bluuebunny/crossref_metadata_2025 huggingface dataset:
FALSE INGUINAL HERNIA
Authors: Hernández O´Reilly M , Ferrero Celemín E , Gajda Escudero J , Vaquero Perez M A , Sánchez López D , García Sancho L , Martínez Alegre J , Rodríguez Haro C , Mellado Sánchez I , Peck García C , Picardo Nieto A L
Published: May 2024

Aim

The case of a patient with fistulizing salpingitis in the inguinal region, simulating an inguinal hernia, is presented.

Material and Methods

Description of a clinical case.

Results

A 61-year-old woman, who had undergone tubal ligation in Cuba over twenty years ago, presented to medical consultation with an abdominal computed tomography (CT) scan suggesting a possible right tubo-ovarian inguinal hernia with an adjacent collection infiltrating the abdominal wall. She was included in surgical list for laparoscopic surgery. Fifteen days later, she came to the emergency department with abdominal pain and suppuration in the right inguinal region. Blood analysis showed no abnormalities, and an urgent abdominal CT scan revealed a collection in the right hemipelvis extending from the right fallopian tube to the subcutaneous region of the right iliac fossa, with gas bubbles suggesting cutaneous fistulization.

An urgent laparoscopic surgical intervention was decided, where the right fallopian tube and ovary with inflammatory appearance were visualized adhered from the theoretical location of the clip used for tubal ligation, to the parietal peritoneum in the inguinal region. The right fallopian tube and ovaries were dissected from the wall and sectioned. The patient was discharged without incidents with follow-up in outpatient clinics.

Conclusions

Tubo-ovarian inguinal hernias are uncommon, occurring in only 3% of all inguinal hernias, and require special care in premenopausal women as they can compromise fertility. This is an unusual case of fistulizing salpingitis in a postmenopausal woman simulating a tubo-ovarian inguinal hernia.
USE OF BIOLOGIC GLUE IN TAPP. TRICKS AND CHALLENGES
Authors: Kochylas N , Papaeleftheriou S , Mpikas K , Magganas D
Published: May 2024

Aim

The fixation of the mesh in transabdominal preperitoneal inguinal hernia repair (TAPP) and the closing of the peritoneal flap are key parts of the operation. This is accomplished with sutures or tackers. The use of biologic glue is an acceptable alternative with the possible advantages of being safer and less painful than the other options. Its use however poses its own set of challenges.

Materials and Methods

24 patients underwent TAPP repair for inguinal hernia, using biologic glue to fix the mesh and close the peritoneal flap. The practical challenges of its use were studied.

Results

No problems were encountered in the fixation of the mesh. In the closing of the peritoneal flap, tackers were used as an adjunct in the first 10 cases. After that, the operation was completed only using glue.

Conclusions

Various conclusions were drawn from the use of glue. First, it works best in a dry environment and with a lightweight microporous mesh, so that the glue can seep through the pores. Second it will not “fix” large creases of the mesh, although this also means a suboptimal positioning of the mesh. Third, it requires gentle moves during withdrawal, as the tip can stick to the tissues, and appliance of a wet gauze after every use, as the clotted glue can block the tip. All in all, after a learning curve period, it can be a safe and effective alternative to sutures and tackers in TAPP.
LUMBAR INCISIONAL HERNIA REPAIR-PREPERITONEAL PLACING OF MESH-THE IMPORTANCE OF CT EVALUATION
Authors: Kostic I , Trifunovic Z , Aleksic A , Lazic B
Published: May 2024

Background

Lumbar hernias can be congenital (primary) or aquired (postoperative and posttraumatic). The margins are well-known: the iliac crest, 12th rib, the erector spinae and the external oblique muscle. The most number of lumbar incisional hernias occur after nephrectomy.

Objective

To show the results in treatment of lumbar incisional hernias in district General hospital and to review the importance of CT evaluation before and after treatment of lumbar incisional hernias (specially for W3 = the width of hernia defect ≥ 10 cm ≈ large hernias).

Methods

This is retrospective case-study analysis from June 2005 till November 2021.The mean follow-up for all patients was 36 months.

Results

From 15 June 2005. to 15 November 2021 we operated 18 patients with diagnosis: Lumbar incisional hernia. 16 patients were operated due to principles of sublay-preperitoneal placing of MESH (all by the same surgeon).

In our evaluation we divided the patients in 3 groups according to the width (size) of hernia defect – W1, W2 and W3.

For the patients with “large hernias” (W3) – 5 patients, we perform CT of abdomen 3 times (before operation, a few months after operation and 2 or 3 years after operation).

All other patients have CT of abdomen before operation-only certain proof for diagnosis.

We do not have recurrences and none of our patients need analgetics more than two weeks after surgery. Laparoscopic incisional hernia surgery is not performed routine in our hospital yet.

Conclusion

Lumbar incisional hernias should be treated with sublay (preperitoneal placing of MESH) whenever is possible. CT evaluation before and after surgery is always usefull for large hernias, with big level of recommendence.
LAPAROSCOPIC-ASSISTED ROBOTIC REPAIR OF RIGHT PARADUODENAL HERNIA
Authors: Kumbhar U
Published: May 2024

Introduction

Paraduodenal hernias (PDH) are internal hernias with right-sided PDHs are often more challenging. Diagnosis is usually incidental in asymptomatic patients, or patients may present with intermittent midabdominal discomfort as well as acute intestinal obstruction or strangulation. The preoperative diagnosis of PDH can be established only via cross-sectional imaging. In cases of uncertainty, diagnostic laparoscopy or laparotomy can be helpful. The surgical principles require reduction of the herniated contents, thorough assessment for viability, and closure of the hernia defect. There are case reports with laparoscopic management of paediatric PDH. However, there are no case reports of robotic repair of the adult PDH.

Method

A 31-year-old male patient presented to the emergency department with upper abdominal pain, distension, and bilious vomiting for two days. He had three similar episodes in the past year and was treated with conservative management. The patient was haemodynamically stable. X-ray abdomen was suggestive of small bowel obstruction. The patient was treated conservatively. CECT abdomen was done and showed closed-loop obstruction with both afferent and efferent loops trapped with a mesenteric pedicle. There was an abnormal course of the jejunal arterial branches and venous tributaries and a collection of small bowel loops in the mid-abdomen, suggesting right-sided PDH. The patient was treated electively with Robotic repair of the Right PDH.

Results

The intraoperative and postoperative periods were uneventful. The patient was discharged on the second postoperative day. The patient is asymptomatic at six-month follow-up.

Conclusion

Robotic paraduodenal hernia repair is a feasible and safe procedure.
MINIMALLY INVASIVE APPROACH TO GRYNFELT HERNIA (L4)
Authors: Licardie E , Moreno-Suero F , Navarro-Morales L , Gómez-Menchero J , Morales-Conde S
Published: May 2024

Aims

Lumbar hernias are defects occurring in the posterolateral wall of the abdomen, at the level of the upper Grynfelt’s triangle and a lower triangle (Petit triangle). The minimally invasive approach provides advantages in comparison to the conventional approach and the possibility of placing a preperitoneal mesh, avoiding contact with bowel.

Methods

We present the case of a 28-year-old man with a history of urological intervention in childhood for congenital defects in both kidneys through bilateral lumbotomy. The patient complained of discomfort at the site of the lumbar hernia for a year. On examination, a soft, reducible lump was palpated in the left posterolateral region of the abdominal wall. Computed tomography scan confirmed the lumbar hernia through the upper Grynfelt’s triangle of 35 mm (hernia type L4, EHS).

Results

Patient underwent surgery by transabdominal laparoscopic approach, placing three trocars in left clavicular midline. Right parietocolic groove is opened and a peritoneum is dissected to access Grynfelt’s triangle. After the reduction of the hernial content (fatty tissue), direct closure of the hernial defect is performed with non-absorbable barbed suture and a tailored PVDF mesh is placed intraperitoneally. Then peritoneal flap is closed with absorbable barbed suture. Patient was discharged on first postoperative day. At one-year follow-up complications or recurrence did not occur.

Conclusions

Laparoscopic approach to lumbar hernias is feasible providing the advantages of minimally invasive surgery, and in addition the possibility to explore the entire abdominal cavity. More studies with larger numbers of patients are needed to draw definitive conclusions.
COMPLEX THORACOABDOMINAL RECONSTRUCTION AFTER A THORACIC ONCOLOGICAL RESECTION
Authors: Lopez-Monclus J , García de León L R , Munoz-Rodriguez J M , Grillo Marin C , Rodriguez Fernandez M , Gil Cidoncha L , Martin Rodrigo P , Blazquez Hernando L A , Valle de Lersundi A R , Medina Pedrique M , Garcia-Urena M A
Published: May 2024

Aim

Surgical reconstruction of the thoracoabdominal region after resective oncological procedures is a surgical challenge. We present our approach to this situation.

Material and Methods

67-year-old patient with the diagnosis of a mixoid sarcoma in the lower left thoracic wall. Previous myocardial stroke (double by-pass), chronic obstructive pulmonary disease, arterial hypertension and obesity (BMI 32.6). An oncological resection including the left 8th, 9th, and 10th left ribs, diaphragm, and the lateral musculature of the abdominal wall is performed. A diaphragmatic PTFE bridged mesh augmentation is performed to maintain pulmonary capacity. The reconstruction is based in the overextended dissection of the preperitoneal retromuscular space and the subdiaphragmatic area, restoring the muscular continuity after reinforcing the dissected area with a reinforced 25 × 30 biological mesh and a 35 × 40 cm large pore polypropylene mesh. The resected area is covered with muscular flaps of the transversus abdominis, anterior serratus and latissimus dorsi muscles with full coverage of the meshes.

Results

No immediate postoperative complications. Discharged in the sixth postoperative day without any complications. No abdominal wall instability after 18-month follow-up. Oncological progression with lung metastasis.

Conclusion

Anatomical restauration of the thoracoabdominal junction after oncological resections is based in the overextended preperitoneal retromuscular dissection with the use of large pieces of meshes, covered with flaps of the surrounding muscles.
PHASIX™ MESH FOR GIANT PARAOESOPHAGEAL HERNIAS – THE FUTURE OF HIATUS HERNIA REPAIR?
Authors: Lorenzo A , Mahmood S , Goltsman D , Berney C
Published: May 2024

Background

Mesh reinforcement of the oesophageal hiatus decreases recurrence rates for giant paraoesophagal hernias. The use of permanent synthetic mesh is associated with significant risk of erosion which is not observed in absorbable biosynthetic mesh – with the trade-off long-term hernia recurrence. We aim to assess the safety and effectiveness of Phasix™ nonST mesh in the repair of giant paraoesophageal hernias.

Method

Patients presenting to Bankstown hospital in 2020–21 with giant paraoesophageal hernias were included. 7 × 10 cm Phasix™ nonST mesh, fashioned in a standardised configuration was inserted behind the oesophagus, secured with fibrin glue and monofilament sutures. A modified Dor technique was used. Primary endpoint was early endoscopic recurrence and secondary endpoints were length of hospital stay, morbidity, mortality and symptom recurrence.

Results

Thirty-two patients (mean age 68.1 years) with giant paraoesophageal hernias underwent laparoscopic Phasix™ nonST mesh repair with modified Dor fundoplication in 32 cases. Dyspnoea (63.6%), epigastric/chest pain (48.5%), and dysphagia (51.5%) were the most common symptoms. Reflux was negligible. There were 62.5% type III and 15.6% type IV hernias. Thirty-five (85%) patients had more than 50% herniation of the stomach. Median length of stay was 3 days and 97% were symptom free at 12 and 24 months. There was no major complication and no mortality. There was one endoscopic and radiological recurrence was found in one (3.1%) patient at 24 months.

Conclusion

Phasix™ non ST mesh reinforcement of the oesophageal hiatus with fibrin glue fixation shows promise in reducing recurrence rates for repair of giant paraoesophageal hernias.
LAPAROSCOPIC REPAIR OF A LEFT BOCHDALEK HERNIA IN AN ADULT
Authors: Maillo C , Sacadura Fonseca J , Oliveira G , Garcia T , Nobre I , Sousa S , Afonso V
Published: May 2024

Introduction

Congenital diaphragmatic hernias have an incidence of 1 in 2000 to 1 in 3000 births. Of them, about 70% are postero-lateral defects (Bochdalek hernias BH). Most of them are symptomatic in newborns with respiratory complaints. In adults, they can produce vague or nonspecific gastrointestinal complaints.

When a BH is diagnosed in adult patients, surgery is recommended when it is symptomatic or even asymptomatic, when the patient is fit for surgery.

Material and method

We present the case of a 53 African male with the incidental diagnosis of a BH in a thoracic CT scan with fat and splenic colon in the hernia.

A laparoscopic approach was performed. The hernia was dissected with the reduction of the viscera and the visualization of the diaphragm.

We performed a suture of the diaphragmatic edges, and a coated mesh was used to reinforce the diaphragm. The mesh was fixed with resorbable tuckers in the lower part and with barbed suture in the upper part.

The patient was discharged 24 hours after surgery.

Discussion

BH has risk of growing because of the negative pressure of the thorax. The risk of an incarceration of a viscera in the thorax can develop serious complications. Laparoscopic approach is a minimally invasive access that allows a good repair of diaphragmatic hernias with a fast recovery. For theses reasons we recommend laparoscopic repair of BH.
POSTOPERATIVE INTERSTITIAL HERNIA AFTER e-TEP CAUSING INTESTINAL OBSTRUCTION
Authors: Maillo C , Oliveira G , Nobre I , Cabrita S , Pires R
Published: May 2024

Introduction

Interstitial or intraparietal hernias are those placed between the two layers of the abdominal wall. They are rare and can be congenital or acquired. One of the presentations can be as bowel obstruction.

Material and Method

We present a case of a 71 caucasian male with primary ventral hernias and diastasis recti operated by laparoscopy performing a total extraperitoneal e-TEP with a retromuscular polipropilene mesh.

The 4th postoperative day he complained with nausea and vomiting.

CT scan demonstrated a bowel obstruction with a small bowell loop adherent to the abdominal wall, but no hernia was demonstrated. Conservative treatment was tried without result.

He was operated again 7 days after the first surgery by laparoscopy approach.

An interstitial hernia with intestinal obstruction was confirmed with 1,4 m of small bowel in the abdominal wall.

The hernia was reduced, and a suture was performed to close the defect.

We present the video of both surgeries, the e-TEP and the interstitial hernia repair.

Conclusion

Even when the repair is extraperitoneal, the tension created with the closure of the posterior fascia can lead to a small hole where a loop of small intestine can pass creating the interstitial hernia. This is a diagnostic we need to have in mind and, when a postoperative obstruction is not rapidly solved, we have to re-operate the patient.
LAPAROSCOPIC SUGARBAKER TECHNIQUE FOR PARAOSTOMAL HERNIAS. HOW WE DO IT
Authors: Medina M , De Luca M , Avilés A , Vaello V , Martinez C , Robin A , Blasquez L , García-Ureña M
Published: May 2024

Aim

To delineate the critical steps involved in Sugarbaker laparoscopic paraostomal hernia repair. By providing a detailed understanding of these steps, surgeons can improve their procedural proficiency, leading to enhanced patient outcomes and reduced postoperative complications.

Material and Methods

We compiled several videos to identify and highlight the critical steps to performing and adequate Sugarbaker laparoscopic repair for paraostomal hernias.

Results

The critical steps in Sugarbaker laparoscopic paraostomal hernia repair were identified and categorized into preoperative, intraoperative, and postoperative phases. These steps include patient selection, stoma site, trocar placement, dissection and reduction of herniated contents, mobilization of the colon, closure of the hernia defect, measurement according to anatomical landmarks for mesh preparation, placement of mesh reinforcement. Emphasis was placed on meticulous technique, anatomical landmarks, and avoidance of potential pitfalls.

Conclusions

Sugarbaker laparoscopic paraostomal hernia repair is a technically demanding procedure requiring adherence to critical steps for optimal outcomes. Surgeons should prioritize thorough preoperative planning, precise intraoperative technique, and vigilant postoperative care to minimize complications and achieve successful hernia repair. Further research and refinement of surgical techniques are warranted to continually improve the efficacy and safety of this approach.
SURGICAL REPAIR OF POSTOPERATIVE PERINEAL HERNIA
Authors: Morante A , Alonso S , Hernández P
Published: May 2024

Background

The incidence of perineal hernia (PH) after abdominoperineal (AP) excision (classic or extralevator) ranges from 1 to 26%. The available data regarding the treatment of PH after rectal surgery are heterogeneous. Open or laparoscopic approach has been described.

Material and Methods

A 89-year-old woman was diagnosed of PH after laparoscopic AP resection due to rectal cancer five years ago. She presented pain associated with a reducible soft mass, increased with Valsalva maneuver and skin problems in perineal scar. Surgical repair by open approach was deemed necessary.

She was positioned in jack-knife position. An elliptical incision was made. The hernia sac was of significant size and was in close contact with the perineal skin and vagina. The final defect measured 6 cm longitudinally by 5 cm transversely. Dissection of the hernia sac was performed until reaching the boundaries of the defect. The dissection was challenging in the region closest to the vagina due to firm adhesions. After sac closure, we continued the dissection to release the hernia sac at the pelvic rim, presacral, and lateral margins. The repair was performed using a prosthesis composed of ovine derived extracellular matrix and polypropylene measuring 10 × 15 cm*, fixed with continuous absorbable sutures, covering the mesh with approximation of the remain of levator muscles. Subcutaneous drain was placed.

Conclusions

We present one of the most used surgical techniques in incisional PH repair.

*Ovitex 1S
ROBOTICALLY ASSISTED REPAIR OF A BILATERAL PARASTOMAL HERNIA
Authors: Mück B , Vogel R , Heinzelmann F , Büchler P
Published: May 2024

Introduction

We report a case involving a 60-year-old patient who underwent a robotic bilateral parastomal hernia repair utilizing two intraperitoneal funnel meshes. The patient had a history of resection of a leiomyosarcoma situated in the pelvis, resulting in the creation of two artificial bowel orifices via midline laparotomy. These orifices included a descendostomy in the left lower abdomen and an ileum conduit in the right lower abdomen.

The CT scan showed a 4,5 × 8 cm MII, MIII, WII incisional hernia of the midline and 3,8 × 5,2 cm parastomal hernia at the site of the ileum conduit and a 3,9 × 4,1 parastomal hernia at the site of the descendostoma.

Methods

The robotic trocars were placed in the upper abdomen directly under the costal margin. After adhesiolysis and mobilization of the two bowel loops a 16 × 16 cm two intrapertioneal funnel meshes were placed around both stomas. In the lower abdomen, the midline was already covered by the two stoma meshes. In the upper abdomen, an additional 10 × 10 PVDF mesh was placed in order to cover the entire scar.

Results

The postoperative recovery was uneventful. Because laxative treatment was necessary discharge was delayed. One month after surgery the patient is free of complains and shows no signs of recurrence.

Conclusion

The management of bilateral parastomal hernias poses technical challenges and is not suitable for traditional procedures involving lateral trocar placement. In cases where cranial or caudal trocar positioning is feasible, the application of an intraperitoneal funnel mesh emerges as an effective approach for addressing bilateral parastomal hernias.
HYBRID APPROACH FOR MADRID-PCS IN LATERAL HERNIAS
Authors: Román García de León L , Munoz-Rodriguez J M , Blazquez Hernando L A , Garcia-Urena M A , Robin Valle de Lersundi A , Fidalgo Martínez C , Fernández Rodríguez M , Artés Caselles M , Lucena de la Poza J L , Lopez-Monclus J
Published: May 2024

Aim

To present a case of a hybrid approach (extended totally extraperitoneal (e-TEP) and open) to perform the Madrid Posterior Component Separation as a treatment for lateral hernias.

Material and Methods

This is a 61-year-old male with a history of left radical nephrectomy in 2010 and subsequently two repairs of the lumbar incisional hernia, one with a preperitoneal prosthesis and the other with a supraaponeurotic mesh.

He presents with a 12 cm incisional hernia in the lumbotomy incision, close to the left semilunar line (L3W3).

A Rives-Stoppa technique was performed with left posterior component separation according to the Madrid modification. The entire dissection was completed by minimally invasive extraperitoneal (e-TEP) approach and subsequently the open approach was used to perform a complete lateral abdominal wall reconstruction.

Results

The patient was discharged with no postoperative complications and very good pain control, with no complications or recurrence at subsequent follow-up.

Conclusions

The hybrid approach allows treatment of lateral hernias while maintaining the advantages of the minimally invasive approach, such as less postoperative pain and early recovery, associated with the complete reconstruction of the lateral abdominal wall of the open approach, making it an alternative for patients with large lateral hernias.
THE ADVANTAGES OF THE LAPAROSCOPIC APPROACH IN MULTI-RECURRENT INGUINAL HERNIA
Authors: Ruiz Marzo R , Rico-Arrastia A , Otegi-Altolaguirre I , González-Tolaretxipi E , Arana-Iñiguez I , Blázquez-Lautre L , Aebastián-Labayen J L
Published: May 2024

Background

Recurrence after inguinal hernia repair remains a clinical problem in current surgery, with a rate of the 13% of all groin hernia repairs. This surgery is technically more demanding for the surgeon. The technique to be used must follow the objective of repair the hernia via virgin tissue planes.

We describe the advantages of the laparoscopic TAPP aproach in these cases.

Method

We present the clinical case of a 64-year-old woman with a multi-recurrent right inguinal hernia. The previous surgeries were: Lichtenstein's open repair and open posterior preperitoneal mesh repair twice.

We performed a preperitoneal right inguinal hernioplasty with a transperitoneal laparoscopic approach. A hernia recurrence was found in the right medial zone, juxtapubic with visceral content, R3M3 in the EHS classification for inguinal hernia. A plication of the transversalis fascia was performed, and later a 3D polypropylene mesh fixed with resorbable tacks was placed.

Results

The patient was discharged after 24 hours.

She was evaluated in an outpatient clinic one month postoperatively. She did not present hernia recurrence or other incidents.

Conclusions

As we can see, minimally invasive repair of recurrent inguinal hernia is safe and feasible. One of the most important advantages of using the laparoscopic approach in cases with recurrent inguinal hernia is that it avoids the previous operation site, avoiding injuries and difficulties in repair due to previous tissue fibrosis. Safety of the procedure is dependent on skilled and well-trained hands for this procedure.
PHASIX™ ST MESH FOR CRURAL REINFORCEMENT DURING GIANT HIATAL HERNIA REPAIR: PRESENTATION OF SURGICAL TECHNIQUE
Authors: Theodoropoulos C , Papazacharias I , Kourtidis L , Neocleus K , Chamzin A , Iordanou C , Kouroumpas E , Ayiomamitis G D
Published: May 2024

Aim

Crural mesh reinforcement during large hiatal hernia repair has been advocated to defend against early recurrences. However, the optimal mesh material and configuration remain in question. This study presents the rationale and surgical technique for crural repair augmentation using Phasix™ ST Mesh.

Methods

We present a case of a giant hiatal hernia and outline the rationale and surgical technique for using Phasix™ ST Mesh in the repair.

Results

A 72-year-old man presented with a giant type IV hiatal hernia. A massive mediastinal protrusion of intra-abdominal fat and viscera, and an associated crucial cardiorespiratory compromise were noted. A preoperative CT scan revealed a widened hiatus measuring 9.2 × 7.6 cm. The patient underwent laparoscopic hiatal hernia repair and Nissen fundoplication. During the procedure, following visceral reduction and hernia sac dissection and excision, a widened round hiatus and significantly thinned crura were found. To reinforce the primary crural suturing, two strips of Phasix™ ST Mesh, each measuring 1.5 × 4 cm, were used, and a U-shaped mesh was placed onlay to augment the repair. The procedure lasted 214 minutes, and the patient was discharged on the 3rd postoperative day without complications.

Conclusions

The application of Phasix™ ST Mesh in the repair of giant hiatal hernias offers the dual benefits of reconstructing the original anatomy and reinforcing the hiatus, while avoiding the implantation of permanent foreign material around the esophagus.
LAPAROSCOPIC EXTENDED TOTALLY EXTRAPERITONEAL (e-TEP) TREATMENT OF VENTRAL HERNIAS: TIPS & TRICKS
Authors: Trujillo J , Gómez J R , Concejo P , Montenegro M A , Schenone F , Jezieniecki C , Montes M , Herreros J , Martín del Olmo J C
Published: May 2024

Aim

Ventral hernias are a pathology with a high incidence within general surgery. Repair techniques have been evolving, and the minimally invasive approach to this type of pathology is currently on the rise due to the advantages offered by the minimally invasive surgery (laparoscopic or robotic): less postoperative pain, SSI, seromas, length of stay (LOS) and faster return to routine daily activities. We present some tips and tricks in the eTEP laparoscopic approach.

Material and Methods

Video presentation.

Results

In the following video, we present certain recommendations that will help you perform a laparoscopic e-TEP approach in a simpler and faster way.Performing an ultrasound of the abdominal wall prior to the start of surgery to locate the lateral border of the rectus.We have modified the position of the trocars, depending on whether we perform a supraumbilical or infraumbilical crossover, in such a way that it will allow us better ergonomics at the time of dissection and sutures.The closure of the anterior rectus sheath, from up to down, is performed with the needle holder in the left hand since it is a more ergonomic position and a more correct closure and better plication of the abdominal diastasis is performed.Measurement of the dissected space using a thread, to have a more accurate mesh of the dissected space.Positioning of the mesh before placing it, using vicryl and silk points, in such a way that they will help us to better extend it within the abdomen.Use of atraumatic fixation systems, such as fibrin glue, which, in addition to fixing the mesh, acts as a hemostatic agent.No drains. Use of an abdominal binder during the first 4 weeks after surgery.

Conclusions

The laparoscopic e-TEP approach is not simple, and requires skill and knowledge of the anatomy of the abdominal wall, and may initially require long times to perform a correct repair; however, applying some of the previously mentioned recommendations, surgical times can be reduced. can decrease as well as the risk of complications.
PRIMARY ABANDON OF HERNIA SAC FOR INGUINOSCROTAL HERNIA: A CASE REPORT
Authors: Trujillo J , Gómez J R , Concejo P , Montenegro M A , Schenone F , Jezieniecki C , Martín del Olmo J C
Published: May 2024

Aims

Surgery for inguinal hernias is one of the most performed surgical procedures around the world. A special sub-group of patients are those who have large inguinal hernias or inguinoscrotal hernias (ISH). They pose a challenge to surgeons with consistently higher rates of postoperative complications and recurrence when compared to “normal” inguinal hernias.

Generally, recommendation for ISH hernias has been to attempt to completely reduce the hernia sac. The abandonment or transection of the hernia sac has been reserved only for cases in which the complete dissection is more difficult, takes a long time or some complications such as bleeding (non-planned tactic). Recently, this approach has been questioned due to the risk of complications and the planned abandonment of the hernia sac has been recommended by some authors.

Methods

Video-case presentation.

Results

A 62-year-old male patient presented with a large right inguinoscrotal hernia that had been increasing in size and causing discomfort, so we decided to perform surgical treatment using a laparoscopic TAPP approach, leaving the sac abandoned.

3 trocars are used to perform the surgery (1 × 12 mm and 2 × 5 mm). After visualizing the large size of the hernial sac, we decided to make the abandoned sac. The first step is to perform a transection of the peritoneum at the level of the deep inguinal ring in such a way that the hernia sac is disconnected from the rest of the peritoneum that we will dissect to place the mesh. The following steps are similar to those we usually perform in a laparoscopic TAPP inguinal hernia. We perform the peritoneal opening approx. 3–4 cm above the inguinal ring, we dissect the Retzius and Bogros space, we dissect the elements of the inguinal cord (this being easier when the hernial sac is left abandoned) and after completing a correct preperitoneal dissection we place a mesh 12 × 16 cm PPL. Finally, the peritoneal flap and the peritoneal defect in the inguinal ring area are closed.

The patient presented a satisfactory evolution without complications and was discharged in 1°POD. The patient had a scrotal seroma that resolved during the 2°POM. Currently, after 18 months of follow-up, he has no signs of hernia recurrence.

Conclusion

Inguino-scrotal hernias represent a greater challenge for surgeons and are associated with a higher risk of recurrence and complications, mainly due to the difficulty in dissecting the hernia sac. Planned abandon of the hernia sac appears to be an interesting alternative in these cases, not only because it reduces the technical difficulty of the surgery but mainly because it is associated with a low rate of complications and acceptable seroma formation.
HOW TO PERFORM A CRANIAL DISSECTION OF A RIVES-STOPPA
Authors: Tuñón-Féquant C I , López-Monclus J , Blázquez-Hernando L A , Robin Valle de Lersundi A , Muñoz-Rodríguez J , Medina-Pedrique M , De Luca M , Avilés-Oliveros A , García-Ureña M A
Published: May 2024

Introduction

Since its inception in 1973 by surgeons Jean Rives and Rene Stoppa, the Rives-Stoppa technique has emerged as a cornerstone in abdominal wall surgery. Given the prevalence of the technique, a thorough understanding of its intricate steps and anatomical relationships is considered essential for competent cranial dissection.

Material and Methods

This video describes step by step the key elements of a cranial dissection according to the Madrid technique, instead of performing a classical Rives. In this approach, a horizontal section of the posterior rectus sheath is performed, allowing a transition to the preperitoneal plane without the risk of diaphragmatic injury. This technique allows unlimited dissection in the preperitoneal plane and allows lateral transition to a pretransversalis plane if necessary. The cranial dissection extends over the xiphoid, navigating along the preperitoneal midline fat until the central tendon of the diaphragm is visualized. The purpose is to facilitate optimal mesh placement with a substantial overlap, contributing to the overall success of the procedure.

Results

This detailed guide provides an overview of the Rives-Stoppa technique, identifying key anatomical relationships that are critical for the general surgeon. The meticulous cranial dissection performed by this technique can increase surgical precision and reduce the incidence of postoperative recurrence.

Conclusions

Understanding the Rives-Stoppa technique coupled with a keen awareness of its anatomical intricacies, proves invaluable for general surgeons. Meticulous cranial dissection not only ensures proper surgical technique, but also serves as an important preventative measure against possible recurrence.
COMPLETELY PRE-PERITONEAL E-MILOS FOR SUBXIPHOID EVENTRATION
Authors: Urbani A , Lopez-Monclus J , Blazquez Hernando L A , Valle de Lersundi A R , Jodra V Vaello , Medina Pedrique M , De Luca M , Avilés Oliveros A , Garcia-Urena M A
Published: May 2024

Aim

To demonstrate the safety and efficiency of the endoscopic mini or less-open sublay operation (e-MILOS) for subxiphoid abdominal wall defects.

Methods

A 79-year-old man with a 2 cm subxiphoid eventration classified as M1 W1 by the European Hernia Society classification and confirmed by computer tomography.

Abdominal wall repair was performed with completely pre-peritoneal e-MILOS. Beginning with the incision through the previous scar and the reduction of the hernia sac in the abdomen, the procedure involved the dissection of the preperitoneal space to place a single-port system. Endoscopic dissection of the preperitoneal plane was carried out up to approximately 10 cm from the edges all around the defect. Placement of a preperitoneal Polypropylene mesh (15 × 15 cm) without fixation. Closure of the defect with a monofilament long absorbable suture.

Results

The patient was discharged on the sixth postoperative day without complications. One-month follow-up revealed no hernia recurrence, no pain, and no bulging.

Conclusion

This intervention demonstrated that E-MILOS is a valid alternative for subxiphoid eventration compared to open surgery, with the advantages of providing better and easier plane visualization.
MESH EXPLANTATION
Authors: Vashistha A
Published: May 2024

Materials and Method

A middle aged lady had multiple surgeries in the past. First she had undergone laparscopic umbillical mesh hernia repair (IPOM), then Sleeve Gastrectomy (in view for morbid obesity) was done, then again incisional hernia repair was done with Onlay Prolene mesh. Now patient came to us with Perforation peritonitis with ischemic bowel. Exploratory laparotomy was done with explantation of mesh and bowel resection with end-to-end anastomosis with primary closure of abdomen. The procedure was uneventful.

Result

The patient had an uneventful recovery.

Conclusion

Mesh used in abdominal surgeries should be used judiciously. Type of mesh being used: (Dual mesh/Biosynthetic mesh) should be considered in complex scenarios.
SPECIALISED HERNIA CLINIC AND DEDICATED HUBS IS IT THE ROUTE TOWARDS OPTIMISATION: DAY CASE INGUINAL HERNIA PERFORMANCE A 12 MONTH SERVICE EVALUATION
Authors: Alam T , Bahri A , Rajendiran S , Ebied H
Published: May 2024

Introduction

Guy’s and St Thomas’ Trust currently performs 88% of inguinal hernia repairs as day case procedures, above The British Association of Day Surgery target of 80%. A specialised hernia clinic was set up in our trust in May 2021, to better identify patients suitable for High Volume Low Capacity (HVLC) Hubs. These are new surgical hubs introduced following COVID to help with the backlog and provide ring fenced beds for low complexity procedures. The clinic also provides standardisation of patient information and literature provision together with enhanced training opportunities for junior surgeons.

Method

A retrospective review of elective day case inguinal and femoral hernia repairs from 01 Jan 2022 to 31 Dec 2022. We primarily assessed unexpected admissions (UA) and the effects of a specialised clinic on service provision and outcomes.

Results

An UA was required in 20 cases; the majority being discharged within 24 hours. The most common reason was due to post-operative acute urinary retention (AUR). Other reasons included monitoring as per request of Anaesthetics, comorbidities, post-operative pain and social reasons. We also found the specialised hernia clinic identified the majority of patients expected to require an admission post-operatively.

Conclusions

The most common reason for an UA was AUR and the most adjustable were social admissions, indicating pathway implementations should involve a retention pathway and home alone surgery, respectively. Furthermore, a specialised hernia clinic was able to better identify cases suitable for HVLC Hubs, therefore could streamline the experience for both patients and surgeons in training.
STUDY ON SELF GRIPPING MESH VS POLYPROPYLENE MESH IN LICHTENSTEIN’S TENSION FREE MESH REPAIRS
Authors: Alexander N , Arora A
Published: May 2024

Open (Lichtenstein’s) inguinal hernioplasty, most widely performed surgery for inguinal hernia is used as the gold standard to which other techniques are compared. In 2002, the EU trialist collaboration analyzed 58 randomized controlled trials and found the use of meshes superior to other techniques. Light weight polypropylene meshes were first introduced in 1998 and are still in use. A newly developed self gripping semi absorbable mesh with incorporated resorbable microhooks providing gripping properties has been said to be superior.

Aim

Observational study comparing the conventional light weight polypropylene mesh and self gripping mesh in inguinal (Lichtenstein’s) hernia repairs in terms of duration of surgery, post-operative pain, seroma formation, wound infection, mesh rejection, foreign body sensation and recurrence rates.

Methods

Observational study included 180 patients, 90 in control (polypropylene group) and 90 in study (self gripping group) satisfying the inclusion criteria. Patients were followed up at 3 months, 6 month and 9 months.

Results

Decreased postoperative pain and lesser duration of surgery noted with the self gripping mesh. However, recurrence rates, seroma formation, foreign body sensation and mesh rejection had no differences between the two groups.

Conclusion

Self gripping mesh found to be better when compared to polypropylene mesh in terms of post-operative pain and duration of surgery.
STUDIES ON SELF GRIPPING MESH VS POLYPROPYLENE MESH IN VENTRAL HERNIA REPAIR
Authors: Alexander N , Arora A
Published: May 2024

Primary open ventral hernia repair is one of the most common surgeries performed in clinical practice. In 2002, the EU trialist collaboration analyzed 58 randomized controlled trials and found the use of meshes superior to other techniques. Light weight polypropylene meshes were first introduced in 1998 and are still in use. A newly developed self gripping mesh, made of low weight polyester with incorporated resorbable micro hooks that provide gripping properties has been believed to be superior.

Aim

Observational study comparing the conventional light weight polypropylene meshes and self gripping mesh in ventral hernia repairs in terms of duration of surgery, post-operative pain, seroma formation and recurrence rates.

Methods

In the prospective observational study 180 patients were included, 90 in control (polypropylene group) and 90 in study (self gripping group) satisfying the inclusion criteria. Patients were followed up 3 months, 6 month and 9 months after surgery.

Results

Results showed decreased postoperative pain and lesser duration of surgery with the self gripping mesh. However, recurrence rates and seroma formation had no differences between the two groups.

Conclusion

The study concludes that the self gripping mesh is better when compared to polypropylene mesh in terms of decreased post-operative pain and lesser duration of surgery.
CURRENT ROLE AND OUTCOMES OF BARBED SUTURES IN FASCIAL CLOSURE OF VENTRAL HERNIA REPAIR: A MULTICENTER STUDY USING THE ABDOMINAL CORE HEALTH QUALITY COLLABORATIVE DATABASE
Authors: Arias-Espinosa L , Wang A , Wermelinger J W , Olson M , Phillips S , Pereira X , Damani T , Malcher F
Published: May 2024

Barbed sutures (BS) have been increasingly used in the last decades but little is known about their adoption in ventral hernia repair (VHR). The aim of this study was to document the use and outcomes of BS in VHR.

Prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) database (ACHQC) was retrospectively reviewed adult patients who underwent VHR with fascial closure from 2020 to 2022. A univariate analysis compared patients with BS against non-barbed sutures (NBS) across the preoperative, intraoperative, and postoperative timeframes.

BS (n = 4,054) were compared with NBS (n = 6,473). BS were used in 86.2% of minimally invasive (MIS) VHR and 92.2% of robotic surgery against 9.6% of open procedures. Notable differences existed including a higher BMI (32 vs 30.5; p < 0.001), more incisional hernias (63.3% vs 51.1%; p < 0.001), wider hernias (4 cm vs 3 cm; p < 0.001), and higher ASA score (p < 0.001) in patients with BS. Outcomes in BS included a shorter LOS (1.4 vs 2.4; p < 0.001), less SSI (1.5% vs 3.6%; p < 0.001), similar SSO (7.6% vs 7.3%; p = 0.657), readmission (3.0 vs 3.2; p = 0.691), and reoperation (1.5% vs 1.45%; p = 0.855), at a longer operative time (p < 0.001). Hernia specific questionnaires for quality of life and pain in BS had a worse preoperative score that was later matched and favorable compared to NBS (p = 0.048). PRO concerning hernia recurrence suggested around 10% at two years (p = 0.532).

Use of barbed sutures in VHR is widespread and highly related to MIS. Outcomes from ACHQC cannot be reported as superior but suggest safety and non-inferiority.
VERY LOW RECCURENCE AT 5-YEAR FOLLOW AFTER TAPP WITH PRO-GRIP IN 1200 PATIENTS
Authors: Birk D
Published: May 2024

The aim of this study was to demonstrate the long term safety and the efficacy of the self-gripping Parietex ProGrip™ mesh (Medtronic) used with the laparoscopic approach for inguinal hernia repair. The incidence of chronic pain, post-operative complications, patient satisfaction and hernia recurrence at follow-up after 5 years.

Methods

Data were collected prospectively using the “hernia-med” register in 1579 primary inguinal hernias. All patients included had undergone surgical repair for inguinal hernia by the laparoscopic transabdominal preperitoneal approach using Parietex ProGrip™ meshes performed in the same hernia referral center in Germany. Pre-, per- and post-operative data were collected, and a follow-up after one and five years was performed prospectively. Complications, pain scored on a 0–10 numeric rating scale (NRS), patient satisfaction and hernia recurrence were assessed.

Results

The only complications were minor and were post-operative: hematoma/seroma (3 cases), secondary hemorrhage through the trocar's site (5 cases), hematuria, emphysema in the inguinal regions (both sides) and hematoseroma in 3,2%. The 5 year follow-up rate was 76%, respectively 1205 patients. There were only 14 reports of hernia recurrence: 1.2% of the hernias. Most patients (95.9%) were satisfied or very satisfied with their hernia repair with only 1.2% reporting severe pain (NRS score 7–10) and 3.6% reported mild pain.

Conclusion

This study demonstrates that in experienced hands, inguinal hernia repair surgery performed by laparoscopic transabdominal preperitoneal hernioplasty using Parietex ProGrip™ self-gripping meshes is rapid, efficient and safe with low pain and low hernia recurrence rate. The promising short term results held true also in the long term follow-up.
LOSS OF DRAINAGE VACUUM AFTER MINIMAL INVASIVE SUBLAY OPERATION – EARLY INDICATOR FOR AN INTERPARIETAL HERNIA WITH SMALL BOWEL OBSTRUCTION – A CASE REPORT
Authors: Borshchigov M , Badendieck S , Huschitt N , Koeppen D
Published: May 2024

Background

Newer repair techniques for abdominal wall hernias, such as the enchanced-view totally extraperitoneal technique or the mini- or less-open sublay operation are increasingly being used. With these new techniques special complications might occur.

Case Report

We present an 81-year-old patient with a recurrent ventral incisional hernia after IPOM repair. The preoperative abdominal CT scan showed the hernia defect, measuring 3 × 3 cm. A repair was performed in MILOS technique, the IPOM mesh was removed. The posterior the rectus sheath was closed under slight tension. A Mesh 15 × 15 cm without fixation and a 14 french Redon drainage were inserted. Over the next 4 postoperative days the drainage had a repeatedly loos of vacuum, until the patient developed clinical symptoms of a ileus. A CT scan showed a bowel dysfunction without a clear sign for incarceration. At this point, the suction drainage was without vacuum a total of seven times. A diagnostic laparoscopy was performed and a small bowel loop was found trapped between the implanted mesh and the posterior rectus sheath, as an interparietal retro-rectus hernia (iRRH). The intestinal loop could be removed, no necrosis or ischemia was found. The fascial defect was covered using vicryl mesh patch.

Conclusion

The role of vacuum drainage remains to be considered. Suction of remaining intraabdominal gas might occur due to fascia dehiscence and CT diagnostics can mislead surgeons decisions. Tension free fascial closure remains of capital importance. Mesh fixation, use of special stitching techniques, transversus-abdominis-release or preoperative application of botulinum toxin should be kept mind.
RECONSTRUCTIVE SURGERY OF THE ABDOMINAL WALL WITH TITANIZED PP MESH IN A CASE OF CHRONIC INFECTION OF ePTFE MESH
Authors: Cardin Guntsche V , Llompart Coll M M , Mensa Pueyo J , Espert Ibáñez J J
Published: May 2024

Background

The use of meshes in abdominal wall reconstructive surgery is common and globally considered the gold standard. Materials like expanded polytetrafluoroethylene (ePTFE) meshes or "Gore-Tex®", once popular, have been shown to pose higher risks of rejection and infection compared to polypropylene (PP) meshes.

Methods

In the case of a 59-year-old man with a history of costal chondrosarcoma that required resection of the 10th left rib in 2009, a Gore-Tex® mesh was used in abdominal wall reconstruction in 2009. He was referred to our center in 2021 due to mesh intolerance.

Explorations (thoraco-abdominal CT and PET-CT) revealed chronic mesh infection with a bacterial biofilm (collection of 20 × 4 × 7 cm (AP × T × CC) encompassing the prosthesis), associating a fistulous tract to the skin surface. Multi-resistant Staphylococcus was isolated, requiring 6 weeks of antibiotic treatment with dalbavancin and rifampicin.

Results

Surgical intervention involved block resection of the collection and fistulous tract, and repair using titanized-PP mesh. After 48 hours of uneventful postoperative course, he was discharged with a home hospitalization regimen of antibiotic therapy with IV Ceftriaxone+Daptomycin. No other microorganisms were isolated in surgical cultures, and the pathology result described a granulomatous reaction to a foreign body. At one-year follow-up, the patient remains asymptomatic, with explorations (CT, PET-CT) ruling out recurrence of infection.

Conclusions

PP meshes are recommended for abdominal reconstructive surgery due to their lower infection and rejection rates compared to ePTFE meshes, due to their macroporous characteristics. However, further research and multidisciplinary management are needed to understand long-term outcomes.