bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-016 SMALL BOWEL PERFORATION WITHIN A GIANT INGUINOSCROTAL HERNIA DUE TO AN INGESTED FOREIGN BODY
Authors: García Galocha J L , Del Campo Martín M , Avellana Moreno R , Sotillo Valenzuela L , Flores Flores C , López Antoñanzas L , Talavera Eguizabal P , Torres García A J 
Published: October 2022

Abstract

Introduction
Bowel perforation due to an ingested foreign body is a rare event. Its presentation within an inguinoscrotal hernia, is even more uncommon.

Case Description
We report the case of a 69-year-old indigent man with a chronic alcoholic liver disease history, who presented in the emergency department due to sepsis. He was complaining of nausea, vomiting and mild abdominal pain. Clinical examination revealed a painful, giant right inguinoscrotal hernia, with cutaneous trophic changes and subcutaneous emphysema. Blood test showed leukocytosis and lactic acidosis. CT scan revealed small bowel perforation with peritonitis inside the hernia sac. The patient underwent emergency surgery. Two 5-centimeters long fishbones were found. Ileocecal resection with ileocolic side-to-side anastomosis and Lichtenstein hernioplasty open repair were performed. A polypropylene mesh was placed.

Discussion
Accidental foreign body ingestion followed by gastrointestinal tract perforation is a rare cause of peritonitis. There are few case reports about this event happening inside a hernia. Perforation is more common at points of physiological angulation or narrowing of the passage within the digestive tract, such as lower esophageal sphincter, pylorus or ileocecal valve. Inguinoscrotal hernias present as a pathologic stenotic area where foreign bodies can produce an obstruction or perforation. In these cases, the hernia repair is challenging due to the contaminated scenario.

Conclusion
The diagnosis of perforation within an inguinal hernia should be suspected in cases of acute abdomen and incarcerated hernia, in order to choose the best surgical treatment option.
P-023 ABDOMINAL WALL HERNIA AND MENTAL HEALTH: PATIENTS LIVED EXPERIENCES AND IMPLICATIONS FOR PATIENT CARE
Authors: Smith O , Mierzwinski M , Mcvey J , Chitsabesan P , Chintapatla S 
Published: October 2022

Abstract

Aim
To qualitatively examine how Abdominal Wall Hernia (AWH) affects patients’ mental health.

Methods
Fifteen patients were interviewed from a purposive sample of AWH patients until no new themes emerged. Interviews explored patient thoughts and experiences of AWH and mental healtth. Data were examinted using Interpretative Phenomenological Analysis (IPA).

Results
Three themes pertaining to mental health were identified: “psychological and emotional distress”, “identity disruption” and “coping mechanisms and support systems”.

Conclusions
This is the first study to qualitatively examine how AWH affects patients’ mental health. Our findings illustrate that AWH is a pathology that can have a significant detrimental impact on people's mental health. This impact has implications for patient care and can be treated and managed through better psychological support. This support may positively affect AWH patient's experience and outcomes in terms of quality of life. We provide recommendations for improved AWH patient care in regards to mental health.
P-024 COMPLEX ABDOMINAL WALL RECONSTRUCTION BY RETROMUSCULAR SUBLAY TECHNIQUE: INITIAL EXPERIENCE IN A THIRD-LEVEL HOSPITAL
Authors: Jezieniecki Fernandez C , Trujillo Díaz J , Ruiz Soriano M , Gomez Sanz T , Cabezudo Molleda G , Rodriguez Lopez M , Montes Manrique M , Herreros Rodriguez J , Beltrán De Heredia Rentería J 
Published: October 2022

Abstract

Aim
Large or complex incisional hernias require more than just mesh placement.There are techniques such as component separation, retromuscular techniques (Rives-Stoppa, transversus abdominis muscle release-TAR), which help to repair the hernia and physiologically rebuild the abdominal wall.However, this type of technique can present a higher incidence rate of complications, such as hematomas, seromas, SSI, skin necrosis.We present our initial experience in complex abdominal wall reconstruction using the retromuscular sublay technique (RST).

Methods
Retrospective study analyzing our database of patients with complex incisional hernia undergoing abdominal wall surgery using the RST, during November-2018 to October-2020.In addition, we conducted a comparative analysis with patients undergoing hernia repair using the onlay-technique.

Results
44 patients underwent RST (male:56.8%, age:66(IQR: 52–73years)). Hospital stay:4(IQR: 2–6days).Pathological history: diabetes mellitus (4.5%), arterial hypertension(20.5%), dyslipidemia(36.4%), smoking(34.1%), alcohol consumption(27.3%), cardiovascular disease(9.1%).ASA-classification:I(9.1%), II(59.1%), III(31.8%). BMI: 29.3±2kg/m2.
Hernia location: midline(95.5%), others(4.5%). Preoperative botulinum toxin (PBT): 20.45%. Preoperative progressive pneumoperitoneum (PPP): 9.1%. Type of surgery performed: Rives-Stoppa(68.2%), TAR(31.8%).
Postoperative complications: global(13.6%), Clavien-Dindo≥III:0%, clinical seroma(13.6%) and ultrasound-seroma(22.7%), SSI(0%). Hernia recurrence:0%.
In the bivariate analysis of patients undergoing hernia repair using the RST compared to patients undergoing onlay repair, we observed that the RST presented lower incidence of global complications, both clinical and ultrasound seromas, surgical site infections and recurrences (13.6% vs 39.1% p=0.004; 13.6% vs 33.3% p=0.019; 22.7% vs 39.1% p=0.07; 0% vs 14.5% p=0.008; 0% vs 5.8% p=0.1; respectively).

Conclusions
In our enviroment, the management of complex incisional hernias using RST and the use of PBT and PPP is effective and safe, with a lower incidence of complications and recurrences.
P-026 SMALL BITE CLOSURE IN EMERGENCY LAPAROTOMY; A RETROSPECTIVE COHORT ANALYSIS
Authors: Khan A , Wintrip D , Light D , Light D 
Published: October 2022

Abstract

Aims
To investigate the outcomes of the implementation of small bite closure in emergency laparotomy

Methods
A retrospective comparative cohort analysis was performed from Northumbria NHS Trust (United Kingdon) surgical database from 2017 to 2021. All cases of emergency laparotomy were included. Cases of open appendicectomy were excluded. Small bite closure was performed by a standardised technique with slowly absorbable sutures. A matched cohort of cases who were closed with mass closure were used for comparison.

Results
262 cases of emergency small bites closure were included, and 247 cases of emergency mass closure. There were comparative age, sex and ASA grade in each group. There was no significant variation in the types of procedure performed.
In the small bites closure group, there were 8 cases of superficial dehiscence (3%), 4 cases of deep dehiscence (1.5%) and 16 wound infections (6%). The mean post operative stay was 10 days (2 to 74). The 30 days mortality was 18 cases (7%) and 40 cases overall (15%).
In the mass closure group, there were 6 cases of superficial dehiscence (2%), 6 cases of deep dehiscence (2%) and 23 wound infections (9%). The mean post operative stay was 14 days (3 to 65). The 30 day mortality was 34 cases (14%) and 65 cases overall (26%).

Conclusion
Small bites closure shows comparative results to mass closure in the emergency setting in post operative outcomes. Small bites closure is safe and feasible in the emergency setting.
P-027 REDUCING SURGICAL WAIT TIMES FOR ABDOMINAL WALL HERNIA OPERATIONS POST COVID-19 BY USING DEDICATED CLINICS
Authors: Renna M , Lyon S , Sindhar J , Ebied H 
Published: October 2022

Abstract

Background
Specialization influences the way that surgeons deliver care and has a direct impact on doctors, healthcare systems and patients. Hernias impact around 2% of the population and repairs are among the most common procedures performed globally. The European Hernia Society recognizes a growing need for specialist surgeons as abdominal wall surgery becomes more complex with newer techniques and more challenging cases being encountered. At this trust, a new specialized hernia clinic was implemented in response to COVID backlogs and the growing need and proven benefits of specialization. The project's aim was to review the impact on procedure wait times and outcomes for hernia repairs.

Methods
A retrospective review of patients undergoing hernia repairs between June 2019 to June 2021 was compared to similar patients who attended the hernia clinic between February 2021 to March 2022. Included operations were inguinal, femoral, and umbilical hernia repairs. Data collected included diagnoses, percentage of day case and wait times.

Results
59 patients underwent surgery pre-intervention with average wait times of 191 days. 72 post-intervention patients had an average wait of 59 days. 59 patients were still awaiting surgery post-clinic. Open surgery incidence increased from 66% to 79%. 86% of patients post-intervention were day cases, compared to 78% of pre-intervention patients.

Conclusions
The new hernia clinic has reduced wait times for surgery and improved day-case rates despite more cases being performed as open procedures. Following these results, the clinic system shows great promise and hernia surgery has the potential to evolve as a sub-specialty.
P-031 AN UNUSUAL CASE OF AN INCARCERATED 5MM PORT SITE HERNIA FOLLOWING LAPAROSCOPIC FUNDOPLICATION
Authors: Christopoulos P , Sinha S , Browning M , Bradley A , Andrews S 
Published: October 2022

Abstract

Aim
Port site hernias are a rare, but recognised risk of laparoscopic surgery. Literature supports fascial closure at port sites of 10mm or greater. However, there are few reported cases of herniation through 5mm port sites.

Methods
This case report focuses on a 67-year-old female who underwent an uncomplicated primary laparoscopic Toupet's fundoplication. 11 days post procedure she presented with an incarcerated port site hernia. CT scan demonstrated high grade small bowel obstruction with a transition point at the site of the 5mm right sided port. A laparotomy was performed, the hernia reduced, small bowel was viable, and the port site hernia was closed internally using vicryl sutures.

Results
The incidence of 5mm trocar-site hernias is rare. A recent literature review found only 10 such cases related to general surgery (cholecystectomy:6; appendicectomy: 2; right hemicolectomy: 1; paraesophageal hernia:1). Risk factors for port-site hernias include: high BMI, midline position, size, number and type of trocar tip. The limited current literature identifies excessive trocar manipulation as the major risk factor for developing 5mm port-site hernias, yet routine fascial closure is not supported.

Conclusion
Herniation at 5mm port sites is rare but attention should be paid when patients present with symptoms suggesting its occurrence.
P-034 RECOMMENDATIONS ON POSTOPERATIVE ACTIVITIES AFTER ABDOMINAL OPERATIONS AND INCISIONAL HERNIA REPAIR - A NATIONAL AND INTERNATIONAL SURVEY
Authors: Schaaf S , Willms A , Güsgen C , Schwab R 
Published: October 2022

Abstract

Aim
There is no conclusive data on postoperative recommendations after abdominal and hernia surgery, and substantial variation in the literature. Thus, this study evaluates the status quo of recommendations of postoperative activity restriction after abdominal surgery.

Material and Methods
A national (German) and international survey (at the 41st EHS Annual Meeting) of general surgeons on postoperative recommendations after abdominal and hernia surgery was pooled and analyzed. Results 74.6% recommended postoperative reduced activity for 2 weeks or less after laparoscopy. For midline laparotomy, 48.8% considered a reduced activity of 4 weeks or less to be sufficient. A majority from the national survey recommended more than 4 weeks instead (60.2%), whereas only 31.5% from the international survey did so (p=0.000). In the pooled analysis, 258 of 450 (57.3%) rated 4 weeks or less suitable. However, the recommendations differed significantly between the surveys (4 weeks or less: a national survey, 47.1% vs. international survey, 64.6%; p=0.000).

Conclusion
There was substantial variation in the given recommendations. However, we found no evidence against immediate mobilization, reduced physical activity, and lifting for up to 2 weeks after laparoscopic surgery and for up to 4 weeks after open abdominal surgery and open incisional/ventral hernia repair in uncomplicated and standard cases. There might be individual and socio-economic benefits to allow patients to return to their whole personal level of activity and work without putting them at risk of complications. Due to lack of evidence, both retrospective and prospective, controlled studies are in need to develop reliable recommendations.
P-035 SEPARATION OF COMPONENTS WITH TRANSVERSUS ABDOMINIS MUSCLE RELEASE TRANSVERSE (TAR): OUR SERIES
Authors: Curado Soriano A , Infantes Ormad M , Aguilar Marquez A , Valera Sanchez Z , Naranjo Fernandez J R 
Published: October 2022

Abstract

Aim
In our series we analyze our experience in the subsequent separation of components with release of the transverse (TAR).

Material & Methods
Study of our series of retrospective cases since 2016 to the present. We analyzed 59 patients with large hernias (midline and sides) all with defects greater than 10 cm. We perform the technique accessing the Rossen space through down to up. We used two meshes as prostheses, one biodegradable and the other made of polypropylene low density.

Results
We present 59 patients (38 men/21woman), of mean age of 61 years old and average BMI 32.05 Kg/m2. The mean postoperative stay was 7 days. The technique was carried out bilateral in 39 patients, and 20 it was applied unilaterally. Mesh implant to retromuscular level in 56 of the cases and 4 preperitoneal. Reinterventions in 4 (6.78%) patients. As minor complications, 8 (13.56%) wound infections, 9 (15.25%) wound seromas, 7 (11.86%) patients with pain chronic with preserved management, 1 (1.69%) edge ischemia and 1 (1.69%) wound sinus. Readmissions 4 patients (6.78%). Average follow-up of 24 months, no recurrence has been detected in any of the patients.

Conclusions
TAR is a complex technique that requires a learning curve, and that, even in equipment experienced, is not exent from serious complications. Therefore, the indication must be individualized and in order for it to be definitive, because once the wall is remodeled with this technique, the surgical options that remain are few.
P-036 CLOSURE OF INFECTED LAPAROSTOMY WITH NPWTI (NEGATIVE PRESSURE WOUND THERAPY WITH INSTALLATION) TO ON-LAY POLYPROPYLENE MESH IN A SEVERELY SARCOPENIC PATIENT
Authors: Ewan H , Zanellato A 
Published: October 2022

Abstract

Aim
To demonstrate NPWTi allows using polypropelene mesh in infected wounds in a patient with sarcopenia at high risk of developing incisional hernia.

Methods
This case describes a severely unwell 50 year-old with a gangrenous caecal volvulus and severe sarcopenia and hypoalbuminaemia. He underwent a right hemicolectomy and ileostomy and on ITU intubated. His wound grew yeast and vancomycin-resistant enterococcus, he developed large bilateral flank collections and on day 8 dehisced.

Results
A washout and laparostomy with mesh partial closure plus silicone-coated dressing was performed. At 48 hours Abthera@ fill was applied and the mesh was trimmed and tightened for gradual closure. Subsequent washouts showed mesh was fixated on the posterior rectus sheath with several holes caused by stitches used to fixate it. As such, the anterior rectus sheath was divided, creating a flap bilaterally. The posterior sheath flaps were reapproximated but the anterior sheath couldn't be, but was kept in place without tension by securing a polypropylene mesh and a NPWTi (Veraflo.)
Successive returns to theatre showed the mesh was intimately attached to aponeurosis and rectus muscle and subsequently there was exuberant granulation tissue on top of mesh. Skin was closed, again with NPWT. Despite leakage from his stoma, he now has a clean healed wound.

Conclusion
NPWTi enabled use of polypropylene mesh in a very hostile wound with gross contamination in a sarcopenic patient with high risk of developing incisional hernia. It is still a short follow up but we expect with this technique will avoid hernia formation.
P-037 ABDOMINAL WALL CLOSURE WITH SMALL-BITES TECHNIQUE USING PDS 3–0 SUTURE: EXPERIENCE IN A THIRD-LEVEL HOSPITAL
Authors: Trujillo Díaz J , Jezieniecki Fernández C , Herreros Rodríguez J , Ruiz Soriano M , Cabezudo Molleda G , Montes Manrique M , Rodriguez López M , Beltrán De Heredia Rentería J 
Published: October 2022

Abstract

Aim
Current studies show the correct closure of the abdominal wall must be carried out with a technique of giving many points and separated from each other with very little distance (small-bites technique) and with a suture of slow absorption.We conducted a review of our experience in abdominal wall closure in which we used a 3–0 polydioxanone (PDS®II)-suture using small-bites technique.

Methods
Retrospective study analyzing our database of patients in whom laparotomy and abdominal wall closure were performed using small-bites with PDS 3–0 suture, needle 26mm-½C, during November-2018 to October-2020.Emergency and elective laparotomies were analyzed.

Results
164 patients were analyzed(men:59.8%,age:73(IQR:61–78years)).LOS:6(IQR:5–10days). Pathological history: diabetes mellitus (28%), arterial hypertension (62.2%), dyslipidemia(67.1%), smoking (45.1%), alcohol consumption(19.5%), cardiovascular disease(19, 5%).BMI:27.45±4.2kg/m2(Range:18.31–38.29).Overweight:70.7%. Obesity:28%.
Laparotomy location: midline(47.6%), pfannenstiel(30.5%), transverse or subcostal(22%). Laparotomy was performed as an auxiliary to laparoscopy in 35.4%. Emergency surgery:40.2%. Neoplasms:56.1%. Associated with hernia repair:17.1%. Associated with surgical reoperations:9.8%.
Complications: no evisceration, SSI(11%),no eventration until current follow-up (17.5±4.3months).
Overweight patients and those who underwent emergency surgery had a higher incidence of SSI (13.6% vs. 4.2% p=0.07; 18.2% vs. 6.1% p=0.015).The location of the laparotomy, the association with hernia repair, reoperations, and neoplasms were not associated with a higher incidence of SSI (p&gt;0.05).

Conclusions
The closure of the abdominal wall using small-bites technique with slow resorption suture (PDS®II 3–0) with a small needle, provides a safe and effective closure, both in midline and transverse laparotomies, in emergency surgery and in patients with associated neoplasms, without increasing the number of complications and with no evidence of evisceration or eventrations.
P-044 LEARNING AND DATA FROM OUR TEP LEARNING CURVE
Authors: Ruiz Marzo R , Rico Arrastia A , Otegi Altolaguirre I , Enguita Germán M , Ramírez Cervera J L , Uribazo Rodríguez M , Sebastián Labayen J L , Blázquez Lautre L 
Published: October 2022

Abstract

Aim
Laparoendoscopic techniques for inguinal repair (TEP) offers advantages such as less postoperatory pain, less local complication rates and early comeback to work activities.
We describe the TEP learning curve in our unit and we present a preliminary analysis of our results.

Material and Methods
We present the retrospective analysis of patients who underwent TEP inguinal hernioplasty between 2018 and 2021 in a Wall Surgery Unit of Navarra Hospital. We perform a descriptive analysis of the collected data.

Results
182 patients were analysed, including 91.6% male with an average age of 57.1 years. 11patients required conversion from TEP to another technique (mainly TAPP and open preperitoneal surgery) due to surgical or anesthetic problems, with a conversion rate of 6%.
4 patients (2%) presented early recurrence and 6 patients (3%) late recurrence. 16 patients (8.8%) had moderate pain (VAS &lt; 5) while 7 patients (3.8%) had severe pain (VAS ≥5). All the patients who presented postoperative pain were reviewed and none presented postoperative neuralgia. No patient showed surgical site infection neither epididymitis. 4 patients (2%) presented seroma and 23 (12.6%) hematoma.

Conclusions
Laparoendoscopic techniques, especially TEP, has more demanding learning curve than open repairs. Support and tutoring are imperative in the first cases. An adequate selection of cases at the beginning is important. Mastering open preperitoneal hernioplasty surgery leads to better and faster results in TEP approach.
P-047 PERINEAL HERNIA: RECTUS ABDOMINIS MUSCLE FLAP REPAIR
Authors: Bockova M , Kocián P , Miletin J , Stolz A , Hoch J 
Published: October 2022

Abstract

Aim
Perineal hernia (PH) is a rare complication of pelvic surgeries. We present two cases of male patients with symptomatic PH following abdominoperineal resection (APR), repaired with rectus abdominis muscle flap.

Cases presentation
N1: 66-year male, 1 year after laparoscopic-assisted APR was treated with rectus abdominis muscle flap repair (RAM) by open abdominal approach. In postoperative period, heavy bronchitis leaded to the disruption of the muscle flap and need of reoperation. The patient healed completely two months after the repair. No recurrence of PH within 5 years has been registered. N2: 64-year male, underwent chemoradiotherapy and open APR for rectal carcinoma. 2 years later, CT showed a PH and 2cm wide mass suspicious of cancer recurrence in pelvis. By the open abdominal – perineal approach, the mass of recurrence was excised, and PH was repaired with vertical rectus abdominis muscle flap (VRAM). The postoperative period was uneventful and 1 year after the surgery, the patient is cancer and PH free.

Discussion
Treatment of more advanced carcinomas or wide use of radiotherapy can lead to an increased number of PH. Abdominal, perineal or combined approaches exists. The pelvic floor reconstruction is mostly realized by mesh implantation or flap repair. In our presented cases, we took advantage of long existing cooperation with plastic surgeon team and chose rectus abdominis muscle flap reconstruction. We proved its feasibility and good effect on PH repair.

Conclusion
Perineal hernia repair is challenging. No consensus regarding the ideal method exists. Every case must be assessed individually.
P-056 ELECTIVE OPEN INGUINAL HERNIA REPAIRS- ARE WE DISCLOSING ALL THE RISKS?
Authors: Zhang C , Butnari V , Anber A , Bhargava A 
Published: October 2022

Abstract

Introduction and Aim
Elective open inguinal hernia repairs are one of the most common procedures carried out in the NHS with over 78000 operations per year. There are many risks associated with this procedure and so obtaining informed consent is imperative to patient care and patient choice. The aim of this study is to compare the quality of consent forms for elective open inguinal hernia repairs to the guidance provided by the Royal College of Surgeons (RCS) and the British Hernia Society (BHS).

Method
60 patients (50 male, 10 female) undergoing elective open inguinal hernia repair between 01/09/2021–20/12/2021 were identified retrospectively. Their consent forms were audited against modified guidelines from RCS and BHS. The grade of the consenting surgeon was also noted.

Results
Sepsis (95%), recurrence (85%), and chronic pain (82%) were the most consented risks. Least consented serious risks were persistent numbness (47%), nerve injury (47%), and mesh infection (40%). Notable disparities existed between rates of consent and grade of surgeon: 64% of registrars consented for nerve injury compared to 9% of SHOs and 82% of SHOs consented for haematoma compared to 20% of consultants.

Conclusion
Serious risks such mesh infection and nerve injury were often missed from consent forms. There is inconsistency in consented risks between different grades of surgeon. A standardised consent form would improve consent consistency and potentially reduce rate of litigation for doctors and the trust. Comprehensive pre-made consent forms were therefore designed to better facilitate a standardised approach to the consenting process.