bluuebunny/crossref_metadata_2025_split huggingface dataset:
OC-029 LAPAROSCOPIC INGUINAL HERNIA REPAIR IS FEASIBLE IN PATIENTS WHO HAVE HAD PREVIOUS ABDOMINO-PELVIC SURGERY WITH NO INCREASED RISK OF COMPLICATIONS COMPARED TO OPEN REPAIR
Authors: Hayward R , Smith J J , Kontovounisios C , Qiu Mbbchir S , Warren O J 
Published: October 2022

Abstract

Introduction
This study aims to understand whether previous abdomino-pelvic (AP) surgery is a predictor of peri-operative complication in inguinal hernia surgery and if there are discrepancies between laparoscopic or open repairs.

Material & Methods
All patients operated on within a 5-year period were audited and subcategorised based upon history of AP surgery. Patients were also categorised into laparoscopic and open groups. Data collected included complication rates, recurrence rates and readmission within 30 days.

Results
205 patients underwent repair of 288 hernias. 80 (39%) patients had a history of AP surgery. 32 patients suffered a complication (15.6%). 85% of the repairs were laparoscopic in the AP group vs 96.4% in the non-AP group (p=0.02). Complication rates were 17.5% and 14.4% in the AP group and non-AP group respectively (p=0.55). These included superficial infection (0% vs 2.4%, p=0.16), haematoma (11.3% vs 4.8%, p=0.08), seroma (5.0% vs 4.8%, p=0.95), persisting numbness (0% vs 0.8%, p=0.42), and chronic pain (1.3% vs 0.8%, p=0.75). There were no mesh infections or explantation in either arm. A greater proportion of patients in AP group required overnight stays (32.5% vs 21%, p=0.08). At median follow up 1.8 years, recurrence rates were 3.8% vs 1.6%, p=0.33 in AP and non-AP groups respectively.

Conclusions
Laparoscopic inguinal hernia is feasible in most patients with a history of AP surgery. Compared to open repair, there were no significant differences in recurrence or complication rates in patients with previous AP surgery. Therefore, previous AP surgery should not be a contraindication for laparoscopic repair.
OC-032 IMAGE-BASED DEEP LEARNING MODELS (DLMS) TO PREDICT LONG TERM QUALITY OF LIFE (QOL) FOLLOWING ABDOMINAL WALL RECONSTRUCTION (AWR)
Authors: Katzen M , Murphy K , Ayuso S , Scarola G , Colavita P , Augenstein V , Heniford B T 
Published: October 2022

Abstract

Aim
To apply image-based DLMs to predict post-operative QOL following AWR.

Materials & Methods
A prospective, institutional hernia-database was queried for patients with preoperative abdominal CT-imaging, a preoperative and 1-year postoperative Carolinas Comfort Scale(CCS) survey, and no recurrence. “Symptomatic” was defined as CCS-score≥2(2=mild and bothersome). Google Xception existing architecture model was used with ImageNet database pre-initialized weights to classify symptomatic and non-symptomatic patients. Patients were divided into 80:20-training:testing samples for model generation and evaluation. Model training, test accuracies, and loss-functions were evaluated to determine performance and discriminative ability.

Results
Of 244 patients, mean age was 60.4±11.8 years, mean BMI:33.0±7.1kg/m2, female:57.1%, tobacco use:14.3%, diabetic: 24.5%. Median[IQR] hernia defect size was Exactly 180cm2[90–324]; 66.1% had a failed repair. CDC wound classifications Included: 75.9% class-I, 8.3% class-II, 9.1% class-III, 6.6% class-IV. Preoperatively, hernia-related pain(70.2%) and movement limitations(72.3%) were common. Mesh position was predominantly preperitoneal(91.6%). Median[IQR] mesh size was 900cm2[572–1050]. Anterior component separation was required in 17.9% and posterior in 20.4%.
One-year postoperatively, reported symptoms included: mesh sensation-39.5%, discomfort-37.8%, movement limitations-37.0%.
DLMs utilized 6,441-CT-images(5,097 training-sample). Proportions of symptomatic patients were 48.9%(85/174) in the training-sample and 50%(35/70) in the test-sample. Highest DLM training accuracy was 85.37%(loss=0.3766) at epoch 15/50 with 79.30%(loss=0.3766) comparative validation accuracy, demonstrating strong discriminative ability in model classification between symptomatic and asymptomatic patients. Lower accuracy due to model overfitting was observed after 50 epochs.

Conclusions
Image-based DLMs using standard, preoperative CT images very successfully predicted 1-year AWR QOL. The impact of DLMs on preoperative counseling/consent for surgery could be revolutionary.
OC-037 HERNIA DEFECT CLOSURE IN POLYPROPYLENE BASED LAPAROSCOPIC HERNIOPLASTY TO AVOID SEROMA FORMATION AND HERNIA RECURRENCE: A PROSPECTIVE COHORT STUDY
Authors: Sarvani M , Lokendra Venkata Prasad M 
Published: October 2022

Abstract

Aim
This is a Prospective Cohort study, to assess a preventive effect, through closing hernia defect in laparoscopic mesh hernioplasty with polypropylene based best hands-on surgical method. The study could provide promising outcomes with diminishing seroma formation and recurrence rate.

Methods
The study were conducted from April 2017 to until date. The study persuaded with nearly 328 cases from Tertiary Care Centre who underwent laparoscopic trans-abdominal and extraperitoneal patch plasty (TAPP) (TEPP). Hernia defect closure were performed through this polypropylene mesh and deployment using sutures to all patients. The primary outcomes regarding seroma formation, recurrence of hernia, Pre-operative status and post-operative complications was all observed and recorded.

Results
About 328 indirect and direct hernia defects were recruited and indulged for study. All the defect closure operations by polypropylene mesh hernioplasty for all types of hernia repair exhibited high success rate, without hernia reccurrence and minimal seroma formation.

Conclusions
The closure of Hernia defect in laparoscopic polypropylene mesh hernioplasty explicated to be secure and effective technique and would significantly decrease post-operative incidence of seroma formation without increasing hernia recurrence risks, chronic and acute pain. The approach can be recommended for scrotal or larger hernia repair as well.
OC-038 RISK FOR CONTRALATERAL INGUINAL HERNIA REPAIR FOLLOWING PRIMARY UNILATERAL HERNIA REPAIR – A REGISTER-BASED STUDY
Authors: Olsson A , Sandblom G , Franneby U , Sondén A , Gunnarsson U , Österberg J , Dahlstrand U 
Published: October 2022

Abstract

Aim
To investigate the incidence as well as the factors predictive for a subsequent hernia repair on the contralateral side following a primary unilateral hernia repair.

Material & Methods
Prospective population-based study of data from the Swedish Hernia Register based on 151,297 patients operated with an index unilateral inguinal hernia mesh repair using open and endo-laparoscopic technique, during 2007–2019. Incidence, predictive factors and time to a contralateral hernia repair was analysed.

Results
There were 7.4% registered contralateral hernia repairs with a median time of 2.7 years to a subsequent contralateral repair following the index unilateral hernia repair. Median follow-up time was 7.5 years. Significant predictors for a subsequent contralateral hernia were, male sex (HR 1.78, 95% CI 1.61–1.97), high age (HR 1.01 95% CI 1.006–1.009), medial inguinal hernia (HR 1.05, 95% CI 1.003–1.098), combined inguinal hernia (HR 1.10, 95% CI 1.03–1.18), hernia defect size 1.5–3.0 cm (HR 1.10, 95% CI 1.03–1.17), hernia defect size &gt; 3 cm (HR 1.36, 95% CI 1.27–1.45) and a repair on the left side (HR 1.30, 95% CI 1.25–1.35). Endo-laparoscopic repairs and obesity were associated with a lower incidence of a later contralateral repair.

Conclusion
If the relevant risk factors, i.e., male sex, high age, large hernia defect size, medial or combined hernia, are present at a unilateral endo-laparoscopic groin hernia repair and the decision has been shared with the patient, exploration of the contralateral groin and prophylactic mesh placement may be considered.
OC-061 IMAGE-BASED DEEP LEARNING MODELS (DLMS) IDENTIFY ABDOMINAL WALL RECONSTRUCTION (AWR) PATIENTS RECEIVING PREOPERATIVE BOTULINUM TOXIN A (BTA) WHO REQUIRE COMPONENT SEPARATION TECHNIQUE (CST)
Authors: Ayuso S , Elhage S , Zhang Y , Katzen M , Marturano M , Salvino M , Augenstein V , Colavita P , Heniford B T 
Published: October 2022

Abstract

Aim
Preoperative BTA facilitates muscle/fascia elongation and fascial closure, which increases the durability of hernia repair and may reduce requirement for CST. The aim of this study was to develop image-based DLMs that predict whether patient will require CST if injected with BTA prior to surgery.

Methods
An institutional database was used to identify AWR patients who received preoperative BTA and had preoperative CT imaging. Axial CT cuts of the hernias were rendered to train and develop a DLM. The primary outcome was a ROC for predicting CST. The DLM was tested on CT scans from a pre-identified subset of patients who underwent CST and did not receive preoperative BTA.

Results
There were 116 patients who met criteria (4,580 CT images). Of these patients, 69 (59.5%) required CST (2884 images); 47 patients (40.5%) did not undergo CST (1,696 images). The DLM ROC was 0.78 (Figure 1); accuracy, sensitivity, and specificity were 0.79, 0.86, and 0.68, respectively. There were 98 patients in the test set; 57 (58.1%) were predicted to require CST and 41 (41.9%) were not. For patients with an M1 hernia component, 21.1% were predicted to be spared CST versus 46.8% those with an M2-M5 hernia component (p=0.04).
Figure 1 Model Performance for CST Prediction

Conclusions
Image-based DLMs accurately predicted which patients receiving preoperative BTA may require CST. When the DLM was applied to a test set, patients with an M1 hernias were very likely to require CST, which is consistent with previously reported data, further validating the model.
OC-069 EFECTIVENESS OF PROPHYLACTIC ONLAY MESH FOR PREVENTION OF TROCAR HERNIA: PRELIMINARY RESULTS OF A RANDOMIZED CLINICAL TRIAL
Authors: Ciscar A , Ruiz P , Saez E , Vila M , Gomez M , Troyano D , Abadal M , Pereira J A , Badia J M 
Published: October 2022

Abstract

Aim
Trocar site hernia (TSH) incidence is a common complication of laparoscopic surgery. In the literature there is a lack of tools to prevent it. Our aim was to assess the effectiveness and safety of a prophylactic measure to decrease it.

Methods
A multicentric randomized clinical trial was performed in high-risk patients (diabetes mellitus and/or age ≥70 years and/or BMI ≥30 Kg/m2 and/or extended incision for specimen retrieval) who underwent laparoscopic cholecystectomy in an elective or emergency setting. Patients were allocated to prophylactic onlay polypropylene mesh fixation (intervention) or standard trocar closure (control). The main aim was to analyze the efficacy of the intervention, being TSH incidence the primary outcome. Clinical and radiological follow up was atleast 1 year after surgery. Secondary endpoints were technique-related complications.

Results
134 patients were included (70 and 62 to intervention and control arm, respectively). Groups were homogeneous. Mean [SD] age, 64.8 (17.3) years; 80 (60, 6%) women. The cumulative TSH incidence was lower in the intervention group although not reaching significant differences, either when were radiologically (16 [26.7%] vs 17 [37%], p = 0.294) or clinically assessed (9 [17.6%] vs 9 [24.3], p = 0.593). No differences in surgical site infection, hematoma or seroma were detected. Mean follow-up was 736 days (min. 365 – max. 1294).

Conclusions
Our preliminary results points out that the overall TSH incidence is extremely high when properly assessed. A polypropylene onlay mesh would not be an effective measure to decrease the TSH incidence. Radiological evaluation would show more accuracy.
OC-070 A NOVEL SELF-GRIPPING LONG-TERM RESORBABLE MESH PROVIDING TEMPORARY SUPPORT FOR PRIMARY VENTRAL AND INCISIONAL HERNIA
Authors: Vestberg R , Bouré L , Lecuivre J , Payet E , Radlovic A , Bayon Y 
Published: October 2022

Abstract
Medtronic recently developed a novel synthetic fully long-term resorbable self-gripping mesh to reinforce soft tissue where weakness exists during ventral hernia repair procedures. This resorbable mesh is a macroporous, knitted, poly-L-lactide, poly-trimethylene carbonate copolymer monofilament mesh with the ProGrip™ technology.
The biocompatibility profile of the mesh has been extensively established and documented. No systemic nor local adverse reactions have been observed from implantation to complete resorption and metabolization of the mesh in a subcutaneous implantation preclinical rabbit model.
Its performance was evaluated at 20 weeks using a modified published preclinical porcine model of hernia repair (Martin, 2013; Deeken, 2013). Histologic examination of the implantation sites confirmed that this novel mesh was well tolerated and led to new extracellular collagen matrix formation. The burst strength of the hernia repair sites reinforced with the new mesh was statistically equivalent to the one of the native abdominal walls.
Currently marketed ProGrip™ meshes have been clinically and successfully used with less mechanical fixation devices than non-self-gripping meshes (Chastan, 2009; Rangwani, 2021). The new self-gripping long-term resorbable mesh fixation performance was demonstrated to be statistically equivalent to the one of ProGrip™ Self-Gripping Polyester Mesh both in ex-vivo testing and in an in vivo porcine model. This should support the ease-of-use feature of the mesh with a limited need for additional mechanical fixation, which will likely be associated with a shorter surgical time.
The preclinical tests of the self-gripping resorbable mesh are compelling enough to make it a new mesh candidate for future clinical use.
P-019 BIOELECTRIC IMPEDANCE ANALYSIS TO DETERMINE THE RISK FACTORS FOR INGUINAL HERNIA
Authors: Bostan M S , Ugurlu C , Sahin A , Koca B , Kocabay A , Ozkan N , Kulacoglu H 
Published: October 2022

Abstract

Aim
To search the risk factors for inguinal hernia development by performing bioelectrical impedance analysis.

Material & Methods
Prospective, multicenter, cross-sectional study. Patients with inguinal hernias constitues the study group (IH), and patients who admitted with other surgical problems in the control group (SC). Age, gender, and BMI of the patients were recorded. Body composition measurements were done by bioelectrical impedance analysis. The relations between the obtained parameters and inguinal hernia were evaluated.

Results
9 female and 125 male patients with a mean age of 53.4± 15.4 in IH, whereas 44 women and 24 men with a mean age of 44.5±15.9 in (SC). There were statistically significant differences between two groups regarding BMI, total body fat, lean abdominal muscle mass, abdominal fat amount, and visceral fat rates. Male gender, low total body fat rate, low total body fat amount, low lean body mass rate, and low visceral fat rate were determined as risk factors for inguinal hernia in univariate analysis. Only low total body fat rate was found to be an independent risk factor.

Conclusions
Low total body fat rate is an independent risk factor for inguinal hernia development.
P-030 LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH POLY-4-HYDROXYBUTYRATE ABSORBABLE BARRIER COMPOSITE MESH
Authors: Alshammari S , Aldohayan A 
Published: October 2022

Abstract

Background
Repair of ventral and incisional hernias (VIHR) is a common procedure, newly introduced resorbable mesh biomaterials provide an attractive option to reduce use of permanent synthetic mesh in hernia surgery and reduce its complications. However, data on the use of slowly resorbable mesh materials remain scarce, this study aims to evaluate the use of poly-4-hydroxybutyrate/absorbable barrier composite mesh (P4HB/ABCM) in laparoscopic repair of VIHR.

Methods
This is a retrospective study of a sequential cohort of patients undergoing 22 laparoscopic VIHR utilizing a P4HB/ABCM mesh. Perioperative characteristics and clinical outcomes were collected.

Results
In total, 26 patients including nineteen females, and seven males underwent laparoscopic VIHR using P4HB/ABCM. All surgeries were performed in a single institution by the same surgeon. The average patient age was 52.6, and the mean BMI was 35.5. All patient had a clean wound classification. The average defect size was 136.4 cm2. All patients were seen in clinic with a median follow-up of 28 months. We observed 4 wound seromas, and no wound infections or recurrences during follow up period.

Conclusion
Results of laparoscopic VIHR with P4HB/ABCM are favourable and encourages further studies on the role of absorbable biosynthetic mesh materials in hernia surgery.
P-059 ROBOT ASSISTED TRANS ABDOMINAL PRE-PERITONEAL (RTAPP) MESHPLASTY FOR GIANT GROIN HERNIAS - OUR HYBRID ROBOTIC SURGERY CHOREOGRAPHY FOR OPTIMIZING OUTCOMES
Authors: Soni V 
Published: October 2022

Abstract

Aim
To demonstrate our successful, cost effective & time saving choreography for managing Large Groin Hernia with Robot assisted Trans Abdominal Pre-Peritoneal (rTAPP) Meshplasty Surgery

Materials & Methods
7 patients with Groin Hernia EHS Classification P/R M/L 3 were operated using Da Vinci Xi Robotic platform and underwent TAPP Meshplasty between October 2021 & June 2022. We noted the instruments used(Robotic and Laparoscopic), the Surgery duration & Console Time, the ease of the surgery & the Choreography, Intra-operative challenges, intra-operative change in surgical steps, post-op pain scores, analgesia usage & outcomes.

Results
Laparoscopic instruments were used in 7/7 (100%) patients for accomplishing various steps. Both flat & 3D Anatomically contoured meshs were used. Usage of Laparoscopic Instruments at various steps & in tandem with Robotic instruments optimizes the cost of the surgery, helps in decreasing surgical duration & utilization of resources. The trends evolve as one negotiates the learning curve.

Conclusions
Our study demonstrated that for Large Groin Hernia it is recommended to include Laparoscopic instruments during Robot assisted surgery along with specific surgical steps for successful completion of rTAPP in a cost-effective manner.
P-068 RESULTS OF THE OPEN INTRAPERITONEAL ONLAY MESH TECHNIQUE WITH A PREFORMED PATCH FOR PRIMARY VENTRAL HERNIA AND INCISIONAL HERNIA
Authors: Barranquero A G , Villalobos Mori R , Maestre González Y , Protti G P , Gutiérrez E , Olsina Kissler J 
Published: October 2022

Abstract

Aim
Primary ventral hernias and incisional hernias are frequent, but long–term results of their repair with a preformed patch are scarce. The aim was to evaluate the surgical results of the treatment of these hernias with the open intraperitoneal onlay mesh (open IPOM) technique, and to determine the needed follow–up for recurrence.

Material and methods
Observational retrospective single institution study of all consecutive patients intervened for ventral or incisional hernia with diameter inferior to 4 cm, from January 2013 to June 2020. The surgical repair was performed according to the open IPOM technique with a preformed patch and the defect was left unclosed. Relapsed hernias, those with a defect ≥ 4 cm, and lateral wall hernias were excluded.

Results
A total of 146 patients were intervened: 61.6% with umbilical hernias, 8.2% with epigastric hernias, 26.7% with trocar incisional hernias, and 3.4% with other incisional hernias.
The global recurrence rate was 7.5% (11/146). Specifically, there it was 7.8% in umbilical hernias, 0% in epigastric hernias, 7.7% in trocar incisional hernias, and 20% (1/5) in other incisional hernias. The median time for recurrence was 14 months (IQR: 4,4–18,7). The median presential follow–up was 17,4 months (IQR: 6,5–27,3), and the median telematic follow-up was 36,9 months (IQR: 27,2–49,6).

Conclusions
The open IPOM technique with a preformed patch offers good results for the treatment of ventral and incisional hernias. A 2-year follow-up is still needed for the recurrence diagnosis.

Note
The preformed patch used was the Parietex™ Composite Ventral Patch (Medtronic, Minneapolis, MN, EEUU).
P-070 SYNTHETIC MESH VERSUS BIOLOGICAL IMPLANT TO PREVENT INCISIONAL HERNIA AFTER LOOP-ILEOSTOMY CLOSURE: A RANDOMIZED FEASIBILITY TRIAL
Authors: Mäkäräinen E , Wiik H , Kössi J , Pinta T , Mäntymäki L M , Mattila A , Kairaluoma M , Ohtonen P , Rautio T 
Published: October 2022

Abstract

Aim
The aim of this study was to evaluate the safety and efficiency of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure.

Material & Methods
Up to one third of patients experience incisional hernia after loop-ileostomy closure, justifying hernia prevention procedures. Although biological meshes have been widely used in contaminated surgical sites instead of synthetic ones due to complication concerns, previous data on the subject does not support this practice. A randomized, controlled, multi-center non-inferior feasibility trial was conducted from April 2018 – November 2021. Patients (n=102) were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene MacroTM, Medtronic) (SM) or a biological mesh (PermacolTM, Medtronic) (BM) to the retrorectus space at loop-ileostomy closure after anterior resection for rectal adenocarcinoma. The primary outcome was rate of surgical site infections (SSI) at 30-day follow-up.

Results
In total, 102 patients were randomized, of which 97 received the intended allocation. At 30-day follow-up, 94 patients (97%) were evaluated. Of patients in the SM group, 1/46 (2%) had SSI and in the BM group 2/48 (4%) had SSI (p&gt;0.90). Uneventful wound healing was recorded in 38/46 (86%) and 43/48 (90%) patients in the SM and BM groups, respectively. One patient from each group underwent reoperation requiring mesh removal (p&gt;0.90).

Conclusions
Both a synthetic mesh and biological mesh were safe in incisional hernia prevention after loop-ileostomy closure. Hernia prevention efficiency will be reported after long-term patient follow-ups.
P-075 DURABLE REPAIR OF INCISIONAL HERNIA BASED ON BIOMECHANICAL PRINCIPLES – 3 YEAR FOLLOW UP
Authors: Nessel R , Löffler T , Rinn J , Kallinowski F 
Published: October 2022

Abstract

Aim
Durable composite constructions of polymers follow specific mechanical principles. Incisional hernia can be repaired durably based on biomechanical principles. How are the results after three years?

Material and methods
The biomechanics of the abdominal wall was analyzed ex vivo with cyclic loading common in material sciences. The resulting GRIP concept was clinically applied. The tissue quality of the individual patient was assessed with computed tomography at rest and during Valsalva's maneuver. All patients recieved single-shot antibiosis. Patients were discharged after full ambulation was achieved.

Results
A total of 228 patients (120 males and 108 females) were treated for incisional hernia. Primary hernia was repaired in 166, recurrence in 62 patients. The patients had an average of 1.3 risk factors with most patients grouped as ASA III (n= 119). Emergency repairs were necessary in 11 patients. Hernia orifices were mostly median (N= 141) and lateral (63 patients) with 23 combined cases. Hernia sizes were on average 9 ± 6 cm wide and 13 ± 8 cm long. The mesh-defect area ratio was 7.75. Fixation was necessary with a median of 60 fixation points to reach adequate GRIP levels. A total of 137 patients were followed for three years so far. Four patients died during follow-up (Follow-up rate 100%). One recurrence was detected in a liver transplant patient reconstructed with a sandwich. Pain levels were low (median NAS = 0 at rest and under load, u-test: p = 0.07672).

Conclusion
Incisional hernia can be repaired durably based on biomechanical principles.