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Incidence and Management of Recurrence after Abdominal Wall Reconstruction
e106
Scientific Poster Presentations: 2016 Clinical Congress
METHODS: We retrospectively analyzed adult patients who underwent ELC (performed 7 days from diagnosis) versus DLC (performed 28 days from diagnosis) for AC and compared outcomes at our institution from 2009-2014. Tokyo Guidelines (TG13) was used to diagnose and grade the severity of AC. RESULTS: Of the 272 included patients, 209 ELC and 63 DLC were performed (Table). DLC patients were older, had more co-morbidities, and had longer lengths of stay (5 vs. 2 days; p<0.0001). However, intra- or postoperative bile duct injuries (1.6 vs 2.4%; p¼1.00), venous thromboembolism events (3.17 vs 0%; p¼0.053), conversion rate (7.9 vs 7.2%; p¼0.839), surgical site infection (4.7 vs 1.9%; p¼0.204), and bleeding complications (14.3 vs 17.7%; p¼0.507) were similar. There were no intraoperative or 30-day mortalities in our population. In the DLC group, 17/63 (26.9%) returned due to gallstone-related complications and 13/17 (76.4%) were re-admitted. Median delay between diagnosis and surgery in DLC group was 50 days (range 1-290). Table. Early laparoscopic cholecystectomy Male sex, n (%) Mean age, y (SD) Median total length of stay, d (range) Conversion rate, n (%)
Delayed laparoscopic cholecystectomy
p Value
96 (45.9)
24 (38.1)
0.2721
52.4 (18.1)
62.3 (15.4)
<0.0001
5 (2-58)
<0.0001
2 (1-14) 15 (7.2)
5 (7.9)
0.8396
Heart disease, n (%)
29 (13.9)
21 (33.3)
0.0005
Diabetes, n (%)
34 (16.3)
20 (31.8)
0.0069
Hypertension, n (%)
82 (39.2)
40 (63.5)
0.0007
Malignancy, n (%)
12 (5.7)
13 (20.6)
0.0003
Lung disease, n (%)
24 (11.5)
14 (22.2)
0.0311
CONCLUSIONS: We demonstrate that delaying definitive treatment for AC is safe and feasible; however, it is associated with increased length of hospital stay. Outcomes after DLC are comparable to those after ELC despite our DLC patient population being older and sicker. Incidence and Management of Recurrence after Abdominal Wall Reconstruction Bruce Ramshaw, MD, FACS, Brandie Forman, Jonathan P Dean, MD, Andrew W Gamenthaler, MD, Michael A Fabian, MD, FACS University of Tennessee Graduate School of Medicine, Knoxville, TN, Halifax Health, Daytona Beach FL INTRODUCTION: In the past decade, general and plastic surgeons have evolved a variety of options using myofascial advancement flaps for abdominal wall reconstruction (AWR). There is very little experience with the management of recurrent hernias after AWR. METHODS: A total of 96 AWRs were performed in 1 hernia program over 43 months (February 2012-September 2015). Recurrent hernias were identified by clinical exam and the methods and results for managing these recurrences are presented. RESULTS: A total of 7 patients developed 8 hernias after AWR. Seven hernias were repaired, 6 laparoscopically and 1 with another AWR. The mean time to diagnosis of recurrence was 10.5 (5-17)
J Am Coll Surg
months and mean time to reoperation was 20.5 (8-36) months. One patient has not yet undergone an operation for their recurrent hernia. The mean length of stay for the initial AWR in this patient group was 7.7 (3-23) days. The mean length of stay for the rerepairs in this group of patients was 2.9 (1-5) days. All patients who have had a re-repair have no evidence of hernia recurrence. CONCLUSIONS: A laparoscopic ventral hernia repair was utilized in the majority of patients who had a recurrence after AWR in a single hernia program. All re-repairs resulted in good short term outcomes. Incidence and Survival for Small Bowel Tumors over the Last Two Decades (1991-2012): A SEER-based Analysis Kunal Suradkar, MBBS, Benjamin Lebwohl, Peter Green, Alfred Neugut, Ravi P Kiran, MD New York Presbyterian Hospital, Columbia University, New York, NY INTRODUCTION: We aimed to evaluate changes in the incidence and survival associated with small bowel tumors over the last two decades. METHODS: From the SEER database (1991 e 2012), patients with small bowel tumors were identified. Predominant tumors were adenocarcinoma (AC), carcinoid (CT), neuroendocrine (NET), diffuse large B-cell lymphomas (DLBCL), and gastrointestinal tumors (GIST). Incidence rates and overall survival (OS) over time were calculated using SEER joinpoint software and Kaplan-Meier tests. RESULTS: Majority of tumors were carcinoid (44.1%) whose incidence (per 100,000) increased from 0.3875 (1991) to 0.9144 (2012) with annual percent change (APC) being 3.51%. This incidence also increased for the individual locations in the duodenum, jejunum, and ileum. The incidence of DLBCL also increased similarly. The incidence for GIST (0.0042 in 1991 and 0.1321 in 2012) and NET (0.0125 in 1991 and 0.2946 in 2012) increased dramatically, the percent change was 3069.8% and 2257.03% with APC being 7.54% and 16.65%, respectively. Incidence of adenocarcinoma however decreased from 0.495 (1991) to 0.4741 (2012) with APC 1.313%. Incidence increased in the duodenum but decreased in the jejunum and ileum. Five year OS for adenocarcinoma, carcinoids, NET, GIST, and DLBCL was 21.3%, 65.5%, 51.7%, 59.3%, and 48.8% in 1991-2000 and 22% (p¼0.312), 74.6% (p<0.001), 71.9% (p<0.001), 72.3% (p¼0.005), 53.4% (p¼0.150) in 2001-2012, respectively. CONCLUSIONS: Incidence of small bowel tumors other than adenocarcinoma is steadily increasing, with GIST and NET having a dramatic increase. Survival for carcinoid, neuroendocrine, and gastrointestinal tumors has strikingly improved in the last decade. Intestinal Smooth Muscle Cell Migration May Contribute to Abdominal Adhesion Formation Clement D Marshall, MD, Michael S Hu, MD, MPH, Tripp Leavitt, Ryan C Ransom, Leandra A Barnes,
Scientific Poster Presentations: 2016 Clinical Congress
METHODS: We retrospectively analyzed adult patients who underwent ELC (performed 7 days from diagnosis) versus DLC (performed 28 days from diagnosis) for AC and compared outcomes at our institution from 2009-2014. Tokyo Guidelines (TG13) was used to diagnose and grade the severity of AC. RESULTS: Of the 272 included patients, 209 ELC and 63 DLC were performed (Table). DLC patients were older, had more co-morbidities, and had longer lengths of stay (5 vs. 2 days; p<0.0001). However, intra- or postoperative bile duct injuries (1.6 vs 2.4%; p¼1.00), venous thromboembolism events (3.17 vs 0%; p¼0.053), conversion rate (7.9 vs 7.2%; p¼0.839), surgical site infection (4.7 vs 1.9%; p¼0.204), and bleeding complications (14.3 vs 17.7%; p¼0.507) were similar. There were no intraoperative or 30-day mortalities in our population. In the DLC group, 17/63 (26.9%) returned due to gallstone-related complications and 13/17 (76.4%) were re-admitted. Median delay between diagnosis and surgery in DLC group was 50 days (range 1-290). Table. Early laparoscopic cholecystectomy Male sex, n (%) Mean age, y (SD) Median total length of stay, d (range) Conversion rate, n (%)
Delayed laparoscopic cholecystectomy
p Value
96 (45.9)
24 (38.1)
0.2721
52.4 (18.1)
62.3 (15.4)
<0.0001
5 (2-58)
<0.0001
2 (1-14) 15 (7.2)
5 (7.9)
0.8396
Heart disease, n (%)
29 (13.9)
21 (33.3)
0.0005
Diabetes, n (%)
34 (16.3)
20 (31.8)
0.0069
Hypertension, n (%)
82 (39.2)
40 (63.5)
0.0007
Malignancy, n (%)
12 (5.7)
13 (20.6)
0.0003
Lung disease, n (%)
24 (11.5)
14 (22.2)
0.0311
CONCLUSIONS: We demonstrate that delaying definitive treatment for AC is safe and feasible; however, it is associated with increased length of hospital stay. Outcomes after DLC are comparable to those after ELC despite our DLC patient population being older and sicker. Incidence and Management of Recurrence after Abdominal Wall Reconstruction Bruce Ramshaw, MD, FACS, Brandie Forman, Jonathan P Dean, MD, Andrew W Gamenthaler, MD, Michael A Fabian, MD, FACS University of Tennessee Graduate School of Medicine, Knoxville, TN, Halifax Health, Daytona Beach FL INTRODUCTION: In the past decade, general and plastic surgeons have evolved a variety of options using myofascial advancement flaps for abdominal wall reconstruction (AWR). There is very little experience with the management of recurrent hernias after AWR. METHODS: A total of 96 AWRs were performed in 1 hernia program over 43 months (February 2012-September 2015). Recurrent hernias were identified by clinical exam and the methods and results for managing these recurrences are presented. RESULTS: A total of 7 patients developed 8 hernias after AWR. Seven hernias were repaired, 6 laparoscopically and 1 with another AWR. The mean time to diagnosis of recurrence was 10.5 (5-17)
J Am Coll Surg
months and mean time to reoperation was 20.5 (8-36) months. One patient has not yet undergone an operation for their recurrent hernia. The mean length of stay for the initial AWR in this patient group was 7.7 (3-23) days. The mean length of stay for the rerepairs in this group of patients was 2.9 (1-5) days. All patients who have had a re-repair have no evidence of hernia recurrence. CONCLUSIONS: A laparoscopic ventral hernia repair was utilized in the majority of patients who had a recurrence after AWR in a single hernia program. All re-repairs resulted in good short term outcomes. Incidence and Survival for Small Bowel Tumors over the Last Two Decades (1991-2012): A SEER-based Analysis Kunal Suradkar, MBBS, Benjamin Lebwohl, Peter Green, Alfred Neugut, Ravi P Kiran, MD New York Presbyterian Hospital, Columbia University, New York, NY INTRODUCTION: We aimed to evaluate changes in the incidence and survival associated with small bowel tumors over the last two decades. METHODS: From the SEER database (1991 e 2012), patients with small bowel tumors were identified. Predominant tumors were adenocarcinoma (AC), carcinoid (CT), neuroendocrine (NET), diffuse large B-cell lymphomas (DLBCL), and gastrointestinal tumors (GIST). Incidence rates and overall survival (OS) over time were calculated using SEER joinpoint software and Kaplan-Meier tests. RESULTS: Majority of tumors were carcinoid (44.1%) whose incidence (per 100,000) increased from 0.3875 (1991) to 0.9144 (2012) with annual percent change (APC) being 3.51%. This incidence also increased for the individual locations in the duodenum, jejunum, and ileum. The incidence of DLBCL also increased similarly. The incidence for GIST (0.0042 in 1991 and 0.1321 in 2012) and NET (0.0125 in 1991 and 0.2946 in 2012) increased dramatically, the percent change was 3069.8% and 2257.03% with APC being 7.54% and 16.65%, respectively. Incidence of adenocarcinoma however decreased from 0.495 (1991) to 0.4741 (2012) with APC 1.313%. Incidence increased in the duodenum but decreased in the jejunum and ileum. Five year OS for adenocarcinoma, carcinoids, NET, GIST, and DLBCL was 21.3%, 65.5%, 51.7%, 59.3%, and 48.8% in 1991-2000 and 22% (p¼0.312), 74.6% (p<0.001), 71.9% (p<0.001), 72.3% (p¼0.005), 53.4% (p¼0.150) in 2001-2012, respectively. CONCLUSIONS: Incidence of small bowel tumors other than adenocarcinoma is steadily increasing, with GIST and NET having a dramatic increase. Survival for carcinoid, neuroendocrine, and gastrointestinal tumors has strikingly improved in the last decade. Intestinal Smooth Muscle Cell Migration May Contribute to Abdominal Adhesion Formation Clement D Marshall, MD, Michael S Hu, MD, MPH, Tripp Leavitt, Ryan C Ransom, Leandra A Barnes,