Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination. A prospective observational study​

Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination. A prospective observational study​ | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination. A prospective observational study​ Ana Ciscar, Josep Maria Badia, Francesc Novell, Santiago Bolivar, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-46694/v3 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Dec, 2020 Read the published version in BMC Surgery → Version 3 posted 4 You are reading this latest preprint version Show more versions Abstract BACKGROUND: Trocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery. Few studies currently describe its incidence or risk factors. The aim of this report is to determine the real incidence of TSIH and to identify risk factors. METHODS: A cross-sectional prospective study was performed including consecutive patients who underwent a laparoscopic procedure during a four months period . All the patients were assessed both clinically (TSIHc) and by an ultrasonographic examination (TSIHu). The main variable studied was the incidence of TSIH. A multivariate analysis was performed to identify risk factors. RESULTS: 76 patients were included. 27.6% of patients were clinically diagnosed as having TSIH (TSIHc) but only 23.7% of those cases were radiologically confirmed (TSIHu). In the logistic regression analysis, age > 70 years (OR 3.462 CI 1.14 - 10.515, p = 0.028) and body mass index (BMI) ≥30 Kg / m 2 (OR 3.313 CI 1.037-10.588, p = 0.043) were identified as risk factors for TSIH. The size of the trocar also showed statistically significant differences (p <0.001). Mean follow-up time was 34 months. CONCLUSIONS: TSIH is under-diagnosed due to the lack of related symptomatology and the inadequacy of the postoperative follow-up period. We detected discrepancies between the clinical and ultrasonographic examinations. TSIHu should be considered as the gold standard for the diagnosis of TSIH. Risk factors such as age, BMI and size of the trocar were confirmed. Patients should be followed-up for a minimum of 2 years. Surgery General Surgery trocar site incisional hernia laparoscopic surgery risk factors incidence. Figures Figure 1 Background Incisional hernia is the most common complication associated with surgical procedures, with an estimated incidence of 0-35% (1,2). As there are few studies with a long-term follow up and the occurrence of the incisional hernia depends on the duration of postoperative follow-up, this estimate may not be accurate. There is a considerable amount of documentation regarding incisional hernia after laparotomy, and several risk and protective factors have been described. Despite the introduction of laparoscopic surgery, incisional hernia is still frequent and, indeed, trocar site incisional hernia (TSIH) is a common complication after laparoscopy. Until recently, even in studies with a long term follow-up, unrealistic TSIH rates of 0.8- 2.9% (3–6) have been described. TSIH can be diagnosed by clinical examination, but imaging tests as computerized tomography (CT) or dynamic abdominal sonography for hernia (DASH) can improve the diagnostic accuracy. At present, a CT scan is considered the gold standard technique for the diagnosis and characterization of TSIH, but it has a few drawbacks: economic cost, patient irradiation, and that it is a static procedure (which can under-diagnose). On the other hand, dynamic abdominal sonography for hernia (DASH) has been shown to be a valid alternative to CT in the diagnosis and characterization of incisional herniation(7,8). One of the key factors for proper detection of the TSIH is the postoperative follow-up time. A short or incomplete follow up could underdiagnose this issue, which is often subclinical (7). The aim of this study was to determine the incidence of trocar-site incisional hernia (TSIH) by clinical and dynamic ultrasonographic examination in patients who underwent laparoscopic surgeries in a general hospital. Secondary outcomes were to evaluate the correlation between clinical and ultrasonographic assessment and to determine the main risk factors for TSIH. Methods Study design . A single-centre cross-sectional study based on prospective clinical and radiological assessment and retrospective risk factor analyses performed at a single hospital. The study has been retrospectively registered in Clinicaltrials.gov on June 4, 2020 under registration number: NCT04410744 Patients . All consecutive patients undergoing laparoscopic surgery (cholecystectomy, colon resection, adrenalectomy, Nissen fundoplication and appendectomy) during a four-month period were included in the study. 30 months after hospital discharge, they were invited by telephone to participate in the study. Detailed project information was provided, and those who accepted received an appointment for an outpatient visit and a dynamic ultrasound examination. A written informed consent was obtained from all participants. Exclusion criteria were age under 18 years, previous umbilical hernia repair, or failure to attend the postoperative appointment. Procedures. In all patients, the umbilical trocar wound was closed with an interrupted suture with synthetic braided absorbable 2/0 suture (Novosyn® or Safil®). During the postoperative outpatient visit, informed consent was obtained and clinical and ultrasonographic examinations were performed. To increase study homogeneity, a single surgeon performed all clinical examinations and all ultrasound examinations were performed by a radiology medical trainee closely supervised by the same abdominal radiology consultant. Sonography was performed using an Applio 500 equipment (Toshiba, Japan) with a 7MHz linear probe. The ultrasound diagnosis was based on the identification of an abdominal wall defect with intraabdominal tissue protrusion. Caudal and cranial diameters of the abdominal wall’s defect were recorded. Patients diagnosed with TSIH were offered elective repair. Measurements and variables . The main variables of the study were clinical (TSIHc) and ultrasound (TSIHu) diagnosis of incisional hernia. Secondary variables analysed were age, sex, diabetes mellitus, chronic obstructive pulmonary disease (COPD), smoking, body mass index (BMI), previous untreated umbilical hernia, malignancy, surgical time, urgent/elective indication, incision size, degree of contamination and surgeon’s experience. Statistical analysis . All results and variables were entered into a specifically designed database (File MakerPro 11.0v3 © 1984-2011 FileMaker, Inc.). Data were collected from clinical interviews, physical and radiological examinations and the electronic medical record. Continuous variables were described as means and standard deviations and categorical variables were described as absolute numbers and percentages. The chi-square test was used to compare categorical variables (Fisher’s exact test was used when needed), and the Student t-test was used to compare continuous variables. Bivariate analysis and multivariate logistic regression analysis were performed to identify independent predictive causal factors for the development of TSIH. Adjusted odds ratios (ORs) were calculated using logistic regression. Variables achieving statistical significance in the bivariate analysis were considered for multivariate analysis. ORs with 95% confidence intervals (CIs) were presented for each studied variable. Differences were significant at the 5% level. All reported P values were two-sided. Statistical analyses were performed using SPSS statistical software (IBM SPSS® Statistics). Results A total of 120 patients, who were operated on, were contacted and 76 of them were finally included in the study (figure 1). 57.9% were women, and the mean age was 58.5years. Among them, 13.2% were diabetic, 5.4% had chronic obstructive pulmonary disease (COPD), 27.5% were obese (BMI over 30kg/m 2 ) and 11.8% had a malignancy. The primary laparoscopic procedures were cholecystectomy (78.9%), sigmoidectomy (10.5%), Nissen fundoplication (7.9%), adrenalectomy (1.3%) and appendectomy (1.3%). Mean postoperative follow-up was 34 months (Table 1). TSIH incidence . Of the 76 patients included in the study, a total of 303 trocar site incisions (TSI) were assessed (151 of 10 mm-TSI and 152 of 5 mm-TSI). A total of 21 patients (27.6%) were clinically diagnosed with having TSIH (TSIHc). However, TSIH was confirmed radiologically (TSIHu) in only 18 cases (23.7%). No patient presented more than one TSIH. Only 47.1% of patients who had a confirmed TSIH presented symptoms. Differences were observed in the TSIH rate depending on the size and location of the trocar. Only 1 out of 18 (5.5%) TSIH occurred in a 5-mm trocar site, whereas the other 17 hernias (94.45%) were located in 10-mm trocar sites. All hernias were located in the umbilical area (M3), except for one located in the left lumbar region (L4). Nine cases of TSIH (15%) suspected by clinical examination were not confirmed following ultrasonography. On the contrary, 5 cases (28%) diagnosed by ultrasonographic examination were not clinically found. Ultrasonography showed a significant better diagnostic capacity than clinical examination (p <0.001). The 5 not clinically suspected cases showed a lower transverse and cranio-caudal diameter measurement (Table 2), although there were not statistical differences. Risk factors for TSIH . Table 3 shows the differences observed between patients with TSIH and those with no TSIH identified radiologically. Only age >70 and BMI ≥ 30 showed statistically significant differences. In the univariate analysis of potential risk factors for TSIH, statistically significant differences were observed for age >70 years (OR 3.462; 95% CI 1.14 – 10.515; p=0.028) and BMI ≥30 (OR 3.313; CI 1.037-10.588; p=0.043) (Table 4). Other variables were discarded. Both, age >70 years (OR 4.464; 95% CI 1.32 - 15.091; p=0.016) and BMI ≥30 (OR 3.572; 95% CI 1.034 - 12.338; p=0.044) were confirmed as risk factors by multivariate analyses (Table 5). Discussion Incisional hernia is defined as a defect in the abdominal wall in placements of postoperative wounds. They are recognizable by clinical examination and/or by imaging tests. The incidence of trocar site incisional hernia has been poorly documented over the years which may be due to the paucity of symptoms and to the lack of long-term postoperative follow-up since the pathology that leads to the laparoscopic surgery is usually benign and no further follow-up is deemed necessary. Consequently, in most situations the follow-up is not sufficient to detect TSIH. In the present study it was hypothesized that the real incidence of trocar site incisional hernia, when properly assessed, could be higher than is currently believed. Therefore, we aimed to analyze the actual TSIH incidence in our environment, measured by both physical and radiological exams, the latter being considered the gold standard technique (8). Incidence . In our series, a high TSIH rate was found. The incidence detected by physical examination was 27.6%, compared to 23.7% when assessed by ultrasound. After having been a neglected issue, during the last decade, few authors have addressed the incidence and risk factors of TSIH after laparoscopic surgery. In 2010, Chiong et al published a retrospective analysis of 1055 patients who underwent surgery due to urologic tumors and found a TSIH rate of 0.66%. All of them were clinically suspected and radiologically confirmed by computed tomography (9). In 2011, a systematic review based on 19 prospective and retrospective studies, which included a total of 30568 adults and 1098 children, documented a TSIH incidence of 0.5-2% (10). In 2013, a retrospective review of 500 patients who underwent laparoscopic and robotic gynecological surgery documented only 3 cases of TSIH (0.6%), diagnosed on physical examination with radiologic confirmation (1 of them required emergency reoperation for hernia reduction and the other two presented asymptomatic bulges), with an average length of time to TSIH appearance of 21 days (4). In 2011, in a narrative review, Comajuncosas et al. described an incidence of 0.18-2.8%, but the authors concluded that the actual incidence was possibly higher (11). Three years later, the same group published a prospective observational study including 241 patients, with a follow-up of 46.8 months, showing an incidence of 25.9%. In this study, TSIH were identified mainly with clinical examination, but an abdominal ultrasound was carried out in doubtful cases (12). Location . In spite of using a systematic protocol for closure, most of TSIH cases were located in the 10mm incisions at the umbilical level. The TSIH rate can change depending on the type of trocar and its location. TSIH have been described at any location, but those situated at the10mm trocar are the most frequent(9,10,12–14). It seems that for 5mm trocars facial closure should not be necessary, but for ≥10mm trocars it would be mandatory. Keeping in mind some previous studies (4,6,10,11) and the results if this study, the standard closure technique may not be enough. Risk factors . We found that obesity and age over 70 years were independent risk factors for the appearance of TSIH. In open surgery, some risk factors for incisional hernias, either individual or dependent on the surgical technique, are well documented. Factors including abdominal aortic aneurysm surgery, obesity, cachexia, advanced age, male sex, COPD, anemia, smoking, steroid treatment, and immunosuppression. (1,10,12,15,16). duration of the procedure, presence of previous umbilical hernia, diabetes mellitus, or smoking, have been described as possible risk factors for TSIH (11,17) but according to our data only age and obesity can be confirmed as risk factors for TSIH. Diagnosis . In our experience, clinical examination overdiagnoses TSIH which is quite surprising and is not in accordance with other authors. A systematic review carried out in 2018 which was led by Kroese et al. (18) concluded that the use of imaging modalities would usually result in more incisional hernia being diagnosed compared to the use of physical examination alone. Bloemen et al. (19) also concluded that performing an ultrasonographic as well as a physical examination yielded a significant number of hernias, mostly asymptomatic ones, which would not have been found using physical examination alone. Follow up . As in open surgery, one of the main problems when considering laparoscopic incisional hernia diagnosis is a proper period of follow-up. There is no certainty about which would be the optimal follow-up time to detect TSIH and most studies describe follow-up for less than one year. In addition, the frequent absence of symptoms would result in a lack of medical consulting. According to the definition of Tonouchi (17), it seems reasonable to advise a minimum follow-up of 2 years, although some authors recommend more than 4 years(12,13). The mean follow up in our series almost achieves 3 years (34 months) which would be quite reasonable. The study has some limitations: there may be some selection bias, as the acceptance could be related to the presence of symptoms and cancer patients having exhaustive oncological controls may have refused to participate so as not to increase the number of outpatient consultations. The fact that the clinical evaluation was performed only by a single physician could also reduce the generalizability of our results. Finally, the relatively small sample size was enough to determine the prevalence of TSIH, but it was probably suboptimal for the calculation of risk factors Conclusions We conclude that TSIH is underdiagnosed in most of the published series. Diagnosing TSIH requires an exhaustive study that includes not only physical examination, but also ultrasonography. A significant number of patients ultimately diagnosed with TSIH hadn´t previously reported symptoms. Age, BMI and the size of the incision are factors that lead to the appearance of TSIH. Remaining questions for further investigation are whether all patients diagnosed with TSIH must be operated on, and whether the high incisional hernia rate justify changes in operative techniques, such as improvements in trocar closure, prophylactic mesh placement or lateralization of the umbilical 10mm trocar. List Of Abbreviations TSIH: Trocar site incisional hernia TSIHc: Trocar site incisional hernia assessed clinically TSIHu: Trocar site incisional hernia assessed by ultrasound examination OR: Odds ratio CI: Confidence intervals CT: Computerized tomography DASH: dynamic abdominal sonography for hernia BMI: Body mass index COPD: Chronic obstructive pulmonary disease TSI: trocar site incision L4: left lumbar region M3: umbilical region Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee (Comitè Ètica Investigació Clínica – Fundació Privada Hospital Asil de Granollers) and it was registered with the number 201530008. Written informed consent to participate was obtained from study participants. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request Competing interests The authors declare that they have no competing interests Funding None reported Author’s contributions AC participated in the study conception and design, acquisition of data (clinical examination), analysis and interpretation of data and in the drafting of manuscript JMB participated in the study conception and design, analysis, interpretation of data and critical revision of manuscript. FN participated in acquisition of data (ultrasound examination) SB participated in acquisition of data (ultrasound examination) EM participated in analysis, interpretation of data and critical revision of manuscript. All authors read and approved the final manuscript. Acknowledgements Acknowledgments. The authors thank Mr. David Morton for his review of the manuscript and Dr Elisabet Palomeras for her statistical advice. References Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, et al. Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14 618 Patients. PLoS One. 2015;10(9):e0138745. Anthony T, Bergen PC, Kim LT, Henderson M, Fahey T, Rege R V, et al. Factors affecting recurrence following incisional herniorrhaphy. World J Surg. 2000;24(1):95-100;discussion 101. Agaba EA, Rainville H, Ikedilo O, Vemulapali P. Incidence of port-site incisional hernia after single-incision laparoscopic surgery. JSLS. 2014;18(2):204–10. Sambasivarao S V. NIH Public Access. 2013;18(9):1199–216. Owens M, Barry M, Janjua AZ, Winter DC. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surg. 2011 Aug;9(4):218–24. Yamamoto M, Minikel L, Zaritsky E. Laparoscopic 5-mm Trocar Site Herniation and Literature Review. JSLS J Soc Laparoendosc Surg. 2011;15(1):122–6. Baucom RB, Beck WC, Phillips SE, Holzman MD, Sharp KW, Nealon WH, et al. Comparative Evaluation of Dynamic Abdominal Sonography for Hernia and Computed Tomography for Characterization of Incisional Hernia. JAMA Surg. 2014 Jun 1;149(6):591. Beck WC, Holzman MD, Sharp KW, Nealon WH, Dupont WD, Poulose BK. Comparative Effectiveness of Dynamic Abdominal Sonography for Hernia vs Computed Tomography in the Diagnosis of Incisional Hernia. J Am Coll Surg. 2016 Jan 25;216(3):447–53. Chiong E, Hegarty PK, Davis JW, Kamat AM, Pisters LL, Matin SF. Port-site Hernias Occurring After the Use of Bladeless Radially Expanding Trocars. Urology. 2010 Mar;75(3):574–80. Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia. 2011 Apr 9;15(2):113–21. Comajuncosas J, Vallverdú H, Orbeal R, Parés D. Eventración de los orificios de los trocares en cirugía laparoscópica. Cirugía española. 2011;89(2):72–6. Comajuncosas J, Hermoso J, Gris P, Jimeno J, Orbeal R, Vallverdú H, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg. 2014 Jan;207(1):1–6. Erdas E, Dazzi C, Secchi F, Aresu S, Pitzalis A, Barbarossa M, et al. Incidence and risk factors for trocar site hernia following laparoscopic cholecystectomy: A long-term follow-up study. Hernia. 2012 Aug 20;16(4):431–7. Cristaudi A, Matthey-Gié M-L, Demartines N, Christoforidis D. Prospective assessment of trocar-specific morbidity in laparoscopy. World J Surg. 2014 Dec;38(12):3089–96. Schmidt SC. Incidence, risk factors and management of incisional hernia in a high volume liver transplant center. Ann Transplant. 2013;18:223–30. Höer J, Lawong G, Klinge U, Schumpelick V. [Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years]. Chirurg. 2002 May;73(5):474–80. Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar site hernia. Arch Surg. 2004 Nov;139(11):1248–56. Kroese LF, Sneiders D, Kleinrensink GJ, Muysoms F, Lange JF. Comparing different modalities for the diagnosis of incisional hernia: a systematic review. Hernia. 2018;22(2):229–42. Bloemen A, van Dooren P, Huizinga BF, Hoofwijk AGM. Comparison of ultrasonography and physical examination in the diagnosis of incisional hernia in a prospective study. Hernia. 2012 Feb;16(1):53–7. Tables Table 1 : Main patient characteristics N 76 Age years (SD) ≤70 n (%) >70 58.47(16.58) 54 (71.1) 22 (28.9) Gender n (%) Male Female 32 (41.1) 44 (57.9) DM n (%) Yes Not 10 (13,2) 66 (86.8) COPD n (%) Yes Not 4 (5.4) 70 (94,6) Smokers n (%) Yes Not 19 (27.1) 51 (72,9) BMI Kg/m 2 (SD) ≥30 n (%) <30 27.54 (4.25) 19 (27.5) 50 (72.5) Weight Kg, (SD) 74.51 (11.76) Height Cm (SD) 163.82 (8.31) Previous umbilical hernia n (%) Yes Not 7 (9.3) 68 (90.7) Surgery type n (%) Cholecystectomy Sigmoidectomy Nissen fundoplication Suprarrenalectomy Appendectomy 60 (78.9) 8 (10.5) 6 (7.9) 1 (1.3) 1 (1.3) Laparoscopic approach n (%) Hasson Veress 76 (100) 0 Operative time minutes (SD) 86.89 (44.13) Surgeon’s experience n (%) Junior Senior 9 (12) 66 (88) Diagnose n (%) Cholelithiasis Acute cholecystitis Colon cancer Hiatal hernia Chronic cholecystitis Porcelain Gallbladder Adrenal adenoma Acute appendicitis 39 (51.3) 16 (21.1) 9 (11.8) 5 (6.6) 4 (5.3) 1 (1.3) 1 (1.3) 1 (1.3) Malignancy n (%) Benign Malign 67 (88.2) 9 (11.8) Surgical wound infection classification n (%) Clean Clean - contaminated Contaminated 8 (10.5) 44 (57.9) 24 (31.6) Emergency n (%) Elective Urgent 51 (67.1) 25 (32.9) TSIHc n (%) 5mm/TSIH 10mm/TSIH 21 (27.6) 1 (4.76) 20 (95.23) TSIHu n (%) 5mm/HLA TSIH 10mm/HLA TSIH Symptomatic Asymptomatic 18 (23.7) 1 (5.5) 17 (94.45) 8 (47.1) 10 (52.9) Content n (%) omentum Small bowel Both 13 (70.6) 3 (17.6) 2 (11.8) Transverse diameter mm (SD) 13.39 (7.55) Cranio caudal diameter mm (SD) 12.37 (8.52) Follow up months (SD) 33.66 (4.36) DM: diabetes mellitus; COPD: chronic obstructive pulmonary disease; BMI: body mass index; TSIHc: trocar site incision hernia clinically diagnosed; TSIHu trocar site incision hernia diagnosed radiologically Table 2: TSIHu positive cases TSIHc + TSIHc - p CC diameter (mm, SD) 13.5 (9.8) 8.6 (3.8) 0.16 T diameter (mm, SD) 14.17 (8.8) 11.2 (4.3) 0.372 BMI (Kg/m 2 , SD) 30.04 (3.3) 28.26 (5.3) 0.517 TSIHu: ultrasound trocar site incision hernia; TSIHc: clinical trocar site incision hernia; CC: craniocaudal; T: transverse; BMI: body mass index Table 3 : Comparison between groups Variable TSIHu + TSIHu - p Age years (SD) ≤70 n (%) >70 62,56 (17) 9 (50) 9 (50) 57,21 (16,4) 45 (77,5) 13 (22,4) 0,019 ¶ 0.037 § Gender n (%) Male Female 7 (39) 11 (61) 25 (43) 33 (57) 0.752 § DIABETES MELLITUS n (%) Yes No 2 (11) 16 (88) 8 (13,8) 50 (86,2) 1 ƒ COPD (%) Yes No 2 (11) 16 (88) 2 (3,6) 54 (96,4) 0.247 ƒ SMOKER (%) Yes No 7 (41,2) 10 (58,8) 12 (22,6) 41 (77,4) 0.135 § BMI Kg/m 2 (SD) ≥30 <30 29.66 (3.89) 8 (47) 9 (53) 26.89 (4.17) 11 (21,2) 41 (78,8) 0.019 † 0.038 § Weight Kg (SD) 77.47 (10.21) 73.53 (12.16) 0.234 † Height Cms, SD 161.29 (7.49) 164.67 (8.46) 0.149 † Previous umbilical hernia n (%) Yes No 3 (1,7) 15 (83) 4 (7) 53 (93) 0.34 ƒ Malignancy n (%) 2 (11,1) 7 (12) 1 ƒ Wound infection classification (%) Clean Clean - contaminated Contaminated 2 (11) 8 (44) 8 (44) 6 (10.3) 36 (62.1) 16 (27.6) 0.371 § Emergency n (%) Urgent Elective 7 (38.9) 11 (61.1) 18 (31) 40 (69) 0.536 § Surgeon’s experience (%) Junior Senior 3 (17) 15 (83) 6 (10.5) 51 (89.5) 0.441 ƒ Operative time (minutes) 94.33 (41.3) 84.6 (45) 0,417 † Follow up (months) 33.17 (5.31) 33.825 (4.05) 0.582 † § Chi square, ƒ f Fisher, † t Student, ¶ U de Mann-Whitney Table 4: Results of univariate logistic regression analysis. Identification of risk factors. Variable OR 95%IC p Age (years) ≤70 >70 Reference 3.462 1.14 – 10.515 0.028 BMI (Kg/m 2 ) 70 Reference 4.464 1.320 – 15.091 0.016 BMI (Kg/m 2 ) <30 ≥30 Reference 3.572 1.034 – 12.338 0.044 Cite Share Download PDF Status: Published Journal Publication published 14 Dec, 2020 Read the published version in BMC Surgery → Version 3 posted Editorial decision: Accept 02 Dec, 2020 Editor assigned by journal 01 Dec, 2020 Submission checks completed at journal 01 Dec, 2020 Editor invited by journal 01 Dec, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-46694","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":5734329,"identity":"72f93053-190c-447b-96d3-8b2bb1fe31c2","order_by":0,"name":"Ana Ciscar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYLCCBBDB3gAkDCxI0cJzAKRFghSrJMAaidDCP7v54YcHf+zkzWc+v7rhR4EEA397dwJ+s+8cM5ZIbEs2nHM7p+xmD9BhEmfObsBvzY0EM4bEhgOMM6Rz0m7wALUYSOTi1yJ/I/0bQ8KfA/YzJM+k3fxDjBaDGzlmDAlsBxJnSLAfu02ULYY3copBfkmewZPDdlvGQIKHoF/kbqRv/Pjjj53tDPbjz26++WMjx9/eS8D7CMBjACaJVQ4C7A9IUT0KRsEoGAUjCAAAHItHcdt9n7YAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-5421-0703","institution":"Consorci Sanitari del Maresme","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ana","middleName":"","lastName":"Ciscar","suffix":""},{"id":5734330,"identity":"901ed7d7-41d0-4636-835f-8415f0bbfccc","order_by":1,"name":"Josep Maria Badia","email":"","orcid":"","institution":"Hospital General de Granollers","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Josep","middleName":"Maria","lastName":"Badia","suffix":""},{"id":5734331,"identity":"8a149a2a-d8ef-44f2-bbcb-69409f90d3c2","order_by":2,"name":"Francesc Novell","email":"","orcid":"","institution":"Consorcio Corporacion Sanitaria Parc Tauli","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Francesc","middleName":"","lastName":"Novell","suffix":""},{"id":5734332,"identity":"713943d9-f67a-4fe5-a47d-9575721a8965","order_by":3,"name":"Santiago Bolivar","email":"","orcid":"","institution":"Hospital Universitari de Bellvitge","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Santiago","middleName":"","lastName":"Bolivar","suffix":""},{"id":5734333,"identity":"15327677-0b38-4b03-baba-0ecf52c9c3b5","order_by":4,"name":"Esther Mans","email":"","orcid":"","institution":"Consorci Sanitari del Maresme","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Esther","middleName":"","lastName":"Mans","suffix":""}],"badges":[],"createdAt":"2020-07-21 10:17:20","currentVersionCode":3,"declarations":"","doi":"10.21203/rs.3.rs-46694/v3","doiUrl":"https://doi.org/10.21203/rs.3.rs-46694/v3","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-020-01000-6","type":"published","date":"2020-12-14T15:01:03+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":4200869,"identity":"dc02d264-da1a-4c6b-bebe-716d334526bb","added_by":"auto","created_at":"2020-12-11 17:36:07","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30210,"visible":true,"origin":"","legend":"Chart","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-46694/v3/59f8461e781aebc7d9af8fc2.jpg"},{"id":13632185,"identity":"df8b11db-93b2-428d-8838-18aa69dffcb4","added_by":"auto","created_at":"2021-09-17 08:20:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":396365,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-46694/v3/a56cea90-5dbe-48ac-8278-9a1813ca21e5.pdf"}],"financialInterests":"","formattedTitle":"Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination. A prospective observational study​","fulltext":[{"header":"Background","content":"\u003cp\u003eIncisional hernia is the most common complication associated with surgical procedures, with an estimated incidence of 0-35%\u0026nbsp;(1,2). As there are few studies with a long-term follow up and the occurrence of the incisional hernia depends on the duration of postoperative follow-up, this estimate may not be accurate.\u003c/p\u003e\n\u003cp\u003eThere is a considerable amount of documentation regarding incisional hernia after laparotomy, and several risk and protective factors have been described. Despite the introduction of laparoscopic surgery, incisional hernia is still frequent and, indeed, trocar site incisional hernia (TSIH) is a common complication after laparoscopy. Until recently, even in studies with a long term follow-up, unrealistic TSIH rates of 0.8- 2.9%\u0026nbsp;(3\u0026ndash;6)\u0026nbsp;have been described.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTSIH can be diagnosed by clinical examination, but imaging tests as computerized tomography (CT) or dynamic abdominal sonography for hernia (DASH) can improve the diagnostic accuracy. At present, a CT scan is considered the gold standard technique for the diagnosis and characterization of TSIH, but it has a few drawbacks: economic cost, patient irradiation, and that it is a static procedure (which can under-diagnose). On the other hand, dynamic abdominal sonography for hernia (DASH) has been shown to be a valid alternative to CT in the diagnosis and characterization of incisional herniation(7,8).\u003c/p\u003e\n\u003cp\u003eOne of the key factors for proper detection of the TSIH is the postoperative follow-up time. A short or incomplete follow up could underdiagnose this issue, which is often subclinical\u0026nbsp;(7).\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to determine the incidence of trocar-site incisional hernia (TSIH) by clinical and dynamic ultrasonographic examination in patients who underwent laparoscopic surgeries in a general hospital. Secondary outcomes were to evaluate the correlation between clinical and ultrasonographic assessment and to determine the main risk factors for TSIH.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy design\u003c/em\u003e\u003c/strong\u003e. A single-centre cross-sectional study based on prospective clinical and radiological assessment and retrospective risk factor analyses performed at a single hospital. The study has been retrospectively registered in Clinicaltrials.gov on June 4, 2020 under registration number: NCT04410744\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eAll consecutive patients undergoing laparoscopic surgery (cholecystectomy, colon resection, adrenalectomy, Nissen fundoplication and appendectomy) during a four-month period were included in the study. 30 months after hospital discharge, they were invited by telephone to participate in the study. Detailed project information was provided, and those who accepted received an appointment for an outpatient visit and a dynamic ultrasound examination. A written informed consent was obtained from all participants. Exclusion criteria were age under 18 years, previous umbilical hernia repair, or failure to attend the postoperative appointment. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eProcedures.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eIn all patients, the umbilical trocar wound was closed with an interrupted suture with synthetic braided absorbable 2/0 suture (Novosyn\u0026reg; or Safil\u0026reg;). During the postoperative outpatient visit, informed consent was obtained and clinical and ultrasonographic examinations were performed. To increase study homogeneity, a single surgeon performed all clinical examinations and all ultrasound examinations were performed by a radiology medical trainee closely supervised by the same abdominal radiology consultant. Sonography was performed using an Applio 500 equipment (Toshiba, Japan) with a 7MHz linear probe. The ultrasound diagnosis was based on the identification of an abdominal wall defect with intraabdominal tissue protrusion. Caudal and cranial diameters of the abdominal wall\u0026rsquo;s defect were recorded. Patients diagnosed with TSIH were offered elective repair.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMeasurements and variables\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e The main variables of the study were clinical (TSIHc) and ultrasound (TSIHu) diagnosis of incisional hernia. Secondary variables analysed were age, sex, diabetes mellitus, chronic obstructive pulmonary disease (COPD), smoking, body mass index (BMI), previous untreated umbilical hernia, malignancy, surgical time, urgent/elective indication, incision size, degree of contamination and surgeon\u0026rsquo;s experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/strong\u003e. All results and variables were entered into a specifically designed database (File MakerPro 11.0v3 \u0026copy; 1984-2011 FileMaker, Inc.). Data were collected from clinical interviews, physical and radiological examinations and the electronic medical record. Continuous variables were described as means and standard deviations and categorical variables were described as absolute numbers and percentages. The chi-square test was used to compare categorical variables (Fisher\u0026rsquo;s exact test was used when needed), and the Student t-test was used to compare continuous variables. Bivariate analysis and multivariate logistic regression analysis were performed to identify independent predictive causal factors for the development of TSIH. Adjusted odds ratios (ORs) were calculated using logistic regression. Variables achieving statistical significance in the bivariate analysis were considered for multivariate analysis. ORs with 95% confidence intervals (CIs) were presented for each studied variable. Differences were significant at the 5% level. All reported \u003cem\u003eP\u003c/em\u003e values were two-sided. Statistical analyses were performed using SPSS statistical software (IBM SPSS\u0026reg; Statistics).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 120 patients, who were operated on, were contacted and 76 of them were finally included in the study (figure 1). 57.9% were women, and the mean age was 58.5years. Among them, 13.2% were diabetic, 5.4% had chronic obstructive pulmonary disease (COPD), 27.5% were obese (BMI over 30kg/m\u003csup\u003e2\u003c/sup\u003e) and 11.8% had a malignancy. The primary laparoscopic procedures were cholecystectomy (78.9%), sigmoidectomy (10.5%), Nissen fundoplication (7.9%), adrenalectomy (1.3%) and appendectomy (1.3%). Mean postoperative follow-up was 34 months (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTSIH incidence\u003c/em\u003e\u003c/strong\u003e. Of the 76 patients included in the study, a total of 303 trocar site incisions (TSI) were assessed (151 of 10 mm-TSI and 152 of 5 mm-TSI). A total of 21 patients (27.6%) were clinically diagnosed with having TSIH (TSIHc). However, TSIH was confirmed radiologically (TSIHu) in only 18 cases (23.7%). No patient presented more than one TSIH. \u0026nbsp;Only 47.1% of patients who had a confirmed TSIH presented symptoms.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDifferences were observed in the TSIH rate depending on the size and location of the trocar. Only 1 out of 18 (5.5%) TSIH occurred in a 5-mm trocar site, whereas the other 17 hernias (94.45%) were located in 10-mm trocar sites. \u0026nbsp;All hernias were located in the umbilical area (M3), except for one located in the left lumbar region (L4).\u003c/p\u003e\n\u003cp\u003eNine cases of TSIH (15%) suspected by clinical examination were not confirmed following ultrasonography. On the contrary, 5 cases (28%) diagnosed by ultrasonographic examination were not clinically found. Ultrasonography showed a significant better diagnostic capacity than clinical examination (p \u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe 5 not clinically suspected cases showed a lower transverse and cranio-caudal diameter measurement (Table 2), although there were not statistical differences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRisk factors for TSIH\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Table 3 shows the differences observed between patients with TSIH and those with no TSIH identified radiologically. Only age \u0026gt;70 and BMI \u0026ge; 30 showed statistically significant differences. \u0026nbsp; In the univariate analysis of potential risk factors for TSIH, statistically significant differences were observed for age \u0026gt;70 years (OR 3.462; 95% CI 1.14 \u0026ndash; 10.515; p=0.028) and BMI \u0026ge;30 (OR 3.313; CI 1.037-10.588; p=0.043) (Table 4). Other variables were discarded. Both, age \u0026gt;70 years (OR 4.464; 95% CI 1.32 - 15.091; p=0.016) and BMI \u0026ge;30 (OR 3.572; 95% CI 1.034 - 12.338; p=0.044) were confirmed as risk factors by multivariate analyses (Table 5). \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIncisional hernia is defined as a defect in the abdominal wall in placements of postoperative wounds. They are recognizable by clinical examination and/or by imaging tests. The incidence of trocar site incisional hernia\u0026nbsp;has been poorly documented over the years which may be due to the paucity of symptoms and to the lack of long-term postoperative follow-up since the pathology that leads to the laparoscopic surgery is usually benign and no further follow-up is deemed necessary. Consequently, in most situations the follow-up is not sufficient to detect TSIH.\u003c/p\u003e\n\u003cp\u003eIn the present study it was\u0026nbsp;hypothesized that the real incidence of trocar site incisional hernia, when properly assessed, could be higher than is currently believed.\u0026nbsp;Therefore, we aimed to analyze the actual TSIH incidence in our environment, measured by both physical and radiological exams, the latter being considered the gold standard technique\u0026nbsp;(8).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIncidence\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e In our series, a high TSIH rate was found. The incidence detected by physical examination was 27.6%, compared to 23.7% when assessed by ultrasound. After having been a neglected issue, during the last decade, few authors have addressed the incidence and risk factors of\u0026nbsp;TSIH after laparoscopic surgery. In 2010, Chiong et al published a retrospective analysis of 1055 patients who underwent surgery due to urologic tumors and found a TSIH rate of 0.66%. All of them were clinically suspected and radiologically confirmed by computed tomography\u0026nbsp;(9). In 2011, a systematic review based on 19 prospective and retrospective studies, which included a total of 30568 adults and 1098 children, documented a TSIH incidence of 0.5-2%\u0026nbsp;(10). In 2013, a retrospective review of 500 patients who underwent laparoscopic and robotic gynecological surgery documented only 3 cases of TSIH (0.6%), diagnosed \u0026nbsp;on physical examination with radiologic confirmation (1 of them required emergency reoperation for hernia reduction and the other two presented asymptomatic bulges), with an average length of time to TSIH appearance of 21 days\u0026nbsp;(4). In 2011, in a narrative review, Comajuncosas et al. described an incidence of 0.18-2.8%, but the authors concluded that the actual incidence was possibly higher\u0026nbsp;(11). Three years later, the same group published a prospective observational study including 241 patients, with a follow-up of 46.8 months, showing an incidence of 25.9%. In this study, TSIH were identified mainly with clinical examination, but an abdominal ultrasound was carried out in doubtful cases\u0026nbsp;(12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLocation\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eIn spite of using a systematic protocol for closure, most of TSIH cases were located in the 10mm incisions at the umbilical level. The TSIH rate can change depending on the type of trocar and its location. TSIH have been described at any location, but those situated at the10mm trocar are the most frequent(9,10,12\u0026ndash;14). It seems that for 5mm trocars facial closure should not be necessary, but for \u0026ge;10mm trocars it would be mandatory. Keeping in mind some previous studies\u0026nbsp;(4,6,10,11)\u0026nbsp;and the results if this study, the standard closure technique may not be enough.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRisk factors\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eWe found that obesity and age over 70 years were independent risk factors for the appearance of TSIH. In open surgery, some risk factors for incisional hernias, either individual or dependent on the surgical technique, are well documented. Factors including abdominal aortic aneurysm surgery, obesity, cachexia, advanced age, male sex, COPD, anemia, smoking, steroid treatment, and immunosuppression.\u0026nbsp;(1,10,12,15,16). duration of the procedure, presence of previous umbilical hernia, diabetes mellitus, or smoking, \u0026nbsp;have been described as possible risk factors for TSIH\u0026nbsp;(11,17)\u0026nbsp;but according to our data only age and obesity can be confirmed as risk factors for TSIH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDiagnosis\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e In our experience, clinical examination overdiagnoses TSIH which is quite surprising and is not in accordance with other authors. A systematic review carried out in 2018 which was led by Kroese et al.\u0026nbsp;(18)\u0026nbsp;concluded that the use of imaging modalities would usually result in more incisional hernia being diagnosed compared to the use of physical examination alone. Bloemen et al.\u0026nbsp;(19)\u0026nbsp;also concluded that performing an ultrasonographic as well as a physical examination yielded a significant number of hernias, mostly asymptomatic ones, which would not have been found using physical examination alone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFollow up\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e As in open surgery, one of the main problems when considering laparoscopic incisional hernia diagnosis is a proper period of follow-up. There is no certainty about which would be the optimal follow-up time to detect TSIH and most studies describe follow-up for less than one year. In addition, the frequent absence of symptoms would result in a lack of medical consulting. According to the definition of Tonouchi\u0026nbsp;(17), it seems reasonable to advise a minimum follow-up of 2 years, although some authors recommend more than 4 years(12,13). The mean follow up in our series almost achieves 3 years (34 months) which would be quite reasonable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study has some limitations: there may be some selection bias, as the acceptance could be related to the presence of symptoms and cancer patients having exhaustive oncological controls may have refused to participate so as not to increase the number of outpatient consultations. The fact that the clinical evaluation was performed only by a single physician could also reduce the generalizability of our results. Finally, the relatively small sample size was enough to determine the prevalence of TSIH, but it was probably suboptimal for the calculation of risk factors\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe conclude that TSIH is underdiagnosed in most of the published series. Diagnosing TSIH requires an exhaustive study that includes not only physical examination, but also ultrasonography.\u0026nbsp; A significant number of patients ultimately diagnosed with TSIH hadn\u0026acute;t previously reported symptoms. Age, BMI and the size of the incision are factors that lead to the appearance of TSIH.\u003c/p\u003e\n\u003cp\u003eRemaining questions for further investigation are whether all patients diagnosed with TSIH must be operated on, and whether the high incisional hernia rate justify changes in operative techniques, such as improvements in trocar closure, prophylactic mesh placement or lateralization of the umbilical 10mm trocar.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003eTSIH: Trocar site incisional hernia\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTSIHc: Trocar site incisional hernia assessed clinically\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTSIHu: Trocar site incisional hernia assessed by ultrasound examination\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOR: Odds ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI: Confidence intervals\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCT: Computerized tomography\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDASH: dynamic abdominal sonography for hernia\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBMI: Body mass index\u003c/p\u003e\n\u003cp\u003eCOPD: Chronic obstructive pulmonary disease\u003c/p\u003e\n\u003cp\u003eTSI: trocar site incision\u003c/p\u003e\n\u003cp\u003eL4: left lumbar region\u003c/p\u003e\n\u003cp\u003eM3: umbilical region\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved\u0026nbsp;by the\u0026nbsp;Ethics Committee\u0026nbsp;(Comit\u0026egrave;\u0026nbsp;\u0026Egrave;tica\u0026nbsp;Investigaci\u0026oacute;\u0026nbsp;Cl\u0026iacute;nica \u0026ndash; Fundaci\u0026oacute; Privada Hospital Asil de Granollers) and it was registered with the number 201530008.\u003c/p\u003e\n\u003cp\u003eWritten informed consent to participate was obtained from study participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone reported\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAC participated in the study conception and design, acquisition of data (clinical examination), analysis and interpretation of data and in the drafting of manuscript\u003c/p\u003e\n\u003cp\u003eJMB participated in the study conception and design, analysis, interpretation of data and critical revision of manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFN participated in acquisition of data (ultrasound examination)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSB participated in acquisition of data (ultrasound examination)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEM participated in analysis, interpretation of data and critical revision of manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcknowledgments. The authors thank Mr. David Morton for his review of the manuscript and Dr Elisabet Palomeras for her statistical advice.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, et al. Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14 618 Patients. PLoS One. 2015;10(9):e0138745.\u003c/li\u003e\n\u003cli\u003eAnthony T, Bergen PC, Kim LT, Henderson M, Fahey T, Rege R V, et al. Factors affecting recurrence following incisional herniorrhaphy. World J Surg. 2000;24(1):95-100;discussion 101.\u003c/li\u003e\n\u003cli\u003eAgaba EA, Rainville H, Ikedilo O, Vemulapali P. Incidence of port-site incisional hernia after single-incision laparoscopic surgery. JSLS. 2014;18(2):204\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eSambasivarao S V. NIH Public Access. 2013;18(9):1199\u0026ndash;216.\u003c/li\u003e\n\u003cli\u003eOwens M, Barry M, Janjua AZ, Winter DC. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surg. 2011 Aug;9(4):218\u0026ndash;24.\u003c/li\u003e\n\u003cli\u003eYamamoto M, Minikel L, Zaritsky E. Laparoscopic 5-mm Trocar Site Herniation and Literature Review. JSLS J Soc Laparoendosc Surg. 2011;15(1):122\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eBaucom RB, Beck WC, Phillips SE, Holzman MD, Sharp KW, Nealon WH, et al. Comparative Evaluation of Dynamic Abdominal Sonography for Hernia and Computed Tomography for Characterization of Incisional Hernia. JAMA Surg. 2014 Jun 1;149(6):591.\u003c/li\u003e\n\u003cli\u003eBeck WC, Holzman MD, Sharp KW, Nealon WH, Dupont WD, Poulose BK. Comparative Effectiveness of Dynamic Abdominal Sonography for Hernia vs Computed Tomography in the Diagnosis of Incisional Hernia. J Am Coll Surg. 2016 Jan 25;216(3):447\u0026ndash;53.\u003c/li\u003e\n\u003cli\u003eChiong E, Hegarty PK, Davis JW, Kamat AM, Pisters LL, Matin SF. Port-site Hernias Occurring After the Use of Bladeless Radially Expanding Trocars. Urology. 2010 Mar;75(3):574\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eHelgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia. 2011 Apr 9;15(2):113\u0026ndash;21.\u003c/li\u003e\n\u003cli\u003eComajuncosas J, Vallverd\u0026uacute; H, Orbeal R, Par\u0026eacute;s D. Eventraci\u0026oacute;n de los orificios de los trocares en cirug\u0026iacute;a laparosc\u0026oacute;pica. Cirug\u0026iacute;a espa\u0026ntilde;ola. 2011;89(2):72\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eComajuncosas J, Hermoso J, Gris P, Jimeno J, Orbeal R, Vallverd\u0026uacute; H, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg. 2014 Jan;207(1):1\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eErdas E, Dazzi C, Secchi F, Aresu S, Pitzalis A, Barbarossa M, et al. Incidence and risk factors for trocar site hernia following laparoscopic cholecystectomy: A long-term follow-up study. Hernia. 2012 Aug 20;16(4):431\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eCristaudi A, Matthey-Gi\u0026eacute; M-L, Demartines N, Christoforidis D. Prospective assessment of trocar-specific morbidity in laparoscopy. World J Surg. 2014 Dec;38(12):3089\u0026ndash;96.\u003c/li\u003e\n\u003cli\u003eSchmidt SC. Incidence, risk factors and management of incisional hernia in a high volume liver transplant center. Ann Transplant. 2013;18:223\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eH\u0026ouml;er J, Lawong G, Klinge U, Schumpelick V. [Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years]. Chirurg. 2002 May;73(5):474\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eTonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar site hernia. Arch Surg. 2004 Nov;139(11):1248\u0026ndash;56.\u003c/li\u003e\n\u003cli\u003eKroese LF, Sneiders D, Kleinrensink GJ, Muysoms F, Lange JF. Comparing different modalities for the diagnosis of incisional hernia: a systematic review. Hernia. 2018;22(2):229\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eBloemen A, van Dooren P, Huizinga BF, Hoofwijk AGM. Comparison of ultrasonography and physical examination in the diagnosis of incisional hernia in a prospective study. Hernia. 2012 Feb;16(1):53\u0026ndash;7.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable style=\"width: 4.2e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 419.6pt;border: none;padding: 4pt;height: 10.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;text-align:left;font-size:16px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTable 1\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e: Main patient characteristics\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border: 1pt solid black;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eN\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;border:none;'\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;border:none;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e76\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 33.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eAge years (SD)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026le;70 n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026gt;70\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e58.47(16.58)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e54 (71.1)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e22 (28.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eGender n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eMale\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e32 (41.1)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e44 (57.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eDM n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eNot\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e10 (13,2)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e66 (86.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eCOPD n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eNot\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e4 (5.4)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e70 (94,6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSmokers n (%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eNot\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e19 (27.1)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e51 (72,9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 33.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eBMI Kg/m\u003csup\u003e2\u003c/sup\u003e (SD)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026ge;30 n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026lt;30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e27.54 (4.25)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e19 (27.5)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e50 (72.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eWeight Kg, (SD)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;border:none;'\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;border:none;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e74.51 (11.76)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eHeight Cm (SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;border:none;'\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;border:none;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e163.82 (8.31)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003ePrevious umbilical hernia n (%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eNot\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e7 (9.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e68 (90.7)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 54.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSurgery type n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 54.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eCholecystectomy\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSigmoidectomy\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eNissen fundoplication\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSuprarrenalectomy\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eAppendectomy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 54.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e60 (78.9)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e8 (10.5)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e6 (7.9)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1 (1.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1 (1.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eLaparoscopic approach n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eHasson\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eVeress\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e76 (100)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eOperative time minutes (SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;border:none;'\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;border:none;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e86.89 (44.13)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSurgeon\u0026rsquo;s experience n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eJunior\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSenior\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;9 (12)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e66 (88)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 87.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eDiagnose n (%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 87.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eCholelithiasis\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eAcute cholecystitis\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eColon cancer\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eHiatal hernia\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eChronic cholecystitis\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003ePorcelain Gallbladder\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eAdrenal adenoma\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eAcute appendicitis\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 87.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e39 (51.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e16 (21.1)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e9 (11.8)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e5 (6.6)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e4 (5.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1 (1.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1 (1.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1 (1.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eMalignancy n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eBenign\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eMalign\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e67 (88.2)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e9 (11.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSurgical wound infection classification n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eClean\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eClean - contaminated\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eContaminated\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;8 (10.5)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e44 (57.9)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e24 (31.6)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eEmergency n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eElective\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eUrgent\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e51 (67.1)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e25 (32.9)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 33.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTSIHc n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e5mm/TSIH\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e10mm/TSIH\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e21 (27.6)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1 (4.76)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e20 (95.23)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 77.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTSIHu n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 77.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e5mm/HLA TSIH\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e10mm/HLA TSIH\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSymptomatic\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eAsymptomatic\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 77.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e18 (23.7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1 (5.5)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e17 (94.45)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e8 (47.1)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e10 (52.9)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eContent n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eomentum\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSmall bowel\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eBoth\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e13 (70.6)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e3 (17.6)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e2 (11.8)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTransverse diameter mm (SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;border:none;'\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;border:none;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e13.39 (7.55)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eCranio caudal diameter mm (SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;border:none;'\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;border:none;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e12.37 (8.52)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eFollow up months (SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.85pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;border:none;'\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;border:none;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e33.66 (4.36)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 419.6pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 12.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eDM: diabetes mellitus; COPD: chronic obstructive pulmonary disease; BMI: body mass index; TSIHc: trocar site incision hernia clinically diagnosed; TSIHu trocar site incision hernia diagnosed radiologically\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;margin-top:6.0pt;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.2e+2pt;margin-left:5.4pt;border-collapse:collapse;border:none;\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:419.6pt;border:none;padding:4.0pt 4.0pt 4.0pt 4.0pt;height:10.65pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:left;font-size:16px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTable 2:\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTSIHu positive cases\u003c/span\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.85pt;border: 1pt solid black;padding: 4pt;height: 11.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.9pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 11.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTSIHc +\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.9pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 11.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTSIHc -\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.95pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 11.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003ep\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eCC diameter (mm, SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e13.5 (9.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;8.6 (3.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.95pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.16\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eT diameter (mm, SD)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e14.17 (8.8)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e11.2 (4.3)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.95pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.372\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104.85pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e, SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e30.04 (3.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.9pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e28.26 (5.3)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104.95pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.517\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 419.6pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTSIHu: ultrasound trocar site incision hernia; TSIHc: clinical trocar site incision hernia; CC: craniocaudal; T: transverse; BMI: body mass index\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;margin-top:6.0pt;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.2e+2pt;margin-left:1.4pt;border-collapse:collapse;border:none;\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:419.75pt;border:none;padding:4.0pt 4.0pt 4.0pt 4.0pt;height:12.0pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:left;font-size:16px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTable 3\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e: Comparison between groups\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border: 1pt solid black;background: rgb(254, 254, 254);padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eVariable\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;background: rgb(254, 254, 254);padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTSIHu +\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;background: rgb(254, 254, 254);padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTSIHu -\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;background: rgb(254, 254, 254);padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eAge years (SD)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026le;70 n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026gt;70\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e62,56 (17)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e9 (50)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e9 (50)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e57,21 (16,4)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e45 (77,5)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e13 (22,4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0,019\u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.037\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eGender n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Male\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Female\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e7 (39)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e11 (61)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e25 (43)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e33 (57)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.752\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 50.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eDIABETES MELLITUS n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Yes\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;No\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 50.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e2 (11)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e16 (88)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 50.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e8 (13,8)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e50 (86,2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 50.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;1\u003csup\u003e\u0026fnof;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eCOPD (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Yes\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;No\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e2 (11)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e16 (88)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e2 (3,6)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e54 (96,4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.247\u003csup\u003e\u0026fnof;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSMOKER (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Yes\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;No\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e7 (41,2)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e10 (58,8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e12 (22,6)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e41 (77,4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.135\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eBMI Kg/m\u003csup\u003e2\u003c/sup\u003e (SD)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026ge;30\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026lt;30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e29.66 (3.89)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e8 (47)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e9 (53)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e26.89 (4.17)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e11 (21,2)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e41 (78,8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.019\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.038\u003c/span\u003e\u003c/strong\u003e\u003csup\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026sect;\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eWeight Kg (SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e77.47 (10.21)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e73.53 (12.16)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.234\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eHeight Cms, SD\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e161.29 (7.49)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e164.67 (8.46)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.149\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 39.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003ePrevious umbilical hernia n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Yes\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;No\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 39.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e3 (1,7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e15 (83)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 39.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e4 (7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e53 (93)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 39.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.34\u003csup\u003e\u0026fnof;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 24.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eMalignancy n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 24.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e2 (11,1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 24.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e7 (12)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 24.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;1\u003csup\u003e\u0026fnof;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 63.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eWound infection classification (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Clean\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Clean - contaminated\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Contaminated\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 63.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e2 (11)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;8 (44)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e8 (44)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 63.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e6 (10.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e36 (62.1)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e16 (27.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 63.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:32.75pt;text-align: right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.371\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eEmergency n (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Urgent\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Elective\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e7 (38.9)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e11 (61.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e18 (31)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e40 (69)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 37.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.536\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 50.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eSurgeon\u0026rsquo;s experience (%)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Junior\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Senior\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 50.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e3 (17)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e15 (83)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 50.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e6 (10.5)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e51 (89.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 50.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.441\u003csup\u003e\u0026fnof;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eOperative time (minutes)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e94.33 (41.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;border:none;'\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;border:none;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:right;border:none;'\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;border:none;'\u003e84.6 (45)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0,417\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 137.3pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 24.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eFollow up (months)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 24.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e33.17 (5.31)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92.15pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 24.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e33.825 (4.05)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91.1pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 24.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.582\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 419.75pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;font-weight:bold;margin-top:10.0pt;line-height:120%;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026sect; Chi square, \u0026fnof; f Fisher, \u0026dagger; t Student, \u0026para; U de Mann-Whitney \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;margin-top:6.0pt;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.2e+2pt;margin-left:5.4pt;border-collapse:collapse;border:none;\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:430.05pt;border:none;padding:4.0pt 4.0pt 4.0pt 4.0pt;height:10.65pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:left;font-size:16px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eTable 4:\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Results of univariate logistic regression analysis. Identification of risk factors. \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107.5pt;border: 1pt solid black;padding: 4pt;height: 11.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eVariable\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 11.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eOR\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 11.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e95%IC\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 11.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003ep\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107.5pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eAge (years)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026le;70\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026gt;70\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eReference\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e3.462\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1.14 \u0026ndash; 10.515\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.028\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107.5pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026lt;30\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026ge;30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eReference\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e3.313\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1.037 \u0026ndash; 10.588\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.043\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.2e+2pt;margin-left:5.4pt;border-collapse:collapse;border:none;\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:430.05pt;border:none;padding:4.0pt 4.0pt 4.0pt 4.0pt;height:10.65pt;\"\u003e\n \u003cp style=\"margin:0in;text-align:left;font-size:16px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cstrong\u003e\u003cspan style='font-family: \"Calibri Light\",sans-serif;'\u003eTable 5:\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;Results of multivariate logistic regression analysis. Identification of risk factors. \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107.5pt;border: 1pt solid black;padding: 4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eVariable\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eOR\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e95%IC\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 4pt;height: 8.5pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003ep\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107.5pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eAge (years)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026le;70\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026gt;70\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eReference\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e4.464\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1.320 \u0026ndash; 15.091\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 33.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.016\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107.5pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026lt;30\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u0026ge;30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003eReference\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e3.572\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;\"\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e1.034 \u0026ndash; 12.338\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 4pt;height: 32.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin:0in;font-size:13px;font-family:Helvetica;color:black;border:none;margin-top:10.0pt;text-align:right;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Calibri Light\",sans-serif;'\u003e0.044\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Cambria\",serif;margin-top:6.0pt;text-align:justify;line-height:150%;'\u003e\u003cspan style='font-size:15px;line-height:150%;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"trocar site incisional hernia, laparoscopic surgery, risk factors, incidence.","lastPublishedDoi":"10.21203/rs.3.rs-46694/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-46694/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND:\u003c/strong\u003e Trocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery. Few studies currently describe its incidence or risk factors. The aim of this report is to determine the real incidence of TSIH and to identify risk factors. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMETHODS:\u003c/strong\u003e A cross-sectional prospective study was performed including consecutive patients who underwent a laparoscopic procedure during a four months period\u003cem\u003e. \u003c/em\u003eAll the patients were assessed both clinically (TSIHc) and by an ultrasonographic examination (TSIHu). The main variable studied was the incidence of TSIH. A multivariate analysis was performed to identify risk factors. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e 76 patients were included. 27.6% of patients were clinically diagnosed as having TSIH (TSIHc) but only 23.7% of those cases were radiologically confirmed (TSIHu). In the logistic regression analysis, age \u0026gt; 70 years (OR 3.462 CI 1.14 - 10.515, p = 0.028) and body mass index (BMI) ≥30 Kg / m\u003csup\u003e2\u003c/sup\u003e (OR 3.313 CI 1.037-10.588, p = 0.043) were identified as risk factors for TSIH.\u0026nbsp;The size of the trocar also showed statistically significant differences (p \u0026lt;0.001). Mean follow-up time was 34 months.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCONCLUSIONS:\u003c/strong\u003e TSIH is under-diagnosed due to the lack of related symptomatology and the inadequacy of the postoperative follow-up period.\u0026nbsp;We detected discrepancies between the clinical and ultrasonographic examinations. TSIHu should be considered as the gold standard for the diagnosis of TSIH. Risk factors such as age, BMI and size of the trocar were confirmed. Patients should be followed-up for a minimum of 2 years.\u003c/p\u003e","manuscriptTitle":"Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination. A prospective observational study​","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2020-12-11 17:36:06","doi":"10.21203/rs.3.rs-46694/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept","date":"2020-12-03T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-12-02T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-12-01T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-12-01T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-11-05 18:33:07","doi":"10.21203/rs.3.rs-46694/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2020-11-05T00:00:00+00:00","index":2,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-11-03T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-11-03T00:00:00+00:00","index":1,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-11-03T00:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable pending editorial decision\n"},{"type":"editorAssigned","content":"","date":"2020-10-30T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-10-29T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-10-29T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-08-04 11:02:41","doi":"10.21203/rs.3.rs-46694/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-10-15T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-12T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\nThis is a generally well written and conducted prospective observational study. I have a few remarks that can further improve the manuscript:\n\n1. The number of patients included is probably enough to answer the diagnostic questions and to determine the prevalence of trocar site hernia. However, the number of patients included is probably suboptimal for calculation of risk factors as shown by the wide confidence intervals in the multivariable analysis. This deserves a short comment under \"limitations\".\n\n2. Clinical assessment of hernias is jeopardizing. In for example clinical assessment of parstomal hernia a considerable interrater variability has been documented. In this study one surgeon only made all assessment to maximize conformance. However, there is an obvious risk that this fact reduces the generalizability unless the interrater variability I evaluated in at least a substantial number of patients. If this is not possible this issue should be addressed as a weakness.\n\n3. The ultrasound investigations were all done by a supervised trainee. Is it possible that some clinically diagnosed hernia were present but not detected by ultrasound in for example obese patients?\n\n4. Gynecologic surgeries are among the most frequent laparoscopic procedures. Why was not these included in the study? This group of patients would probably have further increased the generalizability since the often represent a group of otherwise healthy patients.\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-10-01T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-01T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nAuthors have submitted a cross-sectional prospective observational studyof incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination. 27.6% of patients were clinically diagnosed as having TSIH (TSIHc) but only 23.7% of those cases were radiologically confirmed (TSIHu). In the logistic regression analysis, age \u003e 70 years and body mass index were identified as risk factors for TSIH. They concluded that TSIH is under-diagnosed due to the lack of related symptomatology and the inadequacy of the postoperative follow-up period and suggested that TSIHu should be considered as the gold standard for the diagnosis of TSIH and patients should be followed-up for a minimum of 2 years.\n\nI enjoyed reading and reviewing this paper, because:\n1. The research question is well defined.\n2. The methodology is appropriate.\n3. Statistical analyses in result section are appropriate and figure and tables highlight the trends well.\n4. In discussion authors have done well to bring out important points. The limitations of the study are acknowledged.\n\nThis brings forth new information worthy of dissemination.\n\nHowever, one incongruous point needs to be clarified: why the number of clinically diagnosed patients is more that radiologically diagnosed patients? According to their findings and conclusion - - this should be reverse.\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-09-30T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-09-29T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-07-23T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-07-23T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-07-22T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-07-22T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51d95e26-e325-446d-95bd-045c0065ffcb","owner":[],"postedDate":"December 11th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":991647,"name":"Surgery"},{"id":991648,"name":"General Surgery"}],"tags":[],"updatedAt":"2020-12-20T15:01:42+00:00","versionOfRecord":{"articleIdentity":"rs-46694","link":"https://doi.org/10.1186/s12893-020-01000-6","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2020-12-14 15:01:03","publishedOnDateReadable":"December 14th, 2020"},"versionCreatedAt":"2020-12-11 17:36:06","video":"","vorDoi":"10.1186/s12893-020-01000-6","vorDoiUrl":"https://doi.org/10.1186/s12893-020-01000-6","workflowStages":[]},"version":"v3","identity":"rs-46694","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-46694","identity":"rs-46694","version":["v3"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}