bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-045 LAPAROSCOPIC TAPP APPROACH FOR INGUINO-SCROTAL HERNIAS: IS IT A GOOD OPTION?
Authors: Trujillo Díaz J , Jezieniecki Fernandez C , Gómez López J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C 
Published: October 2022

Abstract

Aim
Hernial defects of the inguinal area have a high incidence, and of them inguino-scrotal defects are less frequent.The classic and most frequently used treatment is the open approach, however, during the last years the endoscopic management of this type of hernias is increasing, obtaining the advantages of MIS.

Material and Method
Retrospective study where we analyzed our database of patients diagnosed with inguino-scrotal hernia undergoing laparoscopic surgery using the TAPP-approach.

Results
8patients with inguino-scrotal hernias were surgically operated on by laparoscopic TAPP approach.Age: 67(RIQ: 39–72.5years)).LOS: 1.
In 75% of patients the duration of surgery was longer than 60minutes.Postoperative complications: scrotal seroma(37.5%), scrotal hematoma(62.5%), Clavien-Dindo≥III: 0%, SSI(0%). Hernia recurrence: 0%. Conversion:0%.Both patients who presented seromas and hematomas in the scrotal region resolved spontaneously after the first and second months.
We performed a comparative analysis between the group of patients operated on for inguino-scrotal hernias versus patients without this type of hernia, both treated by laparoscopic TAPP approach, and observed that patients with inguino-scrotal hernias presented a higher incidence of global complications(50%vs. 4.3% p&lt;0.05),scrotal seroma(37.5% vs.7.2% p=0.008) and hematomas inguino-scrotal(62.5% vs.4.3% p&lt;0.05), all of them with statistically significant differences, however, no differences were found in terms of LOS, serious complications or hernia recurrences.

Conclusions
The laparoscopic TAPP approach to inguino-scrotal hernias is a valid, safe and effective option, and although it presents a high incidence of postoperative scrotal seroma, these are usually resolved conservatively without the need for reoperation.
P-055 LAPAROSCOPIC EXPLANTATION OF GROIN MESH WITH STAPLED EXCISION OF COLO CUTANEOUS FISTULA
Authors: Gandhi J , Chaudhari S 
Published: October 2022

Abstract

Aim
Groin mesh explantation is a challenging situation and a multidisciplinary approach at index explantation surgery can avoid a long term catastrophic situation for the patient .

Material & Method
The history of the patient started a decade back with bilateral laparoscopic TAPP, following which he had swelling in both groin area with high grade fever . He was advised open bilateral groin exploration and explant of the mesh. Post procedure he was kept on antibiotics for few weeks and he was asymptomatic, he developed swelling again and started on anti mycobacterial treatment
He presented four years with foul smelling discharge from the suprapubic area . CT Scan with sinogram revealed a communication with sigmoid colon and tacker from index surgery
We planned laparoscopic approach, stapled excision of sigmoid-cutaneous fistula was performed . Removal of residual mesh and tacker from index under fluoroscopy guidance with skin tract excision .Intra op flexible sigmoidoscopy revealed no lumen compromise .
Histopathology showed granulomatous inflammation for which he was started on atypical mycobacterial treatment for 9 months .He remains uneventful after 2 years of surgery .

Conclusion
Mesh infection should be avoided at index surgery with utmost care to aseptic precautions.
Mesh explantation should be a part of multidisciplinary approach, radiology and colonoscopy were key investigations in this case . One should plan for a complete removal of mesh and tacker/s at index explantation surgery for safe long term outcomes .
P-077 SURGICAL TREATMENT OF LARGE INCISIONAL HERNIA WITH BOTULINUM TOXIN A INJECTION: STUDY PROTOCOL FOR A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL
Authors: Moszkowicz D , Renard Y , Romain B , Gillion J F , Ortega-Deballon P , Passot G 
Published: October 2022

Abstract

Aim
The best strategy for W3 incisional hernia (IH) repair is not known to date and is associated with high risks of recurrence and morbidity. We aim to demonstrate that preoperative Botulinum Toxin A (BTA) injection in the lateral abdominal wall muscles reduces the rate of postoperative morbimortality after large IH (EHS W3) repair with mesh, compared with placebo injection.

Material & Methods
This study will be a prospective, national multi-center, double-blinded, randomized (1:1) superiority phase III trial with two parallel arms: BTA versus placebo injection. Participants will be selected based on an abdomino-pelvic CT-scan without contrast injection performed in the 6 months preceding the patient's surgery. Main inclusion criteria will comprise midline anterior primary or recurrent IH (subxiphoidal to suprapubic), of width ≥ 10 cm, without loss of domain. Patients included will be randomized (1: 1 ratio), by using a computer-generated randomization scheme, and randomization will by stratified on the center and width of the IH (10–15 cm and &gt; 15 cm). Participants will be randomized on the day of the injection, at least 4 weeks before the surgery.

Results
The primary endpoint will be the occurrence of Clavien-Dindo classification grade II or higher post-operative complication during the 90-day postoperative period. Secondary endpoints will include the rates of primary fascial closure, occurrence of component separation techniques, radiological response to injections, consumption of analgesics and pain, and occurrence of clinical and radiological recurrences.

Conclusions
Protocol version 2.0 is currently being assessed for funding by the French Ministry of Health.
P-083 AMYANDS HERNIA WITH RENAL CELL CARCINOMA - A RARE CASE PRESENTATION
Authors: Iqbal A , Kaul A , Sheen A J 
Published: October 2022

Abstract
47 year old gentleman presented to the emergency department with 2 days history of lower abdominal pain and right inguinal swelling which has increased in size during the same duration, he also had one episode of vomiting, bloating and constipation since 2 days. Investigations revealed an inflamed appendix within the right inguinal hernia along with a left renal lesion. The patient underwent emergency open primary repair of inguinal hernia with appendicectomy. Followed up with urology as an outpatient regarding renal lesion and with MDT discussion the patient was subjected for a partial nephrectomy.
P-085 MANAGEMENT OF LATERAL ABDOMINAL WALL HERNIAS
Authors: Köhler G 
Published: October 2022

Abstract
Lateral abdominal wall hernias are rare and inconsistently defined, which is why the use of the EHS classification makes sense, not least for the purpose of comparing the quality of surgical results. A distinction must be made between true fascial defects and denervation atrophy. Based on the available literature, there is generally a low level of evidence with no consensus on the best operative strategy. The proximity to bony structures and the complex anatomy of the three-layer abdominal wall make lateral hernias difficult to care for. The surgical variability include laparo-endoscopic, robotic, minimally- invasive, open or hybrid approaches with different mesh positions in relation to the layers of the abdominal wall. The extensive preperitoneal mesh reinforcement open, transperitoneally laparoscopic (TAPP) or endoscopic extraperitoneally (TEP, TES) has met with the greatest approval. The extent of the required medial mesh- overlap is determined by the distance between the medial defect boundary and the lateral edge of the straight rectus-abdominal muscles. The lateral pre- and retroperitoneal dissection can be extended into the homolateral retrorectus compartment by laterally incising the posterior rectus sheath or can even be expanded by crossing the midline behind the intact linea alba into the contralateral retrorectus compartment. The “intraperitoneal onlay meshplasty” (IPOM) is only a suitable procedure for smaller and closable defects, but it is also important as an “exit strategy” in the case of a defective peritoneum. All procedures are explained using clear illustrations which are protected by copyright and were exclusively published in German in “der Chirurg”.
P-088 HOW TO REPAIR A LATERAL INCISIONAL ABDOMINAL WALL HERNIA?
Authors: Zuvela M , Galun D , Bogdanovic A , Palibrk I , Velickovic J , Djukanovic M , Bogdanovic M , Zivanovic M , Zuvela M , Zuvela M 
Published: October 2022

Abstract

Aim
To present our original method for surgical treatment of patients with lateral incisional hernia (LIH)

Material and Method
Patients with LIH and simultaneous presence of a middle incisional hernia (MIH) were treated by our original technique based on the principles of anterior component separation technique and sublay technique: a) skin and subcutaneous tissue incision along the midline and MIH dissection; b) subcutaneous tissue dissection in the lateral direction to the Spiegel line or the LIH lateral edge on the side of the LIH; c) vertical incision of the external oblique muscle (EOM) lateral to the Spiegel line or the LIH; d) the rectus muscle (RM) dissection from its posterior sheath on the opposite side of the LIH; e) suturing the posterior rectus sheath on the opposite side of the LIH with RM on the side of the LIH; f) suturing of the internal oblique muscle with the lateral edge of the RM on the side of the LIH; g) onlay polypropylene mesh hernioplasty.

Results
Between January 2013 and May 2022, 44 consecutive patients with LIH+MIH underwent surgery. A median (range) LIH defect surface was 90 (20–270) cm2. During mean follow up of 14 months postoperative complications occured in seven (15,9%) patients: seroma in three, hematoma in two, mesh infection and hernia recurrence in one.

Conclusion
Our original method can be one of the good solutions for simultaneous treatment of LIH and MIH.
P-090 EMERGENCY INTRAPERITONEAL ONLAY MESH REPAIR OF INCARCERATED VENTRAL E INCISIONAL HERNIA
Authors: Garbarino S , Latham L , Marzorati A , Gianazza S , Zullo A , Scorza A , Costantini D , Ballabio A , Inversini D , Ietto G , Carcano G 
Published: October 2022

Abstract

Aim
Abdominal wall hernia surgery is the frequent surgical operation. Incarceration and strangulation are the complications for patients going to emergency surgery clinics.Laparoscopic approach in emergency is controversial. IPOM treatment permits safe hernia reduction, accurate abdominal exploration,diagnosis and treatment of unknown hernia.

Material and Methods
in one year,we operated 12 urgent ventral hernia patients with IPOM technique. All patientsshowed hemodynamic stability. We evaluated safety of hernia reduction, conversion rate,operative time,hospital stay, and prosthesis infection.

Results
Nine patients underwent surgery for incarcerated incisional hernia, 3 patients for primary incarcerated ventral hernia. We used a laparoscopic approach. In 10 cases,we placed an intraperitoneal mesh. In two cases, we converted to open surgery, because of small bowel injury. It was never necessary to perform Intestinal resection for strangulated hernia.Contents of hernia sacs were omentum (7 patients), large bowel (1 patients), 4 omentum and small bowel (4 patients). Patients presented signs of small bowel obstruction. Average size of the defect was 6cm.Average operative time was 91 min, the mean post-operative hospital stay was 3.5 days. Post-operative complications weren't recorded. There wasn't mortality. During the follow-up none patients had mesh infection or hernia recurrence.

Conclusion
In emergency the Intraperitoneal Onlay Mesh Repair of Incarcerated Ventral and Incisional Hernia allowed safe adesiolysis, bowel reduction. Laparoscopic approach was associated to low post-operative complications even in emergency setting.
P-092 LAPAROSCOPIC TRANS-PERITONEAL HERNIOPLASTY (TAPP) IN EMERGENCY
Authors: Garbarino S , Latham L , Gianazza S , Colombo E M , Odeh M , Palamara N , Vigezzi A , Costa J , Inversini D , Ietto G , Carcano G 
Published: October 2022

Abstract

The aim efficacy and technical feasibility of TAPP operation by analyzing patients operated on incarcerated inguino-crural hernia in emergency setting.

Materials and methods
In 1 year, we enrolled 8 urgent incarcerated hernia patients operated using laparoscopic trans-peritoneal approach (TAPP) operated on acutely for inguino-crural incarcerated hernia associated with suspected visceral ischemic damage.

Results
We repaired 6 inguinal incarcerated hernia and 2 cases of crural hernia. Among 6 inguinal hernia, only one was recurrent. In one case the laparoscopic approach permitted to exclude an obstructed Spigelian hernia diagnosed through tomography. In another case, TAPP allowed to diagnose omental incarcerated Spigelian hernia. In 3 cases this approach permitted to diagnose concomitant unknown wall defects. All cases presented signs of small bowel obstruction. The content of the sac in three cases was small bowel, in other three cases it was omentum, and in other two cases it contained lipoma. None of the cases were converted to open technique. The operative average time was 95 min; the average hospital stay was 1.5 days. No chronic pain or recurrences were observed after a mean follow up time of 8 months.

Conclusions
The repair of complicated inguino-crural with TAPP in emergency is not a standard treatment. In our experience the laparoscopic approach allowed a safe reduction of hernia, the observation of the feature of hernia content, the diagnosis and repair of unknown wall defect, and a crural defects and contralateral inguinal hernia.
P-095 RECTUS DIASTASIS REPAIR: VARIATIONS OF POSTPARTUM ABDOMINAL WALL ANATOMICAL CHANGES PROPOSE A TAILORED SURGICAL REPAIR. EARLY RESULTS OF THE EXTENDED REPAIR TECHNIQUE STUDY
Authors: Olsson A 
Published: October 2022

Abstract

Aim
A pregnancy can result in permanent anatomical changes such as a persistent rectus diastasis (RD), a widened linea semilunaris and retracted oblique muscles. The diverse anatomical changes contribute to the abdominal deformation and may present in a variety of combinations. A standardized suture repair of the RD may not be sufficient in severe abdominal wall deformation cases. This observational cohort study evaluated an extended repair technique.

Method
A cohort of 44 postpartum women with training resistant core instability symptoms planned for surgical repair were examined with ultrasonography prior to surgery. Participants with severe anatomical changes i.e. diastasis of the linea semilunaris exceeding one cm, were offered an extended repair, re-approximation of both linea alba and linea semilunaris. Results were evaluated with ultrasonography and the Disability Rating Index (DRI), two and twelve months after surgery.
A standardized rectus diastasis suture repair was used in 24 participants with an isolated rectus diastasis. A combined repair with reapproximation of both the linea alba and the linea semilunaris was performed in 20 participants.

Results
Preoperative mean rectus diastasis (widest measurement) was 45 mm (30–75 mm), a mean diastasis of the linea semilunaris (umbilical level) of 15 mm (0–35 mm).
There were no recurrencies at the 12-month follow-up. Early results showed significant improvements of physical function (DRI) but no differences between the two repair technique groups.

Conclusion
The extended repair seems to be a safe and sufficient repair technique in cases with a RD combined with a linea semilunaris diastasis.
P-098 RETHINKING CHRONIC POSTOPERATIVE INGUINAL PAIN (CPIP) DEFINITION
Authors: Kroon L 
Published: October 2022

Abstract

Aim
There is a lack of consensus regarding the definition of chronic postoperative inguinal pain (CPIP). The World Guidelines for Hernia Management (WG) suggests a broader definition of CPIP that does not include pre-operative assessment which decreases comparability between studies. According to the International Association for the Study of Pain (IASP) a clinical assessment of extent and cause of pain is done comparing pre- and postoperative pain, mandating a physical examination at two separate occasions. The aim of this study is to find the real incidence of CPIP with a clinically relevant definition compared to the traditional WG CPIP definition, one year following inguinal hernia repair where both pre- and postoperative clinical evaluation is included.

Material & methods
A prospective observational cohort study performed during one year at a hernia clinic. Patients were clinically assessed and filled out validated questionnaires both pre- and postoperatively. Patients with significant or increased inguinal pain one year after surgery were evaluated for probable causes of chronic pain.

Results
574 patients were included of which 372 were selected for surgical hernia repair. 265 (71%) filled in pre- and postoperative questionnaires. According to WG 9 (3%) patients experienced more pain 1 year after surgery however of those, 5 patients (55%) had non-surgical causes of pain. 3 patients (1.1%) had clinically relevant CPIP one year after surgery (IASP).

Conclusions
Evaluating patient perceived pain both pre- and postoperatively, including a clinical examination of patients with possible CPIP, is imperative to correctly evaluate CPIP following inguinal hernia surgery.
P-099 PERSISTENT POST-SURGICAL PAIN AFTER SURGICAL CORRECTION OF VENTRAL HERNIA REPAIR. PRELIMINARY DATA OF AN OBSERVATIONAL STUDY AT VARESE UNIVERSITY HOSPITAL
Authors: Novazzi C , Guzzetti L , Selmo G , D'onofrio D F , Latham L , Gianazza S , Cannavo' M , Cabrini L , Pappalardo V , Bacuzzi A , Inversini D , Ietto G , Carcano G 
Published: October 2022

Abstract

Aim
Persistent post-surgical pain (PPSP) is one of the most frequent complication after surgery and has important socio-economic consequences.

Materials and methods
We performed an observational analysis of the patients submitted to surgical correction of ventral hernia repair at our University Hospital between 1st February 2021 and 1st January 2022.We registered data about perioperative surgical period. After at least 3 months we proceeded with a phone interview in order to record the incidence of PPSP according to its definition.

Results
We enrolled 61 patients and 26 patients were lost to follow-up. 9 patients (25%) denveloped chronic pain after surgery and 3 cases reported pain that had deteriorated the quality of life (PPSP group).In the PPSP group median age was 53; obesity, COPD, diabetes mellitus, smoking status, were not significant (p &gt; 0,05). Male sex, previous abdominal surgery and open approach showed correlation with PPSP onset. In our cohort demographical and clinical characteristics were not statistically related to PPSP, while the use of locoregional anesthesia could be protective in front of PPSP onset.

Conclusion
At the moment, although there is no shared protocol in the prevention of PPSP, it is possible to implement some interventions to reduce its risk. Our results show that more effective analgesic/anesthetic perioperative measures may help to prevent the adverse consequences of poorly controlled pain, including its transition to PPSP. The main limits of our data is the small cohort analysed and the study protocol without an analysis about immediate postoperative pain and PPSP outbreak.
P-104 A STEP-UP APPROACH FROM IPOM + IN MINIMALLY INVASIVE ABDOMINAL WALL SURGERY
Authors: Arana Iñiguez I , Recreo Baquedano A , Ruiz R , Ariceta López A , Ramírez Cervera J L , Piñera A , Talavera Utrera G , Pérez Otermin I , Otegi Altolagirre I , Blázquez Lautre L 
Published: October 2022

Abstract

Aim
To compare the early outcomes of two different techniques for ventral hernia repair in our abdominal wall surgery unit.

Materials and Methods
A prospective non-randomized review was perfomed including patients who underwent laparoscopic hernia repair from January 2018 to April 2022. All patients were followed-up for 1 month and the hernia orifice was closed in all cases. Patients and hernias characteristics, operative data and early complications were reviewed. Postoperative pain was defined as ≥4 value in Visual Analogue Scale.
We compared 2 laparoscopic techniques: intraperitoneal mesh fixed with a double crown of resorbable tackers (IPOM+) and self gripping sublay positioned mesh (preperitoneal –PREP- or retromuscular –RIVES- position).

Outcomes
During the study period, 44 patients were assigned into 2 groups: 31 (70%) in IPOM+ group and 13 (30%) in Rives/Preperitoneal group. No differences were found in risk factors, population and hernia data between both groups. 6 patients (19%) from IPOM+ group presented postoperative pain and only 1 patient (7,7%) in Rives/Prep group (p: 0,30). There was no differences in other complications, length of stay or operative time.

Conlusion
Early outcomes of sublay techniques (Rives or preperitoneal) do not report more complications during perioperative time, but they could help reducing immediately postoperatorive pain.
P-116 UNUSUAL VISCERAL CONTENT IN PARASTOMAL HERNIAS - A REVIEW OF LITERATURE
Authors: Bandyopadhyay S , Sheen A J , Iqbal A 
Published: October 2022

Abstract
Parastomal hernias remain the most common complication of an ileostomy or colostomy - It is estimated that upto 50 percent of patients with a stoma will develop one. They may be classified as Interstitial, Subcutaneous, Intrastomal or Peristomal. The most common contents of Parastomal Hernias are bowel and omentum.However, other visceras have been reported as a content of a parastomal hernia. This presentation is aimed at a literature review of such surprise surgical situations that are challenging to the surgeons.
Presence of gallbladder in a parastomal hernia has been reported by multiple authors - there is reported incidence of incarceration or acute inflammation of the gallbladder. Cholecystectomy t the time of parastomal hernia repair has been reported though some patients have been treated non-operatively as well.
Similarly, there have been multiple reports of stomach beong the contents of parastomal hernias - there have been patients presenting with gastric outlet obstruction who have been found to have the stomach being a content of their parastomal herniation.
This presentation reviews the available literature and presents the challenges and oprions that a surgeon may face when treating similar patients.