bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-126 GIANT UMBILICAL HERNIAS: EMERGENCY SURGICAL TREATMENT AND DEFINITIVE SURGERY. A CLINICAL CASE
Authors: Maestre González Y , Villalobos Mori R , González Barranquero A , Semeraro Odds C , Mias Carballal M C , Olsina Kissler J J 
Published: October 2022

Abstract

Aim
Complex hernias with loss of domain are a challenge for the surgeon, especially when presenting with complications in the emergency room. The emergency treatment differs from definitive surgery, as the patient's scenario is very different and they often present hemodynamic instability, intestinal perforation, etc..

Clinical Case
58-year-old male patient who underwent emergency surgery for septic shock due to intestinal perforation secondary to intestinal occlusion from a primary umbilical hernia, with loss of domain. Through a median laparotomy on the hernia, intestinal resection was performed. Abdominal wall closure wasperformed directly with the hernia sac, without abdominal wall repair. The patient was discharged for outpatient follow up. We planned the definitive surgery. Prehabilitation of the patient begins with botulinum toxin infiltration one month prior to surgery and by creating a progressive pneumoperitoneum. The definitive surgical procedure consists in performing retromuscular umbilical hernioplasty with a posterior component separation technique with placement of four 30×30 cm polypropylene meshes in the retromuscular space and closure of the anterior wall, associated with dermolipectomy. The patient evolved favorably and was discharged.

Conclusions
The treatment of this type of hernia in the emergency room must be personalized in each case, prioritizing damage control, and followed up by a definitive repair of the hernia. For this repair, it is advisable to perform prehabilitation with botulinum toxin, associated or not, with progressive pneumoperitoneum depending on the characteristics of the patient and the hernia, to avoid an increase in intra-abdominal pressure and the consequent compartment syndrome.
P-128 GET THE COMPLEX HERNIA PATIENT THEATRE READY: THE PERI-OPERATIVE OPTIMISATION PATHWAY PROFORMA WE UTILISE
Authors: Sodde P , Ethisham Z , Pokusevski G , Sabri S , Mihailescu A 
Published: October 2022

Abstract

Aim
In modern times, complex abdominal wall herniae are an area of increased sub-specialisation for the surgeon as well as the multidisciplinary team that work together. Recent advances in pre-op optimisation pathways and protocols, several pre- and intra-operative adjuncts available for these complex cases and a multitude of surgical techniques that can be deployed in open or minimally invasive fashion, have made it increasingly difficult for surgical teams to integrate all aspects of care for their patients. We are proposing for presentation our Hospital Pathway-Proforma used for diagnosis, pre-optimisation and peri-operative care in complex ventral and groin hernias.

Material and Method
“In-house” developed pre-optimisation planning proforma taking into consideration all evidence based interventions that can lower a patient's CEDAR score: BMI reducing, smoking cessation, blood sugar control, nutritional optimisation and skin decolonisation, as well as anaesthetic specific tests and interventions aimed at optimising patient's cardiac, respiratory, renal and metabolic status before undergoing complex abdominal wall reconstruction surgery. The proforma details specific diagnostics and intervention at pre-operative clinic visit one and two, then concentrates on pre-operative and intra-operative adjuncts to be used in each individualised case (e.g. Botox, Fasciotens). Finally the post-operative pathway details specific interventions to be taken for an uneventful post-op recovery.

Results and Conclusion
By using the Profoma-Pathway, the work of the complex hernia surgeon, anaesthestist and entire team taking care of CAWR patients became more organised and streamlined. The local pathway is also useful in auditing the local work in major abdominal wall hernia reconstruction patients.
P-130 LAPAROSCOPIC LUMBAR HERNIA REPAIR. BASED ON ANATOMICAL LANDMARKS AND SAFETY STATEMENTS
Authors: Santilli O , Santilli H , Nardelli N , Scaravonati R 
Published: October 2022

Abstract

Aim
Lumbar hernias are a rare clinical entity (less than 1% of all abdominal hernias) and their surgical treatment is constantly evolving and changing. The aim is to propose a technical systematization of the steps and landmarks to perform a safe and effective repair of an infrequent pathology.

Material & methods
We use a tapp approach. The patient is placed in a dorsal decubitus position with a 45° elevation of the hernia side. The first port in the umbilicus access and two ports are placed along the middle line. Start the dissection using novel articulated instruments marking the anatomical limits of the rectangular trapezoid that involves the semilunar lines, epigastric vessels, spine, and imaginary line between the iliac crest and 11 th rib. Releasing the peritoneal flat until visualizing the psoas and quadratus muscles until the 12th rib, preserving the avascular plane avoids nerves and vascular damage. Hernia sac reduction. Tension-free or not closure of the orifice. Placement of a polypropylene mesh covering all the dissected areas. Mesh fixation using absorbable suture. Closure of the peritoneum.Vacuum maneuver and bulge compression.

Results
The systematic standardization has been applied to all patients. The mean operative time was 90 min. The articulated instruments were useful and allowed safe maneuvers. Outpatient surgery was achieved with a fast return to normal activity. The procedures were performed without intraoperative complications, mortality, or conversion to open surgery.

Conclusion
The step-by-step guide for anatomical landmarks and proven statements offers a safe and effective repair of this rare entity.
P-132 MANAGEMENT OF VENTRAL HERNIA IN OBESITY: OUR ALGORITHM
Authors: Baig S 
Published: October 2022

Abstract

Introduction
Management of ventral hernia in obese is a complex problem. The methods of weight loss, alternatives if the patient cannot undergo bariatric surgery, timing, and type of hernia surgery lacks clarity and are dependent on resources and expertise. There is a need for algorithms based on local population and expertise. In this paper, we present the outcomes of our institutional algorithm.

Methods
It was a retrospective analysis of prospectively collected data. Patients with body mass index(BMI) &gt; 30Kg/m2 were included to undergo surgery as per algorithm considering (a) presentation(symptomatic vs asymptomatic), (b) hernia characteristics(defect width, site, reducibility), and (c) obesity characteristics(BMI, subcutaneous fat, android vs gynecoid). Data on age, BMI, comorbidities, tobacco consumption, hernia width, location, contents, previous surgery, intraoperative parameters(the type of surgery, mesh, drain, fixation), and outcomes(seroma, hematoma, infection, recurrence) were collected.

Results
50 patients underwent treatment as per the algorithm. Mean BMI was 36.6 ± 7.3 kg/m2. The mean follow-up was 17.6 ± 7.2 months. The mean defect width was 4.8 ± 2.9 cm. There were two (4%) recurrences in patients who underwent an anatomical repair under emergency conditions. None of the patients who underwent an elective repair had a recurrence. Total surgical site occurrence was 12% and surgical site occurrence requiring procedural intervention was 8%. There was one (2%) mortality on postoperative day7 due to myocardial infarction.

Conclusion
The algorithm has shown encouraging results in the short-to-medium term. Long-term evaluation with a higher number of patients is needed to confirm its usefulness.
P-133 PROSPECTIVE INTERVENTIONAL STUDY OF THE ANALGESIC EFFICACY OF A CYCLOMESH™ PARIETAL REINFORCEMENT IMPLANT SOAKED IN ROPIVACAINE HYDROCHLORIDE 10MG/ML IN THE TREATMENT FOR UNCOMPLICATED INGUINAL HERNIA
Authors: Siembida N , Ralaihova H , Moulin S , Aubert F , Boulkedid R , Zourabichvili O , Regimbeau J M 
Published: October 2022

Abstract

Background
20–30% of patients operated for inguinal hernia will present early postoperative pain (EPP) which is, after the organizational causes, the first cause of conversion from ambulatory to traditional hospitalization. The objective of this study was to evaluate the interest of a parietal prosthesis (Cyclomesh ™) soaked with ropivacaine in the management of EPP.

Materials and Methods
This is a randomized, phase III, comparative superiority, double-blind, international multicentre study. From October 2019 to February 2022, 290 patients underwent surgery for inguinal hernia with placement of a ropivacaine or saline soaked parietal prosthesis. The primary endpoint was the H6 coughing pain assessment (EVA).

Results
The intention to treat population (ITTp) was composed of 150 patients in the ropivacaine group and 140 in the placebo group, for the per-protocol population (PPp) it was 125 and 115. The prosthesis type had no significant effect on H6 coughing pain, either for the ITTp (3.3 vs 3.2, p=0.12) or the PPp (3.3 vs 3.7, p=0.15). The ropivaciane soaked prosthesis resulted in a decrease in the overall pain at H2 (2.3 vs 3.2, p&lt;0.0001), H4 (2.3 vs 3.1, p&lt;0.0001) and H6 (2.3 vs 2.7, p=0.0039). Regarding painkillers consumption, postoperative complications and number of ambulatory conversions, there was no difference between the two groups.

Conclusion
The placement of a parietal prosthesis (Cyclomesh ™) soaked with ropivacaine did not reduce the H6 coughing pain but allowed a decrease in the overall pain over the first 6 hours after surgery and could simplify the management of patients.
P-135 FIRST EXPERIENCE WITH A NEW CLOSED INCISION NEGATIVE PRESSURE WOUND THERAPY, PREVENA™, IN ABDOMINAL WALL RECONSTRUCTION PATIENTS
Authors: Dixon S , Benson A , Kalaiselvan R , Kanwar S , Samad A , Pritchard-Jones R , West C , Scott M 
Published: October 2022

Abstract

Aim
Surgical site infection (SSI) contributes a significant proportion of post operative morbidity in patients undergoing abdominal wall reconstruction (AWR). Prevena™ closed incision negative pressure wound therapy (ciNPT) has been demonstrated to reduce SSI rates in the elective and emergency laparotomy setting. However, there is no evidence for Prevena™ use in AWR patients. The aim of this study was to assess the safety and feasibility of Prevena™ in AWR patients.

Materials and Method
Patients undergoing AWR at a single trust were selected at random to receive Prevena™. This was applied to the incision under sterile conditions, a continuous pressure of -125mmHg was applied for 7 days. The primary outcome measure was SSI, with secondary outcomes of 90 day mortality, complications and length of stay.

Results
10 patients received ciNPT in the study period, 8 female 2 male, mean BMI was 34.5. All patients had a Rives-Stoppa repair, with 2 patients also requiring bilateral transversus abdominal release (TAR). A vertical panniculectomy with umboplasty was used in 7 cases, fleur-de-lys panniculectomy with umboplasty in 2 cases, and a single case approached via transverse panniculectomy. There were no deaths within 90 days, median length of stay was 4 days. There was a single SSI managed with oral antibiotics, not requiring admission.

Conclusion
Prevena™ has been shown to reduce SSI rates in other patient cohorts and this small series demonstrates it is feasible and safe to use in the AWR setting. Larger studies are required to demonstrate SSI rate reduction in AWR patients.
P-143 INTRAOPERATIVE FLUORESCENCE ANGIOGRAPHY WITH INDOCYANINE GREEN (ICG) IN EMERGENCY LAPAROSCOPIC HERNIA REPAIR
Authors: Bascuas B , Licardie E , Ramirez A , Guadalajara J 
Published: October 2022

Abstract

Aim
Bowel incarceration is common complication in incarcerated hernias, which involves one of the most frequent emergent surgical pathologies.
Real-time fluorescence angiography with ICG is a reliable technique that allows surgeons to assess intestinal blood flow. However, this technique is rarely used in emergency surgery such as incarcerated hernia repair.

Materials & methods
We present the case of a 64-year-old patient with medical history of high blood pressure, atrial fibrillation and hepatitis C, complaining of abdominal pain and vomiting associated to painful inguinal hernia in the past 12 hours. The patient presented inguinal incarcerated hernia without any signs of external complication or elevation of infection and inflammatory parameters in blood test.

Results
We decided to carry out an urgent hernia repair performing transabdominal preperitoneal (TAPP) approach.
Once the hernia was repaired, intraoperative ICG fluorescence angiography was performed in order to evaluate intestinal viability. ICG fluorescence revealed the presence of irreversible ileal ischemia (12 cm) needing resection. Through mini-Pfannenstiel incision we performed the resection and a side to side stapled anastomosis. Postoperative course was uneventful and the patient was discharged 3 days after the surgery.

Conclusions
The combination of laparoscopic approach and ICG fluorescence angiography seems to be an actual useful solution, combining the advantages of minimally invasive surgery and avoiding the risk of bowel perforation due to unnoticed ischemia thanks to the assess of intestinal perfusion.
P-146 A SYSTEMATIC REVIEW OF IMAGING MARKERS FOR HIATUS HERNIA OUTCOMES
Authors: Wei R , Gilmore K , Findlay J , Spellar K 
Published: October 2022

Abstract
Hiatus hernia repair is a common operation with considerable variation in anatomy and technique. At present there are very few predictors of post-operative outcomes. Certain imaging characteristics may help in operative planning and predicting outcomes. The aim of this systematic review is to identify possible radiological markers associated with clinical outcomes in hiatal hernia repair.
A literature search was performed on the 7th December 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology guidelines of the PubMed, EMBASE and Cochrane Central Register of Controlled Trials using the following search term: ((hiatus) OR (paraesophageal)) AND (hernia) AND ((computed tomography) OR (CT) OR (imaging) OR (contrast) OR (swallow) OR (magnetic resonance) OR (ultrasound)). Inclusion criteria were studies (any design) testing the association of a radiological marker with any clinical outcome (either operative or non-operative) of hiatus hernia management. Exclusion criteria were case reports, non-English articles, non-human articles. Articles were screened by 2/3 authors on the basis of title and abstract. Full text articles were then retrieved for detailed analysis. Any disagreement was resolved by consultation with a 3rd/4th author.
Initial search identified 2768 papers, 9 of which were retrieved for full paper evaluation.
Preliminary review of the literature suggests that hernia recurrence is correlated with increased hernia size, although patients tend to be asymptomatic. Multidimensional CT can accurately measure hernia surface area and this could be useful in stratifying risk of re-herniation.
P-147 LAPAROSCOPIC SURGERY IS SUITABLE FOR MOST PATIENTS FOR INGUINAL HERNIA REPAIR AND IS AN EXCELLENT OPTION IN EXPERT HANDS
Authors: Smith J J , Hayward R , Kontovounisios C , Qiu Mbbchir S , Warren O J 
Published: October 2022

Abstract

Introduction
This study reviews the practice of a high-volume surgeon, comparing laparoscopic and open surgery for inguinal hernia. In suitable patients the default was laparoscopic Totally Extra Peritoneal (TEP) approach.

Materials & Methods
Data from patients referred over 5 years with inguinal hernias was collated prospectively and analysed retrospectively. Short and long-term outcomes of laparoscopic and open repairs were compared.

Results
205 patients underwent repair of 288 hernias (90.7% laparoscopic, 9.3% open). 83 patients underwent bilateral repair (95.2% laparoscopic). 22 patients underwent repair of 27 recurrent hernias (68% laparoscopic).
1 case (0.5%), started laparoscopically was converted to open. Complication rates were 13.4% vs 36.8% in the laparoscopic and open arms respectively (p&lt;0.01): superficial infection (1.6% vs 0%, p=0.58); haematoma (6.3% vs 15.8%, p=0.14); seroma (4.8% vs 5.3%, p=0.94); persisting numbness (0% vs 5.3%, p&lt;0.01) and chronic pain (1.1% vs 0%, p=0.65). No patients suffered mesh infections or explantation.
Mean stay was significantly longer in open group (p=0.03), median stay was 0 nights in both groups. At median follow up 1.8 years (Interquartile-range 0.9–3.6 years) recurrence rate was 1.1% (0 female, 2 male) and 15.8% (1 female, 2 male) in the laparoscopic and open arms respectively (p&lt;0.01). Open surgery was associated with significantly higher risk of recurrence (HR: 16.3, 95% CI: 2.7–97.8, p&lt;0.01).

Conclusions
This series demonstrates the vast majority of inguinal hernias, both primary and recurrent can be treated with laparoscopic TEP repair. Higher recurrence and complication rates were associated with open repair, with a caveat of strong selection bias.
P-148 EFFECT OF MEDICAL AND SURGICAL WEIGHT MANAGEMENT PROGRAMMES FOR PRE-OPERATIVE WEIGHT LOSS PRIOR TO VENTRAL HERNIA REPAIR
Authors: Mok J , Pucci A , Markakis H 
Published: October 2022

Abstract

Introduction
Obesity is a recognised risk factor for perioperative morbidity in patients undergoing complex incisional hernia repair. Weight reduction can reduce risk of perioperative complications. The aim of this study was to assess the effects of the different weight management modalities prior to planned incisional hernia repair upon the Carolinas equation for Determining Associated Risks (CeDAR) score.

Method
A prospectively maintained database of patients who were referred to the weight management clinic prior to planned incisional hernia repair was reviewed. Patients’ demographics, weight loss outcomes and CeDAR scores were calculated before and after the intervention.

Results
9 patients were enrolled onto the weight management programme prior to the planned incisional hernia repair (defect size 4 – 14cm), 3 underwent bariatric surgery whilst 6 had medical weight management in the form of a 12-week pre-operative diet programme. The mean age was 54 ± 9.4 years with a mean weight pre-intervention of 110.5 ± 7.4 kg and the mean BMI was 41.78 ± 1.98 kg/m2. Bariatric surgery was associated with a higher percentage weight loss (22.6%) compared to 12week diet programme (10.4%) with an associated higher reduction of CeDAR score (14% and 4% reduction in risk respectively).

Conclusion
Formal weight management programmes prior to complex abdominal wall reconstruction leads to clinically significant weight loss with reduced CeDAR score. Patients with raised BMI considering incisional hernia repair should be counselled for this and where possible offered a suitable weight management to reduce peri-operative risk.
P-151 ROLE OF INDOCYANINE GREEN TO MITIGATE WOUND COMPLICATIONS IN ANTERIOR COMPONENT SEPARATION TECHNIQUE FOR VENTRAL HERNIA REPAIR- OUR EARLY EXPERIENCE
Authors: Gandhi J A , Churiwala J J , Banker A , Shinde P H 
Published: October 2022

Abstract

Aim
The subjective ease of anterior component separation technique (ACST) has made it a widely used surgical option amongst budding surgeons for ventral hernia repairs (VHR). However, surgical site occurrences (SSO) like flap necrosis due to compromised perfusion have frequently been reported. This study aims to evaluate the impact of adoption of indocyanine green-fluorescence angiography (ICG-FA) to map soft tissue perfusion on wound-related complications following open ACST in VHR.

Material & Methods
We performed a retrospective review of patients who underwent VHR with open ACST at a single centre between March 2018 and July 2020. The study comprised of consecutive cases of ACST with onlay meshplasty done before (March 2018–April 2019, n=24) and after (May 2019 to July 2020, n=19) implementation of ICG-FA for intra-operative perfusion mapping of subcutaneous tissue and skin.

Results
The pre-ICG group and post-ICG group were similar in terms of baseline patient demographics and peri-operative details. The rate of SSO was higher in the pre-ICG group, but this result was not statistically significant (46% vs. 26%; p value 0.189). Skin necrosis, however, was observed in significantly less number of patients in the post-ICG cohort (29% vs. 5%; p value 0.045). No mesh infection was observed in either group.

Conclusion
This study demonstrates the effectiveness of perfusion mapping by the use of ICG-FA to determine potential areas of decreased perfusion and thereby minimize wound complications.
P-152 COMPARISON OF ENHANCED-VIEW TOTALLY EXTRAPERITONEAL (ETEP) AND TRANSABDOMINAL (TARM) MINIMAL ACCESS TECHNIQUES FOR RETROMUSCULAR PLACEMENT OF PROSTHESIS IN THE TREATMENT OF IRREDUCIBLE MIDLINE VENTRAL HERNIA
Authors: Churiwala J J , Rege S A , Salvi V , Shah S K 
Published: October 2022

Abstract

Aim
Retromuscular or sublay meshplasty has been advocated to reinstate abdominal wall strength following ventral hernia repair while avoiding complications like visceral adhesions, fistula formation and mesh infection. We aim to compare two minimally invasive approaches of sublay hernioplasty for irreducible ventral midline hernia with respect to their efficacy and safety.

Material & Methods
We performed a retrospective study of 73 patients operated for primary and recurrent irreducible ventral midline hernia by eTEP or TARM repair with sublay meshplasty. We compared the intraoperative and post-operative complications, post-operative pain score, subjective technical ease of procedure, patient satisfaction and recurrence after 3 months and 12 months of surgery.

Results & Conclusion
There was no significant difference in the outcome of surgery and complications by the two techniques. However, there was a significant subjective technical ease in the TARM group (n=35) due to ergonomic port placement and adhesiolysis and reduction of hernia contents done under vision. The number of ports used and post-operative pain score were higher in the TARM group as compared to that of the eTEP group. 96% of the patients belonging to both groups were satisfied with their surgery after a year on telephonic follow-up. However, a multicentric study with a larger sample size would be required to establish the advantage of one technique over the other.