P074 PARASTOMAL AND INCISIONAL HERNIAS FOLLOWING EMERGENCY SURGERY FOR HINCHEY III-IV DIVERTICULITIS: A SYSTEMATIC REVIEW

Aim The aim of this systematic review was to report the risk of parastomal and incisional hernias after emergency surgery for Hinchey III–IV diverticulitis. Material and Methods The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. All randomized controlled trials (RCTs) and cohort studies comparing HP with other surgical treatment options for perforated diverticulitis classified as purulent or faecal (Hinchey III–IV) were considered for inclusion. Exclusion criteria were case series and reports, letters, editorials, reviews and conference abstracts. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence. Seven studies (six randomized controlled trials and one retrospective cohort) with a total of 831 patients were eligible for inclusion. Results The parastomal hernia incidence was 15.2–46.0% for Hartmann procedure, 0–85.2% for primary anastomosis, 4.3% for resection and 1.6 % for laparoscopic lavage. The incisional hernia incidences were 7.8–38.1% for Hartmann procedure, 4.5–27.2% for primary anastomosis, 3.2–25.5% for primary resection, 2.7–11.1% for laparoscopic lavage and 16.1–45.8% for secondary resection. Due to heterogeneity of follow-up methods, follow-up time and lack of both parastomal and incisional hernia as outcome, no meta-analysis was conducted. Conclusions The hernia incidences reported after surgical treatment for complicated diverticulitis may be biased and underestimated. For future RCTs, researchers are encouraged to pay attention to hernia diagnosis, symptoms and prevention.

O32 TREATMENT OF FASCIAL DEHISCENCE IS IMPROVED BY MESH REINFORCEMENT

Aim In 2014 fascial dehiscence (FD) was treated with re-suturing the fascia as the only measure in half of the cases at our institution, with discouraging re-rupture and incisional hernia (IH) rates. A changing path away from fascia closure (FC) by re-suturing solely towards reinforcement of the closed fascia is now evaluated. Material and Methods Retrospective chart review of consecutive patients operated for FD 2016-2020. Available CT scans were scrutinized for IH. Results 58 patients (14 women) with a mean age of 71 years and a mean BMI of 27.3 were treated with: FC by re-suturing as the only measure (n = 1, 1.7%); FC preceded by a reinforced tension line (RTL) suture (n = 9, 15.5%); FC and on-lay mesh reinforcement (n = 23, 39.7%); retromuscular mesh closure (n = 10, 17.2%); open abdomen treatment with retromuscular mesh reconstruction (n = 1, 1.7%); and, open abdomen treatment with vacuum assisted wound closure and permanent on-lay mesh-mediated fascial traction (VAWCPOM) (n = 14, 24.1%). One patient in the RTL-group suffered a re-rupture (1.7%). The in-hospital mortality was 5%. Wound healing problems were seen in 29 (51.9%) patients. IH was evaluable in 49 patients with a total incidence of 22.4% at mean follow-up of 21 months. The hernia incidence for mesh reinforced or reconstructed patients was 17.5% compared to 44.4% in re-sutured or RTL patients. Conclusions FD treatment with mesh reinforced FC prevented re-rupture and resulted in a lower rate of IH. Additional standardization and refining the mesh techniques may further improve results.

O30 THE INCIDENCE OF INCISIONAL HERNIA AT OSTOMY-REVERSAL SITE

Aim The purpose of this study was to evaluate the rate of incisional hernias at the ostomy site after reversal of the ostomy. Material and Methods We used retrospectively compiled database of patients who had undergone ostomy formation and ist reversal. All patients had their surgery performed between Jan. 2011 and December 2019. Patients history, added by clinical examination and CT-scan were performed in order to identify the incidence of incisional hernias. Different variables, like gender, surgical site infection (SSI) and BMI were evaluated as possible risk factors for hernia occurrence. Results Among totally included 224 patients in the study, 190 of all patients had reversal after loop-ileostomy (85%) and 34 patients had reversal after loop-colostomy (15%). Among all stoma reversal patients, 12,8 % developed incisional hernia at the stoma reversal site (n = 28). The incisional hernia occurrence at the ostomy reversal site was present in 20,0% in patients with clinically relevant SSI and only in 9,4% in patients where SSI was absent (p = 0,03). There was no statistical significance in hernia occurrence between both genders and among patients with low, normal and high BMI in our cohort of patients. Conclusions Incisional hernia after ostomy reversal is a common late surgical complication. All measurements that reduce SSI at the reversal site are important for lower hernia incidence. Prophylactic mesh implantation at stoma reversal sites may be considered in these patients.

SPIGELIAN HERNIA – RAREST OF THE RARE CASES. A CASE REPORT OF LEFT SIDED SPIGELIAN HERNIA.

A spigelian hernia is considered as a diagnostic challenge . Although abdominal imaging may be helpful, the ndings of unusual abdominal complaints in the proper anatomic location should alert one to the possibility of a spigelian hernia. Incidence of spigelian hernia ranges from about 0.1% to 2% of all abdominal wall hernias. As spigelian hernias are clinically elusive , we report this rare encounter of a left sided spigelian hernia in a 50 years old female patient and its management.

Long Term Outcome After Open Abdomen Treatment: Function and Quality of Life

Background: Open abdomen treatment (OAT) is widely accepted to manage severe abdominal conditions such as peritonitis and abdominal compartment syndrome but can be associated with high morbidity and mortality. The main risks in OAT are (1) entero-atmospheric fistula (EAF), (2) failure of primary fascial closure, and (3) incisional hernias. In this study, we assessed the long-term functional outcome after OAT to understand which factors impacted most on quality of life (QoL)/daily living activities and the natural course after OAT.Materials and Methods: After a retrospective analysis of 165 consecutive OAT patients over a period of 10 years (2002–2012) with over 65 clinical parameters that had been performed at our center (1), we initiated a prospective structured follow-up approach. All survivors were invited for a clinical follow-up. Forty complete datasets including clinical and social follow-up with SF-36 scores were available for full analysis.Results: The patients were dominantly male (75%) with a median age of 52 years. Primary fascial closure (PC) was achieved in 9/40 (23%), while in 77% a planned ventral hernia (PVH) approach was followed. A total of 3/4 of the PVH patients underwent a secondary-stage abdominal wall reconstruction (SSR), but 2/3 of these reconstructed patients developed recurrent hernias. Fifty-five percent of the patients with PC developed an incisional hernia, while 20% of all patients developed significant scarring (Vancouver Scar Score >8). Scar pain was described by 15% of the patients as “moderate” [Visual Analog Scale (VAS) 4–6] and by 10% as “severe” (VAS > 7). While hernia presence, PC or PVH, and scarring showed no impact on QoL, male sex and especially EAF formation significantly reduced QoL.Discussion: Despite many advantages, OAT was associated with relevant mortality and morbidity, especially in the early era before the implementation of a structured concept at our center. Follow-up revealed that hernia incidence after OAT and secondary reconstruction were high and that 25% of patients qualifying for a secondary reconstruction either did not want surgery or were unfit. Sex and EAF formation impacted significantly on QoL, which was lower than in the general population. With regard to hernia incidence, new strategies such as prophylactic mesh implantation upon fascial closure should be discussed analogous to other major abdominal procedures.

Measuring birth weight and umbilical cord diameter at birth to predict subsequent performance in swine

In the swine industry, pre-weaning mortality, umbilical hernia incidence and pig market weight are a few contributing factors affecting profitability and welfare on farm. Therefore, the ability to reliably predict any of these outcomes is valuable to swine operations. Mortality during the pre-weaning phase, umbilical hernia incidence and poor-quality finisher pigs can represent a multi-million dollar loss and increase in welfare concerns to the producer. Consequently, the objective of this study was to evaluate whether birth weight (BW), umbilical cord diameter at birth (UCD), and the calculated umbilical diameter at birth to birth weight ratio (UCD:BW), are potential indicators of both placental efficiency and relative defect size in the abdominal musculature as well as reliable predictors of pre-weaning mortality, umbilical hernia incidence, and pig body weight at 150 d of age in a commercial facility. Mixed sex commercial piglets were followed through production. Four hundred sixty-five piglets were weighed within 1 h of birth, and the UCD was determined using digital calipers, these animals were followed through weaning. Three hundred eighty-five pigs of the 465 were followed through the post-wean phase in the nursery facility and checked for umbilical hernia incidence. Finally, of the 385 pigs, 177 pigs were assessed for umbilical hernia incidence and weighed a final time at the grower-finisher facility. All data were analyzed using PROC Logistic and PROC GLM procedures. The variables of UCD:BW and BW were significantly associated with the probability of increased pre-weaning mortality (P < 0.001). For example, piglets with a low UCD:BW, but an increased BW had the greatest survival rate. Umbilical diameter (UCD) was not significantly associated with pre-weaning mortality. Post-weaning mortality was not significantly affected by UCD:BW, BW, or UCD variables. Umbilical hernia incidence was not significantly affected by UCD:BW at the nursery phase or growing-finishing phase. Pig body weight at 150 d of age was significantly affected by UCD:BW, BW, and UCD variables (P < 0.001). For example, piglets that had a larger UCD weighed more at 150 d of age. In conclusion, measuring the calculated UCD:BW has the potential to be a novel tool for future research looking into the impacts of umbilical measurements as it relates to placental function, fetal development, piglet survivability and impacts on future performance of the animal.