bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-079 INCIDENCE AND RISK FACTORS OF ABDOMINAL FASCIAL DEHISCENCE AFTER EXPLORATORY LAPAROTOMY- AN AUDIT OF 282 CASES
Authors: Kumar Das Poddar K , Shastri S , Kumar P , Subhadarshan Mishra T , Kumar Sasmal P 
Published: October 2022

Abstract

Background
An audit was performed to identify the incidence and risk factors of post-operative abdominal fascial dehiscence after Exploratory laparotomy.

Methods
The prospectively maintained database of a single unit was reviewed.The demographic parameters, comorbidities, degree of contamination, type of procedures, and the types of suture & needles were reviewed.We analyzed the relation of the type of sutures, type of surgery and degree of contamination on the development abdominal fascial dehiscence within 30 days of surgery .Difference between the groups were analyzed by t tests for continuous variables and Chi squared tests for categorical variables.

Results
50 (17.7%) patients developed fascial dehiscence.Mean Albumin was 2.45 +/- 0.69 g/dl in the dehiscence group, compared to 2.97 +/- 0.86 g/dl in those without dehiscence (p= 0.00).The prevalence of diabetics, smokers and incidence of postoperative surgical site infection were significantly more in the patients with dehiscence (p value - 0.045, 0.043 and 0.00 respectively).Prevalence of class 4 wounds was higher in the group with dehiscence (70% vs 44%, p value 0.001).Type of suture used (Loop PDS No. 1 vs PDS 2–0) did not significantly influence development of facial dehiscence within 1 month.

Conclusion
Results of our study are consistent with existing literature. Important preoperative/intraoperative parameters such as smokingr, diabetics, preoperative hypovolemic shock, albumin are significant predictors of fascial dehiscence in the post operative period. This will enable surgeons to take corrective measures before the surgery
P-080 LAPAROSCOPIC TRANSABDOMINAL RETROMUSCULAR UMBILICAL PROSTHETIC HERNIA REPAIR (LAP-TARUP) & TAPP-INGUINAL IN A SINGLE TIME: A GOOD OPTION IN OBESE PATIENTS?
Authors: Trujillo Díaz J , Jezieniecki Fernandez C , Conceji Cutoli P , Gomez Lopez J R , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C 
Published: October 2022

Abstract

Aim
The association between midline hernias (primary-or-incisional) and inguinal-hernias is not uncommon, nor is its association with obesity, which increases its incidence every day. In obese patients, the laparoscopic-eTEP-approach to treat ventral hernias is a feasible option but with greater surgical difficulty and worse ergonomics. The laparoscopic-TARUP-approach(TransAbdominal-Retromuscular-Umbilical-Prosthetic-Hernia-Repair) offers the advantages of MIS with better ergonomics in obese patients or those with irreducible incarcerated hernias.

Material and Method
77-year-old male patient with obesity (BMI:37.58kg/m2), previous laparoscopic gallbladder surgery,who presents umbilical eventration(EHS: M2–3W2(8cm)) associated with diastasis,in addition to incoercible left inguino-scrotal hernia.

Results
5ports are used to perform the surgery.Initially,the classic TAPP-approach of the left inguinal-hernia is performed.After that the video-endoscope is changed to the location of the right flank and continues with the opening at the lateral edge of the posterior sheath of the right-rectum, the retromuscular-space is dissected and the supraumbilical cross-over and subsequent opening of the posterior contralateral sheath is performed.The dissection and reduction of the hernial sac is continued, and the dissection of the left retromuscular-space is completed.The anterior hernia defect is closed and diastasis is replicated with Stratafix-0.Closure of the posterior sheath of the rectums is performed with V-Lock 3–0. A 21×24cm PVDF-mesh is placed in a retromuscular position fixed with Fibrin, and the lateral opening is closed with V-Lock.The patient had a favourable postoperative period.

Conclusions
The TARUP-approach in midline hernias in obese patients is a valid,safe and better ergonomic option, and is also useful for simultaneously resolving large inguinal hernias by TAPP-approach,as in the case presented.
P-081 LAPAROSCOPIC RIVES-STOPPA ETEP FOR UMBILICAL HERNIA WITH RECTUS ABDOMINIS DIASTASIS: DOWN-TO-UP APPROACH
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

Aim
The association of umbilical or epigastric hernia and diastasis is not uncommon.Classically, it was insisted on the repair only of hernial pathology and not of diastasis.However, according to the latest recommendations,the simultaneous treatment of both pathologies is a valid and effective option.In addition, with the rise of minimally invasive surgery(MIS) of the abdominal wall, more cases of simultaneous MIS repair of midline hernias and diastasis are being reported.

Material & Methods
41-year-old female-patient with umbilical hernia of 3cm associated to diastasis with a distance of 4cm(post-pregnancy). MRI abdominal wall: umbilical hernia and diastasis, not other hernial defects. Laparoscopic management is decided by eTEP-approach .

Results
4ports are used, a dissector-balloon was used to dissect the right retromuscular-space.Another 5mm-trocar is placed in LRQ, 5mm-trocar in LLQ and 12mm in suprapubic-midline.The surgery continues with the dissection of the left retromuscular-space, with the dissection of the umbilical hernial sac and reducing its contents, the section is performed at the medial level of both posterior sheaths of the rectus abdominis muscle until reaching the xiphodeal region.Later we continue with the closure of the anterior wall of the rectums by replicating the diastasis with Stratafix-0.Then the posterior sheath was closed with V-Lock 2–0.A PVDF-mesh of 16×26cm was placed.The patient presented a favorable postoperative evolution and was discharged on 1°-POD.

Conclusions
The laparoscopic-Rives-Stoppa-eTEP-approach for hernia-pathology of the midline associated with diastasis is a valid, efficient, effective and safe option, offering the advantages of MIS:less postoperative pain, less morbidity, early return to routine daily activities with lower healthcare-spending.
P-089 SPONTAONEUS BOWEL EVISCERATION IN UMBILICAL HERNIA: CASE REPORT
Authors: Grappolini N , Garbarino S , Fanelli M , Scorza A , Marzorati A , Colombo E M , Palillo A , Palamara N , Inversini D , Ietto G , Carcano G 
Published: October 2022

Abstract

Aim
Spontaneous rupture of sac of hernia is a less common complication and mainly associated to persistent ascites or congenital wall defects. In literature we have few cases of spontaneous bowel eviscerations in umbilical hernias.

Case Report
a 53-year-old male years old man addicted to heroin, cocaine and alcohol, presented to the Emergency Department with evisceration of small bowel through an existing umbilical hernia. The patient was conscious and not complaining pain. He stated a protrusion of small bowel through his umbilical skin caused to sudden coughing after assumption of a dose of heroin.In emergency room showed an ileal loop with sub ischemic features. Blood test revealed an hepatitis C infection. During the urgent laparotomy there wasn't evidence of ascites and was necessary to performed an ileal resection and latero-lateral anastomosis with mechanical suturing machine. The placement of a prosthesis was performed; therefore, direct plastic surgery of the abdominal wall. After surgery with a short stay in ICU of 24 hours, the patient was discharged in POD 5. The postoperative course was regular without wound complications. After four months he was free from recurrence and VAS was 0.

Conclusions
Spontaneous bowel eviscerations in umbilical hernias is associated with refractory ascites in cirrhotic patients or congenital defect. This case is one of few case depicted in literature as spontaneous evisceration of bowel in non cirrhotic patient with umbilical hernia.
P-091 IMPROVEMENT OF RESPIRATORY PHYSIOLOGY AFTER POSTERIOR COMPONENT SEPARATION TAR: A PILOT STUDY
Authors: Latham L , Gianazza S , Garbarino S , Coriele S G , Fontana F , Timb Timb F , Facchini A , Marcelli Graziosi B , Rossini G , Ballabio A , Palillo A , Costa J , Inversini D , Ietto G , Carcano G 
Published: October 2022

Abstract

Aim
Patients with incisional hernia with a width greater than 9 centimeters, submitted to Posterior Component Separation Trasversus Abdominis Release, by Department of Emergency and Transplantation Surgery in Varese Hospital, were analyzed to define the modifications in respiratory physiology after surgery.

Material and Methods
Patients that underwent Posterior Component Separation were prospectively analyzed by evaluating: volume of laparocele, volume of abdominal cavity and their ratio. Furthermore Pulmonary Peak pressures and Pulmonary Plateau pressures were measured in three different times: at the induction of the anaesthesia, when the mesh was placed and at the closure of the anterior muscular layer. All patients were submitted to a pre-operative simple spirometry, and re-examinated three months after the surgical procedure with the same procedure to check if modifications in their respiratory function were present.

Results
Primary results of the study will be shown to define how this surgical procedure impacts on the respiratory function of the patients. The expectation is that an improvement of the respiratory physiology happens independently from a pulmonary pressure elevation which is determinated by the re-allocation of the herniated viscera in the abdomen when the anterior muscular fascia is closed.

Conclusions
the aim of this study is to show how, the reconstitution of a functional abdominal wall with an efficient respiratory accessory musculature guaranteed by the laparocele correction with Posterior Component Separation, ensures an improvement of respiratory physiology visible with spirometry, independently from the development of a superior intrathoracic pressure.
P-103 LAPAROSCOPIC MANAGEMENT OF VENTRAL HERNIAS: TRANSPERITONEAL APPROACH FOR POSTERIOR COMPONENT SEPARATION WITH THE AIM OF ABDOMINAL WALL RECONSTRUCTION AND EXTRAPERITONEAL MESH REINFORCEMENT
Authors: Riediger H , Kundel L , Gröger C , Adam U , Adolf D , Köckerling F 
Published: October 2022

Abstract

Aim
The Stoppa-Rives sublay and the transversus abdominis release (TAR) technique are well established in open hernia surgery. The principles are currently being translated into minimally invasive surgery with different concepts. In this study, we investigate initial results of laparoscopic sublay and TAR surgery (LASTAR).

Patients and methodology
Over a 20-month period, 23 consecutive patients with ventral incisional hernias underwent surgery. LASTAR surgery was performed conventionally laparoscopically, transperitoneally with adhesiolysis from the anterior abdominal wall, development of the sublay space and TAR, and midline reconstruction and extraperitoneal mesh reinforcement. Perioperative outcomes were evaluated by unadjusted analyses as part of an initial site assessment in comparison to the Herniamed registry.

Results
Hernias were median in 19 cases, of which 70% (M2-M4) and 60% were W3, respectively. Median patient age was 68 and median BMI was 31. Median operative time was 313 minutes, and hospital length of stay was 4 days. Morbidity was 26% (Dindo Clavien (DC) 1: n=4 and DC 2 + 3a: n=2).
Register comparison (LASTAR: n=23 vs. all others: n=63634) showed that comparable defects were treated with component separation but not in minimal invasive technique. The time required for surgery is significantly greatest compared to all other procedures. However, the length of stay is significantly shorter than with component separation

Conclusion
With the presented surgical technique, a first series of patients with ventral incisional hernias was treated using conventional minimally invasive techniques (LASTAR). The significance of the method should be supplemented by follow-up data.
P-108 MARJOLIN'S ULCER AS A COMPLICATION OF UNRESOLVED OPEN ABDOMEN
Authors: Olona C , Casanova R , Vadillo J , Julià E , Varona A , Ferreres J , Rodrigo M , Jorba R 
Published: October 2022

Abstract

Introduction
Marjolin's ulcer (MU) is a rare cutaneous tumour, commonly associated with chronic wounds with difficult healing.
We present a case of UM diagnosed on a persistent unresolved open abdominal closure wound.

Materials and Methods
80-year-old male with a history of ruptured infrarenal aortic aneurysm (2010) that required aorto-unifemoral repair. Postoperative period requiring decompressive laparotomy for abdominal compartment syndrome and treated with negative pressure therapy, and impossibility of definitive abdominal closure due to abdominal muscle retraction.
Loss of outpatient follow-up for 10 years.
Consultation for worsening of the surgical wound with abdominal pain. Examination revealed abdominal incisional hernia M2–4W3 and large abdominal ulcer. Biopsies positive results for squamous cell carcinoma with infiltrative pattern. A computed tomography describes an abdominal wall mass of 14×6×11cm and space-occupying lesion in the left hepatic lobe. Liver biopsy showed a moderately differentiated hepatocarcinoma.
Surgical management consist in intramuscular injection of botulinum toxin and en bloc resection of granulation and ulcerated tissue and ileal loop attached to the lesion. Wall reconstruction with anterior separation of components and supraponeurotic mesh.

Conclusions
Marjolin's ulcer is associated with squamous cell carcinoma with a high rate of metastasis and mortality. This tumour is considered infrequent, of long-term duration and associated with developing societies.
In our environment, this neoplasia can develop in patients with open abdomen treated partially or with closure by second intention, so we consider it necessary to have a high index of diagnostic suspicion in these cases and to perform biopsies for its detection.
P-121 RETROSPECTIVE REVIEW OF PRACTICE AND OUTCOMES USING A SINGLE BRAND BIOLOGIC MESH AT A DISTRICT GENERAL HOSPITAL
Authors: Pokusevski G , Sodde P , Zeb E , Sabri S , Mihailescu A 
Published: October 2022

Abstract

Aim
A retrospective review of all operated hernia patients in which a single brand of Biologic mesh was used, since it's first introduction in our Trust and to date, has been conducted. During last almost 5 years, twelve patients were identified and included. All patients operated with any other type of Biologic mesh and all patients operated with synthetic meshes were excluded, as the aim of the study was to look at the efficiency of a particular product, which was the cheapest biologic mesh at the time of contract with our Hospital.

Material and Methods
Retrospective review of patient's notes and outcomes, including post-op follow-up and long-term follow-up. The study looked at the following criteria: indication of use as per VHWG (ventral hernia working group) classification of the patients, LOS (length of stay) compared with patients operated with synthetic mesh, any post-op complications including SSO/SSI (surgical site occurrence and/or infection) and outcome at follow-up to date, including recurrence, chronic pain or mesh infection.

Results
The biologic mesh studied proved itself as a reliable product and provided a durable repair in the cases where it was used. It was noticed that majority of the cases were emergency presentations for complicated ventral or inguinal hernias, the complexity of the cases compared with elective cases being higher (higher ASA grade patients, non-optimised etc).

Conclusions
The outcome of the study recommends to continue utilising this product, as efficient and financially competitive.
P-145 LARGE FIBROID TUMOR IN A INGUINO-SCROTAL HERNIA – CASE REPORT
Authors: Ungureanu C , Iordache N 
Published: October 2022

Abstract

Aim
One of the most common benign mass of the spermatic cord is lipoma. More rare are the fibrous tumors described as painless, very mobile extra-testicular tumors, which are called “scrotal mouse”; can accompany inguino-scrotal hernias and sometimes mimicking hernia.

Method
We report a case of a 73 years old male, with no previous medical history, presented to our department with a right large inguino-scrotal hernia.
Intraoperatively, we traced the cord into the scrotum and noticed the presence of a mobile tumor, attached to the cord, having 10/5 cm in size. We dissected and excised it. The testicle and cord structures were normal. Also, an indirect hernia sac was ligated and we performed a modified Lichtenstein procedure. The postoperative evolution was uneventful and patient discharged next day. Histopathology shows the diagnosis of a fibroid tumor. Follow-up did not show any recurrence.

Conclusion
Fibroid tumors arising from the cord are poorly defined. Differential diagnosis with vascular, infectious/inflammatory and lipoma should be made. Malignancies should be ruled out. Also we raise the idea that large lipomas found in hernia cure should be excised and further examined.
P-150 TRANSVERSUS ABDOMINIS RELEASE BY MINIMAL INVASIVE SURGERY. OUR EXPERIENCE IN A TERCIARY HOSPITAL
Authors: Menchero J Gómez , Lara Fernandez Y , Gila Bohorquez A , De La Herranz P , Guerrero J L , García Moreno J , Bellido Luque J , Morales Conde S 
Published: October 2022

Abstract

Aim
We present the experience in the transversus abdominis release (TAR) technique using a minimally invasive approach in our center.

Methods
We expose those W3 defects intervened by laparoscopic TAR(n=6). Step 1:
Releasing adhesions from previous surgeries. Step 2: Bilateral Rives space dissection, as well as the Rossen's space, this one using “down to up” technique. Step 3: Closure of the gap with barbed suture. In all cases, a PVDF mesh has been associated with atraumatic fixation, and 2 drains were placed.

Results
The mean age was 62, 100% men, and their BMI was greater than 25Kg/m2. All underwent scheduled surgery, using a minimally invasive approach, placing the mesh at the retromuscular level. Postoperative stay was 7.6 days. We did not obtain major complications (perforation, bleeding), but a drainage hole wound infection was registered. We had no readmissions or any medical complications.
Follow-up of 12 months, without signs of recurrence or chronic pain.

Conclusions
Although Robotic surgery and Botulinum toxin in surgery seems to be the future, in our experience TAR technique performed by laparoscopy is useful for large midline incisional hernias treatment as well as those associated with a lateral component in a terciary Hospital. We obtain good results in terms of recurrence and restoration of the abdominal wall dynamics. However, further studies are necessary to be carried out by experienced teams to reach conclusions.
P-154 GIANT HIATAL HERNIAS: LAPAROSCOPIC REPAIR WITH OR WITHOUT MESH PLACEMENT; EXPERIENCE OF A SINGLE CENTER IN NORTHERN GREECE
Authors: Symeonidou E , Petras P , Mpallas K , Kambaroudis A 
Published: October 2022

Abstract

Aim
Α giant hiatal hernia is defined as a type III paraesophageal hernia, where more than 30% of the stomach lies within the thoracic cavity, with or without any other abdominal viscera, such as pancreas, spleen, or colon. It suggests a rare clinical entity, accounting for less than 0,3% of all hiatal hernias. As a consequence, the surgical treatment, and in particular the laparoscopic approach, is considered challenging and demanding. The purpose of this study is to prove, through our center's experience, that the laparoscopic approach is a safe and effective method of giant hiatal hernia repair.

Material and Methods
8 patients, 4 men and 4 women, 63,83 years old on average, with giant hiatal hernias, are included in this study. In all cases, laparoscopic hiatal hernia repair was performed, without any conversions, in combination with Nissen fundoplication. In addition, in three cases, a poly-4-hydroxybutyrate mesh (Phasix) was applied.

Results
Two patients were reoperated, one due to persistant dysphagia and one due to ileus. The rest of the patients followed an uneventful postoperative course with a short hospital stay and elimination of their symptoms, during a 12-month follow-up period.

Conclusions
Laparoscopic repair of giant hiatal hernias suggests is a challenging operation, which is accompanied by high morbidity and recurrence rates, up to 12% and 10% respectively, as reported in the literature. However, it is a safe and effective procedure when performed in experienced centers.
V-002 MASSIVE INGUINAL HERNIA REPAIR WITH CHEMICAL COMPONENT RELAXATION AND PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM
Authors: Sacco J , Tawkaliyar R , Katzen M , Heniford T 
Published: October 2022

Abstract
Inguinal hernias are one of the most common procedures performed worldwide. Conversely, massive or giant inguinal hernias; defined as extending below the midpoint of the inner thigh are very uncommon. They are often associated with loss of domain, posing a different set of challenges for the surgeon, specially creating intra-abdominal space for the displaced organs. Preoperative progressive pneumoperitoneum (PPP) coupled with chemical denervation with botulinum toxin A (BTA) is one way to increase the size of the intrabdominal cavity to aid in reduction of the hernia contents and closure of the defect.
We present a case of a 51-year-old male with a massive right inguinal hernia with complete loss of domain. The hernia sac contained the entirety of his small bowel and colon except for his proximal duodenum and distal rectum which remained intrabdominal. We preformed preoperative BTA chemical denervation and progressive pneumoperitoneum prior to staged open Inguinal hernia repair. 1 month preoperatively BTA injections were performed under ultrasound guidance into the external and internal obliques at 3 locations bilaterally and an intraabdominal catheter was placed under laparoscopic guidance. The patient was insufflated with filter air 3 times a week for 3 weeks. He then underwent open repair with preperitoneal mesh placed and orchiectomy.
V-009 ROBOTIC UMBILICAL HERNIA REPAIR WITH RETRORECTUS SUBLAY MESH AND PLICATION OF RECTUS DIASTASIS VIA THE TRANSABDOMINAL PREPERITONEAL (TAPP) APPROACH
Authors: Lee Y K , Tomey D , Secchi R , Martinino A , Oviedo R 
Published: October 2022

Abstract

Aim
Umbilical hernias and rectus diastasis can greatly reduce patients’ quality of life, especially in this patient who is a professional athlete and coach. We present a robotic umbilical hernia repair with retrorectus sublay mesh and plication of rectus diastasis through the transabdominal preperitoneal (TAPP) approach.

Material & Methods
Video recording from the operating room was included. In the recording, we demonstrate the steps of this robotic approach with clear visualization of anatomic structures.

Results
A 37-year-old male with an enlarging umbilical hernia with intermittent incarceration and associated rectus diastasis presented for repair due to a significant impact on his work and quality of life. The patient underwent a TAPP robotic repair of his umbilical hernia and plication of rectus diastasis with a retrorectus sublay mesh placement. This was a same-day discharge procedure that the patient tolerated without complications.

Conclusions
Umbilical hernias and associated rectus diastasis can effectively be repaired robotically with retrorectus sublay mesh through the TAPP approach.