR FOR HUGE INCISIONAL HERNIA
Authors: Binjaloud A , Alshammari S , Aldohayan A 
Published: October 2022

Abstract

Introduction
A giant incisional hernia is a serious challenge. Along with loss of domain, the ideal surgical management is difficult to identify, with various surgical techniques and meshes. Obesity and comorbidities in patients with diabetes add to difficulties in repairing incisional hernias with loss of domain. Herein, we present a case in which a double-mesh technique was performed for surgical repair of huge incisional hernias.

Presentation of Case
An 80-year-old male patient with multiple comorbidities presented to the clinic with multiple incisional hernias secondary to a missile injury. The huge incisional hernias affected the patient's daily life and limited his activities. Abdominal computed tomography showed multiple central and lateral incisional hernias. Through a midline laparotomy, a 30 × 35-cm poly-4-hydroxybutyrate/absorbable barrier composite (P4HB/ABC) mesh was sutured to the abdominal wall intraperitoneally, and then a 20 × 25-cm lightweight polypropylene (LWPP) mesh was sutured to the edge of the muscular defect.

Discussion
This report described the case of a patient with multiple huge abdominal hernias, which were repaired using the double-mesh technique. The patient had an uneventful postoperative recovery. However, the patient had a seroma during follow-up, which was managed conservatively.

Conclusion
This report described the usefulness and challenges of using the double-mesh technique for successful repair of multiple central and lateral incisional hernias. We used two types of meshes, P4HB/ABC and LWPP meshes, which yielded good outcomes and no hernia recurrence occurred in a 3-year follow-up.