bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC-045 AMBULATORY HERNIA SURGERY IN PRIMARY CARE
Authors: Kumaran N , Bylapudi S , Kirmani S , Hodgson G L , Tennakoon A , Rao M 
Published: October 2022

Abstract

Background
Approximately 100,000 hernia repairs are performed in the UK annually, the vast majority in hospital usually under general anaesthetic. Due to increased pressure on hospital facilities especially after the COVID-19 pandemic the waiting times for non-emergency surgery for benign conditions has increased. This study outlines the development and feasibility of a dedicated ambulatory primary care hernia service and examines the outcomes achieved between November 2018 and November 2021.

Methods
We prospectively analysed of records of 212 patients who underwent hernia repair in a primary care centre during the above period. Inclusion criteria were a) BMI&lt;35 b) uncomplicated inguinal or umbilical hernia c) non recurrent hernia. The techniques used were Lichtenstein mesh repair for inguinal hernias and a primary sutured repair for ventral hernias. All procedures were performed as day-cases under local anaesthesia without sedation. All patients were telephoned by a healthcare professional a day after their operation. The primary outcomes of the study were length of stay, immediate complications and the secondary outcome was cost effectiveness.

Results
The median length of post-operative stay was 26 minutes. Complications were low and seen only in 5 patients and managed conservatively. The cost of hernia repair in primary care in UK is only £1012 when compared to £1800 in an NHS hospital.

Conclusion
Routine elective abdominal wall hernia repairs can be performed in a primary care setting, safely, with good clinical outcomes and clear economic benefits. However, this depends on the availability of surgeons and adequate funds to establish the service.
OC-046 SURGICAL ASPECTS AND EARLY MORBIDITY OF RECURRENT INGUINAL HERNIAS DURING OPEN REOPERATION
Authors: Spencer Netto F , Mainprize M , Yilbas A , Szasz P 
Published: October 2022

Abstract

Background
Inguinal hernia recurrences (IHR) are relatively common and have higher complexity and complication risk at reoperation when compared with primary inguinal hernias (PIH). This study aims to further characterize the patterns of recurrence and early complications observed by type of hernia repair at the index surgery.

Methods
After REB approval, a review of charts from patients undergoing elective first reoperation for IHR from 2013–2017 was performed. First operations were classified as: childhood repair, laparoscopic repair, open tissue repair, open mesh repair and Shouldice repair. Early complication included hematoma, infection and seroma. Statistical analyses were completed.

Results
A total of 1281 patients underwent 1340 surgeries for IHR in the study period (4.9% of all inguinal hernias operated). There wa an increased proportion of males, direct type hernias and wound infection in IHR group (p&lt;.001) when compared with PIH repairs. During surgical procedure, the length of surgery was longer, scarring of tissues heavier, nerve identification lower in patients with previous open mesh and Shouldice repairs, in comparison to other groups (childhood, laparoscopic and open repair - p&lt;.001).

Conclusion
Recurrent inguinal hernia repairs present higher complexity than PIH repairs and incurr in higher chances of early postoperative complications. The type of PIH repair technique influences surgical difficulties encountered in the open reoperation, with open mesh and Shouldice techniques being associated with higher surgical difficulty. This information may help in surgical planning, according with the anticipated leverl of procedure difficulty.
OC-048 CHRONIC GROIN PAIN. ALGORITHM FOR EVALUATION
Authors: Santilli O , Santilli H , Nardelli N , Scaravonati R 
Published: October 2022

Abstract

Aim
Chronic groin pain is a challenge for surgeons. It is the main symptom in pathologies caused by sports activities (Sportsman's Groin) and is also found as a complication after inguinal hernia repair.
Currently multivariable analysis reports that : younger age (≤40 years), small hernias (EHS I: &lt;1.5 cm), and preoperative pain; are risk factors for the appearance of postoperative chronic pain.
The Manchester Consensus concluded that general surgeons have límited experience on the topic and the difficulty of making randomized trials with high level of evidence
The main objective is to describe a diagnostic algorithm to be used in patients with chronic groin pain and those with small hernia that are going to be repaired.

Material & Methods
A multidisciplinary team had developed an assessment, diagnosis, and treatment algorithm for CGP. The team is composed of surgeons, physiotherapists, orthopedists, and imaging specialists. We implement this algorithm in young patients (16–30) who consult for chronic groin pain, even those with inguinal hernia diagnosis.

Results
A total of 5,737 patients were assessed by the multidisciplinary team from June 2009 to June 2021.
The most frequent clinical entities registered were tendinopathies: iliopsoas-pectineus- related (42.7%) and adductor-related (39.5%).
In those patients with postoperative pain, (45%) reported preoperative pain and (91%) were not related to neuropathies.

Conclusions
The algorithm has proven to be safe and successful. It has been used in patients who consulted with pre and postoperative chronic groin pain, with a high rate of achievement
OC-049 ROBOTIC RE-TAPP: A MINIMALLY INVASIVE ALTERNATIVE FOR THE FAILED POSTERIOR REPAIR
Authors: Amaral P , Dias E , Pivetta L , Carvalho J P , Macret J , Furtado M , Roll S 
Published: October 2022

Abstract

Aim
To describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair.

Material and Methods
patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through may 2022 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence (SSO), surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted.

Results
thirty patients (96,7% male, mean age 56,5 years, mean body mass index 28) had 41 hernias repaired (N=11 bilateral). Average operative time was 165 ± 51.9min (range 90–300). There were three intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Four SSOs occurred (N=3 seromas and N=1 hematoma. After a median 56 months follow-up [IQR 22–77], no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain.

Conclusions
on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be safe, feasible and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.
OC-054 LONG-TERM OUTCOMES OF POSTERIOR COMPONENT SEPARATION WITH TRANSVERSUS ABDOMINIS RELEASE (TAR) IN LARGE AND OTHER COMPLEX VENTRAL HERNIAS: A SINGLE-SURGEON EXPERIENCE
Authors: Chatzimavroudis G , Kotoreni G , Pavlidis T , Gotti K , Papaziogas V 
Published: October 2022

Abstract

Aim
The application of component separation techniques for the repair of large and other complex ventral hernias, has been a landmark in their successful management. The aim of this study is to present our experience with the posterior component separation with transversus abdominis release (TAR) in patients with these very demanding ventral hernias.

Material & Methods
A retrospective analysis of prospectively collected data of all patients who underwent elective ventral hernia repair with TAR technique between January 2016 and May 2021 was performed. Selection of the type of inserted mesh was based on the risk of developing surgical site infection (SSI) and other surgical site occurrences (SSOs). Preoperative, intraoperative, and postoperative data were analyzed.

Results
A total of 167 patients with large and other complex ventral hernias were included in the final analysis. More than 80% of patients had one or more comorbidities. Of all patients, 156 (93.4%) had a history of previous abdominal surgery, 42 (25.1%) had a history of SSI and 11 (6.6%) had active fistulas, of which nine involved previous implanted meshes. Postoperatively, SSOs were presented in 12 patients (7.2%), including three cases of SSI. Neither mesh infection occurred, nor mesh excision required. With a mean follow-up of 3 years, only one recurrence has been observed.

Conclusions
With a wound complication rate of less than 8% and a recurrence rate of less than 1%, our results show that TAR is a reliable, safe and effective technique for the repair of large and other complex ventral hernias.
OC-058 MORTALITY OF THE ELDERLY: ANALYSIS OF DATA FROM THE LAPARASTOMA REGISTRY
Authors: Wöhler A , Schaaf S , Willms A , Schwab R 
Published: October 2022

Abstract

Aim
The therapeutic concept of open abdomen with temporary abdominal wall closure was introduced about 30 years ago. Since that time, various surgical strategies have been tried, continuously developed and established. In May 2015, a laparastoma registry was released in the form of an internet-based online platform.

Methods
Data from the laparastoma registry were analyzed and evaluated. The focus of the study was on the mortality of patients in the age group 75 years and older who underwent laparastoma treatment. Special attention was paid to the previous diseases, risk factors, MPI.

Results
913 patients with open abdomen and subsequent laparastomy treatment were enrolled in the laparastomy registry from 2015 to 2022. 65% of patients were male. 69.6% had secondary diseases. The indications for laparastoma establishment were peritonitis (37.2%, N=340), trauma (9.2%, n=84), abdominal compartment (18.1%, n=165) and others. The overall mortality rate was 28.7%. The mortality rate in the group between 75 and 80 years (n=155) was 36% (OR= 1.445 [CI: 1.002–2.008]; p=0.049). The mortality rate in patients older than 75 years (n=67) was 40.3% (OR 1.680 CI 1.008–2.802; p=0.047).

Conclusion
In the evaluation, three key questions were raised and analyzed by the study: what is the mortality in the elderly patients under laparastoma treatment, what is the mortality in the patients over 75 years old? What are the leading risk factors in the two groups.
OC-059 TEMPORARY ABDOMINAL CLOSURE NEGATIVE THERAPY IMPROVES DEFINITIVE FASCIAL CLOSURE RATES IN PATIENTS WITH OPEN ABDOMEN MANAGEMENT
Authors: Bannon A , Leatherby R , Birtles L , Augustine T , Moinuddin Z , Van Dellen D 
Published: October 2022

Abstract

Aims
Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement of the bowel by a thickened peritoneum due to prolonged peritoneal dialysis exposure. We are an international referral centre, typically managing cases with a planned open abdomen (OAM) and scheduled relook after 24–48 hours. We compare outcomes for those patients whose OAM was with simple packing (betadine-soaked-gauze) with negative pressure therapy providing temporary abdominal closure (TAC).

Methods
A retrospective review of a contemporaneous database of patients who underwent surgery for EPS between 2010–2020 was performed. Primary endpoints were time to definitive closure and closure method (primary fascial closure vs. bridged biologic mesh closure vs. failure to close fascia). Secondary endpoints included comparison of stoma formation, bowel resection, fistulation rate, enterotomy formation, re-operation post closure, and wound infection.

Results
99 patients had OAM (56 static packing; 43 TAC.) Patients with TAC were significantly more likely to undergo primary closure of fascia when compared to those patients managed with static packing, (63% vs 13%, p&lt;0.0001, Chi Sq). The TAC group required fewer theatre episodes (n=2.27 vs. 4.78, p&lt;0.0001, t-test) and time in days to achieve closure (n=2.78 vs n=4.68, p&lt;0.005, Chi Sq), with less failure to close episodes and returns to theatre 30 days post closure.

Conclusion
This study provides definitive evidence of TAC efficacy for fascial closure following OAM. This provides definitive benefit over traditional open abdominal methods. It may provide benefit in definitive open abdominal management in other areas (sepsis and trauma) and requires further study.
OC-063 BASELINE DATA AND NORMAL ANATOMY OF THE ABDOMINAL WALL IN AN OBSERVATIONAL PROSPECTIVE COHORT STUDY OF NULLIPAROUS WOMEN
Authors: Woxnerud K , Sandblom G , Olsson A 
Published: October 2022

Abstract

Aims
The aim of this study was to describe the pre-partum anatomy of the abdominal wall in a cohort of nulliparous women, with the main purpose to use as a reference for management of patients with postpartum abdominal core instability.

Materials & Methods
Seventy consecutive women were examined with ultrasonography measuring inter-recti distance (IRD), anatomical variations of linea semilunaris and the oblique muscles. Waistline was assessed during activated and relaxed abdominal core. Participant characteristics were registered. Questionnaires regarding habitual physical activity (Baecke), low back pain (Oswestry), physical functioning (DRI), urinary incontinence (UDI-6 and IIQ-7) and quality of life (SF-36) were answered.

Results
Response rate was 100%. Mean age was 30.5 years (19–50), mean BMI 23.5 kg/m2 (18.4–37.1). Ultrasonography showed a mean IRD 1.02 mm (0.27–2.35) at the superior border of the umbilicus, 0.93 mm (0.36–2.01) three cm above the umbilicus, 0.21 mm (-0.53–0.98) two cm below the umbilicus; mean thickness of the linea alba 0.28 mm (0.15–0.5); mean distance between the lateral lining of the rectus muscle and the external, internal and transverse oblique muscles of respectively 1.19 (-0.99–2.82), 0.09 mm (-1.37–1.3) and 1.46 mm (-1.36–3.19) at umbilicus level. Responses to the questionnaires showed overall low values on DRI, UDI-6, IIQ-7 and Oswestry; and overall values on Baecke and SF-36 similar to the normative population.

Conclusions
This study provides baseline data on the normal abdominal wall anatomy as well as mean values of activity, physical function, disabilities and quality of life, in a healthy nulliparous female cohort.
OC-064 TISSUE KINDNESS: A COMPARISON OF TISSUE MANIPULATION BETWEEN A NOVEL SUTURING DEVICE FOR STANDARDIZED ABDOMINAL CLOSURE AND MANUAL NEEDLE TECHNIQUE
Authors: Börner G , Lööf E , Edelhamre M , Rogmark P , Montgomery A 
Published: October 2022

Abstract

Aim
Wound healing is influenced by contamination, wound tension, and tissue handling. Suturing includes tweezer compression and medial traction that might compromise the fascia. This study compared forces involved in suturing with a novel suturing device for standardized abdominal closure and curved suture needles of two sizes.

Method
A model to measure suturing-forces was developed. Ten theatre nurses and 25 surgeons were introduced to the novel suturing-device. Participants performed 10×3 needle-pull-throughs using the device and two sizes of conventional suture needles: 36mm Large Needle (LN) and 26mm Small Needle (SN). Tweezer force and medial tissue traction force were recorded. Needle pull-through time, maximum and Area Under Curve forces (AUC) were calculated.

Results
Device training time was 4min 25s. Maximum tweezer-force was 892g (420.4) for the device, 1037g (457.5) for LN and 1097g (491.1) for SN (p&lt;0.001). Maximum traction-force was 62g (57.6) for the device, 61g (45.4) for LN and 54g (50.0) for SN (p=0.117). Tweezer-force AUC was 2422gs (1797.2) for the device, 3442gs (1550.0) for LN and 3221gs (1588.9) for SN (p&lt;0.001). Traction-force AUC was 148gs (239.0) for the device, 174gs (160.8) for LN and 142gs (161.0) for SN (p=0.068). Needle-pull through time was 3.4s (2.15) for the device, 4.4s (2.12) for LN and 3.9s (1.90) for SN (p&lt;0.001)

Conclusion
The suturing device was faster and less traumatic to tissue for tweezer-force. Medial traction forces were similar. The novel suturing device is quick to learn and gentle to the tissue and device seems promising in facilitating fascial closure.
OC-067 HIATAL HERNIA RECURRENCES AFTER LAPAROSCOPIC SURGERY: EXPLORING CONTRIBUTING SURGICAL FACTORS
Authors: Akmaz B , Hameleers A , Boerma E G , Vliegen R F A , Greve J W M , Meesters B , Stoot J H M B 
Published: October 2022

Abstract

Aim
The recurrence rate of hiatus hernia (HH) is high after laparascopic surgery (25–42%). HH repair can be reinforced by means of additional ventral sutures, pledgets or mesh placement. We determined the recurrence rate of HH after surgery and established whether lower long-term recurrence rates can be achieved with reinforcement techniques.

Methods
Patients were included in this retrospective cohort study if they underwent a laparoscopic fundoplication in our hospital between 2012–2019. HH was measured on CT scans and patient files were reviewed.

Results
In total, 307 patients were included, 206 women and 101 men. Pre-operatively, 102 patients were diagnosed with type III HH and 68 patients with type IV HH. The median transverse diameter of the HH was 3.2 cm. 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of ventral sutures in 132 patients, pledgets in 89 patients and mesh in 17 patients. After primary surgery, recurrence of HH was diagnostically confirmed in 64 patients (20.8%). Secondary surgery was performed in 54 patients (17.6%) and tertiary surgery in 5 patients (1.6%). Use of pledgets during primary surgery (OR=0.34, p=0.048) was significantly associated with fewer recurrences, corrected for confounding factors. Use of ventral sutures and mesh were not significantly associated with reduced recurrence rates.

Conclusions
The recurrence rate among HH patients in our hospital was 20.8% with a mean follow-up time of 6 years. In future, the use of pledgets might lead to fewer recurrences after primary laparoscopic repair of HH.
OC-068 THE USE OF VAC IN THE SALVAGE OF INFECTED SYNTHETIC MESHES
Authors: Fouza A , Simeonidou E , Goutziotis I , Petras P , Kambaroudis A 
Published: October 2022

Abstract

Introduction
Mesh-related infections consist a major complication of hernia repair operations that can negatively affect postoperative outcomes. Until recently, surgical removal of the mesh was the only treatment option and it was related to increased morbidity. VAC devices are a proper alternative in treating such infections and can eliminate the need to remove the infected mesh. The negative pressure that is used, removes the exudate and enhances revascularization and granulation of the wound. Such devices promote quicker wound healing, compared to conventional wound dressings.

Aim
The aim of the study is to review current literature and present three relevant cases from our center.

Materials and Methods
During 2020–2021, we encountered three cases of synthetic mesh infection after incisional hernia repair. The patients were treated conservatively, with the application of VAC devices and targeted antimicrobial therapy. All three patients were discharged and continued to visit the hospital as outpatients in order to change the dressings.

Results and conclusions
In all three cases, complete wound healing was achieved and the infection was treated successfully, without removing the mesh. In conclusion, the use of VAC is an alternative therapeutic strategy of low risk that can contribute to the salvage of the infected mesh.
OC-072 SYSTEMATIC REVIEW AND META-ANALYSIS OF PREOPERATIVE ADMINISTRATION OF BOTULINUM TOXIN AS ADJUNCT TO VENTRAL HERNIA REPAIRS
Authors: Dias E , Amaral P , Zucchini G , Pivetta L , Carvalho J P , Macret J , Malheiros C , Roll S 
Published: October 2022

Abstract

Aim
Preoperative application of botulinum toxin (BTX), with or without preoperative progressive pneumoperitoneum (PPP), is an adjunct to complex ventral hernia repairs, causing flaccid paralysis. We aim to evaluate the benefit of BTX in the advancement of the lateral musculature and decrease hernia defect width.

Material & Methods
It was elaborated a systematic review and meta-analysis following PRISMA guidelines and registered at PROSPERO. “Ventral hernia”, “incisional hernia”, “abdominal wall” and “botulinum toxin” were searched. PubMed (Medline), EMBASE (OVID) and LILACS databases research.

Results
Five studies (235 patients) showed tha BTX significantly increases the lateral abdominal wall muscles length (4,07cm) (95%CI (3.65;4.49), p&lt;0,1 I2=47%). Two studies (113 patients) showes that hernia defect width raised 1.24 cm (95%CI (-3.06;5.53), p&lt;0,05, I2=76%) after BTX with or without PPP.

Conclusions
Increase in the volume of the abdominal cavity after BTX and PPP by enlargement of abdominal wall muscles may be related to improve outcomes such as decreasing abdominal compartiment syndrome and surgical site occurrences.
Despite the Increase in the lateral abdominal wall after BTX, the decrease in hernia defect width was not obseved. Insted, meta-analysis showed a tendency of width increasing, taking into account considerable heterogeneity, witch may be related to PPP association.
BTX in complex ventral hernias increases lateral abdominal muscles length and, thus, is suposed to decrease poor surgical outcomes, although the transverse diameter of the defect does not reduced as expected. Futher studies are necessary to evaluate benefits of BTX in complete fascial closure.
OC-073 PATHWAYS OF THE PREPERITONEAL PLANE: FROM THE “FATTY TRIANGLE” IN RIVES TO THE “FATTY TRIDENT” IN EXTENDED RETROMUSCULAR ABDOMINAL WALL RECONSTRUCTION
Authors: Medina Pedrique M , Lopez Monclus J , De Robin Valle De Lersundi A , Blasquez Hernando L , Rial Justo X , Cruz Cidoncha A , Nogueira Sixto M , García-Ureña M Á 
Published: October 2022

Abstract

Aim
Retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence on retromuscular preperitoneal dissections.

Material & Methods
Thirty frozen cadaver torsos were dissected by posterior component separation (PCS). The shape of the preperitoneal fat was identified, and the dimensions and distances were calculated.

Results
Results showed that preperitoneal fat resembles a trident, along the midline under the linea alba, and expands in the epigastrium into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach Retzius´s space. Bogros space communicated the root of the trident laterally with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum uncovered by the preperitoneal trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair.

Conclusion
The concept of preperitoneal fatty trident may be of practical assistance in performing hernia procedures, from the simple ventral hernia repair to more complex preperitoneal ventral repair or PCS techniques. The consistency of this layer allows us to follow three specific pathways to the plane between the peritoneum and muscles to extend the preperitoneal dissection.