abstract abdominalw set.txt 10.12659/AJCR ... - Hernia Surgery

abstract‐abdominalw‐set.txt1. Am J Case Rep. 2020 Aug 31;21:e925026. doi: 10.12659/AJCR.925026.

Refractory Chylous Ascites with Chylothorax and an Umbilical Hernia in a Patient Ineligible for a Transjugular Intrahepatic Portosystemic Shunt.

Fatah A(1), Audiyanto T(2).

Author information:(1)Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.(2)Department of Internal Medicine, Siloam General Hospital, Tangerang, Indonesia.

BACKGROUND Chylous ascites is a rare condition, which is defined by accumulation of a milky fluid due to high triglyceride levels. It is most commonly secondary

to malignancy, liver cirrhosis, infection, and tuberculosis. CASE REPORT A 21‐year‐old woman from rural Indonesia, came to the hospital with chronic dyspnea and a history of repeated paracentesis. Six years ago, she was diagnosed with chronic hepatitis B. For the past 2 years, she had complaints of progressive dyspnea and increased abdominal swelling. On examination, there was

dullness on chest percussion and decreased breath sounds. Shifting dullness was

positive on abdominal examination. Paracentesis and thoracentesis were performed and showed high triglyceride levels. She underwent an abdominal computed tomography scan and was diagnosed with liver cirrhosis, complicated with chylous ascites and chylothorax. Repeated paracentesis was performed as a therapeutic approach; she had strict diet guidelines, and was prescribed octreotide, furosemide, spironolactone, and albumin. Despite this treatment, two years later, she developed an umbilical hernia complicated with ulceration. Hernia repair was not possible due to her comorbidities. She was indicated for a transjugular intrahepatic portosystemic shunt (TIPS) for the refractory chylous

ascites. However, this could not be performed as the patient could not afford this expensive procedure, which was not covered by insurance. CONCLUSIONS Management of refractory chylous ascites is challenging, especially in underdeveloped countries due to socioeconomic problems and limited health care facilities. Although TIPS is indicated in refractory chylous ascites, repeated paracentesis can be useful as an alternative method.

DOI: 10.12659/AJCR.925026PMID: 32865187

2. Int J Surg Case Rep. 2020 Aug 29;74:222‐225. doi: 10.1016/j.ijscr.2020.07.086. Online ahead of print.

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abstract‐abdominalw‐set.txt

Pneumoperitoneum and Pneumatosis cystoides intestinalis, a dangerous mixture. A

case report.

Moyon FX(1), Molina GA(2), Tufiño JF(3), Basantes VM(4), Espin DS(5), Moyon MA(6), Cevallos JM(7), Palacios NE(8), Parra RA(9), Eras KR(10).

Author information:(1)Department of General Surgery, Hospital General San Francisco, IESS Quito‐Ecuador, Ecuador. Electronic address: [email protected].(2)Colegio de Ciencias de la Salud, Universidad San Francisco de Quito USFQ, Quito, Ecuador. Electronic address: [email protected].(3)Department of General Surgery, Hospital General San Francisco, IESS Quito‐Ecuador, Ecuador. Electronic address: [email protected].(4)PGY3 Resident General Surgery, PUCE, Quito, Ecuador. Electronic address: [email protected].(5)Department of General Surgery, Hospital General San Francisco, IESS Quito‐Ecuador, Ecuador. Electronic address: [email protected].(6)Department of General Surgery, Hospital General San Francisco, IESS Quito‐Ecuador, Ecuador. Electronic address: [email protected].(7)Department of General Surgery, Hospital General San Francisco, IESS Quito‐Ecuador, Ecuador. Electronic address: marceloc‐[email protected].(8)PGY4, Radiology Resident, Universidad Central del Ecuador, Quito, Ecuador. Electronic address: [email protected].(9)Department of Internal Medicine, Division of Pathology, Hospital General San

Francisco, IESS Quito‐Ecuador, Ecuador. Electronic address: [email protected].(10)Department of Internal Medicine, Hospital IESS Quito Sur, Quito, Ecuador. Electronic address: [email protected].

BACKGROUND: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by gas infiltration into the intestine wall. When gas is seen in the intestinal wall, it is usually a sign of bowel wall infarction and a surgical emergency; therefore, an adequate differentiation of benign and urgent

conditions of pneumatosis intestinalis is necessary to prevent misdiagnosis and

inadequate therapies.CASE PRESENTATION: We present the case of a 79‐year‐old male with past medical history of Alzheimer's, cholecystectomy, and umbilical hernia. PCI was identified, and conservative therapy was started. Since the patient's pain persisted, a complication was suspected, and surgery was decided. After successful treatment, the patient completely recovered.CONCLUSION: There are many benign and life‐threatening causes of pneumatosis intestinalis, the imaging appearance of both may look very similar. Therefore, clinical history, physical examination, and laboratory test results are the best indicators of whether it is due to a benign or life‐threatening cause. PCI must

be managed with a multidisciplinary team of clinicians, radiologists, and

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abstract‐abdominalw‐set.txtsurgeons to achieve better results for our patients.

Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.ijscr.2020.07.086PMID: 32892124

3. Am Surg. 2020 Aug 28:3134820942149. doi: 10.1177/0003134820942149. Online ahead of print.

Laparoscopic Ventral Hernia Repair in the Geriatric Population : An Assessment of Long‐Term Outcomes and Quality of Life.

Elhage SA(1), Shao JM(1), Deerenberg EB(1), Prasad T(1), Colavita PD(1), Kercher KW(1), Augenstein VA(1), Todd Heniford B(1).

Author information:(1)Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.

OBJECTIVES: Laparoscopic ventral hernia repair (LVHR) has been shown to decrease wound complications and length of stay (LOS) but results in more postoperative discomfort. The benefits of LVHR for the growing geriatric population are unclear. The aim of our study is to evaluate long‐term outcomes and quality of life (QOL) after LVHR in the geriatric population.METHODS: A prospectively collected single‐center database was queried for all patients who underwent LVHR (1999‐2019). Age groups were defined as <40 (young), 40‐64 (middle age), and ≥65 years (geriatric). QOL was assessed with the Carolinas Comfort Scale.RESULTS: LVHR was performed in 1181 patients, of which 13.4% were young, 61.6% middle aged, and 25.0% geriatric. Hernia defect size (64.2 ± 94.4 vs 79.9 ± 102.4 vs 84.7 ± 110.0 cm2) and number of comorbidities (2.2 ± 2.1 vs 3.2 ± 2.2 vs 4.3 ± 2.2) increased with age (all P < .05). LOS increased with age (2.9 ± 2.5 vs 3.8 ± 2.9 vs 5.2 ± 5.3 days, P < .0001). Rates of postoperative cardiac events, pneumonia, respiratory failure, wound complication, reoperation, and death were similar (P > .05). Geriatric patients had increased rate of ileus and urinary retention (all P < .05). Overall recurrence rate was 5.7% with an average follow‐up of 43.5 months, with no differences in recurrence between groups (P > .05). Geriatric patients had better overall QOL at 2 weeks (P = .0008) and similar QOL at 1, 6, and 12 months.DISCUSSION: LVHR offers excellent results in the geriatric population. Despite having increased rates of comorbidities and larger hernia defects, which may relate to LOS, rates of complications and recurrence were similar compared with

younger cohorts, with better short‐term QOL.

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DOI: 10.1177/0003134820942149PMID: 32856944


Outcomes of Laparoscopic‐Assisted, Open Umbilical Hernia Repair.

Shao JM(1), Elhage SA(1), Prasad T(1), Colavita PD(1), Augenstein VA(1), Heniford BT(1).

Author information:(1)Department of Minimally Invasive and Gastrointestinal Surgery, Carolinas Medical Center, Charlotte, NC, USA.

Umbilical hernia repair (UHR) is one of the most commonly performed hernia operations with reported recurrence rate from 1% to 54%. Our aim was to describe an open, laparoscopic‐assisted (OLA) technique and its outcome in an institutional review board‐approved prospective study at a tertiary hernia center from 2008 to 2019. All patients underwent a standard periumbilical incision, open dissection of the hernia, and closure of the fascial defect with

laparoscopic intraperitoneal onlay mesh (IPOM) fixation with permanent tacks. A

total of 186 patients were identified who underwent an OLA UHR repair. Patient characteristics are as follows: average age 52.8 ± 12.5 years, male gender 79.6%, body mass index 31.4 ± 8.0 kg/m2, and average hernia defect size of 2.8 ± 4.8 cm2. Forty‐one (22.0%) patients had previous failed repair. Sixty‐nine (37.1%) patients had another procedure performed at the time of the UHR, most commonly a laparoscopic transabdominal inguinal hernia repair (58%). The mean operative time was 87.3 ± 51.2 minutes, but only 63.9 ± 31.9 minutes for patients undergoing an OLA repair. There were no recurrences (0%) on abdominal physical or radiographic examination with an average follow‐up of 16.5 ± 17.7 months. Postoperative complications included wound erythema (2.7%), hematomas (1.1%), seromas (2.7%), and 4.3% received postoperative oral antibiotics. One person was readmitted for seroma drainage, and another required reoperation for

small bowel obstruction unrelated to the hernia repair. One patient had chronic

pain requiring tack removal. With moderate follow‐up, an OLA UHR with mesh appears to be a durable repair with favorable results, including those patients

with recurrent hernias.

DOI: 10.1177/0003134820942162PMID: 32853047

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An Evaluation of Tension Measurements During Myofascial Release for Hernia Repair.

Parikh RS(1), Faulkner J(1), Borden Hooks W 3rd(1), Hope WW(1).

Author information:(1)Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA.

Tension‐free repairs have revolutionized the way we repair hernias. To help reduce undue tension when performing ventral hernia repair, multiple different techniques of myofascial releases have been described. The purpose of this project is to evaluate tension measurements for commonly performed myofascial releases in abdominal wall hernia repair. Patients undergoing myofascial release techniques for their ventral hernias were enrolled in a prospective Institutional Review Board‐approved protocol to measure abdominal wall tension from June 1, 2011 to August 1, 2019. Abdominal wall tensions were measured using tensiometers before and after myofascial release techniques. Descriptive statistics were performed and data were analyzed. Thirty patients had tension measurements (5 anterior myofascial separation, 25 posterior myofascial separation with transversus abdominis release [TAR]). Average age was 60.1 years (range 29‐81), 83% Caucasian, 53% female, and 42% recurrent hernias. The average hernia defect in patients undergoing anterior myofascial release was 117.3 cm2,

and the average mesh size was 650 cm2. The reduction in tension after anterior release was 4.7 lbs (2.7 lbs vs 7.4 lbs). The average hernia defect in patients

undergoing posterior myofascial release (TAR) was 183 cm2, and the average mesh

size was 761.36 cm2. The reduction in tension after bilateral posterior rectus sheath incision was 2.55 lbs (5.01 lbs vs 7.56 lbs) with 0.66 lbs further reduction in tension after TAR (4.35 lbs vs 5.01). In this evaluation, abdominal wall tension measurements are shown to be a feasible adjunct during open hernia

repair. Preliminary data show tension reductions associated with the different myofascial release techniques and, with further study, may be a useful intraoperative adjunct for decision making in hernia repair.

DOI: 10.1177/0003134820945243PMID: 32853025

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abstract‐abdominalw‐set.txt6. BMC Surg. 2020 Aug 26;20(1):190. doi: 10.1186/s12893‐020‐00852‐2.

Analysis of operation procedure and effect for emergency surgery in general hospital during novel coronavirus pneumonia period.

Liu Y(1), Wang M(2), Shen Y(1), Chen J(1).

Author information:(1)Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China.(2)Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China. [email protected].

BACKGROUND: Novel coronavirus pneumonia (NCP) outbreak in Wuhan, China in early

2020, resulted in over 80 thousand infections in China. At present, NCP has an explosive growth in the world. Surgeons could refuse selective operation during

the outbreak, but they must face the emergency operation. We hope to avoid the spread of NCP while ensuring efficient treatment of emergency cases.METHODS: The data of patients with incarcerated hernia admitted to Beijing Chaoyang Hospital during NCP epidemic were analyzed and compared with those in 2019. All cases were divided into NCP group and 2019 group. The operation data and inpatient protection process of emergency cases were analyzed. Result During the NCP epidemic, 17 cases with incarcerated hernia were treated in our department. A Total of 263 cases of the same disease were admitted in 2019. There was no significant difference in age, gender, BMI and hernia type between

two groups. No significant difference was observed between the two groups in operation method and hospital stay. The waiting time for emergency operation of

NCP group was significantly longer than that of 2019 group (P = 0.002). A buffer ward was set up by administrator of hospital during NCP outbreak. Hospitals were divided into "Red area, Yellow area and Green area" artificially, and strict screening consultation system was implemented. There was no case of SARS‐nCoV‐2

infection in medical staff.CONCLUSION: It was safe and effective to carry out emergency operation on the premise of screening, protection and isolation during the NCP epidemic. The increased waiting time for operation due to NCP screening did not threaten medical safety of emergency incarcerated hernia patients.

DOI: 10.1186/s12893‐020‐00852‐2PMCID: PMC7447598PMID: 32847559 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing

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abstract‐abdominalw‐set.txtinterests


Implementation of an Evidence‐Based Protocol Significantly Reduces Opioid Prescribing After Ventral Hernia Repair.

Peterman DE(1), Knoedler BP(2), Ewing JA(1), Carbonell AM(2), Cobb WS(2), Warren JA(2).

Author information:(1)Department of Surgery, Prisma Health‐Upstate, Greenville, SC, USA.(2)Department of Surgery, Division of Minimal Access, University of South Carolina School of Medicine, Greenville, SC, USA.

BACKGROUND: Increased recognition of the dangers of opioid analgesia has led to

significant focus on strategies for reducing use through multimodal analgesia, enhanced recovery protocols, and standardized guidelines for prescribing. Our institution implemented a standard protocol for prescribing analgesics at discharge after ventral hernia repair (VHR). We hypothesize that this strategy significantly reduces opioid use.METHODS: A standardized protocol for discharge prescribing was implemented in March 2018. Patients were prescribed ibuprofen, acetaminophen, and opioids based on milligram morphine equivalent (MME) use the 24 hours prior to discharge. We retrospectively reviewed prescriptions of opioids for two 6‐month periods‐July‐December 2017 (PRE) and July‐December 2018 (POST)‐for comparison using EPIC report and the South Carolina Prescription Monitoring Program. Analysis performed included Mann‐Kendall linear trend test and Student's t‐test

for continuous variables.RESULTS: VHR was performed in 105 patients in the PRE and 75 patients in the POST group. Total MME prescribed decreased significantly from mean 322.7 + 261.3/median 225 (IQR 150‐400) MME to 141.6 + 150.4/median 100 (50‐184) MME (P < .001). This represents a 57% reduction in mean opioid MME prescriptions. Acetaminophen prescribing increased from 10% to 65%, and ibuprofen from 7.6% to

61.3%. Refills were prescribed in 21 patients (20%) during the PRE period, which decreased to 10.7% during the POST group (P = .141). Implementation of an evidence‐based protocol significantly reduces opioid prescribing after VHR.DISCUSSION: A multimodal approach to postoperative pain management decreases the need for opioids. The additional implementation of an evidence‐based prescribing protocol results in significant reduction of opioid use following VHR.

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DOI: 10.1177/0003134820942207PMID: 32833492

8. Surgery. 2020 Aug 22:S0039‐6060(20)30446‐3. doi: 10.1016/j.surg.2020.07.004.

Online ahead of print.

The continuum of complications in survivors of necrotizing pancreatitis.

Maatman TK(1), Roch AM(1), Ceppa EP(1), Easler JJ(2), Gromski MA(2), House MG(1), Nakeeb A(1), Schmidt CM(1), Sherman S(2), Zyromski NJ(3).

Author information:(1)Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.(2)Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN.(3)Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Electronic address: [email protected].

BACKGROUND: Necrotizing pancreatitis survivors develop complications beyond infected necrosis that often require invasive intervention. Remarkably few data

have cataloged these late complications after acute necrotizing pancreatitis resolution. We sought to identify the types and incidence of complications after necrotizing pancreatitis.DESIGN: An observational study was performed evaluating 647 patients with necrotizing pancreatitis captured in a single‐institution database between 2005

and 2017 at a tertiary care hospital. Retrospective review and analysis of newly diagnosed conditions attributable to necrotizing pancreatitis was performed. Exclusion criteria included the following: death before disease resolution (n =

57, 9%) and patients lost to follow‐up (n = 12, 2%).RESULTS: A total of 578 patients were followed for a median of 46 months (range, 8 months to 15 y) after necrotizing pancreatitis. In 489 (85%) patients 1 or more complications developed and included symptomatic disconnected pancreatic duct syndrome (285 of 578, 49%), splanchnic vein thrombosis (257 of 572, 45%), new endocrine insufficiency (195 of 549, 35%), new exocrine insufficiency (108 of 571, 19%), symptomatic chronic pancreatitis (93 of 571, 16%), incisional hernia (89 of 420, 21%), biliary stricture (90 of 576, 16%), chronic pain (44 of 575, 8%), gastrointestinal fistula (44 of 578, 8%), pancreatic duct stricture (30 of 578, 5%), and duodenal stricture (28 of 578, 5%). During the follow‐up period, a total of 340 (59%) patients required an invasive intervention after necrotizing pancreatitis resolution. Invasive pancreatobiliary intervention was

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abstract‐abdominalw‐set.txtrequired in 230 (40%) patients.CONCLUSION: Late complications are common in necrotizing pancreatitis survivors. A broad variety of problems manifest themselves after resolution of the acute disease process and often require invasive intervention. Necrotizing pancreatitis patients should be followed lifelong by experienced clinicians.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.surg.2020.07.004PMID: 32843212


Concomitant Abdominal Hernia Repair and Peritoneal Dialysis Catheter Insertion:

A Retrospective Analysis.

Croasdale DR(1), Garner MS(1), Ashar A(1), Paul Singh T(1), Tafen‐Wandji M(1), Stain SC(1), Conti DJ(1), Lopez‐Soler RI(2).

Author information:(1)Department of Surgery, Albany Medical College, NY, USA.(2)98139 Section of Renal Transplant, Department of Surgery, Edward Hines Jr. VA Medical Center, Hines, IL, USA.

DOI: 10.1177/0003134820940269PMID: 32829646

10. Medicine (Baltimore). 2020 Aug 21;99(34):e21701. doi: 10.1097/MD.0000000000021701.

Obturator hernia: Clinical analysis of 11 patients and review of the literature.

Park J(1).

Author information:(1)Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.

Obturator hernia is a relatively rare type of abdominal hernia, in which abdominal contents protrude through the obturator canal, a condition that can lead to small bowel obstruction. Its rarity and nonspecific signs and symptoms make a preoperative diagnosis difficult. The present study analyzed the clinical manifestations, diagnostic methods and operative treatment outcomes in patients

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with obturator hernia.Between January 2012 and October 2019, 1028 adults underwent surgical repair of abdominal wall hernia at the Department of Surgery, Kyungpook National University Hospital. The medical records of eleven patients who were treated for small bowel obstruction due to obturator hernia were retrospectively evaluated. Patient characteristics, clinical presentation, preoperative radiological diagnosis, operative findings, treatment, complications, and outcomes were recorded.All 11 patients were elderly women, with a mean age of 80.2 years (range, 71‐87 years). Their mean body mass index was 17.9 kg/m (range, 11.9‐22.2 kg/m). Symptoms at presentation were abdominal pain and vomiting, with a mean duration of symptoms prior to admission of 5.6 days (range, 1‐15 days). Based on abdominopelvic computed tomography (CT) scans, all 11 patients were preoperatively diagnosed with obturator hernia, followed by laparoscopic exploration or laparotomy as soon as possible. Of the 11 patients,

6 (54.5%) had left‐sided, four (36.4%) had right‐sided, and one (9.1%) had bilateral obturator hernias. Three patients (27.3%) required resection of the ileum due to perforation or strangulation. All underwent simple closure of the hernia defect with interrupted or purse‐string sutures. Ten patients recovered uneventfully, whereas one had wound seroma and ileus. Recurrence has not been observed in the 8 surviving patients.Obturator hernia should be included in the

differential diagnosis of intestinal obstruction of unknown origin, especially in emaciated elderly women with chronic disease. Early surgical intervention without delay is imperative to avoid postoperative morbidity and mortality associated with intestinal strangulation due to obturator hernia. Obturator hernia can be sufficiently repaired with simple suture closure without mesh.

DOI: 10.1097/MD.0000000000021701PMCID: PMC7447413PMID: 32846788

11. J Am Coll Surg. 2020 Aug 18:S1072‐7515(20)32097‐4. doi: 10.1016/j.jamcollsurg.2020.08.735. Online ahead of print.

Improved Understanding of Acute Incisional Hernia Incarceration: Implications for Addressing the Excess Mortality of Emergent Repair.

Huckaby LV(1), Dadashzadeh ER(2), Handzel R(2), Kacin A(1), Rosengart MR(3), van der Windt DJ(4).

Author information:(1)Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.(2)Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh,

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abstract‐abdominalw‐set.txtPA.(3)Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Pittsburgh Surgical Outcomes Research Center (PittSORCe), University of Pittsburgh, Pittsburgh, PA.(4)Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: [email protected].

BACKGROUND: Up to 20% of patients undergoing abdominal surgery will develop an incisional hernia. We sought to identify characteristics associated with poor outcomes after acute incisional hernia incarceration.STUDY DESIGN: We performed a retrospective cohort study of adult patients with incisional hernias undergoing elective repair or with acute incarceration between 2010‐2017. The primary outcome was 30‐day mortality. Logistic regression was utilized to determine adjusted odds associated with 30‐day mortality. The American College of Surgeons (ACS) risk calculator was utilized to estimate outcomes had these patients undergone elective repair.RESULTS: A total of 483 patients experienced acute incarceration; 30‐day mortality was 9.52%. Increasing age (aOR 1.05, 95% CI 1.02‐1.08) and bowel resection (aOR 3.18, 95% CI 1.45‐6.95) were associated with mortality. Among those with acute incarceration, 231 (47.9%) had no documentation of a prior surgical evaluation while 252 (52.2%) had been evaluated but had not undergone elective repair. Among patients ≥80 years, 30‐day mortality after emergent repair was high (22.9%) compared to estimated 30‐day mortality for elective repair (0.73%) based on the ACS risk calculator. Estimated mortality was comparable to observed elective repair mortality (0.82%) in an age‐matched cohort. Similar mortality trends were noted for patients <60 and 60‐79 years.CONCLUSION: Comparison of predicted elective repair and observed emergent repair mortality in patients with acute incarceration suggests that acceptable outcomes could have been achieved with elective repair. Almost half of acute incarceration patients had no prior surgical evaluation, thus targeted interventions to address surgical referral may potentially result in fewer incarceration‐related deaths.

Copyright © 2020. Published by Elsevier Inc.

DOI: 10.1016/j.jamcollsurg.2020.08.735PMID: 32822886

12. Int J Surg. 2020 Aug 18;82:76‐84. doi: 10.1016/j.ijsu.2020.07.054. Online ahead of print.

Functional outcomes in symptomatic versus asymptomatic patients undergoing incisional hernia repair: Replacing one problem with another? A prospective cohort study in 1312 patients.

de Smet GHJ(1), Sneiders D(2), Yurtkap Y(2), Menon AG(3), Jeekel J(4), Kleinrensink GJ(4), Lange JF(5), Gillion JF(6); Hernia‐Club Members.

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Collaborators: Abet E(7), Ain JF(8), Arnalsteen L(9), Baraket O(10), Beck M(11), Bellouard A(12), Benizri E(13), Berney C(14), Bilem D(15), Binot D(16), Blanc B(17), Blazquez D(18), Bonan A(19), Boukortt T(20), Brehant O(21), Cas O(22), Champault‐Fezais A(23), Chau A(24), Chollet JM(19), Constantin M(25), Cossa JP(26), Dabrowski A(27), David A(28), Demaret S(29), Dubuisson V(28), Dugue T(27), El Nakadi I(30), Faure JP(31), Frileux P(32), Fromont G(33), Gadiri N(34), Gillion JF(19), Glehen O(35), Hennequin S(36), Isambert M(37), Jurczak F(38), Khalil H(39), Lamblin A(40), Largenton C(41), Lavy M(42), Lepère M(43), Le Toux N(18), Magne E(44), Manfredelli S(45), Mariette C(24), Marion Y(46), Mercoli HA(45), Mesli Smain N(37), Moszkowicz D(47), Najim M(48), Oberlin O(49), Odet E(50), Ortega Deballon P(51), Pavis d'Escurac X(52), Pichot Delahaye V(53), Putinier JB(54), Regimbeau JM(55), Renard Y(56), Romain B(57), Rouquie D(58), Soler M(59), Soufron J(60), Roos S(61), Thillois JM(19), Tiry P(27), Vauchaussade De Chaumont A(62), Vinatier E(63), Vu P(64), Verhaeghe R(16), Zaranis C(65), Zeineb M(66).

Author information:(1)Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: [email protected].(2)Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.(3)Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, the Netherlands.(4)Department of Neuroscience, Erasmus University Medical Center, Rotterdam, the Netherlands.(5)Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, the Netherlands.(6)Unité de Chirurgie Viscérale et Digestive, Hôpital Prive D'Antony, France.(7)Centre Hospitalier, La Roche sur Yon, France.(8)Polyclinique de Val de Saône, Macon, France.(9)Hôpital Privé La Louvière, Lille, France.(10)CHU, Bizerte, Tunisia.(11)Clinique Ambroise Paré, Thionville, France.(12)Clinique L'Archette, Olivet, France.(13)CHU, Nice, France.(14)Bankstown‐Lidcombe Hospital, Sydney, Australia.(15)Sidi‐Bel‐Abbes, Algeria.(16)MCO Côte D'Opale, Boulogne sur Mer, France.(17)CH, Dax, France.(18)Clinique Jeanne D'Arc, Paris, France.(19)Hôpital Privé D'Antony, Antony, France.(20)Clinique, Chlef, France.(21)Abbeville, France.(22)Centre Médico Chirurgical‐Fondation WALLERSTEIN, Arès, France.(23)Groupe Hospitalier Paris St Joseph, Paris, France.(24)CHU, Lille, France.

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abstract‐abdominalw‐set.txt(25)CH, Troyes, France.(26)CMC Bizet, Paris, France.(27)Clinique de Saint Omer, Saint Omer, France.(28)CHU, Bordeaux, France.(29)Clinique, Besançon, France.(30)CHU, Bruxelles, Belgium.(31)CHRU Poitiers, Poitiers, France.(32)Hôpital Foch, Paris, France.(33)Clinique de Bois Bernard, Bois Bernard, France.(34)CHU, Tlemcen, Algeria.(35)CHU, Lyon Sud, France.(36)CH, Cahors, France.(37)Clinique Capio, La Rochelle, France.(38)Clinique Mutualiste, Saint Nazaire, France.(39)CHRU Rouen, Rouen, France.(40)Clinique, Lille, France.(41)Saint Lô, France.(42)CH Saint Joseph, Lyon, France.(43)Clinique Saint Charles, La Roche‐sur‐Yon, France.(44)Clinique Tivoli, Bordeaux, France.(45)CHU, Strasbourg, France.(46)CHU, Caen, France.(47)CHU, Boulogne, France.(48)Clinique Yasmine, Casablanca, Morocco.(49)Croix St Simon Diaconesses, Paris, France.(50)CH, Macon, France.(51)CHU, Dijon, France.(52)Strasbourg, France.(53)Polyclinique de Rillieux, Lyon Nord, France.(54)CH Mutualiste, Grenoble, France.(55)CHU, Amiens, France.(56)CHRU Reims, Reims, France.(57)CHV, Lausanne, France.(58)Clinique Pasteur, Royan, France.(59)Polyclinique Saint Jean, Cagnes‐sur‐Mer, France.(60)Clinique Notre Dame, Vire, France.(61)Clinique Claude Bernard, Albi, France.(62)CHU Broussais, Paris, France.(63)CH, Seclin, France.(64)HPMV, Bry sur Marne, France.(65)Clinique de La Rochelle, France.(66)AHU, La Marsa, Tunisia.

BACKGROUND: Incisional hernias can be associated with pain or discomfort. Surgical repair especially mesh reinforcement, may likewise induce pain. The primary objective was to assess the incidence of pain after hernia repair in patients with and without pre‐operative pain or discomfort. The secondary objectives were to determine the preferred mesh type, mesh location and surgical technique in minimizing postoperative pain or discomfort.MATERIALS AND METHODS: A registry‐based prospective cohort study was performed,

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abstract‐abdominalw‐set.txtincluding patients undergoing incisional hernia repair between September 2011 and May 2019. Patients with a minimum follow‐up of 3‐6 months were included. The incidence of hernia related pain and discomfort was recorded perioperatively.RESULTS: A total of 1312 patients were included. Pre‐operatively, 1091 (83%) patients reported pain or discomfort. After hernia repair, 961 (73%) patients did not report pain or discomfort (mean follow‐up = 11.1 months). Of the pre‐operative asymptomatic patients (n = 221), 44 (20%, moderate or severe pain: n = 14, 32%) reported pain or discomfort after mean follow‐up of 10.5 months. Of those patients initially reporting pain or discomfort (n = 1091), 307 (28%, moderate or severe pain: n = 80, 26%) still reported pain or discomfort after a

mean follow‐up of 11.3 months postoperatively.CONCLUSION: In symptomatic incisional hernia patients, hernia related complaints may be resolved in the majority of cases undergoing surgical repair. In asymptomatic incisional hernia patients, pain or discomfort may be induced in a

considerable number of patients due to surgical repair and one should be aware if this postoperative complication.

Copyright © 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ijsu.2020.07.054PMID: 32818630

13. Hernia. 2020 Aug 18. doi: 10.1007/s10029‐020‐02284‐6. Online ahead of print.

Minimally invasive repair for lateral ventral hernia: tailored approach from a hernia centre at a tertiary care institution.

Wijerathne S(1)(2), Malik S(3), Usmani F(3), Lomanto D(3)(4).

Author information:(1)Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, National University Health System (NUHS), Level 8, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore. [email protected].(2)General Surgery Service, Alexandra Hospital, National University Health System, Singapore. [email protected].(3)Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, National University Health System (NUHS), Level 8, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore.(4)Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

INTRODUCTION: Lateral ventral hernia (LVH) is rare and can be primary or

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abstract‐abdominalw‐set.txtsecondary. Surgical treatment of this rare hernia type is challenging due the anatomic location and technical challenges in placement and secure anchoring of

mesh.METHOD: Patient demographic data, intra‐operative data and post‐operative outcomes on all LVH repairs performed with endo‐laparoscopic and robotic approach between 2016 to 2018 were reviewed and analysed.RESULTS: 22 LVH were repaired in 21 patients. 9 had primary hernia and 13 had secondary hernia. All patients underwent minimally invasive surgery (MIS) for hernia repair with no conversion to open surgery. Fascial defect closure and placement of mesh were performed in all cases. Different approaches were utilized: 9 hernia repaired with laparoscopic intra‐peritoneal on‐lay mesh technique with defect closure (IPOM +), 4 had laparoscopic trans‐abdominal pre‐peritoneal repair (TAPP), another 4 had extended totally extra‐peritoneal repair (eTEP), 3 had robotic TAPP (rTAPP) and 2 repaired with trans‐abdominal partial extra‐peritoneal (TAPE) approach. 4 (19%) of the patients developed post‐operative seroma which were managed conservatively. No other significant complication was noted, and no chronic pain or recurrence reported within a minimum follow‐up of 12 months.CONCLUSION: This case series gives a broad outline of possible MIS options available for LVH repair and recommendations for a tailored approach. The surgical technique needs to be individualized according to the size and anatomic location of the defect, other intra‐operative findings and patient characteristics.

DOI: 10.1007/s10029‐020‐02284‐6PMID: 32809091

14. Ann R Coll Surg Engl. 2020 Aug 18:1‐9. doi: 10.1308/rcsann.2020.0163. Online ahead of print.

Incisional hernia formation in hepatobiliary surgery using transverse and hybrid incisions: a systematic review and meta‐analysis.

Davey S(1), Rajaretnem N(2), Harji D(3), Rees J(4), Messenger D(4), Smart NJ(5), Pathak S(4)(6).

Author information:(1)North Bristol NHS Trust, Bristol, UK.(2)University Hospitals Plymouth, Crownhill, Plymouth, UK.(3)Institute of Health and Society, Newcastle University, UK.(4)University Hospitals Bristol NHS Foundation Trust, Bristol, UK.(5)Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.(6)Bristol Centre for Surgical Research, Bristol Medical School, Bristol, UK.

INTRODUCTION: Evidence suggests that midline incisions should be closed with the

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abstract‐abdominalw‐set.txtsmall‐bite technique to reduce IH formation. No recommendations exist for the closure of transverse incisions used in hepatobiliary surgery. This work systematically summarises rates of IH formation and associated technical factors for these transverse incisions.METHODS: A systematic search was undertaken. Studies describing the incidence of IH were included. Incisions were classified as transverse (two incision types) or hybrid (transverse with midline extension, comprising five incision types). The primary outcome measure was the pooled proportion of IH. Subgroup analysis based on minimum follow‐up of two years and a priori definition of IH with clinical and radiological diagnosis was undertaken.FINDINGS: Thirteen studies were identified and included 5,427 patients; 1,427 patients (26.3%) underwent surgery for benign conditions, 3,465 (63.8%) for malignancy and 535 (9.9%) for conditions that were not stated or classified as 'other'. The pooled incidence of IH was 6.0% (2.0‐10.0%) at a weighted mean follow‐up of 17.5 months in the transverse group, compared with 15.0% (11.0‐19.0%) at a weighted mean follow‐up of 42.0 months in the hybrid group (p

= 0.045). Subgroup analysis did not demonstrate a statistical difference in IH formation between the hybrid versus transverse groups.CONCLUSION: Owing to the limitations in study design and heterogeneity, there is limited evidence to guide incision choice and methods of closure in hepatopancreatobiliary surgery. There is an urgent need for a high‐quality prospective cohort study to understand the techniques used and their outcomes, to inform future research.

DOI: 10.1308/rcsann.2020.0163PMID: 32808799

15. Am J Surg. 2020 Aug 15:S0002‐9610(20)30485‐2. doi: 10.1016/j.amjsurg.2020.07.033. Online ahead of print.

"Least favorite consult": Invited commentary to "Fix it while you can: Mortality after umbilical hernia repair in cirrhotic patients".

Savarise M(1), Buhavac M(2).

Author information:(1)University of Utah Health, Salt Lake City, UT, USA. Electronic address: [email protected].(2)University of Utah Health, Salt Lake City, UT, USA.

DOI: 10.1016/j.amjsurg.2020.07.033PMID: 32854903

Conflict of interest statement: Declaration of competing interest Neither author has any conflict of interest.

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16. Surg Endosc. 2020 Aug 14. doi: 10.1007/s00464‐020‐07888‐8. Online ahead of print.

Impact of perforator sparing on anterior component separation outcomes in open abdominal wall reconstruction.

Elhage SA(1), Marturano MN(1), Prasad T(1), Colavita PD(1), Kercher KW(1), Augenstein VA(1), Heniford BT(2).

Author information:(1)Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.(2)Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA. [email protected].

INTRODUCTION: Anterior component separation (ACS) is a well‐established, highly

functional technique to achieve fascial closure in complex abdominal wall reconstruction (AWR). Unfortunately, ACS is also associated with an increased risk of wound complications. Perforator sparing ACS (PS‐ACS) has more recently been introduced to maintain the subcutaneous perforators derived from the deep epigastric vessels. The aim of this study is to evaluate wound‐related outcomes

in patients undergoing open AWR after implementation of a PS‐ACS technique.METHODS: A prospectively collected database were queried for patients who underwent open AWR and an ACS from 2006 to 2018. Patients who underwent PS‐ACS were compared to patients undergoing ACS using standard statistical methods. Patients undergoing concomitant panniculectomy were included in the standard ACS group.RESULTS: In total, 252 patients underwent ACS, with 24 (9.5%) undergoing PS‐ACS. Age and specific comorbidities were similar between groups (all p > 0.05) except for the PS‐ACS groups having a higher rate of prior tobacco use (45.8% vs 19.6%, p = 0.003). Mean hernia defect area was 381.6 ± 267.0 cm2 with 64.3% recurrent hernias, and both were similar between groups (all p > 0.05). The PS‐ACS group did have more complex wounds with more Ventral Hernia Working Group Grade 3 and

4 hernias (p = 0.04). OR time and length of stay were similar between groups (all p > 0.05). Despite increased complexity, wound complication rates were much lower in the PS‐ACS group (20.8% vs 46.1%, p = 0.02), and all specific wound complications were lower but not statistically different. Hernia recurrence rate was similar between PS‐ACS and ACS groups (4.2% vs 7.0%, p > 0.99) with mean follow‐up of 27.7 ± 26.9 months.

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abstract‐abdominalw‐set.txtCONCLUSIONS: In complex AWR, preservation of the deep epigastric perforating vessels during ACS significantly lowers the rates of wound complications, despite its performance in more complex patients with an increased risk of infection. PS‐ACS should be performed preferentially over a standard ACS whenever possible.

DOI: 10.1007/s00464‐020‐07888‐8PMID: 32797284

17. Alcohol Alcohol. 2020 Aug 14;55(5):497‐511. doi: 10.1093/alcalc/agaa043.

Mortality After Extrahepatic Gastrointestinal and Abdominal Wall Surgery in Patients With Alcoholic Liver Disease: A Systematic Review and Meta‐Analysis.

Adiamah A(1), Ban L(1), Hammond J(2), Jepsen P(3), West J(4), Humes DJ(1)(4).

Author information:(1)Nottingham Digestive Diseases Biomedical Research Centre, National Institute

for Health Research (NIHR), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, NG7 2UH, UK.(2)Division of Hepatobiliary and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK.(3)Department of Hepatology and Gastroenterology and Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark ,8200.(4)Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK.

AIMS: This meta‐analysis aimed to define the perioperative risk of mortality in

patients with alcoholic liver disease (ALD) undergoing extrahepatic gastrointestinal surgery.METHODS: Systematic searches of Embase, Medline and CENTRAL were undertaken to identify studies reporting about patients with ALD undergoing extrahepatic gastrointestinal surgery published since database inception to January 2019. Studies were only considered if they reported on mortality as an outcome. Pooled analysis of mortality was stratified as benign and malignant surgery and specific operative procedures where feasible.RESULTS: Of the 2899 studies identified, only five studies met inclusion criteria, representing cholecystectomy (one study), umbilical hernia repair surgery (one study) and oesophagectomy (three studies). The total number of patients with ALD in these studies was 172. Therefore, any study on liver disease patients undergoing extrahepatic surgery that crucially included a subset with alcohol aetiology was included as a secondary analysis even though they failed to stratify mortality by underlying aetiology. The total number of studies that met this expanded inclusion criteria was 62, reporting on 37,703 patients with liver disease of which 1735 (4.5%) had a definite diagnosis of ALD. Meta‐analysis of proportions of in‐hospital mortality in patients with ALD

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abstract‐abdominalw‐set.txtundergoing upper gastrointestinal cancer surgery (oesophagectomy) was 23% [95% confidence interval (CI) 14‐35%, I2 = 0%]. In‐hospital mortality following oesophagectomy in liver disease patients of all aetiologies was lower, 14% (95%

CI 9‐21%, I2 = 41.1%).CONCLUSION: Postoperative in‐hospital mortality is high in patients with liver disease and ALD in particular. However, the currently available evidence on ALD

is limited and precludes definitive conclusions on postoperative mortality risk.

© The Author(s) 2020. Medical Council on Alcohol and Oxford University Press. All rights reserved. For permissions, please e‐mail: [email protected].

DOI: 10.1093/alcalc/agaa043PMID: 32558895

18. BMJ Open. 2020 Aug 11;10(8):e037107. doi: 10.1136/bmjopen‐2020‐037107.

Protocol of an interdisciplinary consensus project aiming to develop an AGREE II extension for guidelines in surgery.

Antoniou GA(1)(2), Mavridis D(3)(4), Tsokani S(3), López‐Cano M(5), Flórez ID(6)(7), Brouwers M(6), Markar SR(8), Silecchia G(9), Francis NK(10), Antoniou

SA(11)(12).

Author information:(1)Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK [email protected].(2)Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK.(3)Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.(4)Faculté de Médecine, Université Paris Descartes, Paris, France.(5)Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.(6)Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.(7)Department of Pediatrics, Universidad de Antioquia, Medellin, Colombia.(8)Department of Surgery and Cancer, Imperial College London, London, UK.(9)Department of Surgery, University Hospital "La Sapienza", Rome, Italy.(10)Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.(11)Medical School, European University Cyprus, Nicosia, Cyprus.

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abstract‐abdominalw‐set.txt(12)Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus.

INTRODUCTION: Appraisal of Guidelines for Research and Evaluation (AGREE II) is

an instrument that informs development, reporting and assessment of clinical practice guidelines. Previous research has demonstrated the need for improvement in methodological and reporting quality of clinical practice guidelines specifically in surgery. We aimed to develop an AGREE II extension document for

application in surgical guidelines.METHODS AND ANALYSIS: We have performed a structured literature review and assessment of guidelines in surgery using the AGREE II instrument. In exploratory analyses, we have identified factors associated with guideline quality. We have performed reliability and factor analyses to inform the development of an extension document. We will summarise this information and present it to a Delphi panel of stakeholders. We will perform iterative Delphi rounds and we will summarise the final results to develop the extension instrument in a dedicated consensus conference.ETHICS AND DISSEMINATION: Funding bodies will not be involved in the development of the instrument. Research ethics committee and Health Research Authority approval was waived, since this is a professional staff study only and no duty of care lies with the National Health Service to any of the participants. Conflicts of interest, if any, will be addressed by reassigning functions or replacing participants with relevant conflicts. The results will be disseminated through publication in peer reviewed journals, the funders' websites, social media and direct contact with guideline development organisations and peer‐reviewed journals that publish guidelines.

© Author(s) (or their employer(s)) 2020. Re‐use permitted under CC BY‐NC. No commercial re‐use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen‐2020‐037107PMCID: PMC7418673PMID: 32784259

Conflict of interest statement: Competing interests: None declared.

19. Surg Endosc. 2020 Aug 11. doi: 10.1007/s00464‐020‐07894‐w. Online ahead of print.

Are laparoscopic and open ventral hernia repairs truly comparable?: A propensity‐matched study in large ventral hernias.

Shao JM(1), Deerenberg EB(1), Elhage SA(1), Colavita PD(1), Prasad T(1), Augenstein VA(1), Kercher KW(1), Heniford BT(2).

Author information:(1)Department of Surgery, Gastrointestinal and Minimally Invasive Surgery,

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abstract‐abdominalw‐set.txtCarolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC,

28204, USA.(2)Department of Surgery, Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC,

28204, USA. [email protected].

BACKGROUND: The merits of laparoscopic (LVHR) and open preperitoneal ventral hernia repair (OPPVHR) have been debated for more than 2 decades. Our aim was to determine peri‐operative and long‐term outcomes in large hernias.METHODS: A prospective, institutional database at a tertiary hernia center was queried for patients undergoing LVHR and OPPVHR. One‐to‐one propensity score matching was performed for hernia defect size and follow‐up.RESULTS: Three hundred and fifty‐two LVHR and OPPVHR patients were identified with defect sizes closely matched between laparoscopic (182.0 ± 110.0 cm2) and open repairs (178.3 ± 99.8 cm2), p = 0.64. LVHR and OPPVHR patients were comparable: mean age 57.2 ± 12.1 vs 56.6 ± 12.0 years (p = 0.52), BMI: 32.9 ± 6.6 vs 32.0 ± 7.4 kg/m2 (p = 0.16), diabetes 19.0% vs 19.7% (p = 0.87), and smoking history 8.7% vs 23.0% (p < 0.001), respectively. OPPVHR had higher number of recurrent hernias (14.2% vs 44.9%, p < 0.001), longer operative time (168.1 ± 64.3 vs 186.7 ± 67.7 min, p = 0.006), and more components separation (0% vs 20.3%, p < 0.001). Mean mesh size was larger (p < 0.001) in the open group (634.4 ± 243.4 cm2 vs 841.8 ± 277.6 cm2). The hernia recurrence rates were similar (10.8% vs 9.2%, p = 0.62), with average follow‐up of 39.3 ± 32.5 vs 40.0 ± 35.0 months (p = 0.89). Length of stay was higher in the OVHR cohort (5.4 ± 3.0 vs 6.3 ± 3.6 days, p < 0.001), but 30‐day readmission rates (4.0% vs

6.4%, p = 0.31) were similar. Overall wound infection rate (2.9% vs 8.4%, p = 0.03) was higher in the OPPVHR group, but the mesh infection rate was similar between LVHR (1.7%) and OPPVHR (0.6%) (p = 0.33). Postoperative pain (41.1% vs 41.4%, p = 0.95) and overall QOL based on the Carolinas Comfort Scale

at 6 months (p = 0.73) and 5‐years (p = 0.36) were similar.CONCLUSION: Laparoscopic and open preperitoneal repair for large ventral hernias have equivalent hernia recurrence rates, postoperative pain, and QOL on long‐term follow‐up. Patients undergoing OPPVHR were more likely to be recurrent, complex, require components separation, and more likely to develop postoperative wound complications.

DOI: 10.1007/s00464‐020‐07894‐wPMID: 32780243

20. J Cell Mol Med. 2020 Aug 11. doi: 10.1111/jcmm.15676. Online ahead of print.

Musashi2 promotes the progression of pancreatic cancer through a novel ISYNA1‐p21/ZEB‐1 pathway.

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Zhou L(1), Sheng W(1), Jia C(1), Shi X(1), Cao R(1), Wang G(1), Lin Y(1), Zhu F(2), Dong Q(3), Dong M(1).

Author information:(1)Department of Gastrointestinal and Hernia and Abdominal Wall Surgery, First Hospital of China Medical University, Shenyang, China.(2)Division of Cardiology, The People's Hospital of Liaoning Province, Shenyang, China.(3)Department of General Surgery, The People's Hospital of Liaoning Province, Shenyang, China.

Our previous studies found overexpression of Musashi2 (MSI2) conduced to the progression and chemoresistance of pancreatic cancer (PC) by negative regulation of Numb and wild type p53 (wtp53). Now, we further investigated the novel signalling involved with MSI2 in PC. We identified inositol‐3‐phosphate synthase 1 (ISYNA1) as a novel tumour suppressor regulated by MSI2. High MSI2 and low ISYNA1 expression were prevalently observed in 91 PC tissues. ISYNA1 expression

was negatively correlated with MSI2 expression, T stage, vascular permeation and poor prognosis in PC patients. What's more, patients expressed high MSI2 and low ISYNA1 level had a significant worse prognosis. And in wtp53 Capan‐2 and SW1990

cells, ISYNA1 was downregulated by p53 silencing. ISYNA1 silencing promoted cell proliferation and cell cycle by inhibiting p21 and enhanced cell migration and invasion by upregulating ZEB‐1. However, MSI2 silencing upregulated ISYNA1 and p21 but downregulated ZEB‐1, which can be rescued by ISYNA1 silencing. Moreover, reduction of cell migration and invasion resulting from MSI2 silencing was significantly reversed by ISYNA1 silencing. In summary, MSI2 facilitates the development of PC through a novel ISYNA1‐p21/ZEB‐1 pathway, which provides new gene target therapy for PC.

© 2020 The Authors. Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Ltd.

DOI: 10.1111/jcmm.15676PMID: 32779876


Opioid Use After Inguinal and Ventral Hernia Repair.

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abstract‐abdominalw‐set.txtMillard JL(1), Moraney R(2), Childs JC(3), Ewing JA(1), Carbonell AM(2), Cobb WS(2), Warren JA(2).

Author information:(1)Department of Surgery, Prisma Health Upstate‐Greenville Memorial, Greenville, SC, USA.(2)University of South Carolina School of Medicine‐Greenville, Greenville, SC, USA.(3)Department of Surgery, Prisma Health Upstate: Summer Program for Undergraduate Research in Surgery, Greenville, SC, USA.

BACKGROUND: Recent data on opioid consumption indicate that patients typically require far less than is prescribed. Prisma Health Upstate Hernia Center adopted standardized postoperative prescribing after hernia repair and began tracking patient‐reported opioid utilization. The aim of this study is to evaluate patient opioid use after hernia repair in order to guide future prescribing.METHODS: All patients who underwent primary ventral (umbilical and epigastric),

incisional, and inguinal hernia repair between February and May 2019 were reviewed. Patients reported the number of opioid pills taken at their first postoperative visit and documented either in the progress note or in the Americas Hernia Society Quality Collaborative (AHSQC) patient‐reported outcomes

(PRO) questionnaire. All demographic, operative, and outcomes data were captured prospectively in the AHSQC. Opioid use reported as milligram morphine equivalents (MME).RESULTS: A total of 162 surgeries were performed during the study period, and 107 had patient‐reported opioid use for analysis. Inguinal hernia repair was performed in 36 patients, 10 primary ventral hernia repairs, and 61 incisional hernia repairs. No opioid use was reported in 63.9% of inguinal hernias, 60% of

primary ventral hernias, and 20% of incisional hernias. Inguinal hernia patients consumed a mean of 10.5 MME, primary ventral patients 11 MME, and incisional hernia patients 78.5 MME.CONCLUSION: Patients require little to no opioid after primary ventral or inguinal hernia repair and opioid‐free surgery is feasible. Incisional hernia is more heterogenous, but the majority of patients still required less opioid than

previously thought.

DOI: 10.1177/0003134820942179PMID: 32779472

22. Hernia. 2020 Aug 8. doi: 10.1007/s10029‐020‐02280‐w. Online ahead of print.

Variation in abdominal wall closure techniques in lower transverse incisions: a

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nationwide survey across specialties.

Paulsen CB(1), Zetner D(2), Rosenberg J(2).

Author information:(1)Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark. [email protected].(2)Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.

PURPOSE: Lower transverse abdominal incisions are typically used by obstetricians/gynecologists and colorectal surgeons. The suture technique and choice of material when closing the abdomen is an essential factor to decrease the risk of incisional hernia. We conducted a nationwide survey among obstetricians/gynecologists and colorectal surgeons investigating the surgical handling of the fascia, rectus muscle, subcutis, peritoneum, and skin, in lower

transverse incisions.METHODS: All departments of obstetrics/gynecology and departments of surgery performing colorectal surgery in Denmark were invited to participate. An online

questionnaire was sent to consultant obstetricians/gynecologists and colorectal

surgeons. The survey consisted of demographic information together with questions on surgical details. The study was reported according to STROBE guidelines.RESULTS: A total of 252 (64.5%) consultants provided a complete response to the

survey. We found that 98.0% of the colorectal surgeons and 65.8% of the obstetricians/gynecologists used monofilament suture when closing the fascia. The majority of the colorectal surgeons used continuous suture and small bites technique. This was only the case for half of the obstetricians/gynecologists. Approximately two thirds of the colorectal surgeons and one third of the OB/GYN

used the suture length to wound length ratio > 4:1. Furthermore, we found significant differences between the groups in the handling of subcutis, peritoneum, and skin.CONCLUSION: We found significant variation in abdominal wall closure techniques

in lower transverse incisions. Disagreement between the current guidelines within the specialties together with insufficient evidence on the closure of lower transverse incisions emphasizes the need for education as well as further

studies.

DOI: 10.1007/s10029‐020‐02280‐wPMID: 32770366

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abstract‐abdominalw‐set.txt23. Breast Cancer Res Treat. 2020 Aug 6. doi: 10.1007/s10549‐020‐05848‐3. Online ahead of print.

Single‐port laparoscopically harvested omental flap for immediate breast reconstruction.

Kim EK(1), Chae S(2), Ahn SH(3).

Author information:(1)Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi‐ro 173 Beon‐gil, Bundang‐gu, Seongnam‐si, Gyeonggi‐do, 13620, Korea. [email protected].(2)Department of Surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea.(3)Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi‐ro 173 Beon‐gil, Bundang‐gu, Seongnam‐si, Gyeonggi‐do, 13620, Korea.

PURPOSE: Immediate breast reconstruction using laparoscopically harvested omental flap is a safe and feasible technique, providing natural contour and softness to reconstructed breasts with reduced donor‐site morbidity and deformity. We report our experience using single‐port laparoscopically harvested omental flap (SLOF) for immediate breast reconstruction.METHODS: Between February 2015 and December 2018, 129 patients with malignant neoplasm of the breast underwent nipple‐sparing mastectomy (NSM) or breast‐conserving surgery (BCS) followed by immediate SLOF reconstruction at Seoul National University Bundang Hospital. We assessed their clinicopathological data, complications, and cosmetic and oncologic outcomes. Cosmetic outcomes were evaluated by three‐panel assessment and the BCCT.core software program.RESULTS: One hundred and six (82.2%) underwent NSM and 23 (17.8%) underwent BCS. Mean operation time was 205 (range, 134‐316) minutes. Most patients had early‐stage disease; 15 (11.6%) received neoadjuvant chemotherapy. Two had malignant phyllodes tumors. Cosmetic outcomes were excellent or good in 96.9% by three‐panel assessment and 99.2% by the BCCT.core program with a nearly invisible donor‐site scar in the umbilicus. Harvest‐associated complications occurred in five (3.9%) patients, including two umbilical wound infections, one

intra‐abdominal infection, one umbilical hernia, and one pedicle injury. Fat necrosis (13.2%) and epigastric bulging (21.7%) were common mastectomy‐ or reconstruction‐associated complications, but most were mild and some resolved spontaneously. Over a median 38‐month follow‐up, there were three local, two regional, and three systemic recurrences.CONCLUSIONS: SLOF reconstruction is a feasible and safe option for immediate breast reconstruction after NSM or extensive BCS with minimal donor‐site morbidity and great cosmetic outcomes.

DOI: 10.1007/s10549‐020‐05848‐3

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abstract‐abdominalw‐set.txtPMID: 32766951

24. Surg Endosc. 2020 Aug 6. doi: 10.1007/s00464‐020‐07857‐1. Online ahead of print.

S116: Impact of incisional negative pressure wound therapy on surgical site infection after complex incisional hernia repair: a retrospective matched cohort study.

Hopkins B(1)(2), Eustache J(1)(2), Ganescu O(3), Cipolla J(3), Kaneva P(1), Fried GM(1)(2), Khwaja K(1)(2), Vassiliou M(1)(2), Fata P(1)(2), Lee L(4)(5), Feldman LS(1)(2).

Author information:(1)Steinberg‐Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave., L9.309, Montreal, QC, H3G 1A4, Canada.(2)Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.(3)Faculty of Medicine, McGill University, Montreal, QC, Canada.(4)Steinberg‐Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave., L9.309, Montreal, QC, H3G 1A4, Canada. [email protected].(5)Department of Surgery, McGill University Health Centre, Montreal, QC, Canada. [email protected].

INTRODUCTION: Incisional negative pressure wound therapy (iNPWT) may reduce surgical site infections (SSI), which can have devastating consequences after incisional hernia repair. Few comparative studies investigate the effectiveness

of this wound management strategy in this population. The objective of this study is to determine the effect of iNPWT on the incidence of SSI after complex

incisional hernia repair.METHODS: All adult patients undergoing open incisional hernia repair at a single center from 2016 to 2019 were reviewed. A commercial iNPWT dressing was used at

the discretion of the surgeon. Patients were grouped by type of dressing; iNPWT

and standard sterile dressings (SSD). Coarsened exact matching was used to create balanced cohorts for comparison using age, sex, American Society of Anesthesiologists classification, wound classification, and surgical urgency. The primary outcome was the composite incidence of superficial and deep SSI within 30 days. Secondary outcomes included non‐infectious surgical site occurrences (SSO), overall complications, length of stay (LOS), emergency

Página 26

abstract‐abdominalw‐set.txtdepartment visits, and readmission at 30 days.RESULTS: 134 patients underwent complex hernia repair, with 114 patients included after matching (34 iNPWT, 51 SSD). Composite incidence of superficial and deep SSI was 19.3% (11.8% vs. 27.5%, p = 0.107), with significantly lower rates of deep SSI in patients receiving iNPWT (2.9% vs. 17.6%, p = 0.045). After accounting for residual differences between groups, iNPWT was associated with decreased incidence of composite SSI (RR 0.36, 95% CI [0.16, 0.87]). Median LOS

was longer in patients with iNPWT (7 vs. 5 days, p = 0.001). There were no differences in SSO, overall complications, readmission, or emergency department

visits.CONCLUSION: In patients undergoing incisional hernia repair, the use of iNPWT was associated with a lower incidence of SSI at 30 days. Future studies should focus on cost effectiveness of iNPWT, its impact on long‐term hernia recurrences, and the identification of patient selection criteria in this population.

DOI: 10.1007/s00464‐020‐07857‐1PMID: 32761478

25. Surg Infect (Larchmt). 2020 Aug 4. doi: 10.1089/sur.2020.133. Online ahead of print.

Maximal Infected Mesh Removal with Methylene Blue Injection for Mesh Infection after Inguinal Hernia Repair.

Wang D(1), Fu Y(2), Liu Q(2), Chen J(1).

Author information:(1)Department of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.(2)Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.

Background: Mesh infection is a serious complication of inguinal hernia repair,

but surgeons have not reached a consensus on the method of treatment. The aim of this study was to assess the outcomes of maximal mesh removal therapy with methylene blue injection for mesh infection after inguinal hernia repair. Patients and Methods: The study was a monocentric retrospective analysis following STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statements of all patients with mesh infection undergoing maximal mesh

removal operation with methylene blue injection. Demographics, mesh infection characteristics, microbiology, early post‐operative data, and follow‐up data were recorded. Results: Sixteen patients underwent complete removal of infected

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abstract‐abdominalw‐set.txtmesh and 13 had partial removal. The operation time was 76.3 ± 26.0 minutes. In

13 patients the cultures tested positive, five for Staphylococcus aureus. Twelve participants developed surgical site infection post‐operatively and eventually healed after 27.4 ± 16.3 days of dressing. In a mean follow‐up of 46 months, one patient suffered chronic pain and one had chronic sinus in the partial removal group, although none did in the complete removal group, without a statistically

significant difference. No hernia recurrence occurred. Conclusions: Maximal mesh removal therapy with methylene blue injection can be considered as a feasible alternative for the treatment of mesh infection.

DOI: 10.1089/sur.2020.133PMID: 32758044

26. Obes Surg. 2020 Aug 4. doi: 10.1007/s11695‐020‐04899‐1. Online ahead of print.

Incarcerated Umbilical Hernia: A Rare Etiology of Early Bowel Obstruction After

Roux‐en‐Y Gastric Bypass‐A Case Report.

Kordy M(1), Kermansaravi M(2), Mousavimaleki A(1), Rezvani M(3).

Author information:(1)Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.(2)Department of Surgery, Minimally Invasive Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool‐e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. [email protected].(3)Department of Surgery, Inova Fair Oaks Hospital, Fairfax, VA, USA.

DOI: 10.1007/s11695‐020‐04899‐1PMID: 32754795

27. Infection. 2020 Aug 4. doi: 10.1007/s15010‐020‐01495‐4. Online ahead of print.

Mycobacterium bovis infection of an aortobifemoral bypass graft with Streptococcus intermedius superinfection after intravesical bacillus Calmette‐Guérin immunotherapy for bladder cancer.

Dubert M(1)(2), Abihssira S(3), Diamantis S(4), Guenin R(5), Messaoudi R(6), Roux AL(7), Rouis K(8), Lillo A(9), Surgers L(10)(11), Douard R(12), Julia P(3), Lebeaux D(13)(14).

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abstract‐abdominalw‐set.txtAuthor information:(1)Université de Paris, 75006, Paris, France. [email protected].(2)Service de Microbiologie, Unité Mobile D'Infectiologie, AP‐HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France. [email protected].(3)Service de Chirurgie Vasculaire, Hôpital Européen Georges Pompidou, AP‐HP, Paris, France.(4)Service de Maladies Infectieuses, Groupe Hospitalier Sud Ile de France, Melun, France.(5)Service de médecine nucléaire, Centre de Médecine Nucléaire, 77 Santepole, Melun, France.(6)Service d'urologie, Clinique Saint Jean de L'Hermitage, Dammarie‐Les‐Lys, Melun, France.(7)Service de Microbiologie, Hôpital Ambroise Paré, AP‐HP, Boulogne‐Billancourt, Paris, France.(8)Université de Paris, 75006, Paris, France.(9)Centre de Pharmacovigilance, Hôpital Européen Georges Pompidou, AP‐HP, Paris, France.(10)Service de Maladies Infectieuses, Hôpital Saint Antoine, AP‐HP Sorbonne Université, Paris, France.(11)Sorbonne université, CIMI équipe 13, INSERM U1135, 75005, Paris, France.(12)Service de Chirurgie générale, Digestive Et Oncologique, Hôpital Européen Georges Pompidou, AP‐HP, Paris, France.(13)Université de Paris, 75006, Paris, France. [email protected].(14)Service de Microbiologie, Unité Mobile D'Infectiologie, AP‐HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France. [email protected].

BACKGROUND: The Bacillus Calmette‐Guerin (BCG) is a life‐attenuated form of Mycobacterium bovis widely used as immunotherapy for localized bladder cancer. Adverse reactions to intravesical BCG instillations are rare.CASE: We describe a 70‐year‐old man with a history of an aortobifemoral bypass graft, placement of a synthetic mesh for treatment of a ventral hernia and, most recently, superficial bladder cancer treated with BCG therapy. Ten months after

his final intravesical BCG instillation, he complained of fever and asthenia. After 12 months of investigation, he was diagnosed with Mycobacterium bovis infection of his aortobifemoral bypass graft and abdominal mesh, with Streptococcus intermedius superinfection. The bypass graft was excised and replaced with an in situ arterial allograft, the abdominal mesh was removed, and treatment started with amoxicillin, isoniazid, rifampicin and ethambutol. Several additional vascular interventions were needed for allograft degradation, but 12 months after the final procedure, outcome was good.DISCUSSION AND CONCLUSIONS: Among 35 cases of mycotic aneurysm reported after BCG therapy in the last 10 years, only one involved a vascular prosthesis. Surgical repair of such aneurysms using prosthetic grafts is commonly performed,

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abstract‐abdominalw‐set.txtassociated with anti‐mycobacterial treatment. Prognosis is poor with mortality of 14% (4/35) and a 26% rate of aneurysm recurrence under treatment (9/35).

DOI: 10.1007/s15010‐020‐01495‐4PMID: 32749595

28. J Gastrointest Surg. 2020 Aug 3. doi: 10.1007/s11605‐020‐04762‐9. Online ahead of print.

Relationship Between Diverticular Disease and Incisional Hernia After Elective Colectomy: a Population‐Based Study.

Perez NP(1)(2), Chang DC(3), Goldstone RN(4), Bordeianou L(4), Ricciardi R(4), Cavallaro PM(4).

Author information:(1)Department of Surgery, Massachusetts General Hospital, 55 Fruit St, GRB‐425,

Boston, MA, 02114, USA. [email protected].(2)Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA, USA. [email protected].(3)Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA.(4)Department of Surgery, Massachusetts General Hospital, 55 Fruit St, GRB‐425,

Boston, MA, 02114, USA.

BACKGROUND: Recent genetic studies identified common mutations between diverticular disease and connective tissue disorders, some of which are associated with abdominal wall hernias. Scarce data exists, however, shedding light on the potential clinical implications of this shared etiology, particularly in the era of laparoscopic surgery.METHODS: The New York Statewide Planning and Research Cooperative System database was used to identify adult patients undergoing elective sigmoid and left hemicolectomy (open or laparoscopic) from January 1, 2010, to December 31,

2016, for diverticulitis or descending/sigmoid colon cancer. The incidences of incisional hernia diagnosis and repair were compared using competing risks regression models, clustered by surgeon and adjusted for a host of demographic/clinical variables. Subsequent abdominal surgery and death were considered competing risks.RESULTS: Among 8279 patients included in the study cohort, 6811 (82.2%) underwent colectomy for diverticulitis and 1468 (17.8%) for colon cancer. The overall 5‐year risk of incisional hernia was 3.5% among patients with colon cancer, regardless of colectomy route, which was significantly lower than that among diverticulitis patients after both open (10.7%; p < 0.001) and laparoscopic (7.2%; p = 0.007) colectomies. Multivariable analyses demonstrated

that patients with diverticulitis experienced a two‐fold increase in the risk for hernia diagnosis (aHR 1.8; p < 0.001) and repair (aHR 2.1; p < 0.001), and

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abstract‐abdominalw‐set.txtthese findings persisted after stratification by colectomy route.CONCLUSIONS: Patients undergoing elective colectomy for diverticulitis, including via laparoscopic approach, experience higher rates of incisional hernia compared with patients undergoing similar resections for colon cancer. When performing resections for diverticulitis, surgeons should strongly consider adherence to evidence‐based guidelines for fascial closure to prevent this important complication.

DOI: 10.1007/s11605‐020‐04762‐9PMID: 32748338

29. World J Urol. 2020 Aug 3. doi: 10.1007/s00345‐020‐03378‐7. Online ahead of print.

Late complications of robot‐assisted radical cystectomy with totally intracorporeal urinary diversion.

Presicce F(1), Leonardo C(2), Tuderti G(3), Brassetti A(3), Mastroianni R(3), Bove A(3), Misuraca L(3), Anceschi U(3), Ferriero M(3), Gallucci M(3), Simone G(3).

Author information:(1)Department of Urology, Sapienza ‐ University of Rome, Via Alessandro Torlonia 12, Rome, Italy. [email protected].(2)Department of Urology, Sapienza ‐ University of Rome, Via Alessandro Torlonia 12, Rome, Italy.(3)Department of Urology, Regina Elena National Cancer Institute, Rome, Italy.

INTRODUCTION AND OBJECTIVES: To evaluate late complications in a large cohort of patients undergoing robot‐assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD).MATERIALS AND METHODS: We prospectively enrolled patients who underwent RARC and ICUD between August 2012 and June 2019. We excluded patients with Ejection fraction < 36%, retinal vasculopathy, ventriculoperitoneal shunts, and those treated without curative intent. All complications and their onset date have been recorded, defined, and graded according to Clavien classification adapted for radical cystectomy.RESULTS: 210 patients were included, 76% of whom were men, with a mean age of 62 years. Urinary diversions used were Padua Ileal Bladder (PIB) in 80% of cases, and ileal conduit (IC) in 20% of patients (generally older and with more

comorbidity). The mean follow‐up was 30 ± 22 months. The stenosis rate of uretero‐ileal anastomosis was 14%, while a reduction in eGFR (≥ 20%) was observed in about half of the cases. UTIs occurred in 37% of the patients, especially in the first 12 months. Only 2% of patients had bowel occlusion, whereas incisional hernia, lymphocele, and systemic events (metabolic acidosis

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abstract‐abdominalw‐set.txtand major cardiovascular events) occurred respectively in 20%, 10%, and 1% of cases.CONCLUSIONS: Our study evaluates first late complications in a cohort of patients who underwent RARC with ICUD. These data are encouraging and in line with findings from a historical series of open radical cystectomy (ORC). This study is a further step in supporting RARC as a safe and effective surgical option for the treatment of muscle‐invasive bladder cancer (MIBC) in tertiary referral centers.

DOI: 10.1007/s00345‐020‐03378‐7PMID: 32747981

30. Genet Med. 2020 Aug 3. doi: 10.1038/s41436‐020‐0919‐x. Online ahead of print.

Clinical, molecular, and biochemical delineation of asparagine synthetase deficiency in Saudi cohort.

Alharby E(1), Faqeih EA(2), Saleh M(2), Alameer S(3), Almuntashri M(4), Pastore

A(5), Samman MA(6), Alnawfal AM(6), Hashem M(7), Zaytuni D(1), Alharbi G(1), Almannai M(2), Alasmari A(2), Mahmoud AA(8), Alwadei AH(8), Jad L(8), AlOtaibi A(8), Al‐Hakami F(3), Eyaid W(9)(10), Alkuraya FS(7)(11), Alfadhel M(9)(10), Peake RWA(12), Almontashiri NAM(13)(14).

Author information:(1)Center for Genetics and Inherited Diseases, Taibah University, Almadinah Almunwarah, Saudi Arabia.(2)Section of Medical Genetics, Children's Specialist Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.(3)King Abdulaziz Medical City/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.(4)Department of Radiology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.(5)National Institute for Medical Research, The Ridgeway, Mill Hill, London, UK.(6)Molecular Pathology, Pathology and Clinical Laboratory Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia.(7)Department of Genetics, King Faisal Specialist Hospital and Research Center,

Riyadh, Saudi Arabia.(8)Pediatric Neurology Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.(9)Medical Genomics Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard‐Health Affairs (MNGHA), Riyadh, Saudi Arabia.(10)Division of Genetics, Department of Pediatrics, King Abdullah Specialized Children's Hospital (KASCH), King Abdulaziz Medical City, Ministry of National Guard‐Health Affairs (MNGHA), Riyadh, Saudi Arabia.

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abstract‐abdominalw‐set.txt(11)College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.(12)Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA.(13)Center for Genetics and Inherited Diseases, Taibah University, Almadinah Almunwarah, Saudi Arabia. [email protected].(14)Faculty of Applied Medical Sciences, Taibah University, Almadinah Almunwarah, Saudi Arabia. [email protected].

PURPOSE: Asparagine synthetase deficiency (ASNSD) is a rare neurometabolic disease. Patients may not demonstrate low asparagine levels, which highlights the advantage of molecular over biochemical testing in the initial work‐up of ASNSD. We aimed to further delineate the ASNSD variant and phenotypic spectrum and determine the value of biochemical testing as a frontline investigation in ASNSD.METHODS: We retrospectively collected the clinical and molecular information on

13 families with ASNSD from the major metabolic clinics in Saudi Arabia.RESULTS: The major phenotypes included congenital microcephaly (100%), facial dysmorphism (100%), global developmental delay (100%), brain abnormalities (100%), spasticity (86%), and infantile‐onset seizures (93%). Additional unreported phenotypes included umbilical hernia, osteopenia, eczema, lung hypoplasia, and hearing loss. Overall, seven homozygous variants accounted for ASNSD. The p.Tyr398Cys and p.Asn75Ile variants accounted for 54% of the cases. The clinical sensitivity and specificity of the proposed biochemical analysis of cerebrospinal fluid (CSF) for the detection of patients with ASNSD were 83% and

98%, respectively.CONCLUSION: Our study describes the largest reported ASNSD cohort with clinical, molecular, and biochemical characterization. Taking into consideration the suboptimal sensitivity of biochemical screening, the delineation of the phenotype variant spectrum is of diagnostic utility for accurate diagnosis, prognosis, counseling, and carrier screening.

DOI: 10.1038/s41436‐020‐0919‐xPMID: 32741967

31. Int J Surg. 2020 Aug 1;82:54‐55. doi: 10.1016/j.ijsu.2020.07.045. Online ahead of print.

Letter to the editor on "Absorbable versus non‐absorbable tacks for mesh fixation in laparoscopic ventral hernia repair: A systematic review and meta‐analysis" [Int. J. Surg. 53 (2018) 184‐192].

Friis‐Andersen H(1).

Author information:(1)President Danish Hernia Database, Surgical Dept., Horsens Regional Hospital,

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abstract‐abdominalw‐set.txtSundvej 30, DK‐8700, Horsens, Denmark; Aarhus University, DK‐8000, Aarhus C, Denmark. Electronic address: [email protected].

DOI: 10.1016/j.ijsu.2020.07.045PMID: 32750490

32. Ann Surg. 2020 Aug;272(2):288‐303. doi: 10.1097/SLA.0000000000003232.

Hospital Volume and Operative Mortality for General Surgery Operations Performed Emergently in Adults.

Becher RD(1), DeWane MP(1), Sukumar N(2), Stolar MJ(2), Gill TM(3), Maung AA(1), Schuster KM(1), Davis KA(1).

Author information:(1)Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT.(2)Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT.(3)Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.

OBJECTIVE: This study aimed to answer 2 questions: first, to what degree does hospital operative volume affect mortality for adult patients undergoing 1 of 10 common emergency general surgery (EGS) operations? Second, at what hospital operative volume threshold will nearly all patients undergoing an emergency operation realize the average mortality risk?BACKGROUND: Nontrauma surgical emergencies are an underappreciated public health crisis in the United States; redefining where such emergencies are managed may improve outcomes. The field of trauma surgery established regionalized systems of care in part because studies demonstrated a clear relationship between hospital volume and survival for traumatic emergencies. Such a relationship has

not been well‐studied for nontrauma surgical emergencies.METHODS: Retrospective cohort study of all acute care hospitals in California performing nontrauma surgical emergencies. We employed a novel use of an ecological analysis with beta regression to investigate the relationship between hospital operative volume and mortality.RESULTS: A total of 425 acute care hospitals in California performed 165,123 EGS operations. Risk‐adjusted mortality significantly decreased as volume increased

for all 10 EGS operations (P < 0.001 for each); the relative magnitude of this inverse relationship differed substantially by procedure. Hospital operative

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abstract‐abdominalw‐set.txtvolume thresholds were defined and varied by operation: from 75 cases over 2 years for cholecystectomy to 7 cases for umbilical hernia repair.CONCLUSIONS: Survival rates for nontrauma surgical emergencies were improved when operations were performed at higher‐volume hospitals. The use of ecological analysis is widely applicable to the field of surgical outcomes research.

DOI: 10.1097/SLA.0000000000003232PMID: 32675542

33. Surg Laparosc Endosc Percutan Tech. 2020 Aug;30(4):367‐370. doi: 10.1097/SLE.0000000000000806.

Porcine Small Intestinal Submucosa Mesh to Treat Inguinal Hernia in Young Adults Using Laparoscopic Inguinal Hernia Repair: A Retrospective Controlled Study.

Liu Y(1), Cao Z(2), Yang H(1), Shen Y(1), Chen J(1).

Author information:(1)Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University.(2)The Third Clinical Medical School of Capital Medical University, Beijing, P.R. China.

BACKGROUND: The authors evaluated the effects and clinical value of small intestinal submucosa (SIS) mesh to treat inguinal hernia in young adults by the

laparoscopic method.METHODS: The clinical data of 357 cases with inguinal hernia using SIS mesh in our hospital were analyzed retrospectively from June 2014 to June 2018. All cases were divided into 2 groups according to the surgical method. Operation time, hospital stay, cost, postoperative complications, and complications during follow‐up were analyzed.RESULTS: Of the 357 patients, 202 (56.6%) underwent Lichtenstein repair and 155

(43.4%) underwent transabdominal preperitoneal (TAPP) repair. Operation time and hospital costs of the Lichtenstein group were significantly lower compared with

the TAPP group (P<0.05). The incidence of seroma in the Lichtenstein group was lower than that in the TAPP group at 1 week, 1 month, and 3 months postoperatively with significant differences (P<0.05). Perioperative pain scores in the Lichtenstein group were higher than the TAPP group (P<0.05). No statistical difference was observed for hospital stay between 2 groups (P>0.05). In the Lichtenstein group, 1 case recurred during the follow‐up period (0.5%). No intestinal obstruction or intestinal fistula occurred in any patient during the follow‐up period.

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abstract‐abdominalw‐set.txtCONCLUSION: The effect of SIS mesh was positive whether the patient underwent a

Lichtenstein or TAPP method. Seroma was more common in the TAPP method that may

cause lower postoperative pain. Therefore, we recommend individualized treatment.

DOI: 10.1097/SLE.0000000000000806PMID: 32366749

34. J Trauma Acute Care Surg. 2020 Aug;89(2S Suppl 2):S200‐S206. doi: 10.1097/TA.0000000000002769.

Incisional hernia incidence following laparotomy for combat trauma: Investigating 15 years of US war surgery.

Moas V(1), Eskridge S, Clouser M, Kurapaty S, Dyke C, Souza J.

Author information:(1)From Walter Reed National Military Medical Center, Department of Surgery (V.M., C.D., J.S.), Bethesda, Maryland; Naval Health Research Center and Leidos

(S.E., M.C.), San Diego, California; The George Washington School of Medicine (S.K.), Washington DC.

BACKGROUND: While the incidence of incisional hernia (IH) following elective laparotomy has been well described, incidence following emergent laparotomy for

combat trauma has been much less studied. This retrospective cohort investigates the latter to better describe the burden IH represents for the injured warfighter.METHODS: Data were obtained from the Expeditionary Medical Encounter Database for service members who survived a combat‐related injury between January 2002 and December 2016 and underwent abdominal surgery in the first 30 days after injury. Incisional hernia diagnosis at least 30 days after injury was determined from inpatient and outpatient records in the Military Health System's Medical Data Repository.Means and SDs were reported for age and continuous Injury Severity Score, and frequency and percentages were reported for sex, branch of service, paygrade, mechanism of injury, Injury Severity Score, and maximum abdominal Abbreviated Injury Scale. Service members with and without a hernia diagnosis were compared using t test for continuous variables and χ or Fisher exact test (depending on cell size) for categorical variables.Multivariate logistic regression models were used to examine relationships between IH diagnosis and the covariates previously mentioned. Data analysis was completed using SAS software version 9.4 (SAS Institute Inc., Cary, NC).RESULTS: Of the 570 laparotomy patients, 109 (19.1%) developed IH. Of these, 58

(53%) were diagnosed within the first year after injury. An additional 21 (19%)

Página 36

abstract‐abdominalw‐set.txtwere diagnosed within the following year, and 30 (28%) were diagnosed more than

2 years after injury. Presence of gastrointestinal injury, Abbreviated Injury Scale score of 4 and 5, and 5‐year increments of age were positively associated

with hernia formation.CONCLUSION: The incidence of postlaparotomy IH in combat trauma is 19.1%, a considerable source of disability for injured warfighters. Further investigation into hernia‐preventive closure strategies is warranted.LEVEL OF EVIDENCE: Therapeutic study, level IV.

DOI: 10.1097/TA.0000000000002769PMID: 32345894

35. Obes Surg. 2020 Aug;30(8):2980‐2987. doi: 10.1007/s11695‐020‐04626‐w.

Ameliorating Effects and Mechanisms of Intra‐Operative Vagal Nerve Stimulation on Postoperative Recovery After Sleeve Gastrectomy in Rats.

Tian M(1)(2), Alimujiang M(1)(3), Chen JD(4).

Author information:(1)Division of Gastroenterology and Hepatology, Johns Hopkins University School

of Medicine, Baltimore, MD, USA.(2)Department of General Surgery, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.(3)Department of Minimally Invasive Surgery, hernias and abdominal wall surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, China.(4)Division of Gastroenterology and Hepatology, Johns Hopkins University School

of Medicine, Baltimore, MD, USA. [email protected].

PURPOSE: Sleeve gastrectomy is a common bariatric procedure. The aim of this study was to explore the effects and mechanisms of intra‐operative vagal nerve stimulation (iVNS) on postoperative recovery after sleeve gastrectomy in rats.MATERIALS AND METHODS: Rats were randomly divided into groups of sham‐iVNS (n = 12) and iVNS (n = 12), and received sleeve gastrectomy, and were implanted

electrodes for the electrocardiogram (ECG) and gastric pace‐making activity or slow wave (GSW). iVNS or sham‐iVNS was performed during surgery. Postoperative animal behaviors, pain, gastrointestinal functions, autonomic functions, inflammatory cytokines, and hormones in plasma were assessed.RESULTS: In comparison with sham‐iVNS, (1) iVNS accelerated the first drinking time (P = 0.01) and first defecation time (P = 0.02), increased the weight of stool in postoperative day (POD) 1 (P = 0.01) and POD3 (P = 0.01), and reduced postoperative pain at 24 h after surgery (P = 0.01); (2) physiologically, iVNS improved gastric emptying (P < 0.01) at 72 h after surgery, and increased the dominant frequency (P < 0.01) and the percentage of normal GSW (P = 0.04) at

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abstract‐abdominalw‐set.txt6 h after surgery; (3) mechanistically, iVNS increased vagal activity and decreased

sympathovagal ratio at 6 h (vagal, P < 0.01; sympathovagal ratio, P < 0.01) and

24 h (vagal, P = 0.02; sympathovagal ratio, P = 0.01) after surgery, increased the plasma pancreatic polypeptide (P = 0.03) at 1 h after surgery, and decreased the plasma tumor necrosis factor‐α (TNF‐α) at 1 h (P = 0.02) and 6 h (P = 0.03)

and the plasma interleukin‐6 (IL‐6) at 1 h (P = 0.02) after surgery.CONCLUSION: Intra‐operative VNS is effective in accelerating post‐surgical recovery in rats after sleeve gastrectomy by enhancing gastric pace‐making activity and suppressing proinflammatory cytokines mediated via the autonomic mechanisms.

DOI: 10.1007/s11695‐020‐04626‐wPMID: 32318995

36. World J Surg. 2020 Aug;44(8):2572‐2579. doi: 10.1007/s00268‐020‐05505‐2.

Expectant Management of Patients with Ventral Hernias: 3 Years of Follow‐up.

Martin AC(1), Lyons NB(2), Bernardi K(1), Holihan JL(1), Cherla DV(1), Flores JR(1), Huang L(1), Milton A(1), Shah P(1), Kao LS(1), Ko TC(1), Liang MK(1).

Author information:(1)Department of Surgery, Lyndon B. Johnson Hospital, The University of Texas Health Science Center At Houston McGovern Medical School, 5656 Kelley St, Houston, TX, 77026, USA.(2)Department of Surgery, Lyndon B. Johnson Hospital, The University of Texas Health Science Center At Houston McGovern Medical School, 5656 Kelley St, Houston, TX, 77026, USA. [email protected].

BACKGROUND: The safety and effectiveness of expectant management (e.g., watchful waiting or initially managing non‐operatively) for patients with a ventral hernia is unknown. We report our 3‐year results of a prospective cohort of patients with ventral hernias who underwent expectant management.METHODS: A hernia clinic at an academic safety‐net hospital was used to recruit

patients. Any patient undergoing expectant management with symptoms and high‐risk comorbidities, as determined by a surgeon based on institutional criteria, would be included in the study. Patients unlikely to complete follow‐up assessments were excluded from the study. Patient‐reported outcomes were collected by phone and mailed surveys. A modified activities assessment scale normalized to a 1‐100 scale was used to measure results. The rate of operative repair was the primary outcome, while secondary outcomes include rate

of emergency room (ER) visits and both emergent and elective hernia repairs.RESULTS: Among 128 patients initially enrolled, 84 (65.6%) completed the

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abstract‐abdominalw‐set.txtfollow‐up at a median (interquartile range) of 34.1 (31, 36.2) months. Overall,

28 (33.3%) patients visited the ER at least once because of their hernia and 31

(36.9%) patients underwent operative management. Seven patients (8.3%) required

emergent operative repair. There was no significant change in quality of life for those managed non‐operatively; however, substantial improvements in quality

of life were observed for patients who underwent operative management.CONCLUSIONS: Expectant management is an effective strategy for patients with ventral hernias and significant comorbid medical conditions. Since the short‐term risk of needing emergency hernia repair is moderate, there could be a safe period of time for preoperative optimization and risk‐reduction for patients deemed high risk.

DOI: 10.1007/s00268‐020‐05505‐2PMID: 32277279

37. Ann Plast Surg. 2020 Aug;85(2):158‐162. doi: 10.1097/SAP.0000000000002201.

The Biosynthetic Option as an Alternative in Complex Abdominal Wall Reconstruction.

Anderson B(1), Hart AM, Maxwell D, Losken A.

Author information:(1)From the Emory Division of Plastic and Reconstructive Surgery, Atlanta, GA.

Synthetic mesh and acellular dermal matrix reinforcement during complex abdominal wall reconstruction (CAWR) have significantly improved outcomes. In an attempt to further improve outcomes, we combined both into a single biosynthetic by suturing a synthetic mesh on top of porcine acellular dermal matrix. Our aim

was to review our experience with this new technique. Patients undergoing CAWR with the biosynthetic mesh were reviewed from a prospective database from 2015 to 2018. A total of 39 patients were 56.3 ± 10.9 years old, white (59.0%), and female (74.4%), with 31.9 ± 7.4 kg/m of body mass index. Eight repairs were performed on patients classified as greater than or equal to modified Ventral Hernia Working Group (mVHWG) class 3a, and 41.0% followed a concurrent resection of previously placed mesh. The biosynthetic mesh was placed as an underlay (51.3%) or inlay (46.2%) with primary closure in 51.3% and component separation

in 12.8%. Recurrence at 3 years of follow‐up occurred in 3 patients (7.7%). Complications within 60 days occurred in 6 patients (15.4%), including 4 soft tissue infections‐one requiring explantation, with a total of 2 patients (5.1%)

Página 39

abstract‐abdominalw‐set.txtrequiring explantation overall. Type 2 diabetes, previous mesh removal, component separation, and mVHWG class 3b independently predicted noninfectious complications. Male sex and mVHWG class 3b independently predicted surgical site infection. No predictors were found for recurrence. Biosynthetic mesh does not seem to increase the risk of early complications and may reduce recurrences and

improve long‐term outcomes after CAWR.

DOI: 10.1097/SAP.0000000000002201PMID: 32000252

38. Ann Surg Treat Res. 2020 Aug;99(2):82‐89. doi: 10.4174/astr.2020.99.2.82. Epub 2020 Jul 31.

The prognoses and postoperative outcomes of patients with both colorectal cancer and liver cirrhosis based on a nationwide cohort in Korea.

Shin N(1), Han EC(2), Won S(1)(3), Ryoo SB(4), Choe EK(5), Park BK(6), Park KJ(4).

Author information:(1)Department of Public Health Sciences and Institute of Health and Environment, Seoul National University, Seoul, Korea.(2)Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea.(3)Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, Korea.(4)Department of Surgery, Seoul National University College of Medicine, Seoul,

Korea.(5)Department of Surgery, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.(6)Department of Surgery, Chung‐Ang University College of Medicine, Seoul, Korea.

PURPOSE: The management of patients with colorectal cancer (CRC) who have liver

cirrhosis (LC) requires a thorough understanding of both diseases; however, the

prognoses and postoperative outcomes of such patients remain understudied. We investigated the effect of LC on surgical and oncologic outcomes in patients with CRC, and identified prognostic factors.METHODS: We analyzed 453 patients with CRC and LC (CRC‐LC group), 906 with CRC only (CRC group), 906 with LC only (LC group), and 1,812 healthy subjects using

health insurance claim data (2008‐2013).RESULTS: The CRC‐LC group had a higher frequency of intensive care unit

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abstract‐abdominalw‐set.txtadmission than the CRC group; there were no differences between the 2 groups in

terms of early and late postoperative small bowel obstruction and incisional hernia. However, the 30‐day, 60‐day, and 90‐day mortality rates were all significantly higher in the CRC‐LC group. The higher Charlson comorbidity index

(hazard ratio [HR], 1.127) and the lower socioeconomic status (HR, 0.985) were significant worse predictors of 5‐year survival. Patients with underlying LC had a significantly higher HR in both the advanced CRC (HR, 1.858) and nonadvanced CRC (HR, 1.799) subgroups. However, the nonadvanced CRC subgroup showed a lower

HR than the LC group (HR, 0.730).CONCLUSION: Patients with CRC who had underlying LC had a lower survival rate than did those without LC, although the incidence rates of postoperative complications were not significantly different. The presence of LC was associated with a significantly lower survival rate regardless of CRC presence.

Copyright © 2020, the Korean Surgical Society.

DOI: 10.4174/astr.2020.99.2.82PMCID: PMC7406393PMID: 32802813

Conflict of interest statement: Conflict of interest: No potential conflict of interest relevant to this article was reported.

39. J Visc Surg. 2020 Aug;157(4):335‐340. doi: 10.1016/j.jviscsurg.2020.06.016.Epub 2020 Jul 30.

Intraperitoneal catheter introduction for pre‐operative progressive pneumoperitoneum for abdominal hernia with loss of domain (Goni‐Moreno technique).

Allart K(1), Sabbagh C(1), Regimbeau JM(2).

Author information:(1)Digestive surgery department, CHU Amiens Picardie, avenue René‐Laennec, 80054 Amiens cedex 01, France; University of Picardie Jules‐Vernes, 1, chemin du Thil, 80000 Amiens cedex 01, France; Simplifications des soins des patients chirurgicaux complexes (SSPC), Research Clinic Unit, Amiens, France.(2)Digestive surgery department, CHU Amiens Picardie, avenue René‐Laennec, 80054 Amiens cedex 01, France; University of Picardie Jules‐Vernes, 1, chemin du Thil, 80000 Amiens cedex 01, France; Simplifications des soins des patients chirurgicaux complexes (SSPC), Research Clinic Unit, Amiens, France. Electronic

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abstract‐abdominalw‐set.txtaddress: sabbagh.charles@chu‐amiens.fr.

DOI: 10.1016/j.jviscsurg.2020.06.016PMID: 32741730

40. Int J Surg. 2020 Aug;80:157‐161. doi: 10.1016/j.ijsu.2020.07.002. Epub 2020Jul 15.

Acute Care Surgery during the COVID‐19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study.

Cano‐Valderrama O(1), Morales X(2), Ferrigni CJ(3), Martín‐Antona E(4), Turrado

V(2), García A(3), Cuñarro‐López Y(5), Zarain‐Obrador L(3), Duran‐Poveda M(3), Balibrea JM(6), Torres AJ(4).

Author information:(1)Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos, Madrid, Spain. Electronic address: [email protected].(2)Department of Gastrointestinal Surgery, Hospital Clínic, Barcelona, Spain.(3)Department of Surgery. Hospital Rey Juan Carlos, Madrid, Spain.(4)Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.(5)Department of Gynecology and Obstetrics, Universidad Complutense, Madrid, Spain.(6)Department of Gastrointestinal Surgery, Hospital Clínic, Barcelona, Spain; Department of Surgery, Universidad Autónoma, Barcelona, Spain.

BACKGROUND: during the COVID‐19 pandemic, the number of Acute Care Surgery procedures performed in Spanish hospitals decreased significantly. The aim of this study was to compare Acute Care Surgery activity during the COVID‐19 pandemic and during a control period.MATERIAL AND METHODS: a multicenter retrospective cohort study was performed including patients who underwent Acute Care Surgery in three tertiary care hospitals in Spain during a control (11th March 2019 to 21st April 2019) and a pandemic (16th March 2020 to 26th April 2020) period. Type of surgical procedures, patients' features and postoperative complications were compared.RESULTS: two hundred and eighty‐five and 117 patients were included in each group. Mean number of patients who underwent Acute Care Surgery during the control and pandemic periods was 2.3 and 0.9 patients per day and hospital (p < 0.001), representing a 58.9% decrease in Acute Care Surgery activity. Time

from symptoms onset to patient arrival at the Emergency Department was longer during the pandemic (44.6 vs. 71.0 h, p < 0.001). Surgeries due to acute cholecystitis and complications from previous elective procedures decreased

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abstract‐abdominalw‐set.txt(26.7% vs. 9.4%) during the pandemic, while bowel obstructions and abdominal wall hernia surgeries increased (12.3% vs. 22.2%) (p = 0.001). Morbidity was higher during pandemic period (34.7% vs. 47.1%, p = 0.022), although this difference was not statistically significant in the multivariate analysis. Reoperation rate (17.9% vs. 12.8%, p = 0.212) and mortality (6.7% vs. 4.3%, p = 0.358) were similar in both groups.CONCLUSION: during the COVID‐19 pandemic, a significant reduction in the performance of Acute Care Surgery procedures was observed. Moreso, a longer time from symptoms onset to patient arrival at the Emergency Department was noted. Higher morbidity was observed in patients undergoing Acute Care Surgery during the pandemic period, although there was not any difference in mortality or reoperation rate.

Copyright © 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ijsu.2020.07.002PMCID: PMC7361112PMID: 32679205 [Indexed for MEDLINE]

Conflict of interest statement: None. No financial support was needed to perform this study.

41. Langenbecks Arch Surg. 2020 Aug;405(5):551‐561. doi: 10.1007/s00423‐020‐01911‐1. Epub 2020 Jun 29.

Randomized controlled trial of single incision versus conventional multiport laparoscopic cholecystectomy with long‐term follow‐up.

Klein D(1), Barutcu AG(1), Kröll D(1), Kilian M(1)(2), Pratschke J(1), Raakow R(3), Raakow J(4).

Author information:(1)Department of Surgery, Charité Campus Mitte, Campus Virchow Klinikum, Charité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1,

10117, Berlin, Germany.(2)Department of General and Visceral Surgery, Evangelische Elisabeth Klinik, Lützowstraße 26, 10785, Berlin, Germany.(3)Department of General, Visceral and Vascular Surgery, Vivantes Klinikum Am Urban, Dieffenbachstrasse 1, 10967, Berlin, Germany.(4)Department of Surgery, Charité Campus Mitte, Campus Virchow Klinikum, Charité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1,

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10117, Berlin, Germany. [email protected].

BACKGROUND: Within the last years, single‐incision laparoscopic cholecystectomy

(SLC) emerged as an alternative to multiport laparoscopic cholecystectomy (MLC). SLC has advantages in cosmetic results, and postoperative pain seems lower. Overall complications are comparable between SLC and MLC. However, long‐term results of randomized trials are lacking, notably to answer questions about incisional hernia rates, long‐term cosmetic impact and chronic pain.METHODS: A randomized trial of SLC versus MLC with a total of 193 patients between December 2009 and June 2011 was performed. The primary endpoint was postoperative pain on the first day after surgery. Secondary endpoints were conversion rate, operative time, intraoperative and postoperative morbidity, technical feasibility and hospital stay. A long‐term follow‐up after surgery was added.RESULTS: Ninety‐eight patients (50.8%) underwent SLC, and 95 patients (49.2%) had MLC. Pain on the first postoperative day showed no difference between the operative procedures (SLC vs. MLC, 3.4 ± 1.8 vs. 3.7 ± 1.9, respectively; p = 0.317). No significant differences were observed in operating time or the overall rate of postoperative complications (4.1% vs. 3.2%; p = 0.731). SLC exhibited better cosmetic results in the short term. In the long term, after a mean of 70.4 months, there were no differences in incisional hernia rate, cosmetic results or pain at the incision between the two groups.CONCLUSIONS: Taking into account a follow‐up rate of 68%, the early postoperative advantages of SLC in relation to cosmetic appearance and pain did

not persist in the long term. In the present trial, there was no difference in incisional hernia rates between SLC and MLC, but the sample size is too small for a final conclusion regarding hernia rates.TRIAL REGISTRATION: German Registry of Clinical Trials DRKS00012447.

DOI: 10.1007/s00423‐020‐01911‐1PMCID: PMC7449947PMID: 32602079

42. Int J Colorectal Dis. 2020 Aug;35(8):1477‐1488. doi: 10.1007/s00384‐020‐03681‐0. Epub 2020 Jun 25.

Closure of stoma site with or without prophylactic mesh reinforcement: a systematic review and meta‐analysis.

Mohamedahmed AYY(1), Stonelake S(2), Zaman S(2), Hajibandeh S(2).

Author information:(1)Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. [email protected].(2)Department of General Surgery, Sandwell and West Birmingham Hospitals NHS

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abstract‐abdominalw‐set.txtTrust, Birmingham, UK.

AIMS: To evaluate comparative outcomes of the closure of temporary stoma site with or without prophylactic mesh reinforcement METHODS: A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Studies comparing the reversal of stoma with and without prophylactic mesh reinforcement were included. Stoma site incisional hernia (SSIH), surgical site

infection (SSI), operative time, seroma formation, haematoma formation, bowel obstruction, anastomosis leak, length of hospital stay (LOS) and secondary operation to repair the SSIH were the evaluated outcome parameters.RESULTS: Six comparative studies reporting a total of 1683 patients who underwent closure of stoma with (n = 669) or without (n = 1014) prophylactic mesh reinforcement were included. Use of mesh was associated with a significantly lower risk of SSIH (OR 0.22, P = 0.003) and need for surgical intervention to repair SSIH (OR 0.32, P = 0.04) compared with no use of mesh. However, it was associated with significantly longer operative time (MD 47.78, P = 0.02). There was no significant difference in SSI (OR 1.09, P = 0.59), bowel obstruction (OR 1.11, P = 0.74), seroma formation (OR 2.86, P = 0.19), anastomosis leak (OR 1.60, P = 0.15), haematoma formation (OR 1.25, P = 0.75) or LOS (MD ‐ 0.45, P = 0.31) between two groups.CONCLUSION: Prophylactic mesh reinforcement during the closure of temporary stoma may significantly reduce the risk of SSIH and surgical intervention to repair the hernia without increasing the risk of SSI or other morbidities. However, it may increase the procedure time. Future higher‐quality randomised evidence is required.

DOI: 10.1007/s00384‐020‐03681‐0PMID: 32588121

43. J Laparoendosc Adv Surg Tech A. 2020 Aug;30(8):891‐895. doi: 10.1089/lap.2020.0257. Epub 2020 Jun 22.

Abdominal Wall Hernia and Metabolic Bariatric Surgery.

Vilallonga R(1), Beisani M(1), Sanchez‐Cordero S(2), Garcia Ruiz de Gordejuela A(1), Rodríguez‐Luna MR(3), Fort JM(1), Armengol Carrasco M(4).

Author information:(1)Endocrine, Metabolic, and Bariatric Unit, Vall d'Hebron University Hospital,

Universitat Autònoma de Barcelona, Center of Excellence for the EAC‐BC, Barcelona, Spain.(2)Department of General Surgery, Consorci Sanitari de l'Anoia, Hospital d'Igualada, Barcelona, Spain.(3)Research Institute Against Digestive Cancer, IRCAD, Strasbourg University, Strasbourg, France.(4)Department of General Surgery, Vall d'Hebron University Hospital,

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abstract‐abdominalw‐set.txtUniversitat Autònoma de Barcelona, Barcelona, Spain.

The management of morbidly obese patients with a concomitant ventral hernia (VH) is a great challenge for surgeons. There is controversy over the optimal strategy to tackle both health problems, requiring an individualized approach. Obese patients have a higher recurrence rate after hernia repair, and bariatric

surgery in the presence of a VH can be difficult. As morbid obesity is related with severe comorbidities, including increased cardiovascular and anesthetic risks, some advocate for a single‐stage strategy. A primary hernia repair carried out during the bariatric surgery, however, may increase morbidity without definitively solving the problem. Biological meshes are expensive and also have a high recurrence rate. The laparoscopic placement of a synthetic mesh offers good results, but it is worrisome because bariatric surgery is a clean‐contaminated procedure. Moreover, there is a great chance that a plastic surgery would be necessary after completing the weight‐loss process, and the abdominal wall surgery could be performed at that point. There are many arguments, but the evidence is weak. We present an extensive review of the currently available literature on the management of VH in morbidly obese patients. We aim to provide objective information regarding the pros and cons of the different strategies that have been proposed, to facilitate the selection of the best approach to individual morbidly obese patients with abdominal wall hernias precising both of surgical repair.

DOI: 10.1089/lap.2020.0257PMID: 32584652

44. Int J Surg. 2020 Aug;80:40. doi: 10.1016/j.ijsu.2020.06.020. Epub 2020 Jun 20.

An invited commentary on "incisional hernia after liver transplantation: Risk factors, management strategies and long‐term outcomes of a cohort study".

Lykoudis PM(1), Davidson BR(2).

Author information:(1)Division of Surgery & Interventional Science, University College London (UCL), London, UK; 3rd Department of Surgery, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece. Electronic address: [email protected].(2)Centre for Surgical Innovation, Organ Regeneration and Transplant, University College London (UCL), London, UK.

DOI: 10.1016/j.ijsu.2020.06.020PMID: 32574753

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45. J Laparoendosc Adv Surg Tech A. 2020 Aug;30(8):857‐858. doi: 10.1089/lap.2020.0333. Epub 2020 Jun 19.

Letter to the Editor: Case of Appendix Incarcerated in an Umbilical Hernia.

Sidhwa F(1).

Author information:(1)Department of Surgery, San Joaquin General Hospital, French Camp, California, USA.

Umbilical hernias and acute appendicitis are common general surgical problems, but an appendix incarcerated in an umbilical hernia is quite rare. We present a

case of such and briefly review the available literature on the topic. We conclude that future authors should include a minimum set of information in such case reports or case series so that readers can gain as much as possible from our collective experience with this uncommon problem.

DOI: 10.1089/lap.2020.0333PMID: 32559399

46. Clin Biomech (Bristol, Avon). 2020 Aug;78:105076. doi: 10.1016/j.clinbiomech.2020.105076. Epub 2020 Jun 6.

In vivo performance of intraperitoneal onlay mesh after ventral hernia repair.

Lubowiecka I(1), Tomaszewska A(2), Szepietowska K(2), Szymczak C(3), Śmietański

M(4).

Author information:(1)Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland. Electronic address: [email protected].(2)Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland.(3)Gdansk University of Technology, Faculty of Ocean Engineering and Ship Technology, Gdańsk, Poland.(4)Medical University of Gdańsk, 2(nd) Department of Radiology, Hospital Swissmed S.A., Department of Surgery, Poland.

BACKGROUND: Ventral hernia repair needs to be improved since recurrence, postoperative pain and other complications are still reported in many patients.

The behavior of implants in vivo is not sufficiently understood to design a surgical mesh mechanically compatible with the human abdominal wall.METHODS: This analysis was based on radiological pictures of patients who

Página 47

abstract‐abdominalw‐set.txtunderwent laparoscopic ventral hernia repair. The pictures show the trunk of the patient at rest in a standing position and under side bending. The change in the distance between different tacks due to trunk movement was analyzed, which allowed us to determine the in vivo elongation of the mesh incorporated into the abdominal wall.FINDINGS: The relative elongations of the surgical mesh varied from a few percent to greater than 100% in two cases. The median of the median relative elongations obtained for all patients is 9.5%, and the median of the maximum relative elongations for all patients is 32.6%. The maximum elongation occurs between tacks that are next to each other. Trunk movement causes implant deformation, and this study provides quantitative information regarding changes

in the distance between fasteners.INTERPRETATION: The physiological movement of the human abdomen must be regarded as a very important factor in mesh deformation and should be considered in surgical practice to reduce the hernia recurrence rate and postoperative pain.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.clinbiomech.2020.105076PMID: 32535476

Conflict of interest statement: Declaration of Competing Interest None.

47. Surg Endosc. 2020 Aug;34(8):3550‐3559. doi: 10.1007/s00464‐020‐07574‐9. Epub 2020 Jun 4.

Transabdominal (TA) versus totally extraperitoneal (TEP) robotic retromuscular ventral hernia repair: a propensity score matching analysis.

Kudsi OY(1), Chang K(1), Bou‐Ayash N(1), Gokcal F(2).

Author information:(1)Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA.(2)Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA. [email protected].

PURPOSE: Retromuscular mesh placement positioning utilizing the robotic platform can be performed using either a transabdominal or an extraperitoneal approach. The aim of this study is to compare short‐term outcomes of robotic transabdominal access retromuscular (rTA‐RM) repair and robotic totally extraperitoneal access retromuscular (rTEP‐RM) repair for ventral hernias

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abstract‐abdominalw‐set.txtMETHODS: Patients who underwent robotic retromuscular repair between February 2013‐October 2019 were included in the study. A one‐to‐one propensity score matching (PSM) analysis was conducted to obtain two balanced groups. A comparative analysis was performed in terms of perioperative and early post‐operative outcomes.RESULTS: A total of 214 patients were included for PSM analysis. 82 patients were allocated into each study group. Operative times were longer in rTA‐RM group. Adhesiolysis was more frequently required in the rTA‐RM group. Intra‐operative complications occurred more frequently in patients who underwent rTA‐RM repair (p = 0.120; 4.9% in rTA‐RM vs. 0% in rTEP‐RM). The rate of major complications during the first 90 days did not differ between groups (p = 0.277; 7.3% vs. 2.4%, respectively). The proportion of patients with minor perioperative complications was statistically higher in the rTA‐RM group than the rTEP‐RM group (p = 0.003; 30.5% vs. 11%, respectively). Overall rate of surgical site events was higher in the rTA‐RM group than the rTEP‐RM group (p = 0.049; 17.1% vs. 6.1%, respectively). Seroma frequency was higher after rTA‐RM repair (p = 0.047; 13.4% vs. 3.7%).CONCLUSION: Our data suggest that rTEP‐RM repair was associated with shorter surgery duration and improved early post‐operative outcomes in comparison with rTA‐RM repair.

DOI: 10.1007/s00464‐020‐07574‐9PMID: 32500458

48. Adv Pediatr. 2020 Aug;67:131‐143. doi: 10.1016/j.yapd.2020.03.009. Epub 2020 May 26.

Inguinal and Other Hernias.

Kim AG(1), Jarboe MD(2).

Author information:(1)Section of Pediatric Surgery, Department of Surgery, University of Michigan,

Mott Children's Hospital, 1540 East Hospital Drive SPC 4217, Ann Arbor, MI 48109 ‐ 4217, USA.(2)Section of Pediatric Surgery, Department of Surgery, University of Michigan,

Mott Children's Hospital, 1540 East Hospital Drive SPC 4217, Ann Arbor, MI 48109 ‐ 4217, USA; Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Mott Children's Hospital, 1540 East Hospital

Drive SPC 4217, Ann Arbor, MI 48109 ‐ 4217, USA. Electronic address: [email protected].

DOI: 10.1016/j.yapd.2020.03.009

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abstract‐abdominalw‐set.txtPMID: 32591057

Conflict of interest statement: Disclosure The authors have nothing to disclose.

49. J Laparoendosc Adv Surg Tech A. 2020 Aug;30(8):896‐899. doi: 10.1089/lap.2020.0265. Epub 2020 May 21.

Obesity and Ventral Hernia Repair: Is There Success in Staging?

Veilleux E(1), Lutfi R(1).

Author information:(1)Bariatric Surgery, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.

Introduction: Obesity predisposes patients to the development of abdominal wall

hernias. Ventral hernia incidence, size, and recurrence rate are all increased in this population. As such, the surgeon is likely to encounter patients presenting for metabolic and bariatric surgery with existing ventral hernias. Controversy persists regarding the algorithm for treatment in this situation. Do we wait to repair, or is the weight inconsequential? Materials and Methods: We critically reviewed the available literature accessed through PubMed on the repair of ventral hernias in the obese population. Specifically, we focused on the outcomes after staged repair versus concurrent repair at the time of bariatric surgery. We aim at providing an overview of the conclusions from past

and present publications with commentary by the authors. Results: A review of the literature finds conflicting opinions regarding the safety and success of concurrent ventral hernia repair at the time of bariatric surgery. Obese patients frequently have complex hernias and are predisposed to poor wound healing and increased recurrence. Although some small studies find success with

concurrent repair, large registry analyses as well as expert consensus statements advocate for staged repair. Conclusion: For the obese patient with large ventral hernia, the authors recommend a staged approach, beginning with bariatric surgery and deferring the hernia repair until significant weight loss

is obtained. The exception exists, and each patient must be evaluated critically regarding hernia size, contents, and risk of obstruction if left untreated.

DOI: 10.1089/lap.2020.0265PMID: 32453617

50. Surg Endosc. 2020 Aug;34(8):3734‐3741. doi: 10.1007/s00464‐020‐07575‐8. Epub 2020 Apr 27.

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Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral

hernia repair.

Li B(1), Qin C(2), Bittner R(3)(4).

Author information:(1)Department of General Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China.(2)Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China.(3)I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya str., 8, b. 2, Moscow, Russia, 119992. [email protected].(4)Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart,

Germany. [email protected].

BACKGROUND: Up to now the totally extraperitoneal (TEP) technique is limited to

the treatment of inguinal hernias. Applying this anatomical repair concept to the treatment of other abdominal wall hernias, we developed an endoscopic totally extraperitoneal approach (TEA) to treat primary midline ventral hernias, including umbilical and epigastric hernias, in which for mesh placement, an anatomical space is developed between the peritoneum and the posterior rectus sheath in the ventral part of the abdominal wall (preperitoneal space).METHODS: Between September 2017 and December 2019 according to the selection criterions, 28 consecutive primary midline ventral hernias were repaired using TEA. After extensive endoscopic development of the midline extraperitoneal plane, which was started in the suprasymphysic area, and reduction of the hernia sac, the hernia defect was closed and a large mesh was placed in the preperitoneal position to enforce the anterior abdominal wall.RESULTS: All operations were successfully performed without conversion to open surgery. The mean operation time was 103.3 min (range 85‐145 min). Patient‐reported postoperative pain was qualitatively mild with a mean pain visual analogue scale score of 1.9 on postoperative day 1. The average hospital

stay was 1.9 days (range 1‐3 days). Three patients developed minor complications and were treated with no long‐term adverse effects. Readmissions within 30 days

or hernia recurrences were not observed with a mean follow‐up period of 18 months (range 10‐27 months).CONCLUSION: In selected cases, TEA is a safe and feasible minimally invasive alternative in treating primary ventral hernias. This technique preserves the anatomical and physiological structure of the abdominal wall and may significantly reduce trauma and postoperative complications. Additionally, anti‐adhesion‐coated meshes and fixation tackers are not required, thus being

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abstract‐abdominalw‐set.txtcost‐effective. Further studies are necessary to proof the true clinical efficacy in comparison to well‐known alternative techniques.

DOI: 10.1007/s00464‐020‐07575‐8PMCID: PMC7326894PMID: 32342218

Conflict of interest statement: Drs. Binggen Li, Changfu Qin, and Reinhard Bittner have no conflicts of interest or financial ties to disclose.

51. J Surg Res. 2020 Aug;252:240‐246. doi: 10.1016/j.jss.2020.03.024. Epub 2020Apr 15.

The Correlation of Intraabdominal Pressure With Renal Resistive Index.

Candan Y(1), Akinci M(2), Eraslan O(3), Yilmaz KB(4), Karabacak H(1), Dural HI(1), Tatar IG(5), Kaya IO(1).

Author information:(1)Department of Surgery, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey.(2)Department of Surgery, University of Health Sciences, Gulhane Teaching and Research Hospital, Ankara, Turkey. Electronic address: [email protected].(3)Department of Radiology, Tokat Erbaa Ministry of Health State Hospital, Tokat, Turkey.(4)Department of Surgery, University of Health Sciences, Gulhane Teaching and Research Hospital, Ankara, Turkey.(5)Department of Radiology, University of Health Sciences, Ankara Diskapi Teaching and Research Hospital, Ankara, Turkey.

BACKGROUND: To evaluate the correlation between intraabdominal pressure (IAP) measured via the bladder and renal resistive index (RRI) measured by Doppler ultrasonography (USG).METHODS: Eighty consecutive surgical patients were included into this study. Before Doppler USG evaluation, IAP was measured by a Foley catheter via the bladder. The left and right RRI, the diameters of the inferior vena cava and portal vein were measured by colored Doppler USG. Spearman correlation analysis

was used to evaluate the correlation between different measurements. Intraabdominal hypertension (IAH) was defined as of IAP ≥ 12 mmHg. Significantly different variables from the univariate analysis between patients with and without IAH were entered into backward stepwise binary logistic regression analysis of IAH as the dependent variable. P values < 0.05 were accepted as statistically significant.RESULTS: In total, 80 patients were included into study. In 27 patients (34%) IAP was normal and in 53 patients (66%) IAH was diagnosed. The Spearman correlation analysis of IAP and the ultrasonographic measurements revealed a strong correlation between RRI and IAP (P < 0.001). Patients with IAH were more

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likely to be diabetic and had abdominal incisional hernia compared with patients with normal IAP (P < 0.05). The results of the multivariate logistic regression

analysis revealed right RRI as the only independent predictor of IAH (B: 57.04,

S. E.: 13.7, P < 0.001).CONCLUSIONS: There is a strong correlation between IAP and RRI. RRI can be an alternative, noninvasive technique for the diagnosis and follow‐up of IAH after

further evaluations in different patient groups.


DOI: 10.1016/j.jss.2020.03.024PMID: 32304930

52. J Surg Res. 2020 Aug;252:174‐182. doi: 10.1016/j.jss.2020.03.016. Epub 2020Apr 9.

Senior General Surgery Resident Confidence in Performing Abdominal Wall Hernia Repairs.

Leung B(1), Knee A(2), Wu J(1), Fernandez G(1), Seymour NE(1), Al‐Mansour MR(3).

Author information:(1)Department of Surgery, University of Massachusetts Medical School‐Baystate, Springfield, Massachusetts.(2)Department of Medicine, University of Massachusetts Medical School‐Baystate,

Springfield, Massachusetts.(3)Department of Surgery, University of Massachusetts Medical School‐Baystate, Springfield, Massachusetts. Electronic address: [email protected].

BACKGROUND: It is expected that graduating general surgery residents be confident in performing common abdominal wall hernia repairs. The objective of our study was to assess the confidence of senior surgical residents in these procedures and to identify factors that correlate with confidence.METHODS: We performed a cross‐sectional survey of PGY‐4 and PGY‐5 general surgery residents at ACGME‐accredited programs in the United States in the spring of 2019. Respondents rated their confidence level in 12 hernia procedures on a Likert scale from 1 (not confident) to 5 (extremely confident). Respondents were classified as "Not Confident" (Not Confident, Minimally Confident, Neutral

responses) or "Confident" (Confident, Extremely Confident responses). Resident characteristics, program characteristics, and operative experience were

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abstract‐abdominalw‐set.txtcollected, and we calculated the area under the curve to screen which factors discriminated between those confident versus not. Multivariable Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) to identify which factors were most predictive.RESULTS: A total of 93 surveys were completed. Respondents reported low confidence rates (25%‐60%) in the following hernia repairs: minimally invasive (MIS) inguinal, femoral, tissue (nonmesh) inguinal, pediatric inguinal, and abdominal wall reconstruction. High confidence rates (>80%) were reported for open umbilical, open ventral, and MIS ventral hernia repairs. For MIS inguinal hernia repair, PGY‐5 level was associated with a twofold increase in confidence

(PR = 2.01; 95% CI = 1.34‐3.30), and dedicated research years were associated with low confidence (PR = 0.67; 95% CI = 0.43‐1.04). In general, higher operative volumes of a specific repair were associated with increased confidence in that procedure.CONCLUSIONS: Senior surgical residents reported low confidence in performing a variety of essential hernia repairs (particularly MIS inguinal, femoral, and tissue inguinal). Addressing factors associated with low confidence may help increase resident confidence.


DOI: 10.1016/j.jss.2020.03.016PMID: 32278972

53. Clin Imaging. 2020 Aug;64:57‐66. doi: 10.1016/j.clinimag.2020.03.007. Epub 2020 Apr 1.

Abdominal wall and pelvic hernias: classic and unusual hernias and their mimics.

Bedayat A(1), Hassani C(2), Chiang J(2), Hebroni F(2), Ghandili S(3), Chalian H(4), Khoshpouri P(3), Lo HS(5), Karam AR(6).

Author information:(1)Department of Radiological sciences, David Geffen School of Medicine at, UCLA, Los Angeles, CA, USA. Electronic address: [email protected].(2)Department of Radiological sciences, David Geffen School of Medicine at, UCLA, Los Angeles, CA, USA.(3)Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.(4)Department of Radiology, Duke University, Durham, NC, USA.(5)Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA.(6)Department of Radiology, Warren Alpert School of Medicine at Brown University, Providence, RI, USA.

Abdominal and pelvic wall hernias are classically defined as a weakness or opening of the muscular wall through which abdominal or pelvic tissues protrude.

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abstract‐abdominalw‐set.txtThe aim of this manuscript is to review the imaging findings of abdominal and pelvic wall hernias and their mimics and to discuss pearls and pitfalls for accurately diagnosing and classifying these entities.


DOI: 10.1016/j.clinimag.2020.03.007PMID: 32330806

54. Hernia. 2020 Aug;24(4):695‐705. doi: 10.1007/s10029‐020‐02154‐1. Epub 2020 Mar 9.

Long‐term patient‐reported outcomes and quality of the evidence in ventral hernia mesh repair: a systematic review.

Sandø A(1), Rosen MJ(2), Heniford BT(3), Bisgaard T(4).

Author information:(1)Surgical Department, Center for Surgical Science, Zealand University Hospital, Køge, Denmark. [email protected].(2)Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.(3)Section of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Centre, Charlotte, NC, USA.(4)Surgical Department, Center for Surgical Science, Zealand University Hospital, Køge, Denmark.

PURPOSE: Patient‐reported outcome measures (PROMs) have been increasingly accepted to evaluate the quality of surgery. The impact of a hernia on PROMs and the indication for elective ventral hernia mesh repair are poorly researched. The primary objective in this systematic review was to provide evidence for PROM changes at least 3 months after elective ventral hernia mesh repair. Secondarily, a critical appraisal of the study quality was undertaken.METHODS: Ovid MEDLINE, PubMed, Ovid Embase, and CENTRAL were searched (year 2000‐May 12, 2019) for studies reporting any of 21 predefined PROMs pre‐ and ≥ 3 months postoperatively following adult ventral hernia mesh repair. A pre‐study defined analysis method was used to assess pre‐ vs. postoperative PROM changes. Quality assessment was guided by criteria formulated by the National Institutes of Health.RESULTS: The search yielded 11,438 potentially eligible studies of which 24 met

the inclusion criteria. Most studies were of poor or moderate quality and one study was of high quality. There was no evidence for a clinically relevant postoperative improvement in any PROM following umbilical hernia repair or medium‐sized incisional hernia repair. A clinically relevant postoperative improvement of pain, physical impairment, and social involvement was seen in patients with a large‐sized incisional hernia repair and stoma‐related complaints in patients with a medium‐sized parastomal hernia repair.

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abstract‐abdominalw‐set.txtCONCLUSION: This analysis suggested that a minor subset of PROMs improved in patients undergoing large‐sized incisional and medium‐sized parastomal hernia repair. High‐quality studies are imperative in this extremely often conducted surgical procedure.TRIAL REGISTRATION: The review was registered at PROSPERO (CRD42018096671, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=96671 ).

DOI: 10.1007/s10029‐020‐02154‐1PMID: 32152807

55. Hernia. 2020 Aug;24(4):707‐715. doi: 10.1007/s10029‐020‐02146‐1. Epub 2020 Feb 24.

Open mesh vs. suture umbilical hernia repair: systematic review and updated trial sequential meta‐analysis of randomized controlled trials.

Aiolfi A(1), Cavalli M(2), Micheletto G(3), Bruni PG(2), Lombardo F(2), Morlacchi A(2), Bonitta G(4), Campanelli G(2), Bona D(4).

Author information:(1)Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy. [email protected].(2)Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy.(3)Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Milan, Italy.(4)Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.

PURPOSE: To examine the updated evidence on safety, effectiveness, and outcomes

of mesh versus suture elective umbilical hernia (UH) repair and to explore the timely tendency variations favouring one treatment over another.METHODS: MEDLINE and CENTRAL databases were consulted. A systematic review, pairwise meta‐analysis, and trial sequential analysis (TSA) were conducted.RESULTS: Six RCTs were included for a total of 742 patients. Overall, 383 (51.6%) underwent mesh, while 359 (48.4%) underwent suture repair. The estimated pooled postoperative recurrence RR was 0.27 (95% CI 0.13‐0.53; p < 0.001). The TSA showed a statistically significant timely tendency in favour of mesh repair

with a boundary cross curve (Z = 1.96) before reaching the information size. The estimated pooled seroma, haematoma, and wound infection RR were 1.45 (p = 0.368), 0.54 (p = 0.196), and 0.71 (p = 0.375), respectively. The TSA for wound‐related complications showed partial, non‐significant results.CONCLUSIONS: Elective UH mesh repair seems to be associated with reduced risk

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abstract‐abdominalw‐set.txtof postoperative recurrence compared to simple suture repair with a statistically significant timely trend endorsed by the TSA. Definitive considerations concerning the cumulative effect for seroma, haematoma, and wound infection are

premature. Further studies are warranted to endorse these results and deeply investigate the timely tendency variations.

DOI: 10.1007/s10029‐020‐02146‐1PMID: 32096090

56. Hernia. 2020 Aug;24(4):759‐770. doi: 10.1007/s10029‐019‐02114‐4. Epub 2020 Jan 13.

Open retromuscular versus laparoscopic ventral hernia repair for medium‐sized defects: where is the value?

Zolin SJ(1), Tastaldi L(2), Alkhatib H(2), Lampert EJ(2), Brown K(2), Fafaj A(2), Petro CC(2), Prabhu AS(2), Rosen MJ(2), Krpata DM(2).

Author information:(1)Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10‐133, Cleveland, OH, 44195, USA. [email protected].(2)Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, A10‐133, Cleveland, OH, 44195, USA.

PURPOSE: There is increasing emphasis on value in health care, defined as quality over cost required to deliver care. We analyzed outcomes and costs of repairing medium‐sized ventral hernias to identify whether an open retromuscular or laparoscopic intraperitoneal onlay approach would provide superior value to the patient and healthcare system.METHODS: A retrospective analysis of prospectively collected data from the Americas Hernia Society Quality Collaborative was performed for patients undergoing clean, elective repair of ventral hernias between 4 and 8 cm in width at our institution between 4/2013 and 12/2016 for whom at least 1‐year follow‐up was available. Recurrence rates, wound complications, length of stay, patient‐reported outcomes, and perioperative costs were compared.RESULTS: One hundred and eighty‐six patients met criteria (105 open, 81 laparoscopic) with 93.5% having ≥ 2‐year follow‐up. Patients undergoing laparoscopic repair had higher BMI, lower ASA classification, slightly lower prevalence of recurrent hernias and less prior mesh utilization, and slightly smaller hernias. Length of stay was shorter in the laparoscopic group (median 1

vs. 3 days, p < 0.001), without increased readmissions. Recurrence rates, wound

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abstract‐abdominalw‐set.txtcomplications, and patient‐reported outcomes were similar. Laparoscopic repair had higher up‐front surgical costs, yet equivalent total perioperative costs.CONCLUSION: Both laparoscopic and open approaches for elective repair of medium‐sized ventral hernias offer similar clinical outcomes, patient‐reported outcomes, and total perioperative costs. Laparoscopic repair appears to offer superior value based on a significantly reduced postoperative length of stay.

DOI: 10.1007/s10029‐019‐02114‐4PMID: 31930440

57. Ventral Hernia.

Smith J(1), Parmely JD(2).

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–.2020 Aug 10.

Author information:(1)Beaumont Hospital Farmington Hills(2)Beaumont Health

Ventral hernias of the abdomen are defined as a non‐inguinal, nonhiatal defect in the fascia of the abdominal wall. Annually, there are about 350,000 ventral hernia operations. The repair of these abdominal wall defects is a common surgery performed by general surgeons. Surgery is typically recommended for individuals with acceptable operative risk, symptomatic hernias, or those at elevated risk of developing complications from a hernia. They can affect an individual’s quality of life and can lead to hospitalizations and even death in

some cases.

Copyright © 2020, StatPearls Publishing LLC.

PMID: 29763102

58. Pediatric Umbilical Hernia.

Troullioud Lucas AG(1), Jaafar S(2), Mendez MD(3).

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–.2020 Aug 10.

Author information:(1)Lincoln Medical Center(2)Brandon Regional Hospital(3)Lincoln Medical Center/Weil Cornell

Umbilical hernia presents as a bulge at the site of the umbilicus. It is a

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abstract‐abdominalw‐set.txtcommon finding during routine well‐baby visits for the first few months of life. New parents who are not very familiar with this anomaly tend to be very worried

when they see the bulge in their infant’s belly button. On the one hand, parents might be concerned with the idea that their child will suffer serious complications from an umbilical hernia, and they wonder if there are be any measures that they should take to avoid complications. It is important to understand the normal embryology and etiology of the umbilical hernia in order to answer these questions and when it is time to refer the patient for surgical

evaluation.

Copyright © 2020, StatPearls Publishing LLC.

PMID: 29083740

59. Hernia. 2020 Aug;24(4):717‐731. doi: 10.1007/s10029‐019‐02098‐1. Epub 2019 Nov 29.

Seroma prevention strategies in laparoscopic ventral hernia repair: a systematic review.

He C(1), Lu J(1), Ong MW(2), Lee DJK(2), Tan KY(2), Chia CLK(3).

Author information:(1)Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.(2)Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore.(3)Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore. [email protected].

BACKGROUND: Laparoscopic ventral hernia repair (LVHR) has been increasing in popularity over the years. Seroma formation is a common complication of LVHR. The aim of this study is to review the current evidence on seroma prevention strategies following LVHR.METHODS: A systematic search of PubMed, Embase (1946‐13 February 2019) and Medline (1946‐13 February 2019) databases was conducted using terms which include "seroma", "hernia, ventral" and "laparoscopy". All studies are comparative retrospective or prospective human adult studies in peer‐reviewed journals describing at least one intra‐operative intervention designed to decrease the rate of seroma formation in laparoscopic ventral hernia repair.RESULTS: The database searches identified 3762 citations, and 21 studies were included for final analysis. Five studies compared the different methods of mesh fixation, nine studies compared primary defect closure (PFC) and bridged repair,

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abstract‐abdominalw‐set.txttwo studies compared the effect of different types of meshes, two studies looked into the use of electrical cauterization, one study compared single‐ site laparoscopy with conventional laparoscopy, one study looked into the use of fibrin sealant and one study compared transabdominal preperitoneal placement of

mesh with conventional repair. PFC appears to be the most promising with large studies showing a low rate of seroma formation with additional benefits of decreasing wound infection and recurrence rate. Cauterisation of hernia sac and

injection of fibrin sealant also show promising results but are mainly derived from small studies. Other strategies did not demonstrate benefit.CONCLUSION: Currently, primary fascial closure appears to be the most promising

strategy available to decrease seroma formation after LVHR based on the results

of large studies. Other promising strategies that decrease dead space such as cauterisation of the sac and fibrin sealant injection will require further multicentre trials to confirm benefit before an increase in operative time and cost can be justified for their routine use.

DOI: 10.1007/s10029‐019‐02098‐1PMID: 31784913

60. Surg Endosc. 2020 Aug;34(8):3597‐3605. doi: 10.1007/s00464‐019‐07132‐y. Epub 2019 Oct 11.

Comparative review of outcomes: laparoscopic and robotic enhanced‐view totally extraperitoneal (eTEP) access retrorectus repairs.

Lu R(1), Addo A(1), Ewart Z(1), Broda A(1), Parlacoski S(1), Zahiri HR(1), Belyansky I(2).

Author information:(1)Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Suite 100, Annapolis, MD, 21401, USA.(2)Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Suite 100, Annapolis, MD, 21401, USA. [email protected].

BACKGROUND: Building on the principles of eTEP access, described by Dr. Jorge Daes, our group has previously described and standardized a novel minimally invasive approach to restoration of the linea alba and repair of lateral atypical defects of the abdominal wall. The purpose of this report is to present comparative analysis of laparoscopic and robotic eTEP access retrorectus repairs.METHODS: A retrospective review was conducted in patients who underwent laparoscopic eTEP (lap‐eRS) and robotic‐assisted eTEP (robo‐eRS) Rives‐Stoppa repairs between September 2015 and May 2018 at our institution. We analyzed the

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abstract‐abdominalw‐set.txtpreoperative demographics and the perioperative outcomes.RESULTS: Our review identified 206 patients (Lap‐eRS 120 vs. robo‐eRS 86). The groups were comparable (p > 0.05) in gender distribution (47.6% vs. 53% male) and mean age (53.2 vs. 50.8 years), but different (p < 0.05) in mean BMI (31.3 vs. 34.4 kg/m2) and ASA score (2.1 vs. 2.4). The robo‐eRS group had a larger defect size (5.5 vs. 7.1 cm, p < 0.05), a longer mean operative time (120.4 vs. 174.7 min, p < 0.05), and a higher hospitalization cost ($5,091 vs. $6,751, p = 0.005) compared to the lap‐eRS group. Average length of stay (0.2 vs. 0.1 days), length of drain placement (5.3 vs. 5.7 days), and reoperations (2.5% vs. 2.3%) were similar between lap‐eRS and robo‐eRS (p > 0.05). Patients in both groups (lap‐eRS vs. robo‐eRS) were followed for an average of 5.7 months vs. 5.5 months (p = .735) and showed similar recurrence rates (1.7% vs. 1.2%, p > 0.05).CONCLUSION: We present the largest series to‐date of eTEP access laparoscopic and robotic ventral hernia retrorectus repairs. Morbidly obese patients and those with more complex abdominal wall defects were more likely to undergo a robo‐eRS. The significantly longer operative time and higher hospital cost associated with the robo‐eRS group may be in part due to these factors. Both robotic and laparoscopic eTEP Rives‐Stoppa repairs are associated with favorable perioperative outcomes and low recurrence rates.

DOI: 10.1007/s00464‐019‐07132‐yPMID: 31605215

61. Surg Endosc. 2020 Aug;34(8):3540‐3549. doi: 10.1007/s00464‐019‐07142‐w. Epub 2019 Oct 3.

Robotic ventral hernia repair in morbidly obese patients: perioperative and mid‐term outcomes.

Gokcal F(1), Morrison S(1), Kudsi OY(2).

Author information:(1)Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA.(2)Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA. [email protected].

BACKGROUND: Obesity is a growing epidemic and it has been found to be an independent risk factor for a multitude of perioperative complications. We describe our experience with morbidly obese patients who underwent robotic ventral hernia repair (RVHR), examining factors affecting perioperative and mid‐term outcomes.METHODS: From a prospectively maintained database, all morbid obese (BMI ≥ 40 kg/m2) patients who underwent robotic procedures between 2013 and 2018

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abstract‐abdominalw‐set.txtwere analyzed retrospectively including perioperative outcomes and the mid‐term

follow‐up. Complications were assessed with validated grading systems and index. Univariate analyses and multivariate logistic regression analysis were performed to determine the factors associated with the development of any complication. Kaplan‐Meier's time‐to‐event analysis was performed to calculate freedom‐of‐recurrence.RESULTS: Fifty patients with median BMI 42.9 kg/m2 were included. The median last pain score before leaving PACU was 4. The mean LOS of all cohorts was 0.32 day. The postoperative complication rate was 46%. The most frequent complication was persistent pain/discomfort (32%) in early postoperative period. Minor complications (Clavien‐Dindo grade‐I and II) were seen in 40% of patients

while major complications (Clavien‐Dindo grade‐III and IV) were seen in 6%. The

maximum comprehensive complication index® score was 42.9. In regression analysis, BMI, adhesiolysis, intraperitoneal mesh placement, and off‐console time were found to be significantly associated with postoperative complications. Mean follow‐up was 22.7 months. Hernia recurrence was seen in 2% and the mean freedom‐of‐recurrence was 57.4 months (95% CI 54.6‐60.2).CONCLUSIONS: To our best knowledge, this study is the first to present outcomes

of morbidly obese patients who underwent RVHR. The results indicate the safety and efficacy of RVHR in morbid obesity with a low recurrence rate as well as a long freedom‐of‐recurrence time. Further studies are needed to better elucidate

the role of robotic surgery in morbidly obese patients.

DOI: 10.1007/s00464‐019‐07142‐wPMID: 31583469

62. Surg Endosc. 2020 Aug;34(8):3584‐3589. doi: 10.1007/s00464‐019‐07129‐7. Epub 2019 Oct 1.

Updated outcomes of laparoscopic versus open umbilical hernia repair in patients with obesity based on a National Surgical Quality Improvement Program review.

Williams KN(1), Hussain L(2), Fellner AN(2), Meister KM(3).

Author information:(1)Department of General Surgery, TriHealth, Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH, 45220, USA. [email protected].(2)TriHealth Hatton Research Institute, Cincinnati, OH, USA.(3)Department of General Surgery, TriHealth, Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH, 45220, USA. [email protected].

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BACKGROUND: Currently, there's not a well‐accepted optimal approach for umbilical hernia repair in patients with obesity when comparing laparoscopic umbilical hernia repair (LUHR) versus open umbilical hernia repair (OUHR).OBJECTIVE: The objective of this study was to evaluate if there's a difference in postoperative complications after LUHR versus OUHR with the goal of indicating an optimal approach.METHODS: A retrospective analysis was completed using the 2016 National Surgical Quality Improvement Program (NSQIP) database to identify patients with obesity (Body Mass Index (BMI) ≥ 30 kg/m2) who underwent LUHR or OUHR. Patients were divided into OUHR and LUHR groups, and post‐operative outcomes were compared, focusing on wound complications.RESULTS: A total of 12,026 patients with obesity who underwent umbilical hernia

repair were identified; 9695 underwent OUHR, while 2331 underwent LUHR. The LUHR group was found to have a statistically significant higher BMI (37.5 kg/m2 vs. 36.1 kg/m2; p < 0.01) and higher incidence of diabetes mellitus requiring therapy (18.4% vs. 15.8%; p < 0.01), hypertension (47.5% vs. 43.8%; p < 0.01), and current smoker status (18.6% vs. 16.5%; p < 0.02). Superficial surgical site infection (SSI) was significantly higher in the OUHR group (1.5% vs. 0.9%; p < 0.03), and there was a trend towards higher deep SSI in the OUHR group (0.3% vs. 0.5%; p = 0.147). There was no difference in organ space SSI, wound disruption, or return to OR. On logistic regression, composite SSI rate (defined as superficial, deep, and organ space SSIs) was significantly increased in the OUHR group (p < 0.01). Predictive factors significantly associated with increased morbidity included female gender and higher BMI.CONCLUSIONS: In patients with obesity, even though the LUHR group had an overall higher BMI and higher rates of diabetes, hypertension, and current smoking status, they experienced decreased post‐operative wound complications compared to the OUHR group.

DOI: 10.1007/s00464‐019‐07129‐7PMID: 31576443

63. Surg Endosc. 2020 Aug;34(8):3487‐3495. doi: 10.1007/s00464‐019‐07126‐w. Epub 2019 Sep 26.

Transanal hybrid colon resection: techniques and outcomes for benign colorectal

diseases.

Fuchs KH(1), Schulz T(2), Broderick R(3), Breithaupt W(2), Babic B(4), Varga G(2), Horgan S(3).

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abstract‐abdominalw‐set.txtAuthor information:(1)Department of Surgery, Center for the Future of Surgery, University of California San Diego, 9500 Gilman Drive, MC:0740, La Jolla, CA, 92093, USA. Karl‐[email protected].(2)Department of General‐ and Viszeral‐Surgery, AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany.(3)Department of Surgery, Center for the Future of Surgery, University of California San Diego, 9500 Gilman Drive, MC:0740, La Jolla, CA, 92093, USA.(4)Department of Surgery, University of Mainz, Mainz, Germany.

BACKGROUND: Transanal hybrid rectal and colon resection have been introduced in

recent years at dedicated surgical centers. The anus is used as a natural orifice for large size access. The use of transanal hybrid colectomy techniques

is still in its infancy with outcomes and unique complications being identified. The purpose of this work is the evaluation of outcomes for transanal hybrid colon resections (ta‐CR), including intra operative and postoperative complications, results, and advantages.METHODS: A prospectively maintained database was analyzed. Inclusion criteria were any patient who underwent ta‐CR for rectal prolapse, slow transit, obstructive defaecation, and chronic sigmoid diverticulitis. Patients were excluded from ta‐CR if BMI > 30, major previous abdominal surgery, or presence of a large inflammatory mass in diverticulitis. Transanal access was used for all operative steps requiring access of more than 5 mm, such as staplers, large

graspers, and specimen retrieval. Data acquisition and analysis was performed for operative time, complications, and postoperative quality of life.RESULTS: From 2012 to 2017, 82 patients underwent ta‐CR [33 males, 49 females, median age 58 (24‐80)]. Transanal‐subtotal colectomy and ta‐CR for constipation

was performed in 12 patients; ta‐CR and rectopexy in 31, and ta‐CR for diverticulitis was performed in 39 patients. Conversion to traditional approach

was required in 3 cases (3.6%). Intraoperative complication included 1 rectal tear requiring intervention. Post‐op complications included 3 leaks requiring laparoscopic and 1 open revision, the latter developed wound infection and an incisional hernia. Gastrointestinal Quality of Life Index (GIQLI) improved significantly from preoperative 89 to postoperative 119 (p < 0.001). No patients with ta‐CR without open revision developed a hernia post‐op with median 18 months follow‐up.CONCLUSIONS: ta‐CR is a safe and effective NOTES Hybrid technique for colorectal procedures in selected patients with benign colon disorders. GIQLI shows improvement and this technique can have the potential in preventing wound and hernia complications.

DOI: 10.1007/s00464‐019‐07126‐wPMID: 31559574

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64. Surg Endosc. 2020 Aug;34(8):3527‐3532. doi: 10.1007/s00464‐019‐07136‐8. Epub 2019 Sep 25.

Epidural anesthesia for post‐operative pain is associated with a higher incidence of complications following open ventral hernia repair.

Zhou SL(1), Helm MC(1), Goldblatt MI(2).

Author information:(1)Department of Surgery, Medical College of Wisconsin, 8701 W. Watertown Plank

Rd, Milwaukee, WI, 53226, USA.(2)Department of Surgery, Medical College of Wisconsin, 8701 W. Watertown Plank

Rd, Milwaukee, WI, 53226, USA. [email protected].

INTRODUCTION: Ventral/incisional hernia repair is a common procedure. Epidural anesthesia for post‐operative pain control has been used to attempt to limit opioids. The complications associated with epidural anesthesia are starting to be recognized in open ventral hernia repair patients.METHODS: Data were abstracted from the National Surgical Quality Improvement Program (NSQIP) participant use data file for 2015. Adult patients with an open

ventral hernia repair were identified. In an effort to identify complex hernias, patients who required the implantation of mesh and remained inpatient for 2 or more days were included. Patients with epidural anesthesia and general anesthesia (epidural group) were compared to those with general anesthesia alone (non‐epidural). Descriptive statistics and complications were recorded and compared.RESULTS: A total of 1943 patients met inclusion criteria: 1009 patients (51.9%)

in the non‐epidural group and 934 (48.1%) in the epidural group. There were fewer clean cases in the epidural group (63.2%) than the non‐epidural group (68.8%, p = 0.007). Otherwise, there was no difference in gender, age, body mass index, American Society of Anesthesiologists physical status, and current smoking status. There were more pulmonary emboli in the epidural group (1.39%) compared to the non‐epidural group (0.50%, p = 0.04). Urinary tract infection was also significantly higher in the epidural group (3.10%) compared to the non‐epidural group (1.59%, p = 0.03). Transfusions were also administered to more of the epidural patients (5.14%) compared to non‐epidural patients (2.78%,

p = 0.007). The rates of other post‐operative complications were not statistically significant between the two groups. Total length of stay in the hospital was also greater in the epidural group (6.7 vs. 5.0 days, p < 0.0001).CONCLUSIONS: This is an association with the use of epidural anesthesia in open

ventral hernia repairs and an increased incidence of pulmonary emboli,

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abstract‐abdominalw‐set.txttransfusions, and urinary tract infections, as well as an increased length of stay.

DOI: 10.1007/s00464‐019‐07136‐8PMID: 31555915

65. Hernia. 2020 Aug;24(4):873‐881. doi: 10.1007/s10029‐019‐02004‐9. Epub 2019 Jul 19.

Validation and educational impact study of the NANEP high‐fidelity simulation model for open preperitoneal mesh repair of umbilical hernia.

Friedrich U(1), Backhaus J(2), Zipper CT(1), König S(2), Mavroveli S(3), Wiegering A(1)(4), Olbrecht S(5), Puppe F(5), Dietz UA(6)(7).

Author information:(1)Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.(2)Institute of Medical Teaching and Medical Education Research, University of Wuerzburg, Josef‐Schneider Strasse 2, 97080, Wuerzburg, Germany.(3)Imperial College London, South Wharf Road, Paddington, London, W2 1BL, UK.(4)Department of Biochemistry and Molecular Biology, University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany.(5)Institute for Artificial Intelligence and Applied Informatics (VI), University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany.(6)Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany. [email protected].(7)Department of Visceral, Vascular and Thoracic Surgery, Kantonsspital Olten (soH), Baselstrasse 150, 4600, Olten, Switzerland. [email protected].

OBJECTIVE: The aim of the study was to develop, validate and analyze the educational impact of a high‐fidelity simulation model for open preperitoneal mesh repair of an umbilical hernia. The number of surgical simulators available

for training residents is limited. Primary for ethical reasons and secondary for the emerging pay‐per‐quality policies, practicing‐on simulators rather than patients is considered gold standard. Validated full‐procedural surgical models

will become more and more important in training residents. Such models may assure that evidence‐based standards regarding technical aspects of the procedures become integral part of the curriculum. Furthermore, they can be employed as a quality control of residents' skills (Fonseca et al. in J Surg Educ 70:129‐137, 2013).METHODS: In a repeated measures design, medical students, residents in their last year of training and attending surgeons performed an open preperitoneal mesh repair on the NANEP model [NANEP stands for the German acronym Nabelhernien‐Netzimplatation‐Präperitonal (English: Umbilical hernia mesh

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abstract‐abdominalw‐set.txtimplantation preperitoneal)]. Subjects were categorized as "Beginners" (internship students) or "Experts" (residents and surgeons). Content validity was analyzed by criteria of subject‐matter‐experts. Blinded raters assessed surgical skills by means of the Competency Assessment Tool (CAT) using the online platform "CATLIVE". Differential validity was measured by group differences. Proficiency gain was analyzed by monitoring the learning curve (Gallagher et al. in Ann Surg 241:364‐372, 2005). Post‐operative examination of

the simulators shed light on criterion validity.RESULTS: The NANEP model‐proofed content and construct‐valid significant Bonferroni‐corrected differences were found between beginners and experts (p < 0.05). Beginners showed a significant learning increase from the first to the second surgery (p < 0.05). Post‐operative examination data confirmed criterion validity.CONCLUSION: The NANEP model is an inexpensive, simple and efficient simulation model. It has highly realistic features, it has been shown to be of high‐fidelity, full‐procedural and benchtop‐model. The NANEP model meets the main needs of surgical educational courses at the beginning of residency.

DOI: 10.1007/s10029‐019‐02004‐9PMID: 31325054

66. Hernia. 2020 Aug;24(4):839‐843. doi: 10.1007/s10029‐019‐01995‐9. Epub 2019 Jun 28.

Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections.

de Vries HS(1), Verhaak T(1), van Boxtel TH(1), van den Heuvel W(1), Teixeira MB(1), Heisterkamp J(1), Zimmerman DDE(2).

Author information:(1)Department of Surgery, ETZ (Elisabeth‐TweeSteden) Hospital, Tilburg, The Netherlands.(2)Department of Surgery, ETZ (Elisabeth‐TweeSteden) Hospital, Tilburg, The Netherlands. [email protected].

BACKGROUND: Small steps wound closure of midline laparotomy has been reported to decrease the incidence of incisional hernia development in two randomized controlled trials. The aim of the present study was to evaluate the effect of implementing the small steps wound closure technique in clinical practice with regards to the development of incisional ventral hernia (IVH) and surgical site

infections (SSI) in clinical practice.METHODS: Implementation of the small steps wound closure technique using the small tissue bites technique as the standard closure technique for abdominal midline incisions in our clinical practice was done in March 2015. For this study, all patients from June 2013 until June 2016 with a midline laparotomy, either long or small in case of specimen extraction in laparoscopic surgery, in

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either elective or emergency setting were included. Conventional large bite wound closure was compared to small steps wound closure with regards to the development of SSI, IVH as well as burst abdomen.RESULTS: A total of 327 patients were included. The small steps suture technique was used in 136 (42%) of the patients, whereas the conventional large bites suture technique was used in 191 patients (58%). A total of 54 patients in the large bites group developed SSI (28%) compared to 23 (17%) patients in the small steps group (p = 0.02). A total number of 10 patients (7%) developed IVH in the

small steps group compared to 27 patients (14%) in the large bites group (p = 0.08).CONCLUSION: Implementation of small bites wound closure of abdominal midline incisions in clinical practice was correlated with a reduction in surgical site

infections.

DOI: 10.1007/s10029‐019‐01995‐9PMID: 31254134

67. Acta Chir Belg. 2020 Aug;120(4):274‐278. doi: 10.1080/00015458.2018.1541219. Epub 2019 Jan 7.

Incisional lumbar hernia after the use of a lumbar artery perforator flap for breast reconstruction.

Van Cleven S(1), Claes K(2), Vanlander A(1), Van Landuyt K(2), Berrevoet F(1).

Author information:(1)Department of General, Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium.(2)Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium.

Autologous breast reconstruction with a perforator flap has become increasingly

popular. The free lumbar artery perforator (LAP) flap has been described as a good alternative for autologous breast reconstruction. The LAP flap is a perforator flap based on a single pedicle. This flap is easy to harvest, with minimal donor‐site morbidity. We present a case of a lumbar incisional hernia after LAP flap breast reconstruction in a 53‐year‐old patient. The patient had been treated with a bilateral mastectomy for cancer. Secondary breast reconstruction was performed with a bilateral DIEP flap. Reoperation was necessary because of a failed DIEP flap at the left side. Reconstruction was performed with a free LAP flap. The patient was referred for a right lumbar incisional hernia at the donor‐site of the LAP flap. Open repair was performed with a retroperitoneal mesh. The thoracolumbar fascia was closed in with a running suture. Lumbar artery perforator is a perforator flap based on a single

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abstract‐abdominalw‐set.txtpedicle. Although it does not sacrifice any muscle and seems to be associated with minimal donor‐site morbidity, we present the first report of a lumbar incisional hernia repair after LAP flap breast reconstruction treated using an open retroperitoneal mesh repair.

DOI: 10.1080/00015458.2018.1541219PMID: 32698719

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