bluuebunny/crossref_metadata_2025 huggingface dataset:
P-031 TREATMENT OF A VOLUMINOUS INGUINOSCROTAL HERNIA AFTER A PREOPERATIVE PNEUMOPERITONEUM PREPARATION
Authors: Hammami Y , Fteriche F S
Published: May 2023

Voluminous inguinoscrotal hernias that have lost their “right of domain”, are usually hard to repair, and need preoperative preparations to reduce the risk of complications after the treatment, such as compartment syndrome, intestinal ischemia, and respiratory problems.

In this e-poster, we present a case report of a patient who had a voluminous inguinoscrotal hernia containing most of the small intestine and the entire right colon, which we treated after a preoperative pneumoperitoneum preparation (PPP).

The preparation was conducted 20 days before the surgery and the pneumoperitoneum was created through a percutaneous catheter that we inserted in the epigastric region after a radiologic control.

We injected 1000 ml of air per day, and the dose was adapted to the clinical tolerance of the patient.

We performed a reintegration of the hernia's volume, a resection of the hernial sac, and a reduction of the size othe profound inguinal ring via a Raphia, no intestinal resections were made, and the postoperative course was uneventful.

We plan a second intervention that consists of a hernia repair by a mesh insertion and a resection of the extra skin developed as a result of the voluminous hernia.

PPP is an interesting way to prepare the abdominal cavity to receive the component of a voluminous hernia after its reduction. The patient should be closely monitored during the preparation and after the surgery in order. Sometimes a second operation is necessary for definitive cure or aesthetic needs.
P-033 COMPLICATIONS IN E-TEP RIVES:OUR SERIE
Authors: Curado Soriano A , Infantes Ormad M , Sanchez Ramirez M , Valera Sanchez Z , Naranjo Fernandez J R
Published: May 2023

Aim

To study complications in our e-TEP series in ventral and incisional hernias.

Methods

We reviewed all patients undergoing e-TEP for ventral or incisional hernias. We included 33 patients (14 M2 or M3W2 incisional hernias and 11 medium ventral hernias with rectus diastasis), in whom polypropylene mesh was used. Follow-up at least 6 months.

Results

We found 2 patients with interstitial hernia below the mesh, one of them in the acute postoperative period with intestinal obstruction. One patient with recurrence of incisional hernia in the subxiphoid area, one patient with asymmetry of the right hypochondrium, and one patient with a seroma requiring drainage and a hematoma in another (using drainage). Intensive postoperative pain in 6 patients with delayed discharge.

Conclusion

In our series, E-TEP is safe but not free of complications.We started the procedure very ambitiously with M3W2 incisional hernias, but we soon realized that this technique did not allow us to revise the cavity and perform adhesiolysis, so we changed the way we managed these patients, and became more selective, only indicating E-TEP in medium-sized primary hernias associated with rectus diastasis. We managed to improve surgical skill with the cases, reducing postoperative pain, surgical time and hospital stay.
P-035 THE IMPORTANCE OF THE VALSALVA MANEUVER IN IMAGING DIAGNOSIS USING COMPUTER TOMOGRAPHY IN PATIENTS WITH INGUINAL HERNIAS
Authors: Fodor D , Biris P , Suciu B A
Published: May 2023

Aim

Recently, more and more studies have demonstrated the importance of practicing the Valsalva maneuver during the abdominal computer tomography investigation, for bettering the accuracy of the imagistic diagnosis in these patients.

Material and Methods

In this study we introduce 118 patients with inguinal hernias (110 men - 93.22% and 8 women - 6.78%).

The patients were divided into two groups. Group A was comprised of 92 patients with bilateral inguinal hernias. Group B was comprised of 26 patients with unilateral inguinal hernias. The Valsalva maneuver was performed on all the patients included in the study, during the abdominal computer tomography investigation.

The diagnostic confirmation of the hernia was done intraoperatively.

Results

Of the 92 patients studied in group A, 60 patients were confirmed to have bilateral inguinal hernias during the abdominal CT exam - 65%, while for 31 patients the diagnosis was confirmed after the applying the Valsalva maneuver - 34%. In one of the cases, the diagnosis of bilateral inguinal hernia was only established intraoperatively - 1%. Of the 26 patients studied in group B, 23 cases had an established diagnosis of unilateral inguinal hernia due to the abdominal CT exam - 88.5% while in 3 patients the diagnosis was only established after practicing the Valsalva maneuver - 11.5%.

Conclusions

In cases of patients with inguinal hernias, practicing the Valsalva maneuver during the abdominal CT exam, can be considered very useful in the diagnostic accuracy for these types of patients.
P-037 Zinc oxide/collagen (ZnOC) biocomposites for the development of novel meshes
Authors: Prodan A , Cancea B , Matei M , Turculet C , Beuran M
Published: May 2023

When we talk about abdominal wall hernias, we are talking about a complex surgical approach. In recent years there is a special interest in the use and development of meshes with antimicrobial properties. Doctors are making efforts to continue progress in this area.

We propose the development of meshes covered with Zinc Oxide in a collagen matrix. They have biomedical applications and antimicrobial properties.

The objectives of the study are to highlight the major contributions that Zinc Oxide in collagen matrices could make, in the development of new antimicrobial properties. The research will test both the synthesis method of Zinc Oxide in collagen matrix, as well as its ability to inhibit the bacterial activity of different species of bacteria.

We demonstrate the significant contributions that could be made by using composites based on Zinc Oxide in collagen matrices for the development of new biocompatible medical devices with antimicrobial properties.

This will lead to important advances in the development of new networks based on Zinc Oxide in collagen matrix (ZnOC).

Physicochemical characterization of ZnOC composites was performed, using appropriate techniques such as X-ray diffraction (XRD), scanning electron microscopy (SEM and EDS) and transmission electron microscopy (TEM), infrared spectroscopy (FTIR). The antimicrobial properties of ZnOC biocomposites was investigated using clinical and reference microorganisms belonging to Gram positive, Gram negative and fungal families.
P-040 MERY'S SIGN IN LARGE INGUINO-VESICAL HERNIAS – A CASE REPORT AND REVIEW
Authors: Ungureanu C , Ginghina O , Iordache N
Published: May 2023

Inguinal bladder hernia (IBH) is a variety of inguinal hernia rarely found: the urinary bladder is involved in no more than 5% of all groin hernias. Usually asymptomatic and occuring in men aged over 50 years, it can be incidentally encountered during hernia repair. Herein we report a case of a 68 years-old obese patient with a large symptomatic IBH, containing almost whole urinary bladder and successfully treated via open hernia repair using a properitoneal mesh technique, as described by Celdran. This entity of hernia should be suspected when inguinoscrotal hernia is associated with urinary symptoms. We evoke this specific clinical sign: Mery's sign, that implies two-stage micturition, i.e. initial manual compression of hernia is followed by bladder voiding. We emphasize the importance of preoperative diagnosis in order to reduce inadvertent lesions of the bladder or ureters during hernia surgery. Diagnosis is based on ultrasound, CT, cystography, but we also stress the idea of preoperative cystoscopy. Also, uretheral catheterization is an important aspect in diagnosis – intraoperative bladder filling/insufflation with saline fluid/methylene blue. Also it is important to emphasize that postoperative diagnosis can be exerted on bladder injury and leakage occuring after surgery in at least 10%, as literature reports. Treatment of IBH is based on reducing the bladder to its native position and hernia cure: open, laparoscopic or robotic approach.
P-041 3-YEAR RETROSPECTIVE ANALYSIS OF USE OF ONLAY PROPHYLACTIC MESH IN MIDLINE LAPAROTOMY FOR GASTRIC CANCER
Authors: Julià-Verdaguer E , Olona C , Vadillo J , Jorba R
Published: May 2023

Background

Incisional hernias are a frequent complication of abdominal wall incisions, ranging from 12.8% to 69% in long-time series. Recent literature supports the use of prophylactic mesh placement to avoid long-term incisional hernias.

Gastric surgery in our center is performed via midline laparotomy and prophylactic mesh placement is carried out as a usual practice.

The objective of our study is to evaluate long-term results of prophylactic mesh in midline laparotomies for gastric cancer.

Methods

Observational retrospective analysis of all patients undergoing gastric cancer sugery via midline incision with use of a polypropliene autoadhesive prophylactic mesh, between the years 2019–2021.

Outcome measures included demographics, comorbidities, wound complications, reinterventions, neoplastic recurrences and incisional hernias (diagnosed by CT scan).

Results

A cohort of 55 patients (80% male). Mean age 68.1 years old (41–86), BMI 25,75 kg/m2 (18.73–33).

All patients operated for gastric cancer, abdominal wall closure with small bite technique (monofilament absorbable 2/0 suture) and autoadhesive onlay mesh. 72.7% distal subtotal gastrectomies. 89% elective surgery. Mean albumin in preoperative analytic 40.5 g/L.

Postoperative complications: 72% Clavien-Dindo grade II, mean CCI 29 (including 4 reinterventions and 1 exitus). Mean follow-up 24.9 months: 8 (14.5%) neoplastic recurrences, 4 (7.3%) exitus for cancer progression and 3 (5.4%) incisional hernias diagnosed by CT Scan (none of them reoperated). No meshes have been removed.

In a comparative study no risk factors for incisional hernia have been found.

Conclusions

In our setting, the use of polypropylene autoadhesive prophylactic meshes in midline incision for gastric cancer is safe and durable.
P-044 FEASIBILITY AND SAFETY OF A NEW ‘ON-DEMAND ROBOTICS' PLATFORM FOR INGUINAL HERNIA REPAIR
Authors: Mignot H , Capitaine J , Diack B
Published: May 2023

Aim

To assess the feasibility, safety, and efficiency of a novel ‘on-demand robotics' platform for inguinal hernia repair.

Materials & Methods

A robotic system consisting in a sterile surgeon console, two robotic instrument arms, and one robotic endoscope arm, was evaluated. This ‘on-demand robotics' platform allows surgeons to remain sterile and combine work at the surgeon console and at the patient bed, e.g. in case of emergency management. This open platform also integrates with existing operating room (OR) equipment such as 3D laparoscopic camera, insufflator, energy devices and trocars.

We present the first series of 16 transabdominal preperitoneal inguinal hernia repair procedures (9 unilateral, 7 bilateral) performed with the robotic system. Safety outcomes and skin-to-skin procedure times were documented. All procedures were performed by one surgeon with extensive laparoscopic surgery experience.

Results

All 16 patients were successfully treated with no device-related adverse events. Most patients were discharged on the same day. 14 patients had reached 30 day follow-up with no morbidity and maintained outcome. Skin-to-skin procedure time was 64 and 84 minutes for unilateral and bilateral procedures respectively. Unilateral mean robotic times transitioned from 73 to 54 minutes between the 5 first and the last 4 cases, indicative of a fast learning curve.

Conclusions

“On-demand” robotic repair of inguinal hernia is feasible and safe. The described platform provides direct patient access to the sterile surgeon, and uses existing OR equipment. Surgeon's prior laparoscopic experience may also shorten learning curve.
P-050 A CASE OF EPIGASTRIC HERNIA WITH INCARCERATION OF THE LEFT HEPATIC LOBE AND REVIEW OF THE LITERATURE
Authors: Hashim D
Published: May 2023

An epigastrishe hernias with hepatic herniation are extremely rare. This is the first case of epigastric hernie with leber left lobe incaceration in the literatur. The other seven cases are cases with incisional hernia which have been reported so far in the literature. . We report a case of an epigastrishe hernia with incacerated hepatic left lobe along with a review of the literature. A 71-year-old female patient was admitted to our hospital with acute pain and complain of epigastric swelling. On examination, she had a tender 5 cm×5 cm epigastric lump and was diagnosed as incacerated epigastric hernia. Contrast-enhanced CT of the abdomen revealed a ventral hernia with herniation of omentum and left hepatic lobe. The patient underwent open IPOM mesh repair and is asymptomatic at 1-month follow-up.

Background

Ventral hernias with hepatic herniation are extremely rare. Hepatic herniation through congenital defects such as diaphragmatic hernia or omphaloceles are known to occur, but subcutaneous hepatic herniation through a ventral hernia is rarely encountered. We report a case of epigastric hernia with hepatic herniation, and its clinical and radiological findings, along with a review of the literature.
P-051 OPEN ABDOMEN MANAGEMENT IN PATIENT WITH ECMO THERAPY
Authors: Déniz Ramírez A M , González Sánchez L , Tejera Hernández A A , Hernández Hernández J R , Ocampo Pérez J G
Published: May 2023

Management of negative pressure therapy with fascial traction mediated by inlay mesh, in the context of a patient with multiple organ failure (MOF) secondary to sepsis of abdominal origin in treatment with extracorporeal membrane oxygenation therapy (ECMO)

We present the case of a 15-year-old female patient, referred to a hospital after continuous consultations in a primary care center. She refers abdominal pain located in the right iliac fossa of 72 hours of evolution. Blood analysis with high infectious parameters, abdomen on a table and scanner compatible with acute appendicitis complicated by perforation. Urgent surgical intervention, where purulent peritonitis was observed in the four quadrants, the abdomen was kept open with NPT.

In a situation of MOF, the need for high-dose noradrenaline and acute respiratory failure. During intubation, 2nd pneumothorax due to barotrauma. Given early deterioration, ECMO therapy was started. After completion of treatment, decreased intra-abdominal pressure and no restrictive respiratory compromise. Progressive fascial traction, using inlay mesh for 18 days until complete closure, using 2/0 monofilament suture, small bites technique, 4:1 ratio and placement of wide-pore, onlay polypropylene mesh. Partial dehiscence of the surgical wound as the only complication, NPT at 80mm Hg with definitive closure was prescribed. Satisfactory evolution one year after the intervention.

After our experience with this case, we can conclude that NTP in the open abdomen with the help of facial traction mesh, in patients with ECMO therapy in a situation of septic shock, may be an adequate alternative for definitive closure of the abdominal wall.
P-054 IMPLEMENTATION OF A SATISFACTION SURVERY IN HERNIA INTERNATIONAL COOPERATION CAMPAIGN
Authors: García Sánchez C J , Perea Del Pozo E , Alarcón Del Agua I , Butrón Vila T , Kingsnorth A , Padillo Ruíz F J
Published: May 2023

Aim

To assess the feasibility of implementing a survey in a surgical cooperation campaign to know about patients' demographics and satisfaction with service provided.

Material and methods

A survey was designed to collect data about demographics and satisfaction of each patient during our 5 days campaign in The Gambia. Satisfaction items were ranged from 1 to 5. Local nurses were trained to carry out the survey. We encouraged every patient to perform the survey before discharge.

Results

48 patients with hernia were operated. Groin hernioplasty was the most common procedure (45, 93,8%). 45 (93,8%) were men. Mean age was 52,2 years. Only 4 patients (8,3%) did not fill in the survey.

10 (23,8%) patients that filled in the survey were local. Between the foreign ones, median travel distance and time were 103 km (IQR 52–149 km) and 2 hours (IQR 1–3 hours), respectively. The most frequent means of transport was public transport (22, 75,9%). The most frequent job occupation was farmer (15, 31,3%), followed by local businesses (8, 16,7%).

About satisfaction items, all the mean punctuations were over 4,4. All the surveyed patients would recommend the campaign program, and only 2 patients (4,5%) didn't perceived a quality of care according to the cost of the public health services.

Conclusions

A satisfaction survey is a feasible way to study the target population of future cooperation campaigns in a specific destination. It allows to know if the campaign meets the standards of care according to the patient's opinion.
P-060 PREFORMED PATCH VS. FLAT PREPERITONEAL MESH FOR PRIMARY AND INCISIONAL HERNIA: A PROPENSITY-SCORE MATCHED ANALYSIS
Authors: Barranquero A G , Villalobos Mori R , Maestre González Y , López Soler G , Soto Pasamar J , Protti G P , Olsina Kissler J J
Published: May 2023

Aim

The MORPHEUS trial (Ponten et al. [2018]) reported better outcomes with a flat preperitoneal polypropylene mesh compared with a preformed patch for primary midline hernia repair. The aim was to evaluate our results with these meshes and to explore the recurrence factors.

Material & Methods

Observational retrospective study of patients undergoing hernia repair in a tertiary referral center. The preformed patch (PP) was used since April 2013, and the flat preperitoneal mesh (FPM) since March 2016. Recruitment finished in December 2021. A 3:1 Propensity-Score matching was performed to select cases for analysis.

Results

A total of 156 patients were analysed, 117 with PP and 39 with FPM. There were no differences in baseline characteristics, patients’ comorbidities, rates of midline (96.6% vs. 71.4%) or lateral hernias (3.4% vs. 28.6%) or in the proportion of primary (70.9% vs. 69.2%) and incisional hernias (29.1% vs. 30.8%) in PP and FPM groups, respectively. The median hernia defect was 2.5 cm (IQR: 2–3.22). There was a higher rate of defect closure in FPM (100%; 39/39) compared with PP group (12.8%; 15/117).

The recurrence rate was higher in the PP group, with 16.2% (19/117), compared to 2.6% (1/39) in the FPM group (p: 0.027) with a median follow-up of 33.6 months (IQR: 14.2–48.7). In logistic regression, there were no statistically significant differences between meshes (OR: 0.136 [CI95%: 0.018-1.050]), while BMI was a risk factor for recurrence and the defect closure was a protective factor.

Conclusion

Mesh choice did not influence hernia recurrence.
P-062 SEVERE COMPLICATION AFTER EVENTROPLASTY: NECROSIS OF RECTUS ABDOMINIS MUSCLES
Authors: Casanova-Ramos R , Rodríguez-González D , Tuñón-Fequant C , Guil-Ortiz B , Montes-Montero A , Arteaga-González I J
Published: May 2023

Aim

Rectus abdominis muscles are supplied mainly by superior and inferior epigastric arteries, forming an arcade between them. The ligation of one of them during a surgical intervention usually has no clinical repercussions. However, when both arteries flow are interrupted, there is another clinical scenario.

Material and Methods

We describe the case of a 74 years-old woman who was admitted for an elective surgery of fourth recurrence of a midline eventration (M2-5W3 European Hernia Society Classification). We treated using preoperative botulinum toxin and Rives-Stoppa surgical technique. On the second postoperative day, the patient suffered a cardiorespiratory arrest due to a pulmonary embolism, therefore anticoagulation was necessary. After anticoagulation the patient showed severe anemia (Hemoglobin 5 g/dL) and tomography computed scan images revealed a big hematoma of the abdominal wall with active bleeding.

Results

Embolization of both epigastric, right mammary and left pectoral arteries was performed by interventional radiologists. After 12 days, the patient showed cutaneous surgical wound dehiscence and serohematic foul-smelling fluid. We detected necrosis of the rectus muscles when we debrided the wound. It was treated with daily cures and vacuum therapy without mesh removal, achieving a progressive closure. After six months of follow-up, there are no signs of recurrence.

Conclusions

Ischemia of the rectus muscles is a severe complication after eventroplasty that can be treated with debridament of necrotic muscle and vacuum therapy, without removal of mesh if it is sufficiently extended along the healthy abdominal wall and cover the necrotic defect.
P-065 SYNTHETIC MESH VERSUS BIOLOGICAL MESH TO PREVENT INCISIONAL HERNIA AFTER LOOP-ILEOSTOMY CLOSURE: A RANDOMIZED FEASIBILITY TRIAL
Authors: Mäkäräinen E , Wiik H , Kössi J , Pinta T , Mäntymäki L M , Mattila A , Kairaluoma M , Ohtonen P , Rautio T
Published: May 2023

Aim

Up to one third of patients experience incisional hernia after loop-ileostomy closure. Biological meshes have been commonly used in contaminated surgical sites instead of synthetic ones due to complication concerns, previous data on the subject does not support this practice. The aim of this study was to evaluate the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure.

Materials & Methods

A randomized, controlled, multi-center non-inferior feasibility trial was conducted from April 2018 – November 2021. Patients (n=102) were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene MacroTM, Medtronic) (SM) or a biological mesh (PermacolTM, Medtronic) (BM) to the retrorectus space at loop-ileostomy closure after anterior resection for rectal adenocarcinoma. The primary outcome was rate of surgical site infections (SSI) at 30-day follow-up and rate of incisional hernias at 10 months follow-up.

Results

In total, 102 patients were randomized, of which 97 received the intended allocation. Of patients in the SM group, 1/46 (2%) had SSI and in the BM group 2/48 (4%) had SSI (p>0.90) at 30 days follow-up. One patient from each group underwent reoperation requiring mesh removal (p>0.90). At 10 months follow-up, one patient (2%) in both groups had an incisional hernia on clinical examination (p>0.90) at 10 months follow-up. None of the patients had underwent reoperation due to mesh or wound-related complications.

Conclusions

Both a synthetic mesh and biological mesh were safe and effective in incisional hernia prevention after loop-ileostomy closure.
P-066 SURGICAL TREATMENT OF RECTUS DIASTASIS WITH ASSOCIATED HERNIA: INITIAL EXPERIENCE IN A TERTIARY HOSPITAL
Authors: Rodríguez-González D , Tuñón-Féquant C , Casanova-Ramos R , Guil-Ortiz B , Montes-Montero A , Arteaga-González I J
Published: May 2023

Aim

Rectus diastasis (RD) is frequent and may be associated with abdominal wall hernias. Although a plication of the línea alba and mesh placement has been suggested to repair a RD associated with small hernias, numerous surgical techniques have been reported. We present our inicial experience in the treatment of RD and associated hernia (RDAH).

Material and Methods

We reviewed patients with RDAH treated surgically at our hospital from June 2021 to July 2022. The minimum follow-up time was 6 months.

Results

Forty one patients with RDAH were operated in our hospital with an average age of 59.3 years (range 27–83 years), 53.7% female, and 46.3% male. Mean BMI was 29.8 Kg/m2 (range 18.6–40.0 Kg/m2). Fourteen women (34.3%) had a mean of 1.9 previous pregnancies (range 0–4 pregnancies). The most common types of associated hernia with RD were primary midline hernia (51.2%), incisional hernia (26.8%), and recurrent midline hernia (19.5%). Most of the RD was M1-3 (90%) and W1-W2 (80.5%). The mean diameter of associated hernia was 3,1 cm (range 1–8 cm). We performed Rives (43.9%), midline plication with preperitoneal mesh (34.1%), midline plication with onlay mesh (19.5%) and Bezama-Murray technique (2.4%). Hematoma and respiratory failure (7.3%) were found in the first 30 postoperative days. No reccurence was recorded in the follow-up time.

Conclusions

Surgical treatment of RD in patients with RDAH could be recommended to prevent hernia recurrence. The choice of surgical technique should be adapted to the characteristics of the RD, the hernia and the patient.
P-069 TOTAL EXTRAPERITONEAL (TEP) APPROACH FOR THE TREATMENT OF SPIGELIAN HERNIAS: SINGLE-CENTRE EXPERIENCE
Authors: Ruano-Campos A , Pérez-Jiménez A E , García-Galocha J L , Sánchez Del Pueblo C , Gómez Latorre L , Peña Soria M J , Torres García A
Published: May 2023

Aim

Spigelian hernias are rare. Surgical treatment is often recommended. Different minimally invasive techniques are available by means of intraperitoneal or extraperitoneal mesh placement, either by IPOM, transabdominal preperitoneal (TAPP) or total extraperitoneal (TEP) approach. TEP approach is seldom reported in the literature. We present a short series of TEP repair of Spigelian hernias.

Materials and Methods

Between February and October 2022, TEP repair was performed in two patients with unilateral Spigelian hernia, one case of bilateral hernia, and one combined unilateral Spigelian and inguinal hernia, ensuing the following technique. Preperitoneal access was achieved placing a contralateral 11mm trocar, a few centimetres above the umbilicus, posterior to the rectus muscle toward Retzius space. A 5mm trocar was placed suprapubic and another 11mm trocar at the flank. Working space is developed by blunt dissection. Spigelian hernia sac is dissected and reduced. At this point other inguinal or femoral hernias are explored, performing simultaneous repair if necessary. Sufficient preperitoneal space is ensured to allow correct overlap of a polypropylene self-gripping mesh, prior to closing the defect with barbed-polydioxanone suture.

Results

Median age was 72 years. Three cases were right hernias and two left, all diagnosed by imaging test due to symptoms. Latest discharge was 24 hours after surgery. No complications or recurrences were encountered at a median follow-up of 4 months.

Conclusions

Comparative studies between minimally invasive approaches of Spigelian hernias are scarce. In the presented experience, TEP approach proved to be an efficient and reproducible technique with favourable results.
P-070 ROLE OF MESH AUGMENTATION IN TRAM FLAP DEFECTS AFTER BREAST RECONSTRUCTION: LITERATURE REVIEW
Authors: Alabbasi I , Cocciolo F , Birch A , Pawlak M
Published: May 2023

Aim

The aim of this study was to assess the problem of hernia occurrence in patients after transverse rectus abdominis flap in breast reconstructive surgery and the influence of using donor site reinforcement with mesh to prevent bulging and hernia.

Method

Literature searches were performed using databases, using key terms to include related articles in the last ten years.

Results

Out of 65 articles found by the research, 7 articles included in this review, risk factors were identified as obesity, smoking, unipedicule vs bipedicle, mesh vs non-mesh repair. 5 of the included articles involved retrospective study with 6 to 160 patients and follow up period 6 to 48 months, one double blinded study and one was cost utility study retrospective. it is showed that TRAM reconstruction associated with hernia in 18% and 63% had abdominal bulging. using mesh reinforcement reducing bulging 2% to 6% and hernia to 1% to 2%, Consideration should be given particularly in high-risk populations.

Conclusion

Although the literature about the best way to deal with TRAM defect has not been published yet, this review shows the important of mesh augmentation, it magnified the effect of that on patient with high risk for hernia or bulging.
P-072 INCIDENCE OF TROCAR SITE HERNIA AFTER LAPAROSCOPIC BARIATRIC SURGERY, A LONG TERM FOLLOW UP
Authors: López-Negrete E , Rodicio J , Suárez A , Amoza S , Moreno M , Noriega P , Montes A , Sanz L
Published: May 2023

Aim

Given the increased use of laparoscopic surgery, the possible complications associated with it must be considered. Trocar site hernias (TSH) are one of them, being more frequent in obese patients. With this study we want to know the importance of the problem and evaluate our own results.

Methods

We made an observational, descriptive, longitudinal and retrospective study in patients undergoing laparoscopic bariatric surgery with 12mm bladeless trocars without fascial closure between January 2015 and July 2016. They were interrogated about symptoms and postoperative infection in the ports, and an abdominal wall ultrasound were performed by an expert radiologist in December 2022.

Results

45 patients were included. The average age was 49.9 years-old (77.8% women) with a mean initial BMI of 45.5kg/m2 and actual BMI of 30.2 kg/m2. Among risk factors we found 31.1% of smokers, 46.7% of diabetes and 64.4% of respiratory pathology. The main surgery was gastric bypass (88.9%). 7 patients presented TSH (15.6%) and 6 patients presented symptomatology in any trocar site (13.3%), although only 2 (4.4%) showed hernia ecographically at the symptomatic port. We studied 189 ports and detected a 3.7% TSH in the control echography 6–7 years after surgery, all of them in the epigastric trocar.

Conclusions

The incidence of TSH after bariatric surgery with 12mm bladeless trocars is low considering patient´s characteristics. All the THS were in the midline port, which raises the possibility of systematic closure, change its position or contemplate this low incidence as acceptable considering its difficulty of closing.
P-074 SAILING ROUGH SEAS – MANAGING THE COMPLEX RECURRENT INCISIONAL HERNIA PATIENT WITH ADJUVANT TECHNIQUES – CASE REPORT
Authors: Santos G , Taré F , Costa C , Mogne T , Andrade N , Cordeiro B , Pinto F , Capote H
Published: May 2023

Aim

Case report regarding the repair of a complex incisional hernia, with loss of domain (LoD), where adjuvant techniques were used.

Materials and methods

Data from the patient's electronic chart and literature review.

Results

A 77-year-old female patient is referred for evaluation. She had a multi-recurrent incisional hernia, symptomatic with pain and recurrent episodes of intestinal occlusion. Clinical and imaging evaluation confirmed a complex incisional hernia with LoD, located in the left iliac and flank regions.

Abdominal wall muscle blockade was done with botulinum toxin. A progressive pneumoperitoneum catheter was placed laparoscopically, and 11 liters of air were instilled over 13 days. Imaging showed lengthening of the AW muscles.

Posterior component separation and transversus abdominis release was performed on the left side, and a retrorectus dissection the right side. A macroporous polypropylene mesh was attached on the left to the twelfth rib, psoas muscle, transverse process of lumbar vertebrae, iliac crest, Cooper's ligament and pubis, and on the right with transfascial sutures. A seroma developed on the post operative period. No other complications occurred.

Discussion

If a patient never had an AW reconstruction surgery, with a mesh on the retromuscular plane, this option should be offered, by a specialized hernia surgeon, regardless of the number of recurrences. Progressive pneumoperitoneum has existed for many years, but is seldom used. Likewise, botulinum toxin is emerging as a powerful tool to prepare AW reconstruction, but much is still unknow. Heterogeneity in the data is a hinderance to the wide adoption of these techniques.
P-077 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL HERNIA REPAIR (TAPP): OUR EXPERIENCE IN 200 PATIENTS
Authors: Rodríguez Haro C , García-Sancho L , García Virosta M , Hernández O'reilly M , Mellado Sánchez I , Gajda J , Ferrero Celemín E , Martínez Alegre J , Vaquero Pérez M A , Sánchez López J D , Picardo Nieto A L
Published: May 2023

Aim

To review and report our experience in the laparoscopic hernia treatment.

Material & Methods

It's a retrospective observational study including all patients who underwent a laparoscopic transabdominal preperitoneal hernia repair (TAPP) in our hospital between January 2016 to April 2022.

Results

From a total of 190 patients, 92% were male with a median age of 55,7 years old. Most of the cases were a primary hernia repair (81%) and 51,6% had bilateral presentation.

Regarding the type of mesh employed, 89,1% were Adhesix®, 7,5% were Progrip® and 3,2% were flat polypropylen meshes. Tackers were used to fix the mesh only in a 11,2% of the patients.

To close the peritoneum flap an absorbable barbed suture was used in a 94% of the cases, while tackers in a 5,9%.

No intra-operative complications were described and 91,5% of surgeries were performed on an outpatioent basis.

Concerning complications on the first fllow-up month: 7 patients suffered pain (3,4%) and 7 hematoma/seroma.

Long-term complications were: chronic pain in 4 patients (2 with Adhesix®, 1 Progrip®, the forth one unknown; in none of them tackers were used); recurrence happened in 14 patients (7,6%) (11 Adhesix®, 2 Progrip®, 1 flat polypropylen mesh; tackers were used in three of these patients to fix the mesh).

Conclusions

Adhesix® mesh was the most employed (89,1%) and the one with the lowest recurrence rate (6,6%). According to our experience, tackers aren't necessary when an auto-adhesive mesh is used. Although they weren't related with postoperative pain, they didn't seem to prevent recurrence eiher.
P-083 LAPAROSCOPIC APPROACH TO RECURRENCE OF URETEROINGUINAL HERNIA: A CASE REPORT
Authors: Gajda Escudero J , Sánchez López J D , García-Sancho Téllez L , Picardo Nieto A L
Published: May 2023

Aim

The aim of this communication is to present an exceptionally rare type of hernia and its surgical management.

Material and methods

We report the case of a 66-year-old male with recurrence of inguinal hernia. A routine Computed Tomography scan revealed as an incidental finding the ureter forming a loop within the hernia sac. Additional findings included pyelocaliceal duplicity and ureteropelvic dilatation.

Results

An attempted transabdominal peritoneal repair (TAPP) was performed, with dissection of the ureter. To prevent adhesion formation with the ureter, no mesh was placed. An inguinal incision and suture of the deep inguinal ring was performed. The patient was discharged the same day, with no associated complications.

Conclusions

Ureteroinguinal hernia is a rare presentation, but with potentially serious complications. Knowledge of its existence is important in view of the possibility of its incidental finding. There are approximately 140 cases described in the literature, the vast majority of which involve ectopic kidney. Our case presented an inguinoureteral hernia on native kidneys and obstructive voiding symptoms. The laparoscopic TAPP approach allows identification and safe dissection of the ureter. Due to the low frequency of this pathology, there is no consensus on the placement of the mesh in the peritoneal space due to the risk of adhesion of the ureter. Therefore, in our case we opted for an open repair of the hernia.
P-087 LAPAROSCOPIC TREATMENT OF TROCAR SITE HERNIA: A SINGLE-CENTER EXPERIENCE
Authors: Chiari D , Ricchitelli S , Moroni M R , Sorrentino M , Frascarelli A , Platto M , Rovagnati M , Zuliani W
Published: May 2023

Introduction

Trocar site hernia (TSH) is a complication of minimally invasive surgery that is often underestimated. These lesions cause patient discomfort and require surgery for their correction. Although there are some case reports for laparoscopic repair of TSH, there is data missing in the literature about this specific topic. The aim of this study is to evaluate safety and efficacy of the laparoscopic repair of TSH.

Methods

We collected data regarding 213 patients submitted to incisional hernia repair in the Department of General Surgery at Humanitas Mater Domini Clinical Institute in Italy since 2011 and 2019.

We selected the patients submitted to laparoscopic repair of a TSH with an intraperitoenal mesh. We evaluated the clinical and surgical characteristics of the patients and the following outcomes: post-operative hospitalization, complications and long-term recurrences.

Discussion

Forty-two out of 213 patients were operated for a TSH. Forty out of 42 patients (95.2%) were treated with a laparoscopic approach. Follow up: 60 months. Study group: females (62.5%), mean BMI 29.1. According to EHS (European Hernia Society) classification, 35 patients had a midline defect. In 77.5% of cases a ePTFE/PP mesh was implanted. Mean hospitalization: 2 nights. The complication rate was low (1 surgical site infection, 1 seroma and 1 hematoma), without re-intervention. We observed 2 cases of recurrence (5%) developed after 5 months and 36 months, respectively.

Conclusions

Laparoscopic repair of TSH is a safe approach, in absence of specific contraindications. Our experience suggest that a laparoscopic approach could obtain satisfying results.
P-088 OMENTUM PROTECTED IPOM (OPIPOM) – NOVEL TECHNIQUE OF VENTRAL HERNIA REPAIR
Authors: Skach J , Blecher V , Verner T
Published: May 2023

Aim

It is known from experience that adhesions of the small intestine and bands forming adhesions of the omentum are especially potentially dangerous (ileus, fistulas, chronic pain). Therefore, with this technique, we create a space where the mesh and the small intestine come into no contact and the omentum adhesion is controlled to form flat. The aim of our work was to verify this assumption and include this method as safe and effective.

Materials and methods

We perform this by fixind the omentum to the abdominal wall in a line below the hernia defect. The next step is to perform a standard IPOM, but with the use of a lightweight large-pore mesh without anti-adhesive surface treatment and fixing it with stitches. We called it omentum protected IPOM (OpIPOM). We included three departments in the initial multicenter comparative study. From 2017 to 2020, we selected a group of 80 patients originály indicated for retromuscular hernioplasty according to Rives-Stoppa(RS). For comparison of RS and OpIPOM, the method of surgery was dedicated by lot just before the operation in a ratio 1:1.

Results

The average operating time, duration of postoperative drainage,the length of hospitalization, occurence of surgical site infection and complicated seroma favor OpIPOM. Hernia recurrence within two years was for the both methods the same.

Conclusion

The technique is simple, safe, cheaper then IPOM, faster then RS and with a shorter recovery. From our experience controlled adhesion is also not a technical problem of redo laparotomy.
P-091 Primary intestinal lymphoma associated with enteric fistula to an intraperitoneal mesh: what came first?
Authors: Gómez Latorre L , Ruano Campos A , Peña Soria M J , Sajonia-Coburgo M J , Otero De Pablos J , Diez Valladares L I , Fernández Aceñero M J , Torres García A J
Published: May 2023

Aim

To present the possible association between the use of intraperitoneal mesh and the appearance of primary intestinal lymphoma.

Material and Methods

We present the case of a 67-year-old woman with a history of multiple abdominal surgeries (appendectomy, Hartmann's procedure for perforated diverticulitis and reoperation due to hemoperitoneum). Ventral hernia repair was performed placing intraperitoneal composite mesh in 2013. Eight years later, the patient consulted with abdominal pain and bulging located on previous laparotomy scar. Abdominal CT was carried out, demonstrating an intestinal fistula from the jejunum to the mesh with an adjacent 5 cm intraabdominal abscess.

Results

Elective surgery was decided on. An enteric fistula from the jejunum to the previous mesh was observed, as well as pathologic lymph nodes adhered to the mesh. Intestinal resection was performed prior mesh excision. Histopathological analysis was compatible with extranodal B-cell lymphoma of the marginal zone.

Conclusions

Enteric fistula rate associated with the use of intraperitoneal mesh is 0.3–4%. There are no published cases of intestinal lymphoma correlated with the use of intraperitoneal mesh. Primary intestinal lymphoma constitutes 1–4% of bowel malignancies. The most common type is extranodal marginal zone MALT B lymphoma. Typical locations are: gastric (50%), small bowel (33–40%) and colon (10–15%). Situations of chronic inflammation such as celiac disease, inflammatory bowel disease, Campylobacter jejuni infection or inflammatory reactions are known to cause this entity. In this particular case, an excessive inflammatory response to an intraperitoneal mesh resulting in enteric fistula could be the source of malignancy, or vice versa.
P-092 EARLY OUTCOMES OF ROBOTIC-ASSISTED TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR: A SINGLE-INSTITUTION EXPERIENCE
Authors: Jung S , Lee J H , Lee S Y , Lee H S
Published: May 2023

Purpose

Since the introduction of the Da Vinci robot, robot-assisted hernia repairs have become more common. We aim to report our initial experience of robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair.

Methods

A retrospective chart review was performed in patients who underwent R-TAPP inguinal hernia repair with a prosthetic mesh using the Da Vinci platform (Intuitive Surgical Inc). Data were collected for patient characteristics and surgical outcomes.

Results

A total of 21 patients underwent R-TAPP repair consecutively. The mean age was 54.1 ±16.4 years. Twenty patients (95.2%) were male, and the mean body mass index was 23.8 ± 1.9. Bilateral hernia repairs were performed on 2 (9.5%) patients. Six cases (28.5%) of huge scrotal hernias were performed by R-TAPP. The operation time was 91.8 ± 20.4 min for unilateral inguinal hernia and 154.5 ± 26.2 min for bilateral inguinal hernia. The mean console operative time was 61.4 ± 16.9 min for unilateral inguinal hernia and 128 ± 25.5 min for bilateral inguinal hernia. Scrotal vein injury was identified in one patient intraoperatively. Two minor postoperative complications were reported: one with postoperative ileus and the other with umbilical wound seroma. The length of hospital stay was 3.8 ± 0.9 days. Neither mortality nor conversion to open surgery occurred.

Conclusion

Our early experience has demonstrated that the R-TAPP inguinal hernia repair is a safe and feasible approach. Cost-effectiveness, optimal procedural steps, and indications for the robotic approach remain to be further investigated.
P-093 THE NEED FOR STANDARDIZATION IN EMERGENCY FEMORAL HERNIA TREATMENT
Authors: Noditi G , Negrau A , Valean C , Duta C , Tarta C , Brebu D , Al-Hajjar H , Hajjar R
Published: May 2023

Aim

Evaluating the need for a standardized surgical technique in emergency femoral hernia cases

Material & methods: There were 69 femoral hernia cases admitted in our surgical department during 01.01.2012–22.12.2022, of which 43 cases were admitted to the Emergency Department, and 26 were elective cases. We have retrospectively evaluated the medical files of all the patients who underwent surgery with a diagnosis of femoral hernia. Moreover, demographic data, surgical technique, sex, length of hospital stay, intraoperative and postoperative complications were retrospectively analyzed.

Results

The sex distribution among the cases was as follows: 56 of the patients were female while the other 13 were male. The patients age was between 26 and 92 years old, with most cases between 70–79 years old (n=18). Of all the patients admitted through emergency department only one was operated using laparoscopic technique while the rest were operated using multiple open surgical techniques, 16 cases were incarcerated, 10 cases were strangulated femoral hernia, out of which 3 required small bowel resections. Amid elective cases, only 4 of them were operated using laparoscopic technique (TAPP).

Conclusions

The standardization of emergency surgical techniques in cases of femoral hernia could lead to a lower number of post-operative complications, and therefore could lead to a safer strategy in the treatment of femoral hernia patients.
P-095 EXPERIENCE IN COOPERATION PROJECT IN TANZANIA
Authors: Garcia Garcia L , González Sánchez L , Álvaro Roures M , Antonini G , Kimaro J , Hernández Hernández J R
Published: May 2023

Objectives

In rural África, hernia and caesarean section are the most common elective procedures with a very high burden of morbidity and mortality in inguinal hernias. We present the interventions carried out during 2022 by European aid workers in a referral and third level hospital in Tanzania and the techniques performed from the scarce material available.

Material and Methods

A retrospective observational study of the number of inguinal hernias operated in a Hospital in Tanzania by European aid workers.

Results

Throughout 2022 the hospital performed 2818 surgical interventions (1445 men and 1373 women) of which 155 were inguinal hernias (5.5% of total interventions). Of this total, only 5 were repaired with mesh using the Lietchenstein technique (3% of operations). The remaining cases were repaired by herniorrhaphy using the Shouldice technique. The postoperative period was between 24 and 48 hours. Follow-up is carried out in less than 5% due to the fact that this is a rural hospital, with 17 reoperations.

Conclusions

Treatment of inguinal hernia in cooperative projects are challenging to the surgeon's skills and require a thorough understanding of the anatomy of the inguinal region and nonprosthetic repair options.
V-003 Parastomal & ileal conduit hernia: Top docking robotic eTEP approach
Authors: Villalobos R , Maestre Y , González-Barranquero A , Escartin A , Olsina J
Published: May 2023

Aim

Parastomal hernias are frequent in patients with end colostomy. Recently, the robotic approach for the treatment of this pathology had spread abroad. On the other hand, patients with an ileal conduit urinary diversion after a radical cystoprostatectomy have a high risk of incisional hernia development. The combination of both parastomal hernia and ileal conduit hernia is rare. The aim of this video is to describe a top docking robotic eTEP approach combining a modified retromuscular Sugarbaker technique (Pauli) with a retromuscular keyhole for the parastomal and ileal conduit hernias respectively.

Material and Methods

The case is a 71 years old man patient with a BMI of 36 who presented a progressive 2-year discomfort bulging around the end colostomy that turned in an intermittent constipation. Additionally, a progressive bulging started the last 6 months on the ileal conduit. An abdominal CT scan was made showing a bilateral ostomal defect with small bowel parastomal content and fat tissue in the ileal conduit. Once the patient was assessed, a top docking robotic eTEP approach was planned with a Xi Da Vinci robotic platform. The patient was in a hyperextended supine position.

Result

The patient was discharged 3 days after the operation with a mild pain controlled by oral medication.

Conclusion

The Pauli technique and retromuscular keyhole for combined parastomal and ileal conduit hernia performed by a top docking robotic approach is feasible, but a long follow-up is needed to demonstrate its effectiveness.