bluuebunny/crossref_metadata_2025_split huggingface dataset:
DD-07 INCISIONAL HERNIA FOLLOWING LAPAROSCOPIC COLORECTAL LIVER METASTASIS RESECTION. FIRST COMPARATIVE STUDY
Authors: Hassan A , Elfarouq A , Katheria V , Subar D 
Published: October 2022

Abstract

Aim
Since first laparoscopic liver surgery (LLR) in 1991, no literature to compare Incisional hernia (IH) incidence between LLR and open Resection (OLR). This is the first comparative study

Material and methods
Single centre retrospective review of Colorectal Liver Metastasis resections between 2011 till 2018. The primary end point is developing IH related to liver resection. Incidence of IH was compared between LLR and OLR. Factors including Age, Gender, Diabetes Mellitus, Steroid intake, Pre-op Creatinine and Albumin, Previous Liver resection ASA score were compared between both groups. Subcutaneous and peri-renal fat thickness measured as indicative of fat distribution. Numeric results presented in Mean±SD. SPSS 20 (IBM, Armonk, USA) used for statistical analysis. p ≤ 0.05 was considered statistically significant

Results
247 procedures with follow-up 41 ± 29 Months. IH was observed in 48 case (19.4%). Incidence was 10%, 19% at 1, 3 years respectively (Kaplan-Meier). 87 case (35%) had LLR and 160 (65%) OLR. OLR had lower pre-op Albumin (32±9 Vs 35±8 g/L, p 0.01, Mann-Whitney U), longer hospital stay (10±7 Vs 6±4 days, p 0.00, Mann-Whitney U) and more major liver resections i.e. Resection of 3 or more segments (58% Vs 29% in LLR, p 0.00, Chi2). No difference in IH Incidence in LLR (8%, 19% Vs 10%, 19%) and OLR at 1, 3 years respectively. Similarly, no difference in hernia size (53±37 mm in LLR Vs 50 ± 33 in OLR, p 0.96, Mann-Whitney U)

Conclusion
No difference in IH incidence or size between LLR and OLR.
DD-08 RETAINER II – DEVELOPMENT AND VALIDATION OF A PATIENT REPORTED OUTCOME MEASURE (PROM) FOR INGUINAL HERNIA REPAIR
Authors: Corghan S , Fullard A , Fleming C ,   I S R C
Published: October 2022

Abstract

Aim
Outcome reporting following inguinal hernia repair is heterogenous. We aim to develop an inguinal hernia repair PROM.

Methods
The evaluation and development of a disease-specific instrument will be performed in accordance with FDA guidelines for developing PROMs in three phases
Item Generation: An systematic review(PROSPERO ID CRD42021271735) and narrative analysis will be undertaken to identify health related quality of life(HrQoL) issues relevant to patients with inguinal hernia, this will be used to identify themes and concepts to help inform the interview guide.
Pre-Testing: A pre-test questionnaire will be developed based on the conceptual framework devised in Phase I and tested with a sample of 20–30 patients to reach consensus regarding the questionnaire format and structure to confirm that instructions and items are clear, understandable, relevant, and applicable. Quantitative assessment of face validity of the measure will be undertaken using the QQ-10 and data fanalysed both quantitatively and qualitatively.
PROM Evaluation: A field test will be undertaken to evaluate the RETAINER II tool for reliability and validity using psychometric techniques from Classical Test Theory. Each patient will complete:
An approximate sample of 50–100 patients will be purposively sampled ensuring representation of all subgroups. Qualitative analysis, using NVIVO 12 for Windows(QSR International Pty Ltd., Australia) will be performed independently. A test-retest will be undertaken. Consenting participants will complete a second questionnaire pack 5–7 days after inital questionnaires (approximately 50 patients).
OC-002 EVALUATION OF GIANT INGUINAL HERNIA REPAIR RESULTS - A RETROSPECTIVE SINGLE INSTITUTION CASE-CONTROL PROPENSITY SCORE MATCHED STUDY
Authors: Demma J A , Shpigelman O , Marom G , Fishman Y , Pikarsky A , Almogy G 
Published: October 2022

Abstract

Background
Giant inguinal hernia (GIH), defined as a hernia descending below the inner-thigh midpoint in upright position, is rare. Case reports describe techniques in which the abdominal cavity is prepared and care is taken to prevent abdominal compartment syndrome (ACS). Our aim was to analyze and review our experience with GIH repair.

Methods
Retrospective single-institution, case-control, study included adults who underwent GIH repair between 2014–2021 at an university referral center. Technique included endo-tracheal intubation, head-down positioning, maximal pre-incision reduction of hernia contents, and repair with mesh. Follow-up was conducted in outpatient clinic. Results were compared to a time-based control group.

Results
During the study period, 58 patients underwent an open GIH repair with mesh without abdominal preparation. Control group included 232 patients who underwent open non-giant inguinal hernia repair (control group). Bowel resection was not necessary in any case. The in-hospital and 30-day complication rates were 17.2% and 68.9% in the GIH group, and 8.2% and 27.2%, in the control group (p=0.04, OR=2.3; and p&lt;0.001, OR=5.9, respectively). Ischemic orchitis was common in the GIH group (65.5%) compared to the control group (13.4%) (p&lt;0.001, OR=12.3). ACS, major complications and mortality were not reported. 90-day complication rates were similar. 2 cases of recurrence (0.9%) were observed in the control group.

Conclusions
Our study suggests that GIH repair is safe and feasible, and there is no need for abdominal cavity preparation. Early complications, mainly ischemic orchitis, are more common than control group, but without long-term implications and with a very low recurrence rate.
OC-005 ENDOSCOPIC SURGICAL SKILL QUALIFICATION SYSTEM IN JAPAN: PROVEN PERFORMANCE IN HERNIA SURGERY
Authors: Ueno N , Eguchi T , Hayakawa T 
Published: October 2022

Abstract
Endoscopic Surgical Skill Qualification System by Japan Society for Endoscopic Surgery is implemented from 2004.
Laparoscopic inguinal hernia repair (TAPP, TEP) is positioned as a low difficulty level operation under general surgery field in this system.
An application qualification to the system demands the list of a specified operative cases, to participate in education seminars, and training of endoscopic surgery over 2 years after the Board Certified.
A specified case quantity is the operative experience of above 5 examples of a high-difficulty level and 45 examples of a low difficulty level operation.
Candidates submit 3 no edited videos of the endoscopic surgery performed for indirect hernia with the orifice above 1.5 cm in a male-sex. Which to examine among 3 videos is decided randomly by the society.
Two hernia-specified referees examine one candidate. When both results don't agree, an extra referee will examine newly and fixes the result.
An evaluation is estimated within 60 points of common standards and 40 points by an hernia. Equal to or more than 70 points in amount become a pass. Acceptance rate in hernia was 16% in 2021.
The Nationwide Survey of Endoscopic Surgery reported recurrence rates of after laparoscopic hernia surgery as 5% in TEP in and 4% in TAPP in 2012–2013, 2.0% and 1.3% in 2018∼2019, what is improved beyond the period.
It's no exaggeration to say that the Qualification System has played a big part.
The Qualification System like no other in the world is to be introduced.
OC-008 TRENDS IN INGUINAL HERNIA REPAIR: A TAILORED APPROACH
Authors: Khanmohammed Z , Fadaee N , Huynh D , Capati I , Towfigh S , Tung R 
Published: October 2022

Abstract

Aim
Inguinal hernias (IH) can be repaired via open, laparoscopic, and robotic approaches, with or without mesh. We aim to understand the changing trends in IH repair that may serve as a guideline toward a tailored approach for hernia repair.

Materials & Methods
All patients undergoing primary IH repair from 2009–2021 by a single surgeon at a specialty hernia center were included. Temporal differences were evaluated using Chi-squared, Fisher's exact test, and logistic linear regression.

Results
Over 12 years, 533 patients underwent primary IH repair. Most were males (59.1%), average age 51.7 years, and average BMI 26.6 kg/m2. IHs were repaired via open (28.3%) or minimally invasive (MIS) approaches (71.7%), either with (93.4%) or without mesh (6.6%).
Trends showed a significant increase in females undergoing IH repair (p&lt;0.001) and increase in MIS approach (p&lt;0.001). There was a significant decrease in open approach (p&lt;0.001) and an overall trend away from mesh-based repairs and toward tissue-based repairs (p&lt;0.001).

Conclusions
We present our hernia specialty center's best practices for IH repair, which is a result of a tailored approach. Our 12-year study shows a significant trend toward the use of MIS approach for IH repair. This is aligned with international consensus guidelines, especially for females. While mesh use remains the standard of care in the US, we show a progressive and significant trend away from the overuse of mesh in IH, especially for females.
OC-012 THE COMBINATION OF THE THREE MODIFICATIONS OF THE COMPONENT SEPARATION TECHNIQUE IN THE MANAGEMENT OF COMPLEX SUBCOSTAL WALL DEFECT
Authors: Zuvela M , Galun D , Bogdanovic A , Loncar Z , Zivanovic M , Zuvela M , Zuvela M 
Published: October 2022

Abstract

Aim
To present a concept combining three modifications of the component separation technique (CST) in one procedure as an original solution for the management of complex subcostal abdominal wall defect.

Material and Methods
Between January 2010 and January 2022, seven patients with complex subcostal hernia defects compromised by infection, radiation, or chemotherapy underwent surgery in which three modifications of CST were combined into one procedure. Major complex subcostal hernia was defined by either width or length of the defect being greater than 10 cm. The following were the stages of the operative technique: (a) the “method of wide myofascial release” at the side of the hernia defect; (b) “openbook variation” of the component separation technique at the opposite side of the hernia defect; (c) a modified component separation technique for closure of midline abdominal wall hernias in the presence of enterostomies; (d) suturing of the myofascial flaps to each other to cover the defect; and (e) repair augmentation with an absorbable mesh in the onlay position.

Results
The median (range) length and width of the complex subcostal hernias were 15 cm (10–19) and 15 cm (8–24), respectively. The overall morbidity rate was 57.1% (wound infection, seroma and skin necrosis). There was no hernia recurrence during the median follow-up time of 19 (range 3–84) months.

Conclusion
The operative technique integrating three modifications of CST in one procedure with onlay absorbable mesh reinforcement is a feasible solution for the management of complex subcostal abdominal wall defect.
OC-013 INDIVIDUAL STRATEGY FOR PATIENTS WITH ABDOMINAL WALL EVENTRATION – DIFFERENT COMPONENTS SEPARATION TECHNIQUE WITH MESH AUGMENTATION
Authors: Zuvela M , Bogdanovic A , Galun D , Palibrk I , Velickovic J , Djukanovic M , Bidzic N , Zivanovic M , Zuvela M , Zuvela M 
Published: October 2022

Abstract

Aim
To present individual approach for patients with abdominal wall eventration using various anterior component separation techniques (aCST) with mesh augmentation.

Materials and Methods
Between January 2008 and April 2022, 194 patients with abdominal wall eventration underwent surgery by single surgeon. Surgical treatment consists: a) enlargement of the abdominal cavity using different aCST (Ramirez CST, modified CST in the presence of enterostomies, “open book” modification CST, “method of wide myofascial release” or combination of these techniques); b) mesh augmentation (sublay or onlay hernioplasty); c) prolonged muscle relaxation and mechanical respiratory support in intensive care unit.

Results
Type of abdominal wall reconstruction: 143 Ramirez CST, 35 modification CST in the presence of enterostomies, 11“open book” CST modification, 5 “method of wide myofascial release”, 159 onlay mesh hernioplasty and 35 sublay mesh hernioplasty. Mean hernia defect size was 255 cm2 (100–750). During the mean follow-up of 31 months, 78 (40%) patients had one or more complications: intraabdominal hypertension 8 (4,1%), seroma 13 (6,7%), hematoma 10 (5,1%), wound/mesh infections 21 (10,8%), skin necrosis 40 (20,6%), pain 3 (1,6%), and recurrence 5 (2,6%). There were 10 (5,1%) postoperative deaths. The cause of dead was significant comorbidity in 8 patients and postoperative compartment syndrome in two.

Conclusion
Eventration disease is a complex surgical problem and its treatment is associated with significant complications. Individual strategy for each patient based on multidisciplinary approach using different component separation techniques with mesh augmentation may improve postoperative results.
OC-017 INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE FOR THE LAPAROSCOPIC TREATMENT OF PRIMARY AND INCISIONAL VENTRAL HERNIA IN DAY SURGERY REGIME
Authors: Bellino R , Giaccone M , Bertot L , Rosati S , Balestra G , Sandrucci S 
Published: October 2022

Abstract
IPOM technique is a well-established technique for the repair of primary and incisional ventral hernia; and outpatient regime is considered a cost-effective strategy without compromising the quality of care. In this retrospective observational study, we evaluated the application of IPOM technique through outpatient setting, with the use of a non-absorbable, transparent, light prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent polypropylene film.
179 consecutive procedures of primary and incisional hernia repair from 2011 to 2022 have been included in this study (149 with the above-mentioned composite meshes and 30 with other meshes, semi-absorbable and non-absorbable). All the procedures were performed through 3 abdominal trocars executing cold adhesiolysis to release the contents of the hernial sac without dissecting the latter. The abdominal wall was then prepared by blunt dissection to create the space for the mesh and to favor a prompt cell colonization. Mesh fixation was achieved using transparietal points and resorbable tackers.
The primary outcomes of the study were the evaluation of any risk factors for conversion from outpatient regime to standard hospitalisation, and the hernia recurrence, in two subgroups: primitive hernias (n=72) and incisional hernias (n=107).
Our clinical experience showed that IPOM technique through outpatient setting is a safe and effective approach. No statistically significant difference in the recurrence rate between the primitive and incisional hernias groups (5.9% vs 5.0%, p=0.80) was found. Moreover, we found a relationship between the rate of unexpected hospitalization and age of the patients, number of defects and hernia dimension.
OC-020 INCISIONAL HERNIA REPAIR WITH MESH REIMAGINED: PILOT STUDY USING ABDOMINOPLASTY AS PERMANENT AUTOLOGOUS BIOLOGICAL REINFORCEMENT IN HERNIA REPAIR
Authors: Tung R , Fadaee N , Rahban R , Towfigh S 
Published: October 2022

Abstract

Aim
EHS consensus recommends mesh implantation for all incisional hernia (IH) repairs, regardless of size. We propose considering abdominoplasty in the algorithm for IH repairs wherein the plicated fascia functions as a permanent autologous biologic onlay repair over the primary repair of the IH.

Materials & Methods
Four patients with midline IHs underwent abdominoplasty. Their IHs were first closed primarily with #2–0 permanent suture. Next, a two-layer anterior plication of the overlying fascia was performed with permanent suture. No mesh was implanted. Patients were followed up post operatively to monitor for hernia recurrence.

Results
All patients were female with average age 51 years. All had at least one midline IH (1cm-1.7cm wide). Three (75%) had recurrent IHs. Three (75%) had diastasis recti. Patients were followed at 1 year, with no (0%) recurrence.

Conclusion
Abdominoplasty may be a safe and effective alternative for IH repair compared to traditional mesh-based repair. In effect, the patient's own plicated fascia functions as a permanent autologous biologic onlay reinforcement to the IH repair. Meanwhile, the plication may reduce tension off the primary defect closure, thus reducing recurrence. Our pilot study in small IHs showed no hernia recurrence one-year postoperatively after abdominoplasty. Thus, abdominoplasty may serve as an alternative surgical option to a subset of patients with IH. We aim to judiciously expand indications for abdominoplasty for IH repair to address wider defects in select candidates. We hope our experience will supplement the current algorithm for IH repairs by providing a non-mesh alternative.
OC-021 HYBRID ROBOTIC SURGERY - USING LAPAROSCOPY TO BETTER ROBOTIC OUTCOMES
Authors: Soni V 
Published: October 2022

Abstract

Aim
To show that Hybrid Robotic Surgery is essential for a successful and a cost effective General Surgery Robotic Surgery Program

Material & Methods
38 Consecutive cases of General Surgery done from October 2021 to June 2022 were studied with respect to usage of Robotic Instruments & Laparoscopic Instruments, the utility of each instrument, Surgical time, costs & patient outcomes.

Results
A Hybrid approach by using Laparoscopic Instruments (Ports and/or Instruments) was necessary in 38/38 patients (100%) for atleast some step & in 32/38 patients for atleast one important surgical step. Robotic Platform was used to perform Hernia Surgery like TAPP (Trans Abdominal Pre-Peritoneal) & IPOM (Intra-peritoneal Onlay Meshplasty) (n=23). Laparoscopic Instruments were used in all the cases 23/23 (100%).

Conclusions
Usage of Laparoscopic Instruments helped reduce the Surgery duration, decrease use of Robotic instruments, help negate the Haptic blind spots proving to be a cost effective & a tool for optimal Robotic utilization. Laparoscopic instrumentation and steps remain an integral part of Robotic Surgery. The findings highlight the need for dual instrument set, both Robotic & Laparoscopic Instruments, in each Robotic Surgery and underscores the importance of adequate Laparoscopy knowledge and skills for a Robotic Surgery Program.
OC-022 MAINTAINING AN ELECTIVE ABDOMINAL WALL RECONSTRUCTION SERVICE DURING THE COVID 19 PANDEMIC
Authors: Dixon S , Benson A , Kalaiselvan R , Kanwar S , Samad A , Pritchard-Jones R , West C , Scott M 
Published: October 2022

Abstract

Aim
Elective surgery services suffered significantly due to the COVID-19 pandemic. The aim of this study was to analyse the impact and outcomes of abdominal wall reconstruction (AWR) performed during the COVID-19 pandemic, assessing safety and sustainability.

Material and Methods
A retrospective review of all patients undergoing AWR in a single NHS trust, multiple surgeons, between 23rd March 2020 and 22rd March 2022, the 2 years following U.K. Government imposed lockdown, was undertaken and compared with the pre-pandemic AWR activity. Procedures were initially undertaken at a cold site and when demonstrated to be safe, main site operating restarted. The primary outcome was 90 day mortality, secondary outcomes of COVID-19 infection within 7 days, length of stay, critical care requirement, and complication rate.

Results
In the study period, 173 patients underwent AWR, compared with 99 cases in a single year preceding lockdown. 90 day mortality rate was zero. No patients returned positive COVID tests to the trust within 7 days of AWR, and no patients were readmitted for COVID related symptoms. Critical care admission was required in 7 patients, 3 of these were planned admissions pre-operatively. The surgical site occurrence rate was 9.8% (17), infection 5.8% (10), seroma 2.3% (4) and haematoma 1.7% (3). There were no recurrences reported, with follow up ranging between 1 and 18 months.

Conclusion
Continuing AWR services during the COVID pandemic is feasible and safe. Peri-operative COVID infection rates are low, critical care requirements minimal, and there is no impact on patient morbidity or mortality.
OC-036 DEVELOPMENT OF NOVEL IMAGE-BASED DEEP LEARNING MODELS (DLMS) TO PREDICT OUTCOMES IN ABDOMINAL WALL RECONSTRUCTION (AWR) WITH IMBALANCED DATA SETS
Authors: Ayuso S , Elhage S , Zhang Y , Salvino M , Aladegbami B , Augenstein V , Colavita P , Heniford B T 
Published: October 2022

Abstract

Aim
The development of DLMs with imbalanced datasets represents a major challenge in the fields of artificial intelligence and surgery. The aim of this study was to develop and compare DLMs that predict mesh infection and pulmonary failure following AWR.

Methods
A prospectively maintained institutional database was used to identify AWR patients with preoperative CT scans. Standardized axial cuts of CT scans were rendered to DLMs. Conventional DLMs (CDLM) were developed two-class training system (i.e., learns negative and positive outcomes). CDLMs were compared to DLMs that were developed using a Generative Adversarial Network Anomaly (GANomaly) framework, which utilizes image augmentation and anomaly detection. The primary outcomes were receiver operating characteristic (ROC) values for predicting mesh infection and pulmonary failure.

Results
CT scans from 510 patients were utilized (10,004 images). Mesh infection and pulmonary failure occurred in 3.7% and 5.6% of patients, respectively. The CDLMs were less effective than GANomaly for predicting mesh infection (ROC 0.61 vs 0.73, p&lt;0.01) and pulmonary failure (ROC 0.59 vs 0.70, p&lt;0.01). Although the CDLMs had higher accuracies/specificities for predicting mesh infection (0.93 vs 0.78, p&lt;0.01/0.96 vs 0.78, p&lt;0.01) and pulmonary failure (0.88 vs 0.68, p&lt;0.01/0.92 vs 0.67, p&lt;0.01), they were substantially compromised by decreased model sensitivity (0.25 vs 0.68, p&lt;0.01/ 0.27 vs 0.73, p&lt;0.01).

Conclusions
Compared to CDLMs, GANomaly DLMs showed improved performance on imbalanced datasets, predominantly by increasing model sensitivity. Understanding patients who are at-risk for postoperative complications can improve risk stratification.
OC-039 WHAT IS THE INFLUENCE OF FEMALE GENDER AND FEMORAL HERNIA ON PERIOPERATIVE OUTCOME IN GROIN HERNIA REPAIR?
Authors: Kundel L , Riediger H , Köckerling F 
Published: October 2022

Abstract
Groin hernias are rare in women compared to men. The proportion of women in the overall collective of operated groin hernias is between 8–12%. The rate of femoral hernias in women is higher than in men. Femoral hernias account for 3% of all primary groin hernias and 18% of all groin hernias in females. Very little is known about the influence of female gender and a femoral hernia on the outcome in groin hernia repair.
For this retrospective analysis of prospectively collected data from the Herniamed Registry 347.054 primary elective unilateral groin hernia repairs were selected. 42.595 (12.3%) procedures have been performed in females. 10.265 (3%) patients had a femoral hernia. A multivariable analysis was undertaken to investigate the influence of confirmatory defined patient- and procedure-related characteristics on the perioperative outcome.
A significantly favorable correlation was found between the total perioperative complication rate and female gender (OR =0.886; 0.844–0.931) p&lt;0.001. Other factors with positive impact on the perioperative outcome are the laparo-endoscopic approach, smaller defects, medial defects and normal weight. A significantly unfavorable relation was identified between the total perioperative complication rate and a femoral hernia (OR =1.172; 1.095–1.254)p&lt;0.001. Other unfavorable influencing factors on the perioperative outcome are higher age, higher ASA score, antithromboric medication, smoking, COPD and corticosteroid medication.
The risk of perioperative complications is lower in female compared to male groin hernia repair, but not in femoral hernias.