VP007 MULTIRECIDIVATED DESMOÍD TUMOR OF THE THORAX-ABDOMINAL WALL

Aim

Treatment of recurrent desmoid tumors represents a real challenge for the surgeon. The purpose of the video is to show the treatment of a multirecidivated complex desmoid tumor that affects the lateral thoracoabdominal wall.

Material and Methods

24-year-old woman with the diagnosis of recurrent desmoid tumor. She was operated in 2014 for a 10 cm desmoid tumor in the left chest wall with affected margins in the biopsy. In 2016 she underwent surgery for a 5 cm recurrence, which was excised en bloc along with the 6th, 7th, 8th and 9th rib arches. In 2018 she presented a recurrence in the scar treated by radiotherapy. She now presents a recurrence that in the CT scan is seen as an 8 cm tumor that affects the thoraco-abdominal wall.

Results

We perform a complete resection with free margins and “en bloc” resection of the 8th, 9th, 10th and 11th rib arches. We repair the defect using a reverse TAR and rebuild the wall with the Madrid APPROACH technique with BioA and polypropylene meshes.

The patient was discharged 11 days after surgery without any complications. The pathological study showed an 8 cm desmoid tumor with free surgical margins. The patient a year after surgery remains disease free.

Conclusions

The resection of a desmoid tumor that affects the abdominal and/or thoracic wall, especially if it is recurrent, represents a challenge for the surgeon. Component separation techniques and Madrid APPROACH may be very useful to achieve an optimal repair.

P017 COMPLEX ABDOMINAL WALL RECONSTRUCTION IN ELDERLY PATIENTS

Aim

Our study aims to analyze and evaluate the results obtained in patients older than 80 years old who underwent complex abdominal wall reconstruction (CAWR) in a multicenter abdominal wall unit using different surgical approaches.

Material and Methods

Patients were identified from a prospective maintained multicenter database. Demographic characteristics, incisional hernias’ (IH) characteristics, as well as postoperative outcomes, including short and long-term complications have been analyzed.

Results

21 patients were identified. The mean age was 82.5 (+/- 2.4) years old . There were 10 (47.6%) midline IH, 5 (23.8%) lateral IH, 4 (19%) synchronous midline and lateral IHs, and 2 (9.6%) parastomal hernias (PH). 9 (42.8%) Madrid TAR modification technique, 5 (23.8%) Rives-Stoppa, 3 (14.3%) lateral preperitoneal approaches, 1 (4.8%) midline preperitoneal approach and 1 (4.8%) anterior component separation were performed. In patients with PH, a modification of the Pauli technique (4.8%), and a unilateral TAR with a keyhole repair associated (4.8%) were performed.

There were 7 (33,3) surgical site occurrences (SSO), 1 (4.8%) seroma, 3 (14.3%) hematomas and 3 (14.3%) surgical site infections. Only 3 (14.3%) SSO required procedural intervention. During a mean follow-up of 20.6 (+/- 15.9) months, 1 (4.8%) hernia recurrence was diagnosed. No cases of postoperative bulging were recorded. There were also no cases of chronic pain in the sample.

During follow-up, 3 patients died from surgery unrelated causes.

Conclusions

CAWR in the elderly patient, after an adequate preoperatively selection of patients, presented acceptable short- and long-term results, despite the advanced population age.

O07 SHORT-TERM OUTCOMES OF A MULTICENTRE PROSPECTIVE STUDY USING A “VISIBLE” PVDF ONLAY MESH FOR THE PREVENTION OF MIDLINE INCISIONAL HERNIA

Aim

Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under MRI.

Material and Methods

This is a prospective multicentre observational cohort study. Preliminary results from the first three months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. MRIs were performed six weeks after treatment. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position.

Results

Between July 2016 and December 2020, 178 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with BMI being the only significant risk factor (OR = 1.14, 95% CI = 1.00-1.31, p = 0.048). The formation of a seroma was also associated with BMI (OR = 1.11, 95% CI = 1.02-1.21, p = 0.02).

Conclusions

The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to understand how the mesh behaves during the early process of integration.

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.

[Diabetes and ignored disorders of glucose tolerance in primary care. Evidence from opportunistic detection. Group for the Study of Diabetes in Tarragona]

OBJECTIVE

To investigate the level of attendance for care of people with glucose tolerance disorders, both known and not, and to discuss their real impact on Primary Care.

DESIGN

Simple prospective randomised sampling. Opportunist detection among spontaneous users over 40, excluding pregnant women.

SETTING

Primary Health Care.

PATIENTS AND OTHER PARTICIPANTS

Data was recorded using a pre-designed survey, which included the recognised Diabetes (DM) risk factors.

MEASUREMENTS AND MAIN RESULTS

Of the 183 cases evaluated, DM was already known in 13 (7.1%). 15 (8.2%) with unknown DM and 27 (14.7%) with GIT. A strong link was demonstrated with the average age and a marked tendency to overweight and obesity only significant when comparing DM with the rest. As to the risk factors researched, there was a significant association with antecedents of prior tolerance abnormality, DM in pregnancy, hyperglucaemiant medicines and ischaemic disease, in cases where family antecedents of definite diabetes were not found.

CONCLUSIONS

The frequency of attendance of users with diabetes and unknown glucose tolerance disorders is very high in spontaneous primary care consultations. These results suggest that opportunist detection should be encouraged in primary health care centres.