P019 OUTCOMES OF OPEN LATERAL APPROACHES FOR L3-L4 INCISIONAL HERNIAS

Aim Our study aimed to compare and evaluate results of two different open lateral approaches for L3–L4 incisional hernias (IH) operated in a multicentric complex abdominal wall unit. Material and Methods Patients who underwent surgery for L3–L4 IH were identified from a prospective maintained multicenter database. The lateral IH were approached laterally, performing a reverse transversus abdominis release (TAR) or a lateral retromuscular preperitoneal approach (LRP). Outcomes included short and long-term complications, such as recurrence, bulging and pain. Results 61 patients were identified. There were 28 (45.9%) cases of L3 IH and 33 (54.1%) cases of L4 IH. 28 (34.7%) LRP approaches and 33 (24.5%) reverse TAR techniques were performed. There were surgical site occurrences (SSO) in 13 (21.3%) patients, 7 (11.5%) in the reverse TAR group and 6 in the LRP group. 8 (13.1%) SSO required procedural intervention (4 in each group). During a mean follow-up of 26.57 (+/- 19.23) months, no cases of recurrence were diagnosed. There were 12 (19.7%) cases of asymptomatic bulging that did not required reintervention (7 in the LRP group), and only one case of symptomatic bulging that needed intervention (in the LRP group). Furthermore, two patients (3.3%) required daily no opioids treatment for pain. Two (3.3%) cases of mortality were registered (both in the LRP group). Conclusions Despite the high complexity associated of L3-L4 IH, both lateral approaches showed acceptable long-term results, without any statistical difference between groups.

O06 PATIENT-REPORTED KNOWLEDGE OF HERNIA SURGERY: A QUANTITATIVE STUDY OF FIRST TIME REFERRED PATIENTS TO AN ABDOMINAL WALL UNIT FOR HERNIA REPAIR

Aim The objective of this study was to gather information on patient-reported knowledge (PRK) in the field of hernia surgery. Material and Methods A prospective quantitative study was designed to explore different aspects of PRK and opinions regarding hernia surgery. Patients referred for the first time to a surgical service with a presumed diagnosis of hernia and eventual hernia repair were eligible, and those who gave consent completed a simple self-assessment questionnaire before the clinical visit. Results The study population included 449 patients (72.8% men, mean age 61.5). Twenty (4.5%) patients did not have hernia on physical examination. The patient’s perceived health status was “neither bad nor good” or “good” in 56.6% of cases. Also, more patients considered that hernia repair would be an easy procedure (35.1%) rather than a difficult one (9.8%). Although patients were referred by their family physicians, 32 (7.1%) answered negatively to the question of coming to the visit to assess the presence of a hernia. The most important reason of the medical visit was to receive medical advice (77.7%), to be operated on as soon as possible (40.1%) or to be included in the surgical waiting list (35.9%). Also, 46.1% of the patients considered that they should undergo a hernia repair and 56.8% that surgery will be a definitive solution. Conclusions PRK of patients referred for the first time to an abdominal wall surgery unit with a presumed diagnosis of hernia was quite limited and there is still a long way towards improving knowledge of hernia surgery.

The wall unit: State policy and the emergence of fashion in People’s Poland

Consumption in modern, capitalist countries is studied through the lens of fashion. We claim that it is fruitful to apply the concept of fashion to an analysis of consumption in a modern socialist country. By using the example of the wall unit, we discuss the emergence of fashion through the mechanism of state policy in Poland under the Communist regime. The socialist state was responsible for the propagation and implementation of modernity. The idea of progress was internalized by citizens and enacted by social emulation. Additionally, our study reveals that social class was a means of determining different attitudes toward fashion: members of the working class saw value in imitation and exact copying (revealing a monocentric approach to fashion) while the middle class engaged in a polycentric approach, that is, they valued individual creativity, mixed various styles, and were inspired by trends from western countries.

173 Long Term Analysis of The Evolution of Practice and Results of Abdominal Wall Reconstruction by A Single Surgeon

Background It is estimated that at least 12-15% of abdominal operations lead to incisional hernias, and Worldwide, evidence shows high rates of recurrence after surgical repair ranging from 12.7% in the Danish hernia registry to 23% in the Swedish registry. Method This is a retrospective analysis of the practice of a single surgeon at a tertiary centre. An electronic database provided all hernia surgeries done by the surgeon. A total of 185 patients with complete data were included who had open hernia repair. Electronic patient records were analysed to collect the data. Results 185 patients, with a median age of 57 years (IQR 68 – 49), and BMI of 31.14 (IQR 36.02 – 27.52), had a hernia recurrence rate of 15.6% (29/185). More than 80% of the cases were complex hernias with a European Hernia classification of M3 and/ or W3, with dense intestinal adhesions and multiple previous repairs. Variability in techniques and mesh evolved over this period, from anterior component separation to transversus abdominis release to achieve closure of the abdomen. Polypropylene meshes were used for non-contaminated or less complex cases. The use of biologics in the early years has been superseded by biosynthetic. Conclusions The creation of the abdominal wall unit and subsequent MDT at this centre resulted in a rise of total procedures, complexity of cases and patients with significant co-morbidities. Specialised abdominal wall surgeons are associated with better results when performing complex abdominal wall reconstructions.

A structured pathway for developing your complex abdominal hernia service: our York pathway

Purpose Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors’ knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. Methods A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. Results We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. Conclusion A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.

Excitation of Shear Layer Due to Surface Roughness Near the Leading Edge: An Experiment

In this paper, a comprehensive study has been performed to address the excitation of a separated boundary layer near the leading edge due to surface roughness. Experiments are performed on a model airfoil with the semicircular leading edge at a Reynolds number (Rec) of 1.6×105, where the freestream turbulence (fst) is 1.2%. The flow features are investigated over the three rough surfaces with the roughness characteristic in the wall unit of 17, 10.5, and 8.4, which are estimated from the velocity profile at a location far downstream of reattachment. The wall roughness results in an early transition and reattachment, leading to a reduction of the laminar shear layer length apart from the bubble length. It is worthwhile to note that although the large-amplitude pretransitional perturbations are apparent from the beginning for the rough surface, the shear layer reflects the amplification of selected frequencies, where the fundamental frequency when normalized is almost the same as that of the smooth wall. The universal intermittency curve can be used to describe the transition of the shear layer, which exhibits some resemblance to the excitation of the boundary layer under fst, signifying the viscous effect.

A Study on Fire Hazards in Multiple Compartments with Lightweight Partition Walls

This paper presents the study of a fire risk to the backside of two miniatures of ISO 9705 2/5 using a lightweight partition for indoor space division and reproduction of the ISO 9705 test. An SGP partition, stud partition, glass wool panel, urethane foam panel, sandwich panel, and glass partition were selected as the test specimens, which are frequently used in construction. According to the ISO 9705 test standard, stabilization was achieved using a measuring device that recorded data before the ignition of a burner and continued recording for 120 s thereafter. After ignition was achieved, the power was increased to 300 kW for 600 s and then reduced to 100 kW for 600 s. The specimens were subsequently observed for 180 s, and the fire risk to the backside and the fire pattern of the wall unit were analyzed. Owing to the amount of heat generated by the ignition source, the maximum temperature of the backside was observed to be 67.7 ℃ for the SGP partition, 55.1 ℃ for the stud partition, 52.4 ℃ for the glass wool panel, 727.4 ℃ for the sandwich panel, 561 ℃ for the urethane foam panel, and 630.5 ℃ for the glass partition. In the cases of the sandwich and urethane foam panels, the explosion of flammable gas occurred by virtue of fusion of the interior materials. The reinforced glass was fractured owing to the temperature difference between the heat- and nonheat-responsive parts. Ultimately, the fire risk to the nearby section room was deemed to be high.

Influence of housing methods of young bulls of Hereford breed on their meat productivity and survival rate

The indicators of productivity, survival rate and behavior of young bulls of Hereford breed were studied in a comparative aspect when they were raised in winter in the northern part of Kolpashevsky district of the Tomsk region. During the housing period, low average air temperatures were observed: from 20°С in October to –50°С in December – January and –49°С in February. Bulls of the control group were kept in a unit of the "three-wall" type during wintering, while bulls of the experimental group – in a lightweight unit. The increase in live weight of bulls of experimental group was 2.2 times higher than that in the control group, the slaughter weight was by 68.3 kg and the weight of internal fat was by 6.0 kg more than in the control. In the experimental group, the survival rate of bulls before slaughtering was 2 times higher than that in the control. In terms of live weight, experimental animals from the age of 15 months to slaughter exceeded the control group by 19%. Ethological studies showed that different types of housing units had a significant impact on animal behavior. The feed intake of the bulls of the control group was shorter by 54 minutes, (15%) than that of the experimental group. Animals also spent 95 minutes (20.21%) less on chewing cud compared to the experimental bulls. When kept in a lightweight type of unit, bulls were in motion for a longer time, as a result of which they rested 45 minutes less, which contributed to the increase in the metabolic processes in the body. The animals of the experimental group spent 50 minutes longer on eating food in comparison with the bulls in the “three-wall” unit. The air temperature in a unit of the "three-wall" type was close to the ambient air temperature, wherein the bulls spent most of their time lying down. The profitability of growing bulls in the experimental group exceeded the control indicator by 1.6 times. In the light-type premises, the housing conditions of bulls in the winter period at extremely low air temperatures were most favorable.

A large-scale detachment system in the central Eastern Alps (Upper Austroalpine Unit, Austria)

<p>Based on new structural field data and Raman micro-spectroscopy on carbonaceous material a major detachment juxtaposing Drauzug-Gurktal Nappe System (DGN) against the transgressive Permo-Mesozoic cover sequence of the Ötztal-Bundschuh Nappe System (BN, Stangalm Mesozoic s. str.) in the area SE of Flattnitz (Carinthia, Austria). An Eo-alpine top-SE kinematic has been identified.</p><p>The hanging wall unit comprise lithologies of the DGN phyllites, conglomerates and graphite schists (Stolzalpe nappe), which have experienced only low grade greenschist deformation. Raman constrains 350°C±40°C.</p><p>The footwall unit consists of dolomitic ultra-mylonites, calcitic marble mylonites, meta-conglomerates and quarzites (Stangalm Mesozoic and Kuster nappe), which have experienced at least four main deformation phases. The oldest structures (D1) corresponding to Eo-Alpine nappe stacking are overprinted by (D2) isoclinal recumbent folds with E-W oriented shallow dipping fold axis and an axial plane schistosity, dipping shallowly to WSW. Ductile to brittle-ductile top to the E shearing (D3) is indicated by ESE-trending stretching lineation, C-type shear bands, stylolites, crystal- and shape preferred orientations of mineral grains. Late brittle deformation (D4) is recorded in steep joint sets with dip-directions to NW. Raman constrains 480°C±40°C.</p><p>The detachment zone comprises a complicate zone of high strain including units from DGN folded together within the Stangalm Mesozoic, which have experienced the same deformation as the BN.</p>