P48 Exploration of variation in Management of Acutely Symptomatic Hernia – results from the MASH practice survey

Abstract Introduction There is minimal evidence to guide the emergency management of groin and abdominal wall hernia. The aim of this project is to understand current variations in clinical practice across the UK when managing common types of acutely symptomatic hernia. Methods A survey of clinical practice was developed to explore the management of acutely symptomatic abdominal wall hernia (ASH) including groin (GH), umbilical (UH), and incisional hernia (IH). The survey captured respondent characteristics. It explored preferences in the management of each type of ASH, including factors related to treatment and repair strategy. Surgeons at ST3+ level with a UK practice were invited to participate through Twitter and collaborative networks. Results In total, 144 responses were received (response rate 26%). Of these, 62 (43.1%) were Consultant Surgeons, 105 (72.9%) did not have a specialist hernia practice, and 95 (66%) did not follow specific guidelines for emergency hernia repair. There was variation in investigations used e.g. CT required for IH (91%) but less for GH (34.7%) and UH (47.2%). Open repair was preferred in all settings. For GH with ischaemic bowel 76 (52.8%) would suture repair vs. 67 (46.5%) who would use a mesh (64.2% permanent synthetic) this is similar for IH, where 59 (41%) chose suture vs. 71 (49.3%) mesh, although 61.9% favoured biologic mesh for IH. Suture repair was preferred for UH with ischaemic bowel (69.4%). Conclusion The survey demonstrates variation in treatment of ASH. Areas which require further exploration include use of mesh and laparoscopy in the emergency setting.

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Mesh hernioplasty in emergency repair of traumatic abdominal wall hernia following bull horn injury

BMJ Case Reports ◽

10.1136/bcr-2021-244384 ◽

2021 ◽

Vol 14 (7) ◽

pp. e244384

Author(s):

Arvind Kumar Bodda ◽

Prakash Kumar Sasmal ◽

Swastik Mishra ◽

Ankit Shettar

Keyword(s):

Abdominal Wall ◽

Rural Areas ◽

Motor Vehicle ◽

Abdominal Wall Hernia ◽

Abdominal Hernia ◽

Emergency Setting ◽

Traumatic Abdominal Wall Hernia ◽

Vehicle Accidents ◽

Emergency Repair ◽

Mesh Hernioplasty

Traumatic abdominal wall hernia (TAWH) is uncommon, mostly following motor vehicle accidents, fall from height and bullfighting. Bullhorn injury, common in rural areas, presents as either penetrating injuries to the abdomen or blunt injuries leading to internal organs injury. Rarely the bull horn injury may lead to TAWH. We report a 70-year-old female from a rural area who suffered bull horn injury to the abdomen leading to TAWH without penetrating the horn and was managed in the emergency by an open mesh hernioplasty. We suture closed the 10×5 cm size defect and reinforced it with a polypropylene mesh of 15×15 cm in the emergency setting. The patient recovered well without any complications or recurrence and doing well at 1 year of follow-up. Mesh hernioplasty can be considered a feasible and safe option in the emergency repair of traumatic abdominal hernia following bull horn injury.

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Elective Repair of Adult Abdominal Wall Hernia: A Nigerian Tertiary Hospital Experience

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.1.668 ◽

2021 ◽

Vol 3 (1) ◽

pp. 68-72

Author(s):

Emeka Ray-Offor ◽

Chidi Joshua Okeke

Keyword(s):

Hernia Repair ◽

Abdominal Wall ◽

Operating Time ◽

Abdominal Wall Hernia ◽

Tertiary Hospital ◽

Laparoscopic Technique ◽

Suture Repair ◽

True Incidence ◽

Repair Technique ◽

Elective Repair

Background: Hernia repair is one of the most common procedures performed by general surgeons, mostly in an elective setting. The true incidence/prevalence of hernias in Nigeria is unknown, however, suture (tissue) repair is predominantly reported. Aims: To study the distribution of adult abdominal wall hernia and the surgical and anaesthetic techniques for elective repair in a Nigerian tertiary hospital. Methods: A retrospective cross-sectional study of surgical patients undergoing elective abdominal wall hernia repair in University of Port Harcourt Teaching Hospital Nigeria from January 2009 to December 2014. Data extracted from the theatre records were patients’ demographic, type of hernia, repair technique, anaesthesia, operating time, and cadre of performing surgeon. Statistical analysis was performed using SPSS version 20. Results: A total of 400 adult patients had elective repair of abdominal wall hernias during study period. The age range was from 17- 85 years (mean 39.3 ± 6.0) and M: F ratio of 1.9:1. There were 287(70.9%) inguinal, 43(10.6%) incisional and 36(8.9%) epigastric hernias. Mesh repair was recorded in 11(2.7%) cases with laparoscopic technique in 2 cases. Subarachnoid block was the choice anaesthesia in 365(85.4%) cases. The least mean operating time (38.6 mins) recorded was in repair of femoral hernia and longest (105.3mins) with incisional hernia repair. Conclusions: Suture repair is the predominant repair technique. Routine hernioplasty and laparoscopic hernia repair need to be encouraged.

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EP37 A need to train paediatric rheumatologists in musculoskeletal ultrasound scanning. How do we move forward?

Rheumatology Advances in Practice ◽

10.1093/rap/rkaa052.036 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Fatemeh Jenabi ◽

Katie Mageean ◽

Alice Leahy ◽

Brian Davidson ◽

Hans de Graaf

Keyword(s):

Case Report ◽

Clinical Practice ◽

Small Group ◽

Response Rate ◽

Paediatric Rheumatology ◽

Musculoskeletal Ultrasound ◽

Ultrasound Scan ◽

Training Module ◽

Image Guided ◽

The Uk

Abstract Case report – Introduction Musculoskeletal ultrasound is used by clinicians around the world and learning this skill is included in paediatric rheumatology training programmes in several countries. However, in the UK only a few clinicians use it in their daily practice. British Society of Rheumatologists has recently shown interest in ultrasound scan training in paediatric rheumatology. Paediatric rheumatologist team in Wessex would like to set up an ultrasound training module for paediatric rheumatology for anyone interested, including trainees and consultants. The team aimed to check the clinicians' interest and demand for it nationally. Case report - Case description A brief questionnaire was sent to 45 paediatric rheumatologist consultants in the UK and 14 paediatric rheumatology trainees to gain more information about the use of MSK-USS in clinic. We also sought the clinicians' opinion to ensure the potential ultrasound scan module will meet their needs. 40 out of 45 paediatric rheumatologists replied (response rate of 89%) and 7out of 14 specialist trainees responded (response rate 50%). 80% (32) consultants and all paediatric rheumatology trainees felt that musculoskeletal ultrasound (MSK-USS) performed by a clinician in clinic would benefit their patients. Majority stated that for urgent cases, it could take up to 2 weeks in their centre for a departmental USS to be done and reported. Only 32.5% (13) could arrange MSK- USS on the same day for urgent scans. The number of MSK-USS and MRI scans requested per month were similar. 70% (28) of the clinicians and trainees have access to an ultrasound scanner. Majority of clinicians expressed their enthusiasm (median of 80%) for an interactive paediatric rheumatology musculoskeletal ultrasound online module as well as the platform in which images and clips. 100% (7) of trainees were keen to learn MSK-USS as part of their training and majority felt that they could dedicate regular time for it alongside their other clinical duties. Case report - Discussion This study highlighted that various paediatric rheumatology departments within the UK already had discussions about the use of MSK-USS as part of clinical practice without making progress. Majority of paediatric consultants in the UK feel that USS performed by the clinician is beneficial for the patients, particularly for image guided injections and performing synovial biopsies. However, a small group reported reservations due to inter-operator variation and challenges of interpreting non classical signs on scan as well as the risk of over-interpretation of scan findings regarding inflammation. Moreover, another obstructing factor for some consultants to use MSK-USS can be time constraints in terms of becoming proficient in MSK-USS and time to perform USS in the clinic. Case report - Key learning points This study highlighted that various paediatric rheumatology departments within the UK already had discussions about the use of MSK-USS as part of clinical practice without making progress. Majority of paediatric consultants in the UK feel that USS performed by the clinician is beneficial for the patients, particularly for image guided injections and performing synovial biopsies. However, a small group reported reservations. Wessex rheumatology team is in the process of setting up an ultrasound training module for paediatric rheumatology which could be what is needed to push discussion into action. We intend to carry out the same study in other European countries such as Italy, Netherlands, France and Germany to gather more evidence. Given the lack of evidence in this area, such studies would be important in shaping the future clinical practice of paediatric rheumatology. Taking the high interest rate of current trainees, we also recommend addition of a specific ultrasound training module for paediatric rheumatology trainees as part of the GRID (specialist) curriculum.

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Current trends in hernia surgery in NHS England

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0118 ◽

2020 ◽

Vol 102 (1) ◽

pp. 25-27 ◽

Cited By ~ 7

Author(s):

M Pawlak ◽

B Tulloh ◽

A de Beaux

Keyword(s):

Abdominal Wall ◽

Primary Endpoint ◽

Mesh Repair ◽

Significant Proportion ◽

Abdominal Wall Hernia ◽

Suture Repair ◽

Hernia Surgery ◽

Current Trends ◽

Primary Hernia ◽

Prevention Of Recurrence

Background Mesh is recommended for the repair of most hernias when prevention of recurrence is the primary endpoint. However, mesh may be associated with increased complications for the patient. The aim of this study was to quantify the use of mesh for abdominal wall hernia surgery in NHS England in recent years. Materials and methods The NHS Digital Secondary Uses Service database for 2016/17 and 2017/18 was interrogated for numbers of patient undergoing elective primary hernia surgery. Using the specific hernia code inguinal (T201-9), umbilical (T241-9), incisional (T251-9) and other abdominal wall hernia (T271-9), the use of mesh or suture repair was determined. Recurrent and emergency hernia surgery were excluded. All data were provided by NHS RightCare. Results There are almost 100,000 hernia repairs performed annually in NHS England. For every four hernias, three are repaired with mesh. The percentage repaired by mesh varies by hernia type. Mesh repairs in inguinal, umbilical and incisional hernias accounted for 95%, 50% and 82%, respectively. Conclusions Mesh repair for all hernia types is more common than suture repair. However, for umbilical and other abdominal wall hernias, a significant proportion are repaired without the use of mesh.

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Identification of fifty-seven novel loci for abdominal wall hernia development and their biological and clinical implications: results from the UK Biobank

Hernia ◽

10.1007/s10029-021-02450-4 ◽

2021 ◽

Author(s):

J. Wei ◽

M. Attaar ◽

Z. Shi ◽

R. Na ◽

W. K. Resurreccion ◽

...

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Hernia ◽

Clinical Implications ◽

Uk Biobank ◽

The Uk

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Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

BJS Open ◽

10.1002/bjs5.50315 ◽

2020 ◽

Vol 4 (5) ◽

pp. 924-934

Author(s):

◽

Matthew J Lee ◽

Thomas M Drake ◽

Adele E Sayers ◽

Ciaran J Walsh ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Abdominal Wall ◽

Bowel Obstruction ◽

Abdominal Wall Hernia ◽

The Uk

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What delirium detection tools are used in routine clinical practice in the UK? A Freedom of Information investigation of UK hospitals

10.1101/2021.01.12.21249699 ◽

2021 ◽

Author(s):

Zoë Tieges ◽

Jacqueline Lowrey ◽

Alasdair M. J. MacLullich

Keyword(s):

Clinical Practice ◽

Response Rate ◽

Confusion Assessment Method ◽

Assessment Method ◽

Assessment Tools ◽

Detection Methods ◽

Freedom Of Information ◽

Delirium Assessment ◽

Information Request ◽

The Uk

ABSTRACTPurposeOur aim was to collect information on delirium assessment processes and pathways in non-intensive care settings in the UK.MethodsWe sent a Freedom of Information request to 169 UK NHS hospitals, trusts and health boards (units) in July 2020 to obtain data on usage of delirium assessment tools in clinical practice and delirium pathways or guidelines.ResultsWe received responses from 154 units (91% response rate). 146 (95%) units reported use of formal delirium assessment processes and 131 (85%) units had guidelines or pathways in place. The 4AT was the most widely used tool, with 117 (80%) units reporting use. The Confusion Assessment Method was used in 652 (45%) units, and the SQiD in 52 (36%) units.ConclusionsOur findings show that the 4AT is the most commonly-used tool in the UK, with 80% of units reporting implementation. This study adds to our knowledge of real-world implementation of delirium detection methods at scale.

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POLYPROPYLENE MESH REPAIR IN ABDOMINAL WALL HERNIAS;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.10.774 ◽

2017 ◽

Vol 24 (10) ◽

pp. 1566-1571

Author(s):

Malik Azhar Hussain ◽

Naveed Ashraf Malik

Keyword(s):

Abdominal Wall ◽

Recurrence Rate ◽

Polypropylene Mesh ◽

Mesh Repair ◽

Open Repair ◽

Demographic Data ◽

Abdominal Wall Hernia ◽

Quasi Experimental ◽

Operative Notes ◽

Study Setting

Objectives: To determine the beneficial out comes, recurrence rate andcomplications of the repair of abdominal wall hernia reinforced with polyprolene mesh. StudyDesign: This was a retrospective interventional quasi experimental study. Setting: Surgicaldepartments of Central Hospital and Prince Abdul Aziz Bin Musaad Hospital, Arar, SaudiArabia. Duration of Study: November 2012 to October 2016. Material and Methods: Adultpatients of both genders, who underwent repair for various abdominal wall hernias duringabove mentioned period, were included in the study. Their demographic data, relevant historyand physical examination, post-operative notes, prognosis and any complications, includingrecurrence, infection, adhesions, pain and mesh degradation were recorded in a pre-structuredquestionnaire. The data was then analyzed with standard statistical methods. Results: From atotal of 156 patients, 94 (60.3%) were males and 62 (39.7%) female between the age of 20 to75 years. There were relatively fewer complications, including seroma (12.8%), post-operativepain (9.6%), infection (3.8%), adhesions (0.6%) and no recurrence rate. The uneventful recoverywas observed in 73% of cases. Conclusions: Pure polypropylene mesh is economical than thenewer composite meshes for the open repair of abdominal wall hernia, is easily available andcaused relatively fewer complications with no recurrence rate.

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